1
|
Bryant RA, Azevedo S, Yadav S, Cahill C, Kenny L, Maccallum F, Tran J, Choi-Christou J, Rawson N, Tockar J, Garber B, Keyan D, Dawson KS. Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2024:2818040. [PMID: 38656428 PMCID: PMC11044011 DOI: 10.1001/jamapsychiatry.2024.0432] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/09/2024] [Indexed: 04/26/2024]
Abstract
Importance Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy. Objective To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity. Design, Setting, and Participants A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief-13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months. Interventions Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress. Main Outcomes and Measures The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life. Results The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events. Conclusions and Relevance In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration. Trial Registration anzctr.org.au Identifier: ACTRN12612000307808.
Collapse
Affiliation(s)
- Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Choi-Christou
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Julia Tockar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjamin Garber
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie S. Dawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Tran J, Alrajhi I, Chang D, Sherwood KR, Keown P, Gill J, Kadatz M, Gill J, Lan JH. Clinical relevance of HLA-DQ eplet mismatch and maintenance immunosuppression with risk of allosensitization after kidney transplant failure. Front Genet 2024; 15:1383220. [PMID: 38638120 PMCID: PMC11024336 DOI: 10.3389/fgene.2024.1383220] [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: 02/07/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
The optimal immunosuppression management in patients with a failed kidney transplant remains uncertain. This study analyzed the association of class II HLA eplet mismatches and maintenance immunosuppression with allosensitization after graft failure in a well characterized cohort of 21 patients who failed a first kidney transplant. A clinically meaningful increase in cPRA in this study was defined as the cPRA that resulted in 50% reduction in the compatible donor pool measured from the time of transplant failure until the time of repeat transplantation, death, or end of study. The median cPRA at the time of failure was 12.13% (interquartile ranges = 0.00%, 83.72%) which increased to 62.76% (IQR = 4.34%, 99.18%) during the median follow-up of 27 (IQR = 18, 39) months. High HLA-DQ eplet mismatches were significantly associated with an increased risk of developing a clinically meaningful increase in cPRA (p = 0.02) and de novo DQ donor-specific antibody against the failed allograft (p = 0.02). We did not observe these associations in patients with high HLA-DR eplet mismatches. Most of the patients (88%) with a clinically meaningful increase in cPRA had both a high DQ eplet mismatch and a reduction in their immunosuppression, suggesting the association is modified by immunosuppression. The findings suggest HLA-DQ eplet mismatch analysis may serve as a useful tool to guide future clinical studies and trials which assess the management of immunosuppression in transplant failure patients who are repeat transplant candidates.
Collapse
Affiliation(s)
- Jenny Tran
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ibrahim Alrajhi
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Doris Chang
- Vancouver Coastal Health Research Institute, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karen R. Sherwood
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul Keown
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Institute, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jagbir Gill
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Providence Health Care Research Institute, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Kadatz
- Vancouver Coastal Health Research Institute, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John Gill
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Providence Health Care Research Institute, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James H. Lan
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Institute, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Nephrology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
3
|
Yuan M, Peng L, Huang D, Gavin A, Luan F, Tran J, Feng Z, Zhu X, Matteson J, Wilson IA, Nemazee D. Structural and mechanistic insights into disease-associated endolysosomal exonucleases PLD3 and PLD4. Structure 2024:S0969-2126(24)00079-0. [PMID: 38537643 DOI: 10.1016/j.str.2024.02.019] [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: 12/04/2023] [Revised: 02/12/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
Endolysosomal exonucleases PLD3 and PLD4 (phospholipases D3 and D4) are associated with autoinflammatory and autoimmune diseases. We report structures of these enzymes, and the molecular basis of their catalysis. The structures reveal an intra-chain dimer topology forming a basic active site at the interface. Like other PLD superfamily members, PLD3 and PLD4 carry HxKxxxxD/E motifs and participate in phosphodiester-bond cleavage. The enzymes digest ssDNA and ssRNA in a 5'-to-3' manner and are blocked by 5'-phosphorylation. We captured structures in apo, intermediate, and product states and revealed a "link-and-release" two-step catalysis. We also unexpectedly demonstrated phosphatase activity via a covalent 3-phosphohistidine intermediate. PLD4 contains an extra hydrophobic clamp that stabilizes substrate and could affect oligonucleotide substrate preference and product release. Biochemical and structural analysis of disease-associated mutants of PLD3/4 demonstrated reduced enzyme activity or thermostability and the possible basis for disease association. Furthermore, these findings provide insight into therapeutic design.
Collapse
Affiliation(s)
- Meng Yuan
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA.
| | - Linghang Peng
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Deli Huang
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Amanda Gavin
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Fangkun Luan
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Jenny Tran
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Ziqi Feng
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Xueyong Zhu
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Jeanne Matteson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Ian A Wilson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA; Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, CA 92037, USA.
| | - David Nemazee
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA.
| |
Collapse
|
4
|
Duro MV, Van Valkenburgh J, Ingles DE, Tran J, Cai Z, Ebright B, Wang S, Kerman BE, Galvan J, Hwang SH, Sta Maria NS, Zanderigo F, Croteau E, Cunnane SC, Rapoport SI, Louie SG, Jacobs RE, Yassine HN, Chen K. Synthesis and Preclinical Evaluation of 22-[ 18F]Fluorodocosahexaenoic Acid as a Positron Emission Tomography Probe for Monitoring Brain Docosahexaenoic Acid Uptake Kinetics. ACS Chem Neurosci 2023; 14:4409-4418. [PMID: 38048230 PMCID: PMC10739598 DOI: 10.1021/acschemneuro.3c00681] [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: 10/22/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
Docosahexaenoic acid [22:6(n-3), DHA], a polyunsaturated fatty acid, has an important role in regulating neuronal functions and in normal brain development. Dysregulated brain DHA uptake and metabolism are found in individuals carrying the APOE4 allele, which increases the genetic risk for Alzheimer's disease (AD), and are implicated in the progression of several neurodegenerative disorders. However, there are limited tools to assess brain DHA kinetics in vivo that can be translated to humans. Here, we report the synthesis of an ω-radiofluorinated PET probe of DHA, 22-[18F]fluorodocosahexaenoic acid (22-[18F]FDHA), for imaging the uptake of DHA into the brain. Using the nonradiolabeled 22-FDHA, we confirmed that fluorination of DHA at the ω-position does not significantly alter the anti-inflammatory effect of DHA in microglial cells. Through dynamic PET-MR studies using mice, we observed the accumulation of 22-[18F]FDHA in the brain over time and estimated DHA's incorporation coefficient (K*) using an image-derived input function. Finally, DHA brain K* was validated using intravenous administration of 15 mg/kg arecoline, a natural product known to increase the DHA K* in rodents. 22-[18F]FDHA is a promising PET probe that can reveal altered lipid metabolism in APOE4 carriers, AD, and other neurologic disorders. This new probe, once translated into humans, would enable noninvasive and longitudinal studies of brain DHA dynamics by guiding both pharmacological and nonpharmacological interventions for neurodegenerative diseases.
Collapse
Affiliation(s)
- Marlon
Vincent V. Duro
- Department
of Radiology, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Juno Van Valkenburgh
- Department
of Radiology, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Diana E. Ingles
- Department
of Medicine, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Jenny Tran
- Department
of Medicine, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Zhiheng Cai
- Department
of Medicine, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Brandon Ebright
- Alfred
E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California 90089, United States
| | - Shaowei Wang
- Department
of Medicine, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Bilal E. Kerman
- Department
of Medicine, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Jasmin Galvan
- Department
of Medicine, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Sung Hee Hwang
- Department
of Entomology and Nematology and UC Davis Comprehensive Cancer Center, University of California, Davis, California 95616, United States
| | - Naomi S. Sta Maria
- Zilkha
Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Francesca Zanderigo
- Department
of Psychiatry, Columbia University, New York, New York 10032, United States
- Molecular
Imaging and Neuropathology Area, New York
State Psychiatric Institute, New
York, New York 10032, United States
| | - Etienne Croteau
- Sherbrooke
Center for Molecular Imaging, University
of Sherbrooke, Sherbrooke, QC J1H 4C4, Canada
| | - Stephen C. Cunnane
- Research
Center on Aging, Department of Medicine, University of Sherbrooke, Sherbrooke, QC J1H 4C4, Canada
| | - Stanley I. Rapoport
- National
Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland 20892-9304, United States
| | - Stan G. Louie
- Alfred
E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California 90089, United States
| | - Russell E. Jacobs
- Zilkha
Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Hussein N. Yassine
- Department
of Medicine, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| | - Kai Chen
- Department
of Radiology, Keck School of Medicine, University
of Southern California, Los Angeles, California 90033, United States
| |
Collapse
|
5
|
Yuan M, Peng L, Huang D, Gavin A, Luan F, Tran J, Feng Z, Zhu X, Matteson J, Wilson IA, Nemazee D. Structural and mechanistic insights into disease-associated endolysosomal exonucleases PLD3 and PLD4. bioRxiv 2023:2023.11.20.567917. [PMID: 38045427 PMCID: PMC10690185 DOI: 10.1101/2023.11.20.567917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Endolysosomal exonucleases PLD3 and PLD4 (phospholipases D3 and D4) are associated with autoinflammatory and autoimmune diseases. We report structures of these enzymes, and the molecular basis of their catalysis. The structures reveal an intra-chain dimer topology forming a basic active site at the interface. Like other PLD superfamily members, PLD3 and PLD4 carry HxKxxxxD/E motifs and participate in phosphodiester-bond cleavage. The enzymes digest ssDNA and ssRNA in a 5'-to-3' manner and are blocked by 5'-phosphorylation. We captured structures in apo, intermediate, and product states and revealed a 'link-and-release' two-step catalysis. We also unexpectedly demonstrated phosphatase activity via a covalent 3' phosphistidine intermediate. PLD4 contains an extra hydrophobic clamp that stabilizes substrate and could affect oligonucleotide substrate preference and product release. Biochemical and structural analysis of disease-associated mutants of PLD3/4 demonstrated reduced enzyme activity or thermostability and the possible basis for disease association. Furthermore, these findings provide insight into therapeutic design.
Collapse
Affiliation(s)
- Meng Yuan
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
- These authors contribute equally
| | - Linghang Peng
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
- These authors contribute equally
| | - Deli Huang
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
- These authors contribute equally
- Present address: Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, Zhejiang 310058, China
| | - Amanda Gavin
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Fangkun Luan
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Jenny Tran
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Ziqi Feng
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Xueyong Zhu
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Jeanne Matteson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - Ian A. Wilson
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
- Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, CA 92037, USA
| | - David Nemazee
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA 92037, USA
| |
Collapse
|
6
|
Kakodkar P, Zhao Y, Pan H, Wu F, Pearce T, Webster D, Elemary M, Sabry W, Kwan L, Pelzer L, Bosch M, Sherwood KR, Lan J, Tran J, Liwski R, Keown P, Mostafa A. Validation of next-generation sequencing-based chimerism testing for accurate detection and monitoring of engraftment in hematopoietic stem cell transplantation. Front Genet 2023; 14:1282947. [PMID: 37937195 PMCID: PMC10626454 DOI: 10.3389/fgene.2023.1282947] [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: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
Allogenic hematopoietic stem cell transplantation (allo-HSCT) is a life-saving treatment for various hematological disorders. The success of allo-HSCT depends on the engraftment of donor cells and the elimination of recipient cells monitored through chimerism testing. We aimed to validate a next-generation sequencing (NGS)-based chimerism assay for engraftment monitoring and to emphasize the importance of including the most prevalent cell subsets in proficiency testing (PT) programs. We evaluated the analytical performance of NGS-based chimerism testing (AlloSeq-HCT and CareDx) with a panel of targeted 202 informative single-nucleotide polymorphisms (SNPs) (i.e., linearity and precision, analytical sensitivity and specificity, system accuracy, and reproducibility). We further compared the performance of our NGS panel with conventional short tandem repeat (STR) analysis in unfractionated whole blood and cell-subset-enriched CD3 and CD66. Our NGS-based chimerism monitoring assay has an impressive detection limit (0.3% host DNA) for minor alleles and analytical specificity (99.9%). Pearson's correlation between NGS- and STR-based chimerism monitoring showed a linear relationship with a slope of 0.8 and r = 0.973. The concordance of allo-HSCT patients using unfractionated whole blood, CD3, and CD66 was 0.95, 0.96, and 0.54, respectively. Utilization of CD3+ cell subsets for mixed chimerism detection yielded an average of 7.3 ± 7-fold higher donor percentage detection compared to their corresponding unfractionated whole blood samples. The accuracy of the NGS assay achieved a concordance of 98.6% on blinded external quality control STR samples. The reproducibility series showed near 100% concordance with respect to inter-assay, inter-tech, inter-instrument, cell flow kits, and AlloSeq-HCT software versions. Our study provided robust validation of NGS-based chimerism testing for accurate detection and monitoring of engraftment in allo-HSCT patients. By incorporating the cell subsets (CD3 and CD66), the sensitivity and accuracy of engraftment monitoring are significantly improved, making them an essential component of any PT program. Furthermore, the implementation of NGS-based chimerism testing shows potential to streamline high-volume transplant services and improve clinical outcomes by enabling early relapse detection and guiding timely interventions.
