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Ussery E, McMaster M, Palace V, Parrott J, Blandford NC, Frank R, Kidd K, Birceanu O, Wilson J, Alaee M, Cunningham J, Wynia A, Clark T, Campbell S, Timlick L, Michaleski S, Marshall S, Nielsen K. Effects of metformin on wild fathead minnows (Pimephales promelas) using in-lake mesocosms in a boreal lake ecosystem. Sci Total Environ 2024:172457. [PMID: 38649046 DOI: 10.1016/j.scitotenv.2024.172457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
Due to its widespread use for the treatment of Type-2 diabetes, metformin is routinely detected in surface waters globally. Laboratory studies have shown that environmentally relevant concentrations of metformin can adversely affect the health of adult fish, with effects observed more frequently in males. However, the potential risk to wild fish populations has yet to be fully elucidated and remains a topic of debate. To explore whether environmentally relevant metformin exposure poses a risk to wild fish populations, the present study exposed wild fathead minnows (Pimephales promelas) to 5 or 50 μg/L metformin via 2 m diameter in-lake mesocosms deployed in a natural boreal lake in Northern Ontario at the International Institute for Sustainable Development - Experimental Lakes Area (IISD-ELA). Environmental monitoring was performed at regular intervals for 8-weeks, with fish length, weight (body, liver and gonad), condition factor, gonadosomatic index, liver-somatic index, body composition (water and biomolecules) and hematocrit levels evaluated at test termination. Metabolic endpoints were also evaluated using liver, brain and muscle tissue, and gonads were evaluated histologically. Results indicate that current environmental exposure scenarios may be sufficient to adversely impact the health of wild fish populations. Adult male fish exposed to metformin had significantly reduced whole body weight and condition factor and several male fish from the high-dose metformin had oocytes in their testes. Metformin-exposed fish had altered moisture and lipid (decrease) content in their tissues. Further, brain (increase) and liver (decrease) glycogen were altered in fish exposed to high-dose metformin. To our knowledge, this study constitutes the first effort to understand metformin's effects on a wild small-bodied fish population under environmentally relevant field exposure conditions.
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Affiliation(s)
- Erin Ussery
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Mark McMaster
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Vince Palace
- University of Manitoba, Winnipeg, Manitoba, Canada; International Institute for Sustainable Development-Experimental Lakes Area, Winnipeg, Manitoba, Canada
| | - Joanne Parrott
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Nicholas C Blandford
- University of Manitoba, Winnipeg, Manitoba, Canada; International Institute for Sustainable Development-Experimental Lakes Area, Winnipeg, Manitoba, Canada
| | - Richard Frank
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Karen Kidd
- McMaster University, Department of Biology, Hamilton, Ontario, Canada
| | - Oana Birceanu
- Western University, Department of Physiology and Pharmacology, London, Ontario, Canada
| | - Joanna Wilson
- McMaster University, Department of Biology, Hamilton, Ontario, Canada
| | - Mehran Alaee
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Jessie Cunningham
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Abby Wynia
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Thomas Clark
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Sheena Campbell
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Lauren Timlick
- International Institute for Sustainable Development-Experimental Lakes Area, Winnipeg, Manitoba, Canada
| | - Sonya Michaleski
- International Institute for Sustainable Development-Experimental Lakes Area, Winnipeg, Manitoba, Canada
| | - Stephanie Marshall
- Environment and Climate Change Canada, Aquatic Contaminants Research Division, Burlington, Ontario, Canada
| | - Kristin Nielsen
- University of Texas at Austin, Department of Marine Science, Port Aransas, TX, USA
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Howard K, Garvey G, Anderson K, Dickson M, Viney R, Ratcliffe J, Howell M, Gall A, Cunningham J, Whop LJ, Cass A, Jaure A, Mulhern B. Development of the What Matters 2 Adults (WM2A) wellbeing measure for Aboriginal and Torres Strait Islander adults. Soc Sci Med 2024; 347:116694. [PMID: 38569315 DOI: 10.1016/j.socscimed.2024.116694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE As wellbeing is culturally bound, wellbeing measures for Aboriginal and Torres Strait Islander peoples must be culturally relevant and grounded in Aboriginal and Torres Strait Islander values and preferences. We describe the development of a nationally-relevant and culturally grounded wellbeing measure for Aboriginal and Torres Strait Islander adults: the What Matters to Adults (WM2A) measure. METHODS We used a mixed methods approach to measure development, combining Indigenist methodologies and psychometric methods. Candidate items were derived through a large national qualitative study. Think-aloud interviews (n = 17) were conducted to assess comprehension, acceptability, and wording of candidate items. Two national surveys collected data on the item pool (n = 