Collapse
Affiliation(s)
- Pramath Kakodkar
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yayuan Zhao
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Henry Pan
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Fang Wu
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Twyla Pearce
- Histocompatibility and Immunogenetics Laboratory, St. Paul’s Hospital, Saskatoon, SK, Canada
| | - Destinie Webster
- Histocompatibility and Immunogenetics Laboratory, St. Paul’s Hospital, Saskatoon, SK, Canada
| | - Mohamed Elemary
- Department of Hematological Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Waleed Sabry
- Department of Hematological Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Luvinia Kwan
- HLA Laboratory, Cancer Care Manitoba, Winnipeg, MB, Canada
| | - Lindsay Pelzer
- Department of Hematological Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Mark Bosch
- Department of Hematological Oncology, Saskatchewan Cancer Agency, Saskatoon, SK, Canada
| | - Karen R. Sherwood
- University of British Columbia, Vancouver Coastal Health, Vancouver, BC, Canada
| | - James Lan
- Department of Transplant Nephrology, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Jenny Tran
- University of British Columbia, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Robert Liwski
- Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Paul Keown
- University of British Columbia, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Ahmed Mostafa
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Histocompatibility and Immunogenetics Laboratory, St. Paul’s Hospital, Saskatoon, SK, Canada
| |
Collapse
|
7
|
Pao C, Arbona C, Fan W, Tran J. Duty-related trauma and PTSD symptoms in US urban firefighters. Occup Med (Lond) 2023; 73:324-331. [PMID: 37523669 DOI: 10.1093/occmed/kqad076] [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: 08/02/2023] Open
Abstract
BACKGROUND Little is known about the multi-dimensional nature of traumatic duty-related events encountered by firefighters in relation to their post-traumatic stress disorder (PTSD) risk. AIMS To describe the types of duty-related events encountered by career firefighters and explore if years in the fire service or total event load moderated the association of trauma exposure to PTSD symptoms. METHODS Participants included 755 career, male firefighters (19% of the department's firefighters and 76% of those who accessed the electronic anonymous survey). The Duty-Related Incident Stressors scale was used to assess exposure to 25 potentially traumatic events (event load) and self-appraisal of the stress associated with these events, grouped by type of event (indirect, direct and colleague-related). The Post-Traumatic Stress Disorder Checklist was used to assess PTSD symptoms. RESULTS Firefighters rated colleague-related events as the most stressful, followed by indirect and direct events. Event load (r = 0.25) and indirect, direct and colleague-related events stress (r = 0.32-0.35) were positively associated with PTSD symptoms. Results of moderation analyses indicated that event load served as a risk factor in the relation of indirect events stress to PTSD symptoms, and as a buffer in the relation of direct events stress to PTSD symptoms. Years in the fire service were not associated with PTSD symptoms nor moderated the relation of event stress to PTSD symptoms. CONCLUSIONS Findings underscored the importance of considering the differential effects that types of duty-related traumatic events and cumulative exposure to trauma may have on firefighters' PTSD symptoms.
Collapse
Affiliation(s)
- C Pao
- Mental Health, South Texas Veterans Healthcare System, San Antonio, TX 78223-1633, USA
| | - C Arbona
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA
| | - W Fan
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX 77204, USA
| | - J Tran
- National Aeronautics and Space Administration (NASA), Houston, TX 77058, USA
| |
Collapse
|
8
|
Richmond-Bryant J, Odera M, Subra W, Vallee B, Rivers L, Kelley B, Cramer JA, Wilson A, Tran J, Beckham T, Irving J, Reams M. Oral histories document community mobilisation to participate in decision-making regarding a hazardous waste thermal treatment facility. Local Environ 2023; 29:57-73. [PMID: 38313002 PMCID: PMC10836827 DOI: 10.1080/13549839.2023.2249498] [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] [Received: 12/29/2022] [Accepted: 08/10/2023] [Indexed: 02/06/2024]
Abstract
Colfax, Louisiana hosts a commercial hazardous waste thermal treatment (TT) facility, which treats fireworks, explosives, and military ordnances by open-burn/open-detonation one mile from the edge of the nearest community. Seventy-one percent of Colfax's residents are Black, and forty-six percent live below poverty, indicating the community's structural vulnerability. This community-based study originated at the behest of Colfax community members. We hypothesized that the close relationships among members of this enclave may have enhanced the community's ability to mobilize in opposition to the TT facility. We conducted semi-structured oral history interviews with nineteen community members and examined the social and interorganizational networks used by the Colfax community to claim its role in decision-making regarding the TT facility after years of exclusion from this process. Interview transcripts were analyzed through the lens of community capacity theory to gain insight into how interactions among community members about the environmental hazards led to social mobilization and improved participation in the decision-making process using codes for communication, organization, and outcome. Additionally, we reviewed Louisiana Department of Environmental Quality records for complaints about the facility to gauge public participation. One notable theme across several interviews was exclusion from the initial decision-making process related to the facility. However, interviewees noted a sustained effort was made among community members to educate themselves about the facility, organize a response through neighbor-to-neighbor contact, and take action by submitting formal complaints and participating in public hearings. Through the lens of environmental justice, this study illustrates an evolving condition of procedural justice.
Collapse
Affiliation(s)
- Jennifer Richmond-Bryant
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695-8008 USA
| | - M Odera
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695-8008 USA
| | - W Subra
- Louisiana Environmental Action Network, Baton Rouge, LA, 70806 USA
| | - B Vallee
- Central Louisiana Coalition for a Clean and Healthy Environment, Colfax, LA, 71417 USA
| | - L Rivers
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695-8008 USA
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, 27711 USA
| | - B Kelley
- Department of History, North Carolina State University, Raleigh, NC, 27695-8101 USA
| | - J A Cramer
- T. Harry Williams Oral History Center, Louisiana State University, Baton Rouge, LA, 70803 USA
| | - A Wilson
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695-8008 USA
| | - J Tran
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695-8008 USA
| | - T Beckham
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, 27695-8008 USA
| | - J Irving
- Department of Environmental Sciences, Louisiana State University, Baton Rouge, LA, 70803 USA
| | - M Reams
- Department of Environmental Sciences, Louisiana State University, Baton Rouge, LA, 70803 USA
| |
Collapse
|
9
|
Bryant R, Dawson K, Azevedo S, Yadav S, Tran J, Choi-Christou J, Andrew E, Beames J, Keyan D. Positive affect training to reduce mental health problems during the COVID-19 pandemic: a proof-of-concept randomised clinical trial. BMJ Ment Health 2023; 26:e300737. [PMID: 37385663 PMCID: PMC10577780 DOI: 10.1136/bmjment-2023-300737] [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: 04/25/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The social restrictions occurring during the pandemic contributed to loss of many sources of reward, which contributes to poor mental health. OBJECTIVE This trial evaluated a brief positive affect training programme to reduce anxiety, depression and suicidality during the pandemic. METHODS In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-19-related psychological distress across Australia were randomly allocated to either a 6-session group-based programme based on positive affect training (n=87) or enhanced usual care (EUC, n=87). Primary outcome was total score on the Hospital Anxiety and Depression Scale-anxiety and depression subscales assessed at baseline, 1-week post-treatment, 3 months (primary outcome time point) as well as secondary outcome measures of suicidality, generalised anxiety disorder, sleep impairment, positive and negative mood and COVID-19-related stress. FINDINGS Between 20 September 2020 and 16 September 2021, 174 participants were enrolled into the trial. Relative to EUC, at 3-month follow-up the intervention led to greater reduction on depression (mean difference 1.2 (95% CI 0.4 to 1.9)), p=0.003), with a moderate effect size (0.5 (95% CI 0.2 to 0.9)). There were also greater reduction of suicidality and improvement in quality of life. There were no differences in anxiety, generalised anxiety, anhedonia, sleep impairment, positive or negative mood or COVID-19 concerns. CONCLUSIONS This intervention was able to reduce depression and suicidality during adverse experiences when rewarding events were diminished, such as pandemics. CLINICAL IMPLICATIONS Strategies to improve positive affect may be useful to reduce mental health issues. TRIAL REGISTRATION NUMBER ACTRN12620000811909.
Collapse
Affiliation(s)
- Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmine Choi-Christou
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Elpiniki Andrew
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Joanne Beames
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Bryant RA, Dawson KS, Azevedo S, Yadav S, Cahill C, Kenny L, Maccallum F, Tran J, Rawson N, Tockar J, Garber B, Keyan D. Augmenting trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomised clinical trial. Lancet Psychiatry 2023; 10:21-29. [PMID: 36436532 DOI: 10.1016/s2215-0366(22)00368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although exposure therapy is central in most front-line psychotherapies of post-traumatic stress disorder (PTSD), many patients do not respond to this treatment. We aimed to investigate the effects of brief aerobic exercise on the efficacy of exposure therapy in reducing the severity of PTSD. METHODS We did a single-blind, parallel, randomised controlled trial in Sydney, NSW, Australia. We included adults (aged ≥18 years) with clinician-diagnosed PTSD. We excluded participants aged 70 years or older, with imminent suicidal risk (reporting suicidal plan), presence of psychosis or substance dependence, history of moderate-to-severe traumatic brain injury, or presence of a physical disorder or impairment that might be exacerbated by aerobic exercise (eg, back pain). We randomly assigned participants (1:1) to nine 90-min weekly sessions of exposure therapy for PTSD with 10 min aerobic exercise or to the control group of exposure therapy with 10 min passive stretching. The primary outcome was PTSD severity measured by the clinician-administered PTSD scale 2 (CAPS-2), independently assessed at baseline, 1 week after treatment, and 6 months after treatment (primary outcome timepoint). FINDINGS Between Dec 12, 2012, and July 25, 2018, we enrolled 130 participants with PTSD, with 65 (50%) participants randomly assigned to exposure therapy with exercise and 65 (50%) to exposure therapy with passive stretching, including 79 (61%) women and 51 (39%) men, with a mean age of 39·1 years (SD 14·4; range 18-69). 99 (76%) participants were White, 14 (11%) were Asian, and 17 (13%) were listed as other. At the 6-month follow-up assessment, participants in the exposure therapy with exercise group showed greater reductions in CAPS-2 scores relative to those in the exposure therapy with stretching group (mean difference 12·1 [95% CI 2·4-21·8]; p=0·023), which resulted in a moderate effect size of 0·6 (0·1-1·1). No adverse events associated with the intervention were reported. The trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864. INTERPRETATION Brief aerobic exercise has the potential to augment long-term gains of exposure therapy for PTSD, which accords with evidence from studies in animals and humans on the role of exercise in modulating the extinction learning processes. This strategy might offer a simple and affordable means to augment treatment gains for exposure therapy in people with PTSD. FUNDING Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia; Brain Dynamics Centre, Westmead Institute for Medical Research, Sydney, NSW, Australia.
| | - Katie S Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Suzanna Azevedo
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Maccallum
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Julia Tockar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Benjamin Garber
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
11
|
Van Valkenburgh J, Duro MVV, Burnham E, Chen Q, Wang S, Tran J, Kerman BE, Hwang SH, Liu X, Sta Maria NS, Zanderigo F, Croteau E, Rapoport SI, Cunnane SC, Jacobs RE, Yassine HN, Chen K. Radiosynthesis of 20-[ 18F]fluoroarachidonic acid for PET-MR imaging: Biological evaluation in ApoE4-TR mice. Prostaglandins Leukot Essent Fatty Acids 2022; 186:102510. [PMID: 36341886 PMCID: PMC9888757 DOI: 10.1016/j.plefa.2022.102510] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 02/02/2023]
Abstract
Dysreglulated brain arachidonic acid (AA) metabolism is involved in chronic inflammation and is influenced by apolipoprotein E4 (APOE4) genotype, the strongest genetic risk factor of late-onset Alzheimer's disease (AD). Visualization of AA uptake and distribution in the brain can offer insight into neuroinflammation and AD pathogenesis. Here we present a novel synthesis and radiosynthesis of 20-[18F]fluoroarachidonic acid ([18F]-FAA) for PET imaging using a convergent route and a one-pot, single-purification radiolabeling procedure, and demonstrate its brain uptake in human ApoE4 targeted replacement (ApoE4-TR) mice. By examining p38 phosphorylation in astrocytes, we found that fluorination of AA at the ω-position did not significantly alter its biochemical role in cells. The brain incorporation coefficient (K*) of [18F]-FAA was estimated via multiple methods by using an image-derived input function from the right ventricle of the heart as a proxy of the arterial input function and brain tracer concentrations assessed by dynamic PET-MR imaging. This new synthetic approach should facilitate the practical [18F]-FAA production and allow its translation into clinical use, making investigations of dysregulation of lipid metabolism more feasible in the study of neurodegenerative diseases.
Collapse
Affiliation(s)
- Juno Van Valkenburgh
- Department of Radiology, Keck School of Medicine University of Southern California, Los Angeles, CA 90033, United States of America
| | - Marlon Vincent V Duro
- Department of Radiology, Keck School of Medicine University of Southern California, Los Angeles, CA 90033, United States of America
| | - Erica Burnham
- Department of Medicine, Keck School of Medicine University of Southern California, Los Angeles 90033, CA, United States of America
| | - Quan Chen
- Department of Radiology, Keck School of Medicine University of Southern California, Los Angeles, CA 90033, United States of America
| | - Shaowei Wang
- Department of Medicine, Keck School of Medicine University of Southern California, Los Angeles 90033, CA, United States of America
| | - Jenny Tran
- Department of Medicine, Keck School of Medicine University of Southern California, Los Angeles 90033, CA, United States of America
| | - Bilal E Kerman
- Department of Medicine, Keck School of Medicine University of Southern California, Los Angeles 90033, CA, United States of America
| | - Sung Hee Hwang
- Department of Entomology and Nematology and UC Davis Comprehensive Cancer Center, University of California, Davis, CA 95616, United States of America
| | - Xiaodan Liu
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Naomi S Sta Maria
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Francesca Zanderigo
- Department of Psychiatry, Columbia University, New York, NY 10032, United States of America; Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY 10032, United States of America
| | - Etienne Croteau
- Research Center on Aging, Department of Medicine, University of Sherbrooke, Sherbrooke, QC J1H 4C4, Canada
| | - Stanley I Rapoport
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, United States of America
| | - Stephen C Cunnane
- Research Center on Aging, Department of Medicine, University of Sherbrooke, Sherbrooke, QC J1H 4C4, Canada
| | - Russell E Jacobs
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States of America
| | - Hussein N Yassine
- Department of Medicine, Keck School of Medicine University of Southern California, Los Angeles 90033, CA, United States of America.
| | - Kai Chen
- Department of Radiology, Keck School of Medicine University of Southern California, Los Angeles, CA 90033, United States of America.
| |
Collapse
|
12
|
Go J, Tran J, Khan M, Al-Mohtaseb Z. Application of data mining algorithms to study data trends for corneal transplantation. J Fr Ophtalmol 2022; 45:700-709. [DOI: 10.1016/j.jfo.2022.01.023] [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] [Received: 08/02/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 11/28/2022]
|
13
|
Jean-Richard-dit-Bressel P, Tran J, Didachos A, McNally GP. Instrumental aversion coding in the basolateral amygdala and its reversion by a benzodiazepine. Neuropsychopharmacology 2022; 47:1199-1209. [PMID: 34493829 PMCID: PMC9018846 DOI: 10.1038/s41386-021-01176-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/30/2021] [Indexed: 02/02/2023]
Abstract
Punishment involves learning the relationship between actions and their adverse consequences. Both the acquisition and expression of punishment learning depend on the basolateral amygdala (BLA), but how BLA supports punishment remains poorly understood. To address this, we measured calcium (Ca2+) transients in BLA principal neurons during punishment. Male rats were trained to press two individually presented levers for food; when one of these levers also yielded aversive footshock, responding on this punished lever decreased relative to the other, unpunished lever. In rats with the Ca2+ indicator GCaMP6f targeted to BLA principal neurons, we observed excitatory activity transients to the footshock punisher and inhibitory transients to lever-presses earning a reward. Critically, as rats learned punishment, activity around the punished response transformed from inhibitory to excitatory and similarity analyses showed that these punished lever-press transients resembled BLA transients to the punisher itself. Systemically administered benzodiazepine (midazolam) selectively alleviated punishment. Moreover, the degree to which midazolam alleviated punishment was associated with how much punished response-related BLA transients reverted to their pre-punishment state. Together, these findings show that punishment learning is supported by aversion-coding of instrumental responses in the BLA and that the anti-punishment effects of benzodiazepines are associated with a reversion of this aversion coding.
Collapse
Affiliation(s)
| | - Jenny Tran
- grid.1005.40000 0004 4902 0432School of Psychology, UNSW Sydney, Kensington, NSW Australia
| | - Angelos Didachos
- grid.1005.40000 0004 4902 0432School of Psychology, UNSW Sydney, Kensington, NSW Australia
| | - Gavan P. McNally
- grid.1005.40000 0004 4902 0432School of Psychology, UNSW Sydney, Kensington, NSW Australia
| |
Collapse
|
14
|
Bryant RA, Tran J, Williamson T, Korgaonkar MS. Neural processes during response inhibition in complex posttraumatic stress disorder. Depress Anxiety 2022; 39:307-314. [PMID: 34964209 DOI: 10.1002/da.23235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A common feature of complex posttraumatic stress disorder (CPTSD) is impulsivity. Despite the importance of this characteristic in functional difficulties in CPTSD, little is known about its mechanisms. The aim of this study was to identify the distinctive neural profile of CPTSD during attempted inhibition. METHODS The present study examined functional alterations in neural networks involved in inhibitory control across functional magnetic resonance imaging (fMRI) and electroencephalogram (EEG) paradigms in CPTSD (n = 30), PTSD (n = 40), and healthy control (n = 40) participants who completed a Go/NoGo response inhibition task during separate fMRI and EEG sessions. Brain activations were calculated during the NoGo trials relative to the baseline to evaluate response inhibition functioning. RESULTS There was reduced bilateral thalamic activation in participants with CPTSD relative to PTSD and controls during inhibition trials, but no activation differences between PTSD and controls for this brain region. There were no differences in functional connectivity between the thalamus and other regions involved in cognitive control between groups. No differences were observed between groups on EEG responses. CONCLUSIONS These findings provide initial evidence of aberrant functioning in the neurocircuitry of inhibitory control, involving the thalamus, in CPTSD. This evidence suggests that CPTSD is distinguished from PTSD by impaired neural processes implicated in response inhibition.
Collapse
Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Williamson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia.,Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Department of Psychiatry, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
15
|
Huang E, Huynh L, Gordon A, Chandhoke R, Morales B, Skarecky D, Tran J, Ahlering T. Validation of prostate specific antigen doubling time kinetics following radical prostatectomy to guide active observation and intervention. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00282-2] [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: 11/28/2022]
|
16
|
Huang E, Huynh L, Gordon A, Chandhoke R, Morales B, Skarecky D, Tran J, Ahlering T. Active observation of biochemical recurrence without treatment following radical prostatectomy: Long term analysis of outcomes. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Tran J, Marathe S, Stefanutti G, Alphonso N, Venugopal P. Outcomes of Paediatric Patients Needing Laparotomy During Extra-Corporeal Membrane Oxygenation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.414] [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: 10/16/2022]
|
18
|
Sherwood K, Tran J, Günther O, Lan J, Aiyegbusi O, Liwski R, Sapir-Pichhadze R, Bryan S, Caulfield T, Keown P. Genome Canada precision medicine strategy for structured national implementation of epitope matching in renal transplantation. Hum Immunol 2022; 83:264-269. [DOI: 10.1016/j.humimm.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/12/2021] [Accepted: 01/05/2022] [Indexed: 02/08/2023]
|
19
|
Bryant RA, Dawson KS, Keyan D, Azevedo S, Yadav S, Tran J, Rawson N, Harvey S. Effectiveness of a Videoconferencing-Delivered Psychological Intervention for Mental Health Problems during COVID-19: A Proof-of-Concept Randomized Clinical Trial. Psychother Psychosom 2022; 91:63-72. [PMID: 34875669 PMCID: PMC8820421 DOI: 10.1159/000520283] [Citation(s) in RCA: 10] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Anxiety and depression have increased markedly during the COVID-19 pandemic. There is a lack of evidence-based strategies to address these mental health needs during the pandemic. OBJECTIVE We aim to conduct a proof-of-concept trial of the efficacy of a brief group-based psychological intervention delivered via videoconferencing for adults in Australia distressed by the pandemic. METHODS In this single-blind, parallel, randomised controlled trial, adults who screened positive for COVID-related psychological distress across Australia were randomly allocated to either a 6-session group-based program based on behavioural principles (n = 120) or enhanced usual care (EUC, n = 120). Primary outcome was total score on the Hospital Anxiety and Depression (HADS) anxiety and depression subscales assessed at baseline, 1 week posttreatment, 2 months (primary outcome time point), and 6 months after treatment, as well as secondary outcome measures of worry, sleep impairment, anhedonia, mood, and COVID-19-related stress. RESULTS Between May 20, 2020, and October 20, 2020, 240 patients were enrolled into the trial. Relative to EUC, at 2 months participants receiving intervention showed greater reduction on anxiety (mean difference, 1.4 [95% CI, 0.3 to 2.6], p = 0.01; effect size, 0.4 [95% CI, 0.1 to 0.7]) and depression (mean difference, 1.6 [95% CI, 0.4 to 2.8], p = 0.009; effect size, 0.4 [95% CI, 0.2 to 0.7]) scales. These effects were maintained at 6 months. There were also greater reductions of worry, anhedonia, COVID-19-related fears, and contamination fears. CONCLUSIONS This trial provides initial evidence that brief group-based behavioural intervention delivered via videoconferencing results in moderate reductions in common psychological problems arising during the COVID-19 pandemic. This program may offer a viable and scalable means to mitigate the rising mental health problems during the pandemic.