312, n = 354). Items were analysed using exploratory factor analysis (EFA), and item response theory (IRT) to test dimensionality, local dependence and item fit. A Collaborative Yarning approach ensured Aboriginal and Torres Strait Islander voices were privileged throughout. RESULTS Fifty candidate items were developed, refined, and tested. Using EFA, an eight factor model was developed. All items met pre-specified thresholds for maximum endorsement frequencies, and floor and ceiling effects; no item redundancy was identified. Ten items did not meet thresholds for aggregate adjacent endorsement frequencies. During Collaborative Yarning, six items were removed based on low factor loadings (<0.4) and twelve due to conceptual overlap, high correlations with other items, endorsement frequencies, and/or low IRT item level information. Several items were retained for content validity. The final measure includes 32 items across 10 domains (Balance & control; Hope & resilience; Caring for others; Culture & Country; Spirit & identity; Feeling valued; Connection with others; Access; Racism & worries; Pride & strength). CONCLUSIONS The unique combination of Indigenist and psychometric methodologies to develop WM2A ensures a culturally and psychometrically robust measure, relevant across a range of settings and applications.
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Affiliation(s)
- K Howard
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia.
| | - G Garvey
- The First Nations Cancer & Wellbeing Research Team, The School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane Qld 4072, Australia
| | - K Anderson
- The First Nations Cancer & Wellbeing Research Team, The School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane Qld 4072, Australia
| | - M Dickson
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia; The Poche Centre for Indigenous Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - R Viney
- The Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Ultimo, NSW, 2007, Australia
| | - J Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5001, Australia
| | - M Howell
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia; Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - A Gall
- The First Nations Cancer & Wellbeing Research Team, The School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane Qld 4072, Australia
| | - J Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin NT, Australia
| | - L J Whop
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, 2600, Australia
| | - A Cass
- Menzies School of Health Research, Charles Darwin University, Darwin NT, Australia
| | - A Jaure
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, NSW, 2006, Australia
| | - B Mulhern
- The Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Ultimo, NSW, 2007, Australia
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Yoganathan S, Whitney R, Thomas M, Danda S, Chettali AM, Prasad AN, Farhan SMK, AlSowat D, Abukhaled M, Aldhalaan H, Gowda VK, Kinhal UV, Bylappa AY, Konanki R, Lingappa L, Parchuri BM, Appendino JP, Scantlebury MH, Cunningham J, Hadjinicolaou A, El Achkar CM, Kamate M, Menon RN, Jose M, Riordan G, Kannan L, Jain V, Manokaran RK, Chau V, Donner EJ, Costain G, Minassian BA, Jain P. KCTD7-related progressive myoclonic epilepsy: Report of 42 cases and review of literature. Epilepsia 2024; 65:709-724. [PMID: 38231304 DOI: 10.1111/epi.17880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVE KCTD7-related progressive myoclonic epilepsy (PME) is a rare autosomal-recessive disorder. This study aimed to describe the clinical details and genetic variants in a large international cohort. METHODS Families with molecularly confirmed diagnoses of KCTD7-related PME were identified through international collaboration. Furthermore, a systematic review was done to identify previously reported cases. Salient demographic, epilepsy, treatment, genetic testing, electroencephalographic (EEG), and imaging-related variables were collected and summarized. RESULTS Forty-two patients (36 families) were included. The median age at first seizure was 14 months (interquartile range = 11.75-22.5). Myoclonic seizures were frequently the first seizure type noted (n = 18, 43.9%). EEG and brain magnetic resonance imaging findings were variable. Many patients exhibited delayed development with subsequent progressive regression (n = 16, 38.1%). Twenty-one cases with genetic testing available (55%) had previously reported variants in KCTD7, and 17 cases (45%) had novel variants in KCTD7 gene. Six patients died in the cohort (age range = 1.5-21 years). The systematic review identified 23 eligible studies and further identified 59 previously reported cases of KCTD7-related disorders from the literature. The phenotype for the majority of the reported cases was consistent with a PME (n = 52, 88%). Other reported phenotypes in the literature included opsoclonus myoclonus ataxia syndrome (n = 2), myoclonus dystonia (n = 2), and neuronal ceroid lipofuscinosis (n = 3). Eight published cases died over time (14%, age range = 3-18 years). SIGNIFICANCE This study cohort and systematic review consolidated the phenotypic spectrum and natural history of KCTD7-related disorders. Early onset drug-resistant epilepsy, relentless neuroregression, and severe neurological sequalae were common. Better understanding of the natural history may help future clinical trials.