Collapse
Affiliation(s)
- Richard A. Bryant
- University of New South Wales, Sydney, New South Wales, Australia,Westmead Institute for Medical Research, Sydney, New South Wales, Australia,Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia,*Richard A. Bryant,
| | - Katie S. Dawson
- University of New South Wales, Sydney, New South Wales, Australia
| | - Dharani Keyan
- University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanna Azevedo
- University of New South Wales, Sydney, New South Wales, Australia
| | - Srishti Yadav
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jenny Tran
- University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Rawson
- University of New South Wales, Sydney, New South Wales, Australia
| | - Samuel Harvey
- University of New South Wales, Sydney, New South Wales, Australia,Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Moran T, Tran J, Joshi S. Subarachnoid Haemorrhage as the Initial Presentation of Aortic Coarctation in a 28 Year-Old Man. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Bryant RA, Kenny L, Rawson N, Cahill C, Joscelyne A, Garber B, Tockar J, Tran J, Dawson K. Two-year follow-up of trauma-focused cognitive behavior therapy for posttraumatic stress disorder in emergency service personnel: A randomized clinical trial. Depress Anxiety 2021; 38:1131-1137. [PMID: 34520092 DOI: 10.1002/da.23214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/07/2021] [Accepted: 08/28/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Emergency service personnel experience elevated rates of posttraumatic stress disorder (PTSD). There are few controlled trials for PTSD in this population, and none report longer term effects of treatment. This study evaluated the benefits of cognitive behavior therapy (CBT) for PTSD in emergency service personnel who received either brief exposure (CBT-B) to trauma memories or prolonged exposure (CBT-L) 2 years following treatment. METHODS One hundred emergency service personnel with PTSD were randomized to CBT-L, CBT-B, or Wait-List (WL). Following posttreatment assessment, WL participants were randomized to an active treatment. Participants randomized to CBT-L or CBT-B were assessed at baseline, posttreatment, 6-month, and 2-year follow-up. Both CBT conditions involved 12 weekly individual sessions comprising education, CBT skills building, imaginal exposure, in vivo exposure, cognitive restructuring, and relapse prevention. Reliving trauma memories occurred for 40 min per session in CBT-L and for 10 min in CBT-B. RESULTS At the 2-year follow-up, there were no differences in PTSD severity (Clinician Administered PTSD Scale) between CBT-L and CBT-B. There were very large effect sizes for CBT-L (1.28, 95% confidence interval [CI] = 0.90-1.64) and CBT-B (1.28, 95% CI = 0.05-1.63) from baseline to 2-year follow-up. CONCLUSIONS This study highlights that CBT can be an effective treatment of PTSD in emergency service personnel using either prolonged or brief periods of reliving the trauma memory, and that these benefits can last for at least 2 years after treatment.
Collapse
Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Amy Joscelyne
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Benjamin Garber
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Julia Tockar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, Australia
| |
Collapse
|
22
|
Canoy D, Tran J, Zottoli M, Ramakrishnan R, Hassaine A, Rao S, Li Y, Salimi-Khorshidi G, Norton R, Rahimi K. Association between cardiometabolic disease multimorbidity and all-cause mortality in 2 million women and men registered in UK general practices. BMC Med 2021; 19:258. [PMID: 34706724 PMCID: PMC8555122 DOI: 10.1186/s12916-021-02126-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/13/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI), stroke and diabetes share underlying risk factors and commonalities in clinical management. We examined if their combined impact on mortality is proportional, amplified or less than the expected risk separately of each disease and whether the excess risk is explained by their associated comorbidities. METHODS Using large-scale electronic health records, we identified 2,007,731 eligible patients (51% women) and registered with general practices in the UK and extracted clinical information including diagnosis of myocardial infarction (MI), stroke, diabetes and 53 other long-term conditions before 2005 (study baseline). We used Cox regression to determine the risk of all-cause mortality with age as the underlying time variable and tested for excess risk due to interaction between cardiometabolic conditions. RESULTS At baseline, the mean age was 51 years, and 7% (N = 145,910) have had a cardiometabolic condition. After a 7-year mean follow-up, 146,994 died. The sex-adjusted hazard ratios (HR) (95% confidence interval [CI]) of all-cause mortality by baseline disease status, compared to those without cardiometabolic disease, were MI = 1.51 (1.49-1.52), diabetes = 1.52 (1.51-1.53), stroke = 1.84 (1.82-1.86), MI and diabetes = 2.14 (2.11-2.17), MI and stroke = 2.35 (2.30-2.39), diabetes and stroke = 2.53 (2.50-2.57) and all three = 3.22 (3.15-3.30). Adjusting for other concurrent comorbidities attenuated these estimates, including the risk associated with having all three conditions (HR = 1.81 [95% CI 1.74-1.89]). Excess risks due to interaction between cardiometabolic conditions, particularly when all three conditions were present, were not significantly greater than expected from the individual disease effects. CONCLUSION Myocardial infarction, stroke and diabetes were associated with excess mortality, without evidence of any amplification of risk in people with all three diseases. The presence of other comorbidities substantially contributed to the excess mortality risks associated with cardiometabolic disease multimorbidity.
Collapse
Affiliation(s)
- Dexter Canoy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House, 75 George St., OX1 2BQ, Oxford, UK. .,NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Jenny Tran
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House, 75 George St., OX1 2BQ, Oxford, UK
| | | | - Rema Ramakrishnan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House, 75 George St., OX1 2BQ, Oxford, UK
| | - Abdelaali Hassaine
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House, 75 George St., OX1 2BQ, Oxford, UK
| | - Shishir Rao
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House, 75 George St., OX1 2BQ, Oxford, UK
| | - Yikuan Li
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House, 75 George St., OX1 2BQ, Oxford, UK
| | - Gholamreza Salimi-Khorshidi
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House, 75 George St., OX1 2BQ, Oxford, UK
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kazem Rahimi
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House, 75 George St., OX1 2BQ, Oxford, UK.,NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
23
|
Tran J, Norton R, Canoy D, Ayala Solares JR, Conrad N, Nazarzadeh M, Raimondi F, Salimi-Khorshidi G, Rodgers A, Rahimi K. Multi-morbidity and blood pressure trajectories in hypertensive patients: A multiple landmark cohort study. PLoS Med 2021; 18:e1003674. [PMID: 34138851 PMCID: PMC8248714 DOI: 10.1371/journal.pmed.1003674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/01/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Our knowledge of how to better manage elevated blood pressure (BP) in the presence of comorbidities is limited, in part due to exclusion or underrepresentation of patients with multiple chronic conditions from major clinical trials. We aimed to investigate the burden and types of comorbidities in patients with hypertension and to assess how such comorbidities and other variables affect BP levels over time. METHODS AND FINDINGS In this multiple landmark cohort study, we used linked electronic health records from the United Kingdom Clinical Practice Research Datalink (CPRD) to compare systolic blood pressure (SBP) levels in 295,487 patients (51% women) aged 61.5 (SD = 13.1) years with first recorded diagnosis of hypertension between 2000 and 2014, by type and numbers of major comorbidities, from at least 5 years before and up to 10 years after hypertension diagnosis. Time-updated multivariable linear regression analyses showed that the presence of more comorbidities was associated with lower SBP during follow-up. In hypertensive patients without comorbidities, mean SBP at diagnosis and at 10 years were 162.3 mm Hg (95% confidence interval [CI] 162.0 to 162.6) and 140.5 mm Hg (95% CI 140.4 to 140.6), respectively; in hypertensive patients with ≥5 comorbidities, these were 157.3 mm Hg (95% CI 156.9 to 157.6) and 136.8 mm Hg (95% 136.4 to 137.3), respectively. This inverse association between numbers of comorbidities and SBP was not specific to particular types of comorbidities, although associations were stronger in those with preexisting cardiovascular disease. Retrospective analysis of recorded SBP showed that the difference in mean SBP 5 years before diagnosis between those without and with ≥5 comorbidities was -9 mm Hg (95% CI -9.7 to -8.3), suggesting that mean recorded SBP already differed according to the presence of comorbidity before baseline. Within 1 year after the diagnosis, SBP substantially declined, but subsequent SBP changes across comorbidity status were modest, with no evidence of a more rapid decline in those with more or specific types of comorbidities. We identified factors, such as prescriptions of antihypertensive drugs and frequency of healthcare visits, that can explain SBP differences according to numbers or types of comorbidities, but these factors only partly explained the recorded SBP differences. Nevertheless, some limitations have to be considered including the possibility that diagnosis of some conditions may not have been recorded, varying degrees of missing data inherent in analytical datasets extracted from routine health records, and greater measurement errors in clinical measurements taken in routine practices than those taken in well-controlled clinical study settings. CONCLUSIONS BP levels at which patients were diagnosed with hypertension varied substantially according to the presence of comorbidities and were lowest in patients with multi-morbidity. Our findings suggest that this early selection bias of hypertension diagnosis at different BP levels was a key determinant of long-term differences in BP by comorbidity status. The lack of a more rapid decline in SBP in those with multi-morbidity provides some reassurance for BP treatment in these high-risk individuals.
Collapse
Affiliation(s)
- Jenny Tran
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Dexter Canoy
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Nathalie Conrad
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Milad Nazarzadeh
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Francesca Raimondi
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Gholamreza Salimi-Khorshidi
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kazem Rahimi
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
- National Institute of Health Research Oxford Biomedical Research Centre, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- * E-mail:
| |
Collapse
|
24
|
Keyan D, Dawson K, Azevado S, Yadav S, Tran J, Bryant RA. Brief videoconferencing psychological intervention for reducing COVID-19 related distress: study protocol for a randomized controlled trial. BMC Public Health 2021; 21:474. [PMID: 33750351 PMCID: PMC7942517 DOI: 10.1186/s12889-021-10529-x] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 12/23/2022] Open
Abstract
Background Globally COVID-19 has had a profound impact on the psychological wellbeing of millions of people, and there is an urgent imperative to address elevated levels of distress during the COVID-19 pandemic. The World Health Organization (WHO) has developed Problem Management Plus (PM+), a low intensity psychological intervention for adults experiencing psychological distress. This paper outlines the study protocol for a trial that tests the effectiveness of an adapted version of PM+ to reduce distress associated with COVID-19. Methods A single-blind, parallel, randomized controlled trial will be carried out for distressed people across Australia. via video conferencing on a small group basis. Following informed consent, adults that screen positive for levels of psychological distress (General Health Questionnaire-12 (GHQ-12 score ≥ 3) and have access to videoconferencing platform will be randomised to an adapted version of gPM+ (n = 120) or enhanced treatment as usual (ETAU) (n = 120). The primary outcome will be reduction in psychological distress including anxiety and depression at 2-months post treatment. Secondary outcomes include worry, sleep problems, anhedonia, social support, and stress in relation to COVID-19. Discussion The trial aims assess whether an adapted version of videoconferencing PM+ that is specifically designed to target COVI-19 related distress will result in reduced distress relative to enhanced usual care. Trial registration This trial was prospectively registered on the ANZCTR on 14/4/20 (ACTRN12620000468921).
Collapse
Affiliation(s)
- Dharani Keyan
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Katie Dawson
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Suzanna Azevado
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Srishti Yadav
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jenny Tran
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia.
| |
Collapse
|
25
|
Guerrero K, Sunder Rajkumar S, Cairo Z, Adame J, Tran J, Rawas R, Rawas R, Aquino J, Spring M, Ranaraja A, Jayasinghe SA. Bioinformatics Analysis of Proteins Involved in Bacterial Curli Assembly Indicate Conserved Amino Acids that May Play a Role in Structure/Function. Biophys J 2021. [DOI: 10.1016/j.bpj.2020.11.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
26
|
Korgaonkar MS, Tran J, Felmingham KL, Williams LM, Bryant RA. Neural correlates of emotional processing in panic disorder. NeuroImage: Clinical 2021; 32:102902. [PMID: 34911204 PMCID: PMC8650813 DOI: 10.1016/j.nicl.2021.102902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/08/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022] Open
Abstract
Abnormal non-conscious emotion processing in panic
disorder. Impaired recruitment of implicit regulatory regions
during affect processing. Lower pgACC activation in panic disorder for sad and
happy faces. Deficits in key regulatory connections between
inhibitory and emotion brain regions. Lower pgACC-amygdala connectivity for sad and fear
faces.
Background Deficits in emotional processing are conceptualized in
prevailing models of anxiety to underpin key symptoms of panic disorder (PD).
Neuroimaging studies show evidence of aberrant neural functioning in PD patients
during emotional processing, however little is understood about how
non-conscious emotional processing impacts neural processes. Method We examined activation and functional connectivity
differences in brain regions involved in emotional processing between PD and
healthy controls (HC) during subliminal and supraliminal presentations of facial
emotions. Twenty-two PD and 33 HC participants were shown happy, sad, neutral,
fear, anger and disgust facial expressions during functional magnetic resonance
imaging using a 3T MRI scanner. We performed voxelwise ROI analyses at
FWE-corrected p < 0.05 for main effects of group and
group*emotion interactions. Results There was less pregenual anterior cingulate cortex
(pgACC) activation to subliminal presentations of happy and sad faces in PD
compared to HC participants (group*emotion). In addition, PD patients had less
pgACC - right amygdala connectivity than HC participants during sad and fear
subliminal processing (group*emotion). PD patients also exhibited lower right
cerebellum activity across all supraliminal presentations of facial expressions
compared to HC. Conclusion These findings suggest that there is aberrant neural
processing in PD patients during both conscious and preconscious processing of
both positive and negative stimuli, suggesting impaired recruitment of implicit
regulatory networks during affective processing. It appears that PD patients may
experience deficits in key regulatory connections between inhibitory and
emotional neural networks at very early stages of processing of negative
affective states.
Collapse
|
27
|
Tompkins LS, Madison A, Schaffner T, Tran J, Ang P. 118. Eliminating Blood Culture Contamination with an Initial-specimen Diversion Device. Open Forum Infect Dis 2020. [PMCID: PMC7776884 DOI: 10.1093/ofid/ofaa439.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Blood samples obtained via traditional venipuncture can become contaminated by superficial and deeply embedded skin flora. We evaluated the hospital-wide use of an initial-specimen diversion device (ISDD) designed to shunt these microorganisms away from the culture bottle to reduce blood culture contamination (BCC) and sequelae: false-positive central line-associated bloodstream infections (CLABSIs), repeat blood culture draws, inappropriate antibiotic usage, increased patient length-of-stay and misdiagnosis. The study aimed to show the proportion of blood cultures containing contaminants drawn by phlebotomy staff using the ISDD versus those drawn using traditional methods. Nursing staff continued to use traditional methods to draw blood cultures in the emergency department (ED) and from inpatients. Methods Over a four-month trial at Stanford Health Care (SHC), 4,462 blood cultures were drawn by phlebotomy staff using the ISDD (Steripath Gen2, Magnolia Medical Technologies) in the ED and from inpatients; 922 blood cultures were obtained by phlebotomy staff using standard methods. Additionally, 1,413 blood cultures were drawn by nursing staff using standard methods. The number of matched sets (2 bottles [aerobic/anaerobic] plus 2 bottles [aerobic/anaerobic], with total volume 40 ml) obtained through traditional methods and by the ISDD were recorded. Contaminants were defined by the National Healthcare Safety Network (NHSN). In addition, sets in which 1 out of 4 bottles contained vancomycin-resistant Enterococcus (VRE) or Candida sp. were also recorded, even though these are not considered contaminants by the NHSN. Results Of 4,462 blood cultures obtained using the ISDD there were zero contaminants found (BCC rate 0%) versus 29 contaminated sets using traditional methods (BCC rate 3.15%). Twenty-eight contaminants were observed from nursing staff blood culture draws (BCC rate 1.98%). Zero false-positive CLABSIs were associated with use of the ISDD for the trial period. No matched sets containing 1 of 4 bottles with VRE or Candida sp. were observed. Table Stanford Health Care blood culture collection methods and contamination events (March 15, 2019 - July 21, 2019) ![]()
Conclusion The trial results encourage adoption of the ISDD as standard practice for blood culture at SHC. Disclosures All Authors: No reported disclosures
Collapse
Affiliation(s)
- Lucy S Tompkins
- Stanford University School of Medicine, Stanford, California
| | | | | | - Jenny Tran
- Stanford Health Care, Stanford, California
| | | |
Collapse
|
28
|
Coutsouvelis J, Adams J, Bortz H, Chau M, Chiang K, Foo J, Ibrahim K, Kerr K, O'Connor S, Powell M, Rowan G, Siderov J, Tey A, Tran J, Vasileff H, Munro C. Standard of practice in oncology and haematology for pharmacy services. J Pharm Pract Res 2020. [DOI: 10.1002/jppr.1686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- John Coutsouvelis
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Alfred Health Melbourne Australia
- Centre Medication Use and Safety Monash University Parkville Australia
| | - Julie Adams
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- View Health Pty Ltd; chemo@home Pty Ltd West Perth Australia
| | - Hadley Bortz
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Alfred Health Melbourne Australia
| | - Maggie Chau
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Melbourne Health Parkville Australia
| | - Karen Chiang
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Melbourne Health Parkville Australia
- St Vincent's Hospital Fitzroy Australia
| | - Josephine Foo
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Eastern Health Melbourne Australia
| | - Karim Ibrahim
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- St Vincent's Hospital Darlinghurst Australia
- St Vincent's Clinical School University of NSW Sydney Australia
| | - Kimberley‐Ann Kerr
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- SA Pharmacy Lyell McEwin Hospital Elizabeth Vale Australia
| | - Shaun O'Connor
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- St Vincent's Hospital Fitzroy Australia
| | - Michael Powell
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Gold Coast Health Gold Coast University Hospital Southport Australia
| | - Gail Rowan
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Peter MacCallum Cancer Centre Melbourne Australia
| | - Jim Siderov
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Austin Health Heidelberg Australia
| | - Amanda Tey
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Monash Health Clayton Australia
| | - Jenny Tran
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Cancer Institute NSW Eveleigh Australia
| | - Hayley Vasileff
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- SA Pharmacy Women's and Children's Hospital North Adelaide Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
| |
Collapse
|
29
|
Canoy D, Zottoli M, Tran J, Ramakrishnan R, Hasseine A, Nazarzadeh M, Rao S, Li Y, Salimi-Khorshidi G, Norton R, Rahimi K. Cardiometabolic disease, comorbidities and risk of death: findings using data from large-scale electronic health records. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2848] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Myocardial infarction (MI), stroke and diabetes are separately associated with increased risk of mortality but it is uncertain if their combined effects are proportional, amplified or less than the expected risk of each disease individually. In addition, patients with these conditions tend to also have other long-term comorbidities. How the relationship between cardiometabolic disease and risk of death is modified by the presence of comorbidity is unclear.
Purpose
We investigated the separate and combined effects of MI, stroke and diabetes on all-cause mortality, and examined the impact of comorbidity on these associations.
Methods
We selected a patient cohort of 2,007,731 (51% women) aged ≥16 years at registration with their general practice, using large-scale UK primary care electronic health records that were linked to the national death registry. We identified patients with a recorded diagnosis of MI, stroke, diabetes or none before 2005 (baseline), and classified the patient cohort into mutually exclusive categories of their baseline disease status. For each group, we also extracted information on another major 53 long-term conditions prior to baseline. The cohort was followed until death, deregistration from the practice or censored at the end of study (31 Dec 2014). We used Cox regression, and tested for departure from additivity and multiplicativity to assess interaction.
Results
At baseline, the mean age of the cohort was 51 (SD=18) years and 7% (N=145,910) had a cardiometabolic disease. Over an average follow-up of 7 (SD=3) years, 270,036 died (mean age of death=79 years). After adjusting for baseline age and sex, the hazard ratio (HR) (95% confidence interval [CI]), relative to those without cardiometabolic disease, were as follows: diabetes=1.53 (1.51 to 1.55), MI=1.54 (1.51 to 1.56), stroke=1.87 (1.84 to 1.90), diabetes and MI=2.16 (2.09 to 2.23), MI and stroke=2.39 (2.28 to 2.49), diabetes and stroke=2.56 (2.47 to 2.65), and all three=3.17 (2.95 to 3.41). After adjusting for the 53 comorbidities, the HR (95% CI) were attenuated: diabetes=1.37 (1.35 to 1.39), MI=1.25 (1.23 to 1.27), stroke=1.49 (1.46 to 1.52), diabetes and MI=1.60 (1.55 to 1.65), MI and stroke=1.52 (1.45 to 1.59), diabetes and stroke=1.91 (1.84 to 1.98), and all three=1.77 (1.64 to 1.91). The results did not materially changed with adjustment for smoking and deprivation level. Test for interaction revealed some minor synergistic effects when cardiometabolic disease co-occurred but excess risks were lower than expected for two combined vs individual disease effects; no significant interaction was seen for all three vs individual disease effects.
Conclusion
MI, stroke and diabetes are associated with excess mortality, which was partly due to associated chronic conditions. We found no evidence that the co-occurrence of these three conditions contribute to a higher excess mortality than expected from each of them separately.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): NIHR Oxford Biomedical Research Centre; Oxford Martin School, University of Oxford
Collapse
Affiliation(s)
- D Canoy
- University of Oxford, Oxford, United Kingdom
| | - M Zottoli
- University of Oxford, Oxford, United Kingdom
| | - J Tran
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | | | - A Hasseine
- University of Oxford, Oxford, United Kingdom
| | | | - S Rao
- University of Oxford, Oxford, United Kingdom
| | - Y Li
- University of Oxford, Oxford, United Kingdom
| | | | - R Norton
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - K Rahimi
- University of Oxford, Oxford, United Kingdom
| |
Collapse
|
30
|
Canoy D, Tran J, Norton R, Ayala Solares R, Conrad N, Nazarzadeh M, Raimondi F, Salimi-Khorshidi G, Rodgers A, Rahimi K. Association between comorbidities and blood pressure trajectories in patients with hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2726] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Our knowledge of how to better manage elevated blood pressure in presence of comorbidities is limited; in part due to exclusion or underrepresentation of multimorbid patients from major clinical trials.
Purpose
To investigate the burden and types of comorbidities in patients with hypertension, to assess how such comorbidities and other variables affect blood pressure levels over time.
Methods
The study was conducted using linked electronic health records from the UK Clinical Practice Research Datalink study from its inception on 1 January 1985 to 30 September 2015. Using linked electronic health records, we compared systolic blood pressure levels among 295,487 patients with diagnosed hypertension by type and numbers of major comorbidities from at least 5 years before to up to 10 years after hypertension diagnosis. We used a multiple landmark cohort design in order to investigate associations prospectively with time-updated information that takes advantage of the dynamic nature of electronic health records.
Results
Time-updated multivariable linear regression analyses showed that the presence of more comorbidities was independently associated with lower blood pressure during follow-up. This negative association was not specific to particular types of comorbidities; although associations were stronger in those with pre-existing cardiovascular disease. Tracking patients backwards to years prior to hypertension diagnosis revealed that the association between comorbidities and blood pressure were even more pronounced in years before hypertension diagnosis. Despite substantial declines in blood pressure in the first year after diagnosis, subsequent changes were modest, with no evidence of a more rapid decline in those with more or specific types of comorbidities.
Conclusions
Blood pressure levels at which patients were diagnosed with hypertension varied substantially and were lower when patients had more comorbidities. This early selection bias was a key determinant of long-term differences in blood pressure by comorbidity status and provides an additional explanation for the lower blood pressure in multimorbid patients.