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Affiliation(s)
- Sangeetha Yoganathan
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Robyn Whitney
- Comprehensive Pediatric Epilepsy Program, Division of Neurology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Maya Thomas
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sumita Danda
- Department of Medical Genetics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Asuri N Prasad
- Division of Pediatric Neurology and Clinical Neurosciences, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Sali M K Farhan
- Department of Neurology and Neurosurgery, and Department of Human Genetics, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Daad AlSowat
- Division of Pediatric Neurology, Neurosciences Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Musaad Abukhaled
- Division of Pediatric Neurology, Neurosciences Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hesham Aldhalaan
- Division of Pediatric Neurology, Neurosciences Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Uddhava V Kinhal
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Arun Y Bylappa
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Ramesh Konanki
- Department of Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, Telangana, India
| | - Lokesh Lingappa
- Department of Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, Telangana, India
| | | | - Juan P Appendino
- Pediatric Neurology Service, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Morris H Scantlebury
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessie Cunningham
- Hospital Library and Archives, Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aristides Hadjinicolaou
- Division of Neurology, Department of Pediatrics, CHU (Centre Hospitalier Universitaire) Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Christelle Moufawad El Achkar
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mahesh Kamate
- Department of Pediatric Neurology, Jawaharlal Nehru Medical College, KLE (Karnataka Lingayat Education) Academy of Higher Education and Research, KLE's Dr Prabhakar Kore (PK) Hospital, Belagavi, Karnataka, India
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Manna Jose
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Gillian Riordan
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Vivek Jain
- Department of Pediatric Neurology, Neoclinic Children's Hospital, Jaipur, Rajasthan, India
| | - Ranjith Kumar Manokaran
- Division of Pediatric neurology, Department of Neurology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vann Chau
- Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth J Donner
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gregory Costain
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, and Program in Genetics & Genome Biology, SickKids Research Institute, Toronto, Ontario, Canada
| | - Berge A Minassian
- Division of Neurology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Puneet Jain
- Epilepsy Program, Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Malhotra AK, Ide K, Salaheen Z, Mahood Q, Cunningham J, Hutchison J, Guerguerian AM. Acute Fluid Biomarkers for Diagnosis and Prognosis in Children with Mild Traumatic Brain Injury: A Systematic Review. Mol Diagn Ther 2024; 28:169-187. [PMID: 38133736 DOI: 10.1007/s40291-023-00685-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Fluid biomarkers have the potential to improve the accuracy of diagnosis and prognosis in children with mild traumatic brain injury. Our primary objective was to assess the diagnostic and prognostic utility of acute blood and fluid biomarkers in children with mild traumatic brain injury. METHODS We performed a systematic review of the published literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Fluid biomarker studies assessing pediatric mild traumatic brain injury diagnosis or prognosis were included if blood or fluids were sampled within 24 h of injury. RESULTS Thirty-two studies involving 4743 patients were included comprising 25 diagnostic studies and ten prognostic studies with three studies assessing both diagnosis and prognosis. Sixteen of the 25 diagnostic studies reported the area under the receiver operating characteristic curve (AUC) for predicting abnormal computed tomography scans of the head; S100 calcium binding protein B (S100B, N = 6 studies, AUC range 0.67-1.00), glial fibrillary acidic protein (N = 5, AUC range 0.41-0.85), ubiquitin C-terminal hydrolase (N = 3, AUC 0.59 and 0.83), neuron specific enolase (N = 1, AUC 0.99), total tau (N = 1, AUC 0.65), and interleukin-6 (N = 1, AUC 0.61). In four of the ten prognostic studies, increased acute serum S100B levels, tumor necrosis factor-α, or interleukin-8 were associated with post-concussive symptoms or fatigue from 3 to 12 months post-injury. CONCLUSIONS The largest amount of evidence supported the potential use of S100B, glial fibrillary acidic protein, and UCH-L1, but there was mixed accuracy for diagnosis and prognostication for all biomarkers in pediatric mTBI.