Mean SBP (mmHg) over time
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Institute for Health Research Oxford Biomedical Research Centre, Rhodes Trust and Clarendon Fund
Collapse
Affiliation(s)
- D Canoy
- University of Oxford, Oxford, United Kingdom
| | - J Tran
- University of Oxford, Oxford, United Kingdom
| | - R Norton
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | | | - N Conrad
- University of Oxford, Oxford, United Kingdom
| | | | - F Raimondi
- University of Oxford, Oxford, United Kingdom
| | | | - A Rodgers
- The George Institute for Global Health, Sydney, Australia
| | - K Rahimi
- University of Oxford, Oxford, United Kingdom
| |
Collapse
|
31
|
Kane AV, Giordano NA, Tran J, Kent ML, Highland KB. Association between traumatic brain injuries and ketamine infusion side effects following combat injury. BMJ Mil Health 2020; 168:359-361. [PMID: 32753538 DOI: 10.1136/bmjmilitary-2020-001443] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Ketamine is a vital component for acute pain management in emergency trauma care for both civilian and military hospitals. This preliminary analysis examined whether combat-injured US service members sustaining traumatic brain injuries (TBI) experienced increased odds of ketamine side effects compared with those without TBI. METHODS This preliminary analysis included combat-injured service members, ages ≥18 years with documented pain scores during the 24 hours before and 48 hours after receiving an intravenous ketamine infusion at Walter Reed National Military Medical Center (WRNMMC) between 2007 and 2014. Logistic regression modeling examined the association between TBI and ketamine side effects (eg, hallucinations, nightmares, dysphoria, nausea, decreased oxygen saturation) during hospitalisation. RESULTS Of the 77 patients, 62% presented with a documented TBI. Side effects were documented for 18.8% of those without TBI and 24.4% of those with TBI. Analyses were unable to find evidence against the null hypothesis with the current sample size, even when adjusting for injury characteristics and preinfusion opioid doses (adjusted OR=0.90 (95% CI 0.26 to 3.34), p=0.87). CONCLUSION In this small sample of combat-injured service members, we were unable to detect a difference in ketamine-related side effects by documented TBI status. These hypothesis-generating findings support the need for future studies to examine the use of intravenous ketamine infusions for pain management, and subsequent care outcomes in patients who experience polytraumatic trauma inclusive of TBI.
Collapse
Affiliation(s)
- Alexandra Victoria Kane
- Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland, USA .,Defense and Veterans Center for Integrative Pain Management, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - N A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - J Tran
- Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland, USA.,Defense and Veterans Center for Integrative Pain Management, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| | - M L Kent
- Department of Anesthesiology, Duke University, Durham, North Carolina, USA
| | - K B Highland
- Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland, USA.,Defense and Veterans Center for Integrative Pain Management, Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
| |
Collapse
|
32
|
Conrad N, Judge A, Canoy D, Tran J, Pinho-Gomes AC, Millett ERC, Salimi-Khorshidi G, Cleland JG, McMurray JJV, Rahimi K. Temporal Trends and Patterns in Mortality After Incident Heart Failure: A Longitudinal Analysis of 86 000 Individuals. JAMA Cardiol 2020; 4:1102-1111. [PMID: 31479100 PMCID: PMC6724155 DOI: 10.1001/jamacardio.2019.3593] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Question Why has there been no improvement in the prognosis for patients with heart failure over the past 15 years when considerable advances in heart failure care have been introduced during the same period? Findings In this cohort study of patients who received a new diagnosis of heart failure between 2002 and 2013 in the United Kingdom, cardiovascular mortality declined by 27% and premature deaths from any cause declined by 21%. Improvements to overall mortality were hindered by noncardiovascular diseases, which represented most deaths and increased by 22% over time. Meaning Management strategies that solely target cardiovascular outcomes appear insufficient to improve the survival of patients with heart failure; the management of associated comorbidities, particularly infection prevention, appears as a major priority and opportunity. Importance Despite considerable improvements in heart failure care, mortality rates among patients in high-income countries have changed little since the early 2000s. Understanding the reasons underlying these trends may provide valuable clues for developing more targeted therapies and public health strategies. Objective To investigate mortality rates following a new diagnosis of heart failure and examine changes over time and by cause of death and important patient features. Design, Setting, and Participants This population-based retrospective cohort study analyzed anonymized electronic health records of individuals who received a new diagnosis of heart failure between January 2002 and December 2013 who were followed up until December 2014 from the Clinical Practice Research Datalink, which links information from primary care, secondary care, and the national death registry from a subset of the UK population. The data were analyzed from January 2018 to February 2019. Main Outcomes and Measures All-cause and cause-specific mortality rates at 1 year following diagnosis. Poisson regression models were used to calculate rate ratios (RRs) and 95% confidence intervals comparing 2013 with 2002, adjusting for age, sex, region, socioeconomic status, and 17 major comorbidities. Results Of 86 833 participants, 42 581 (49%) were women, 51 215 (88%) were white, and the mean (SD) age was 76.6 (12.6) years. While all-cause mortality rates declined only modestly over time (RR comparing 2013 with 2002, 0.94; 95% CI, 0.88-1.00), underlying patterns presented explicit trends. A decline in cardiovascular mortality (RR, 0.73; 95% CI, 0.67-0.80) was offset by an increase in noncardiovascular deaths (RR, 1.22; 95% CI, 1.11-1.33). Subgroup analyses further showed that overall mortality rates declined among patients younger than 80 years (RR, 0.79; 95% CI, 0.71-0.88) but not among those older than 80 years (RR, 0.97; 95% CI, 0.90-1.06). After cardiovascular causes (898 [43%]), the major causes of death in 2013 were neoplasms (311 [15%]), respiratory conditions (243 [12%]), and infections (13%), the latter 2 explaining most of the observed increase in noncardiovascular mortality. Conclusions and Relevance Among patients with a new heart failure diagnosis, considerable progress has been achieved in reducing mortality in young and middle-aged patients and cardiovascular mortality across all age groups. Improvements to overall mortality are hindered by high and increasing rates of noncardiovascular events. These findings challenge current research priorities and management strategies and call for a greater emphasis on associated comorbidities. Specifically, infection prevention presents as a major opportunity to improve prognosis.
Collapse
Affiliation(s)
- Nathalie Conrad
- The George Institute for Global Health, University of Oxford, Oxford, England
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, England.,Bristol National Institute for Health Research Biomedical Research Centre, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, England.,Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, England
| | - Dexter Canoy
- The George Institute for Global Health, University of Oxford, Oxford, England.,National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, England.,Deep Medicine, Oxford Martin School, University of Oxford, Oxford, England.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jenny Tran
- The George Institute for Global Health, University of Oxford, Oxford, England.,Deep Medicine, Oxford Martin School, University of Oxford, Oxford, England
| | - Ana-Catarina Pinho-Gomes
- The George Institute for Global Health, University of Oxford, Oxford, England.,Deep Medicine, Oxford Martin School, University of Oxford, Oxford, England
| | | | - Gholamreza Salimi-Khorshidi
- The George Institute for Global Health, University of Oxford, Oxford, England.,Deep Medicine, Oxford Martin School, University of Oxford, Oxford, England
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Imperial College London, London, England
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Kazem Rahimi
- The George Institute for Global Health, University of Oxford, Oxford, England.,National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, England.,Deep Medicine, Oxford Martin School, University of Oxford, Oxford, England.,Oxford University Hospitals NHS Foundation Trust, Oxford, England
| |
Collapse
|
33
|
Huynh L, See K, Tran J, Jaime A, Su H, Ahlering T. Validation of Patient-Reported Outcomes Via Online Questionnaires (PROVOQ) as a quality improvement and urinary continence assessment tool following radical prostatectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32715-4] [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: 11/29/2022] Open
|
34
|
Abstract
BACKGROUND Little is known regarding the mental health of women firefighters. AIMS To identify demographic, work-related and mental health characteristics associated with post-traumatic stress disorder (PTSD) symptoms and lifetime suicidal ideation in female firefighters compared with male colleagues. METHODS Participants were firefighters (75 women and 2564 men) employed in a large urban fire department in the USA. Chi-square, correlations, t-tests and analyses of variance were conducted to examine the predictors of PTSD symptoms and lifetime suicide ideation in men and women. RESULTS Approximately 20% of women scored positively for PTSD and 30% reported lifetime suicidal ideation. Women with PTSD symptoms were more likely to be in their mid-career years (11-20) than in their first 10 years (87% versus 44%; χ2 = 8.77, P < 0.05) and to have received counselling (53% versus 14%; χ2 = 8.11, P < 0.01). Being single (73% versus 58%; χ2 = 6.02, P < 0.05), having a second job (68% versus 38%; χ2 = 5.79, P < 0.05) and having received counselling (41% versus 11%; χ2 = 8.51, P < 0.01) predicted suicide ideation. Depression and general stress positively predicted PTSD symptoms and suicide ideation. PTSD also predicted suicide ideation. CONCLUSIONS Compared to male firefighters, women were at high risk for PTSD symptoms and suicide ideation. Particularly for women, few socio-demographic and work-related variables were associated with these outcomes. Mental health variables predicted depression and suicide ideation for both gender groups. Therefore, in screening and intervention efforts, it may be most fruitful to focus on mental health risk correlates of PTSD and suicide ideation.
Collapse
Affiliation(s)
- N Noor
- The Menninger Clinic, Houston, TX, USA
| | - C Pao
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - M Dragomir-Davis
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | - J Tran
- Firefighter Support Network, Houston Fire Department, Houston, TX, USA
| | - C Arbona
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| |
Collapse
|
35
|
Dey D, Parihar VK, Szabo GG, Klein PM, Tran J, Moayyad J, Ahmed F, Nguyen QA, Murry A, Merriott D, Nguyen B, Goldman J, Angulo MC, Piomelli D, Soltesz I, Baulch JE, Limoli CL. Neurological Impairments in Mice Subjected to Irradiation and Chemotherapy. Radiat Res 2020; 193:407-424. [PMID: 32134362 DOI: 10.1667/rr15540.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radiotherapy, surgery and the chemotherapeutic agent temozolomide (TMZ) are frontline treatments for glioblastoma multiforme (GBM). However beneficial, GBM treatments nevertheless cause anxiety or depression in nearly 50% of patients. To further understand the basis of these neurological complications, we investigated the effects of combined radiotherapy and TMZ chemotherapy (combined treatment) on neurological impairments using a mouse model. Five weeks after combined treatment, mice displayed anxiety-like behaviors, and at 15 weeks both anxiety- and depression-like behaviors were observed. Relevant to the known roles of the serotonin axis in mood disorders, we found that 5HT1A serotonin receptor levels were decreased by ∼50% in the hippocampus at both early and late time points, and a 37% decrease in serotonin levels was observed at 15 weeks postirradiation. Furthermore, chronic treatment with the selective serotonin reuptake inhibitor fluoxetine was sufficient for reversing combined treatment-induced depression-like behaviors. Combined treatment also elicited a transient early increase in activated microglia in the hippocampus, suggesting therapy-induced neuroinflammation that subsided by 15 weeks. Together, the results of this study suggest that interventions targeting the serotonin axis may help ameliorate certain neurological side effects associated with the clinical management of GBM to improve the overall quality of life for cancer patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Faizy Ahmed
- Departments of Anatomy and Neurobiology, University of California, Irvine, California 92697
| | | | | | | | | | | | | | - Daniele Piomelli
- Departments of Anatomy and Neurobiology, University of California, Irvine, California 92697
| | - Ivan Soltesz
- Departments of Neurology and Neurological Sciences, Stanford University, Palo Alto, California 94305
| | | | | |
Collapse
|
36
|
Martinez-Salazar EL, Tran J, Patiño A, Sureshkumar A, Catanzano T. Infections of the Male and Female Reproductive System: Spectrum of Imaging Findings. Semin Ultrasound CT MR 2020; 41:2-9. [DOI: 10.1053/j.sult.2019.10.007] [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: 11/11/2022]
|
37
|
Patiño A, Martinez-Salazar EL, Tran J, Sureshkumar A, Catanzano T. Review of Imaging Findings in Urinary Tract Infections. Semin Ultrasound CT MR 2020; 41:99-105. [DOI: 10.1053/j.sult.2019.09.004] [Citation(s) in RCA: 2] [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: 12/23/2022]
|
38
|
Ayala Solares JR, Diletta Raimondi FE, Zhu Y, Rahimian F, Canoy D, Tran J, Pinho Gomes AC, Payberah AH, Zottoli M, Nazarzadeh M, Conrad N, Rahimi K, Salimi-Khorshidi G. Deep learning for electronic health records: A comparative review of multiple deep neural architectures. J Biomed Inform 2020; 101:103337. [DOI: 10.1016/j.jbi.2019.103337] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/25/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022]
|
39
|
Rahimi K, Mohseni H, Kiran A, Tran J, Nazarzadeh M, Rahimian F, Woodward M, Dwyer T, MacMahon S, Otto CM. Elevated blood pressure and risk of aortic valve disease: a cohort analysis of 5.4 million UK adults. Eur Heart J 2019; 39:3596-3603. [PMID: 30212891 PMCID: PMC6186276 DOI: 10.1093/eurheartj/ehy486] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/07/2018] [Indexed: 12/30/2022] Open
Abstract
Aims To test two related hypotheses that elevated blood pressure (BP) is a risk factor for aortic valve stenosis (AS) or regurgitation (AR). Methods and results In this cohort study of 5.4 million UK patients with no known cardiovascular disease or aortic valve disease at baseline, we investigated the relationship between BP and risk of incident AS and AR using multivariable-adjusted Cox regression models. Over a median follow-up of 9.2 years, 20 680 patients (0.38%) were diagnosed with AS and 6440 (0.12%) patients with AR. Systolic BP (SBP) was continuously related to the risk of AS and AR with no evidence of a nadir down to 115 mmHg. Each 20 mmHg increment in SBP was associated with a 41% higher risk of AS (hazard ratio 1.41, 95% confidence interval 1.38–1.45) and a 38% higher risk of AR (1.38, 1.31–1.45). Associations were stronger in younger patients but with no strong evidence for interaction by gender or body mass index. Each 10 mmHg increment in diastolic BP was associated with a 24% higher risk of AS (1.24, 1.19–1.29) but not AR (1.04, 0.97–1.11). Each 15 mmHg increment in pulse pressure was associated with a 46% greater risk of AS (1.46, 1.42–1.50) and a 53% higher risk of AR (1.53, 1.45–1.62). Conclusion Long-term exposure to elevated BP across its whole spectrum was associated with increased risk of AS and AR. The possible causal nature of the observed associations warrants further investigation.
Collapse
Affiliation(s)
- Kazem Rahimi
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK.,Deep Medicine, Oxford Martin School, University of Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hamid Mohseni
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK
| | - Amit Kiran
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK
| | - Jenny Tran
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK.,Deep Medicine, Oxford Martin School, University of Oxford, UK
| | - Milad Nazarzadeh
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK.,Deep Medicine, Oxford Martin School, University of Oxford, UK.,The Collaboration Center of Meta-analysis Research, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Fatemeh Rahimian
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK.,Deep Medicine, Oxford Martin School, University of Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK.,The George Institute for Global Health, University of Sydney, Sydney, Australia.,Department of Epidemiology, Johns Hopkins University, Baltimore MD, USA
| | - Terence Dwyer
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK
| | - Stephen MacMahon
- The George Institute for Global Health, University of Oxford, Le Gros Clark Building, South Park Road, Oxford, UK.,The George Institute for Global Health, University of Sydney, Sydney, Australia
| | | |
Collapse
|
40
|
Ayala Solares JR, Canoy D, Raimondi FED, Zhu Y, Hassaine A, Salimi-Khorshidi G, Tran J, Copland E, Zottoli M, Pinho-Gomes AC, Nazarzadeh M, Rahimi K. P1548Long-term past, current and usual systolic blood pressure and incident cardiovascular disease: risk prediction using large-scale, routinely recorded clinical data. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0309] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The impact of long-term exposure to elevated systolic blood pressure (SBP) on future cardiovascular disease (CVD) in “real-world” settings, and its relevance to risk prediction, are less investigated.
Purpose
To examine the risk of incident CVD in relation to long-term past, current, and usual SBP, and compare their predictive performance, using evidence from large-scale electronic health records (EHR).
Methods
Using data extracted from UK primary care linked EHR, we applied a landmark cohort study design, by including patients aged 40 (N≈64,000), 50 (N≈80,000) and 60 (N≈67,000) years (y) at study entry who had recorded SBP and with no prior CVD or previous antihypertensive or lipid-lowering prescriptions at baseline. We estimated past SBP (mean, time-weighted mean, and variability recorded up to 10 years prior to baseline) and usual SBP (correcting current values for past time-dependent SBP variability). We used Cox regression to estimate hazard ratio (HR), and applied Bayesian analysis within a machine learning framework in developing and validating models. To evaluate predictive performance of the models, we used discrimination (area under the curve [AUC]) and calibration metrics. The outcome was incident CVD (first hospitalisation for or death from coronary heart disease or stroke/transient ischaemic attack). Analyses were conducted separately for each age cohort.
Results
After a mean follow-up of 8 years, the numbers of patients who developed incident CVD were over 1000 (40y), 3000 (50y) and 5000 (60y). Higher past, current and usual SBP values were separately and independently associated with increased incident CVD risk. Per 20-mmHg rise in SBP, the HR (95% credible interval [CI]) for current SBP for ages 40, 50 and 60 years were 1.18 (1.08 to 1.26), 1.22 (1.18 to 1.30) and 1.22 (1.19 to 1.24); the corresponding HR were stronger in magnitude for past SBP (mean and time-weighted mean) and usual SBP (HR ranged from: 40y=1.31 to 1.41, 50y=1.39 to 1.45 and 60y=1.32 to 1.48). For each age cohort, the AUC (95% CI) for the model that included current SBP, sex, smoking, deprivation, diabetes and lipid profile in the validation sample were: 40y=0.739 (0.730 to 0.746), 50y=0.750 (0.716 to 0.810), and 60y=0.647 (0.642 to 0.658). Adding past SBP mean, time-weighted mean or variability to this model were associated with modest increases in the AUC and all models showed good calibration. Small improvements in the AUC were similarly observed when evaluating models separately for men and women within each age cohort.
Conclusion
Using multiple SBP recordings from patients' EHR showed stronger associations with incident CVD than a single SBP measurement, but their addition to multivariate risk prediction models had negligible effects on model performance.
Acknowledgement/Funding
Oxford Martin School and National Institute for Health Research Oxford Biomedical Research Centre
Collapse
Affiliation(s)
- J R Ayala Solares
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - D Canoy
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - F E D Raimondi
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - Y Zhu
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - A Hassaine
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - G Salimi-Khorshidi
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - J Tran
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - E Copland
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - M Zottoli
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - A C Pinho-Gomes
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - M Nazarzadeh
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| | - K Rahimi
- University of Oxford, The George Institute for Global Health (UK), Oxford, United Kingdom
| |
Collapse
|
41
|
Ayala Solares JR, Canoy D, Raimondi FED, Zhu Y, Hassaine A, Salimi-Khorshidi G, Tran J, Copland E, Zottoli M, Pinho-Gomes AC, Nazarzadeh M, Rahimi K. Long-Term Exposure to Elevated Systolic Blood Pressure in Predicting Incident Cardiovascular Disease: Evidence From Large-Scale Routine Electronic Health Records. J Am Heart Assoc 2019; 8:e012129. [PMID: 31164039 PMCID: PMC6645648 DOI: 10.1161/jaha.119.012129] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Indexed: 02/06/2023]
Abstract
Background How measures of long‐term exposure to elevated blood pressure might add to the performance of “current” blood pressure in predicting future cardiovascular disease is unclear. We compared incident cardiovascular disease risk prediction using past, current, and usual systolic blood pressure alone or in combination. Methods and Results Using data from UK primary care linked electronic health records, we applied a landmark cohort study design and identified 80 964 people, aged 50 years (derivation cohort=64 772; validation cohort=16 192), who, at study entry, had recorded blood pressure, no prior cardiovascular disease, and no previous antihypertensive or lipid‐lowering prescriptions. We used systolic blood pressure recorded up to 10 years before baseline to estimate past systolic blood pressure (mean, time‐weighted mean, and variability) and usual systolic blood pressure (correcting current values for past time‐dependent blood pressure fluctuations) and examined their prospective relation with incident cardiovascular disease (first hospitalization for or death from coronary heart disease or stroke/transient ischemic attack). We used Cox regression to estimate hazard ratios and applied Bayesian analysis within a machine learning framework in model development and validation. Predictive performance of models was assessed using discrimination (area under the receiver operating characteristic curve) and calibration metrics. We found that elevated past, current, and usual systolic blood pressure values were separately and independently associated with increased incident cardiovascular disease risk. When used alone, the hazard ratio (95% credible interval) per 20–mm Hg increase in current systolic blood pressure was 1.22 (1.18–1.30), but associations were stronger for past systolic blood pressure (mean and time‐weighted mean) and usual systolic blood pressure (hazard ratio ranging from 1.39–1.45). The area under the receiver operating characteristic curve for a model that included current systolic blood pressure, sex, smoking, deprivation, diabetes mellitus, and lipid profile was 0.747 (95% credible interval, 0.722–0.811). The addition of past systolic blood pressure mean, time‐weighted mean, or variability to this model increased the area under the receiver operating characteristic curve (95% credible interval) to 0.750 (0.727–0.811), 0.750 (0.726–0.811), and 0.748 (0.723–0.811), respectively, with all models showing good calibration. Similar small improvements in area under the receiver operating characteristic curve were observed when testing models on the validation cohort, in sex‐stratified analyses, or by using different landmark ages (40 or 60 years). Conclusions Using multiple blood pressure recordings from patients’ electronic health records showed stronger associations with incident cardiovascular disease than a single blood pressure measurement, but their addition to multivariate risk prediction models had negligible effects on model performance. See Editorial Ahmad and Oparil
Collapse
Affiliation(s)
- Jose Roberto Ayala Solares
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom.,4 National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Dexter Canoy
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom.,4 National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom.,5 Faculty of Medicine University of New South Wales Sydney Australia
| | - Francesca Elisa Diletta Raimondi
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom
| | - Yajie Zhu
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom
| | - Abdelaali Hassaine
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom.,4 National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Gholamreza Salimi-Khorshidi
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom
| | - Jenny Tran
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom
| | - Emma Copland
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom.,4 National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Mariagrazia Zottoli
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom.,4 National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Ana-Catarina Pinho-Gomes
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom
| | - Milad Nazarzadeh
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom.,3 Collaboration Center of Meta-Analysis Research Torbat Heydariyeh University of Medical Sciences Torbat Heydariyeh Iran
| | - Kazem Rahimi
- 1 Deep Medicine Oxford Martin School Oxford United Kingdom.,2 The George Institute for Global Health (UK) University of Oxford United Kingdom.,4 National Institute for Health Research Oxford Biomedical Research Centre Oxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| |
Collapse
|
42
|
|
43
|
Sheu J, Tran J, Rady P, Dao H, Tyring S, Nguyen H. 皮肤多瘤病毒: 利用分子和临床先进技术对抗新出现的病毒种类. Br J Dermatol 2019. [DOI: 10.1111/bjd.17964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Conrad N, Judge A, Canoy D, Tran J, O’Donnell J, Nazarzadeh M, Salimi-Khorshidi G, Hobbs FDR, Cleland JG, McMurray JJV, Rahimi K. Diagnostic tests, drug prescriptions, and follow-up patterns after incident heart failure: A cohort study of 93,000 UK patients. PLoS Med 2019; 16:e1002805. [PMID: 31112552 PMCID: PMC6528949 DOI: 10.1371/journal.pmed.1002805] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective management of heart failure is complex, and ensuring evidence-based practice presents a major challenge to health services worldwide. Over the past decade, the United Kingdom introduced a series of national initiatives to improve evidence-based heart failure management, including a landmark pay-for-performance scheme in primary care and a national audit in secondary care started in 2004 and 2007, respectively. Quality improvement efforts have been evaluated within individual clinical settings, but patterns of care across its continuum, although a critical component of chronic disease management, have not been studied. We have designed this study to investigate patients' trajectories of care around the time of diagnosis and their variation over time by age, sex, and socioeconomic status. METHODS AND FINDINGS For this retrospective population-based study, we used linked primary and secondary health records from a representative sample of the UK population provided by the Clinical Practice Research Datalink (CPRD). We identified 93,074 individuals newly diagnosed with heart failure between 2002 and 2014, with a mean age of 76.7 years and of which 49% were women. We examined five indicators of care: (i) diagnosis care setting (inpatient or outpatient), (ii) posthospitalisation follow-up in primary care, (iii) diagnostic investigations, (iv) prescription of essential drugs, and (v) drug treatment dose. We used Poisson and linear regression models to calculate category-specific risk ratios (RRs) or adjusted differences and 95% confidence intervals (CIs), adjusting for year of diagnosis, age, sex, region, and socioeconomic status. From 2002 to 2014, indicators of care presented diverging trends. Outpatient diagnoses and follow-up after hospital discharge in primary care declined substantially (ranging from 56% in 2002 to 36% in 2014, RR 0.64 [0.62, 0.67] and 20% to 14%, RR 0.73 [0.65, 0.82], respectively). Primary care referral for diagnostic investigations and appropriate initiation of beta blockers and angiotensin-converting-enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) both increased significantly (37% versus 82%, RR 2.24 [2.15, 2.34] and 18% versus 63%, RR 3.48 [2.72, 4.43], respectively). Yet, the average daily dose prescribed remained below guideline recommendations (42% for ACE-Is or ARBs, 29% for beta blockers in 2014) and was largely unchanged beyond the first 30 days after diagnosis. Despite increasing rates of treatment initiation, the overall dose prescribed to patients in the 12 months following diagnosis improved little over the period of study (adjusted difference for the combined dose of beta blocker and ACE-I or ARB: +6% [+2%, +10%]). Women and patients aged over 75 years presented significant gaps across all five indicators of care. Our study was limited by the available clinical information, which did not include exact left ventricular ejection fraction values, investigations performed during hospital admissions, or information about follow-up in community heart failure clinics. CONCLUSIONS Management of heart failure patients in the UK presents important shortcomings that affect screening, continuity of care, and medication titration and disproportionally impact women and older people. National reporting and incentive schemes confined to individual clinical settings have been insufficient to identify these gaps and address patients' long-term care needs.