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Affiliation(s)
- Armaan K Malhotra
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Kentaro Ide
- Department of Critical Care and Anesthesia, The National Center for Child Health and Development, Tokyo, Japan
| | - Zaid Salaheen
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Quenby Mahood
- Reference Library, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jessie Cunningham
- Reference Library, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jamie Hutchison
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [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] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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Hicks KA, Fuzzen MLM, Dhiyebi HA, Bragg LM, Marjan P, Cunningham J, McMaster ME, Srikanthan N, Nikel KE, Arlos MJ, Servos MR. Intersex manifestation in the rainbow darter (Etheostoma caeruleum): Are adult male fish susceptible to developing and recovering from intersex after exposure to endocrine active compounds? Aquat Toxicol 2023; 261:106636. [PMID: 37487446 DOI: 10.1016/j.aquatox.2023.106636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
For over a decade, intersex has been observed in rainbow darter (RD) (Etheostoma caeruleum) populations living downstream wastewater treatment plants (WWTPs) in the Grand River, Ontario, Canada. To further our understanding of intersex development in adult male fish, the current study addressed three objectives: i) can intersex be induced in adult male fish, ii) is there a specific window of exposure when adult male fish are more susceptible to developing intersex, and iii) can pre-exposed adult male fish recover from intersex? To assess intersex induction in adult male fish, wild male RD were exposed in the laboratory for 22 weeks (during periods of spawning, gonadal regression, and gonadal recrudescence) to environmentally relevant concentrations of 17α-ethinylestradiol (EE2) including nominal 0, 1, and 10 ng/L. Intersex rates and severity at 10 ng/L EE2 were similar to those observed historically in adult male populations living downstream WWTPs in the Grand River and confirmed previous predictions that 1-10 ng/L EE2 would cause these adverse effects. To assess a window of sensitivity in developing intersex, male RD were exposed to nominal 0, 1 or 10 ng/L EE2 for 4 weeks during three different periods of gonadal development, including (i) spawning, (ii) early recrudescence and (iii) late recrudescence. These short-term exposures revealed that intersex incidence and severity were greater when RD were exposed while gonads were fully developed (during spawning) compared to periods of recrudescence. To assess if RD recover from intersex, wild fish were collected downstream WWTPs in the Grand River and assessed for intersex both before and after a 22-week recovery period in clean water that included gonadal regression and recrudescence. Results showed that fish did not recover from intersex, with intersex rates and severity similar to those both before and after the transition to clean water. This study further advances our knowledge on intersex manifestation in adult male fish including their sensitivity to endocrine active compounds during different periods of their annual reproductive cycle and their limited ability to recover from intersex after onset of the condition.
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Affiliation(s)
- Keegan A Hicks
- Alberta Environment and Protected Areas, 4938 89th Street, Edmonton, AB T6E5K1 Canada; Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada.