Collapse
Affiliation(s)
- Nathalie Conrad
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
- Bristol National Institute for Health Research Biomedical Research Centre, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, United Kingdom
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Dexter Canoy
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Jenny Tran
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Johanna O’Donnell
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Milad Nazarzadeh
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Collaboration Center of Meta-Analysis Research, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | | | - F. D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom
| | - John G. Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - John J. V. McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kazem Rahimi
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
- * E-mail:
| |
Collapse
|
45
|
Tran J, Wright F, Takara S, Shu CC, Chu SY, Naganathan V, Hirani V, Blyth FM, Le Couteur DG, Waite LM, Handelsman DJ, Seibel MJ, Milledge KL, Cumming RG. Oral health behaviours of older Australian men: the Concord Health and Ageing in Men Project. Aust Dent J 2019; 64:246-255. [PMID: 30972755 DOI: 10.1111/adj.12694] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Concord Health and Ageing in Men Project (CHAMP) is a cohort study of the health of a representative sample of older Australian men. The aim of this paper is to describe the oral health behaviours and dental service use of CHAMP participants and explore associations between oral health behaviours with and general health status. METHOD Information collected related to socio-demographics, general health, oral health service-use and oral health behaviours. Key general health conditions were ascertained from the health questionnaire and included physical capacity and cognitive status. RESULTS Fifty-seven percent of the men reported visiting a dental provider at least once or more a year and 56.7% did so for a "dental check-up". Of those with some natural teeth, 59.3% claimed to brush their teeth at least twice or more a day. Most men (96%) used a standard fluoride toothpaste. Few participants used dental floss, tooth picks or mouth-rinses to supplement oral hygiene. Cognitive status and self-rated general health were associated with dental visiting patterns and toothbrushing behaviour. CONCLUSIONS Most older men in CHAMP perform favourable oral health behaviours. Smoking behaviour is associated with less favourable dental visiting patterns, and cognitive status with toothbrushing behaviour.
Collapse
Affiliation(s)
- J Tran
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Fac Wright
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - S Takara
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Department of Oral Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - C-C Shu
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sk-Y Chu
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - V Naganathan
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Ageing and Alzheimer's Institute, Geriatric Medicine and Rehabilitation, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - V Hirani
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - F M Blyth
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Concord Clinical School, Concord Repatriation General Hospital, University of Sydney, Concord, New South Wales, Australia
| | - D G Le Couteur
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - L M Waite
- Centre for Education and Research and Ageing, Concord Clinical School and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - D J Handelsman
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - M J Seibel
- Concord Clinical School, Concord Repatriation General Hospital, University of Sydney, Concord, New South Wales, Australia
| | - K L Milledge
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - R G Cumming
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
46
|
Sheu JC, Tran J, Rady PL, Dao H, Tyring SK, Nguyen HP. Polyomaviruses of the skin: integrating molecular and clinical advances in an emerging class of viruses. Br J Dermatol 2019; 180:1302-1311. [PMID: 30585627 DOI: 10.1111/bjd.17592] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Human polyomaviruses (HPyVs) are small, nonenveloped, double-stranded DNA viruses that express tumour antigen proteins. Fourteen species of polyomaviruses have been discovered in humans, and since the 2008 discovery of the first cutaneous polyomavirus - Merkel cell polyomavirus (MCPyV) - six more species have been detected in the skin: trichodysplasia spinulosa-associated polyomavirus (TSPyV), HPyV6, HPyV7, HPyV9, HPyV10 and HPyV13. Of these cutaneous species, only MCPyV, TSPyV, HPyV6 and HPyV7 have been definitively associated with diseases of the skin, most commonly in immunocompromised individuals. MCPyV is a predominant aetiology in Merkel cell carcinomas. TSPyV is one of the aetiological factors of trichodysplasia spinulosa. HPyV6 and HPyV7 have been recently linked to pruritic skin eruptions. The roles of HPyV9, HPyV10 and HPyV13 in pathogenesis, if any, are still unknown, but their molecular features have provided some insight into their functional biology. RESULTS In this review, we summarize the known molecular mechanisms, clinical presentation and targeted therapies of each of the eight cutaneous HPyVs. CONCLUSIONS We hope that heightened awareness and clinical recognition of HPyVs will lead to increased reports of HPyV-associated diseases and, consequently, a more robust understanding of how to diagnose and treat these conditions.
Collapse
Affiliation(s)
- J C Sheu
- Department of Dermatology, Baylor College of Medicine, Houston, TX, U.S.A
| | - J Tran
- Department of Dermatology, Baylor College of Medicine, Houston, TX, U.S.A
| | - P L Rady
- Department of Dermatology, McGovern Medical School, Houston, TX, U.S.A
| | - H Dao
- Department of Dermatology, Baylor College of Medicine, Houston, TX, U.S.A
| | - S K Tyring
- Department of Dermatology, McGovern Medical School, Houston, TX, U.S.A
| | - H P Nguyen
- Department of Dermatology, Baylor College of Medicine, Houston, TX, U.S.A.,Department of Dermatology, McGovern Medical School, Houston, TX, U.S.A.,Department of Dermatology, Emory University School of Medicine, Atlanta, GA, U.S.A
| |
Collapse
|
47
|
Byrne AE, Redmayne GM, Lam T, Tran J, Chan DK. Implementation and evaluation of a pharmacist‐led oral anticancer medication management clinic. J Pharm Pract Res 2018. [DOI: 10.1002/jppr.1429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Aimee E. Byrne
- Department of Pharmacy Prince of Wales Hospital Sydney Australia
| | | | - Thanh Lam
- Department of Pharmacy Prince of Wales Hospital Sydney Australia
| | - Jenny Tran
- Department of Pharmacy Prince of Wales Hospital Sydney Australia
| | - Daisy K. Chan
- Department of Pharmacy Prince of Wales Hospital Sydney Australia
| |
Collapse
|
48
|
Rahimian F, Salimi-Khorshidi G, Payberah AH, Tran J, Ayala Solares R, Raimondi F, Nazarzadeh M, Canoy D, Rahimi K. Predicting the risk of emergency admission with machine learning: Development and validation using linked electronic health records. PLoS Med 2018; 15:e1002695. [PMID: 30458006 PMCID: PMC6245681 DOI: 10.1371/journal.pmed.1002695] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/15/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Emergency admissions are a major source of healthcare spending. We aimed to derive, validate, and compare conventional and machine learning models for prediction of the first emergency admission. Machine learning methods are capable of capturing complex interactions that are likely to be present when predicting less specific outcomes, such as this one. METHODS AND FINDINGS We used longitudinal data from linked electronic health records of 4.6 million patients aged 18-100 years from 389 practices across England between 1985 to 2015. The population was divided into a derivation cohort (80%, 3.75 million patients from 300 general practices) and a validation cohort (20%, 0.88 million patients from 89 general practices) from geographically distinct regions with different risk levels. We first replicated a previously reported Cox proportional hazards (CPH) model for prediction of the risk of the first emergency admission up to 24 months after baseline. This reference model was then compared with 2 machine learning models, random forest (RF) and gradient boosting classifier (GBC). The initial set of predictors for all models included 43 variables, including patient demographics, lifestyle factors, laboratory tests, currently prescribed medications, selected morbidities, and previous emergency admissions. We then added 13 more variables (marital status, prior general practice visits, and 11 additional morbidities), and also enriched all variables by incorporating temporal information whenever possible (e.g., time since first diagnosis). We also varied the prediction windows to 12, 36, 48, and 60 months after baseline and compared model performances. For internal validation, we used 5-fold cross-validation. When the initial set of variables was used, GBC outperformed RF and CPH, with an area under the receiver operating characteristic curve (AUC) of 0.779 (95% CI 0.777, 0.781), compared to 0.752 (95% CI 0.751, 0.753) and 0.740 (95% CI 0.739, 0.741), respectively. In external validation, we observed an AUC of 0.796, 0.736, and 0.736 for GBC, RF, and CPH, respectively. The addition of temporal information improved AUC across all models. In internal validation, the AUC rose to 0.848 (95% CI 0.847, 0.849), 0.825 (95% CI 0.824, 0.826), and 0.805 (95% CI 0.804, 0.806) for GBC, RF, and CPH, respectively, while the AUC in external validation rose to 0.826, 0.810, and 0.788, respectively. This enhancement also resulted in robust predictions for longer time horizons, with AUC values remaining at similar levels across all models. Overall, compared to the baseline reference CPH model, the final GBC model showed a 10.8% higher AUC (0.848 compared to 0.740) for prediction of risk of emergency admission within 24 months. GBC also showed the best calibration throughout the risk spectrum. Despite the wide range of variables included in models, our study was still limited by the number of variables included; inclusion of more variables could have further improved model performances. CONCLUSIONS The use of machine learning and addition of temporal information led to substantially improved discrimination and calibration for predicting the risk of emergency admission. Model performance remained stable across a range of prediction time windows and when externally validated. These findings support the potential of incorporating machine learning models into electronic health records to inform care and service planning.
Collapse
Affiliation(s)
- Fatemeh Rahimian
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Gholamreza Salimi-Khorshidi
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Amir H. Payberah
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Jenny Tran
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Roberto Ayala Solares
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Francesca Raimondi
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Milad Nazarzadeh
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Dexter Canoy
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Kazem Rahimi
- Deep Medicine, Oxford Martin School, Oxford, United Kingdom
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| |
Collapse
|
49
|
Tran J, Norton R, Conrad N, Rahimian F, Canoy D, Nazarzadeh M, Rahimi K. 5260Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: a population-based cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5260] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Tran
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - R Norton
- The George Institute for Global Health, Sydney, Australia
| | - N Conrad
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - F Rahimian
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - D Canoy
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - M Nazarzadeh
- Torbat Heydariyeh University of Medical Sciences, Collaboration Center of Meta-Analysis Research, Torbat Heydariyeh, Iran (Islamic Republic of)
| | - K Rahimi
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| |
Collapse
|
50
|
Tran J, Norton R, Conrad N, Canoy D, Rahimi K. P5725Association between comorbidity and prescription of anti-hypertensives in incident hypertension: a population cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5725] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Tran
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - R Norton
- The George Institute for Global Health, Sydney, Australia
| | - N Conrad
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - D Canoy
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| | - K Rahimi
- University of Oxford, The George Institute for Global Health, Oxford, United Kingdom
| |
Collapse
|