| | - Meghan L M Fuzzen
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Hadi A Dhiyebi
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Leslie M Bragg
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Patricija Marjan
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada; Department of Biological Sciences, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - Jessie Cunningham
- Aquatic Contaminant Research Division, Water Science and Technology Branch, Environmentand Climate Change Canada, 867 Lakeshore Road, Burlington, ON L7S 1A1 Canada
| | - Mark E McMaster
- Aquatic Contaminant Research Division, Water Science and Technology Branch, Environmentand Climate Change Canada, 867 Lakeshore Road, Burlington, ON L7S 1A1 Canada
| | - Nivetha Srikanthan
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Kirsten E Nikel
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Maricor J Arlos
- Department of Civil and Environmental Engineering, University of Alberta, 9211-116 St. NW, Edmonton, AB T6G 1H9 Canada
| | - Mark R Servos
- Department of Biology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
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7
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Perlman P, Vorstman J, Hoang N, Summers J, Baribeau D, Cunningham J, Mulsant BH. Support to caregivers who have received genetic information about neurodevelopmental and psychiatric vulnerability in their young children: A narrative review. Clin Genet 2023. [PMID: 37098443 DOI: 10.1111/cge.14349] [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: 03/19/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023]
Abstract
Diagnosis of pathogenic genetic variants associated with neurodevelopmental and psychiatric disorders (NPDs) is increasingly made early in life. This narrative review focuses on the need for, and provision of, psychological supports following genetic diagnosis. We conducted a literature search of publications on how caregivers are informed about the NPD vulnerability associated with genetic variants, challenges and unmet needs when receiving this information, and whether psychological supports are provided. Given its early recognition, the 22q11.2 deletion has been studied thoroughly for two decades, providing generalizable insights. This literature indicates the complex caregivers' needs related to learning about potential NPD vulnerabilities associated with a genetic variant, include how to communicate the diagnosis, how to identify early signs of NPDs, how to deal with stigma and a lack of medical expertise outside of specialized genetics clinics. With one exception, no publications describe psychotherapeutic support provided to parents. In the absence of support, caregivers struggle with several unmet needs regarding potential longer-term NPD implications of a genetic diagnosis. The field needs to go beyond explaining genetic diagnoses and associated vulnerabilities, and develop approaches to support caregivers with communicating and managing NPD implications across the child's lifespan.
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Affiliation(s)
- Polina Perlman
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Vorstman
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ny Hoang
- Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Jane Summers
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Baribeau
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Jessie Cunningham
- SickKids Hospital Library, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addition and Mental Health, Toronto, Ontario, Canada
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8
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Sahly AN, Whitney R, Costain G, Chau V, Otsubo H, Ochi A, Donner EJ, Cunningham J, Jones KC, Widjaja E, Ibrahim GM, Jain P. Epilepsy surgery outcomes in patients with GATOR1 gene complex variants: Report of new cases and review of literature. Seizure 2023; 107:13-20. [PMID: 36931189 DOI: 10.1016/j.seizure.2023.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 11/15/2022] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 03/13/2023] Open
Abstract
AIM To report seizure outcomes in children with GATOR1 gene complex disorders who underwent epilepsy surgery and perform a systematic literature search to study the available evidence. METHODS The records of children with pathogenic/likely pathogenic variants in GATOR1 gene complex who underwent epilepsy surgery were reviewed. Clinical, radiological, neurophysiological, and histological data were extracted/summarized. The systematic review included all case series/reports and observational studies reporting on children or adults with genetic (germline or somatic) variants in the GATOR1 complex genes (DEPDC5, NPRL2, NPRL3) with focal epilepsy with/without focal cortical dysplasia who underwent epilepsy surgery; seizure outcomes were analyzed. RESULTS Eight children with pathogenic/likely pathogenic variants in GATOR1 complex genes were included. All had drug-resistant epilepsy. Six children had significant neurodevelopmental delay. Epilepsy surgery was performed in all; clinical seizure freedom was noted in 4 children (50%). Systematic literature search identified 17 eligible articles; additional 30 cases with patient-level data were studied. Lesional MRI brain was seen in 80% cases. The pooled rate of seizure freedom following surgery was 60%; FCD IIa was the most encountered pathology. INTERPRETATION Epilepsy surgery may be effective in some children with GATOR1 complex gene variants. Seizure outcomes may be compromised by extensive epileptogenic zones.
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Affiliation(s)
- Ahmed N Sahly
- Division of Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Neurosciences, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Robyn Whitney
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Gregory Costain
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vann Chau
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hiroshi Otsubo
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ayako Ochi
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth J Donner
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Hospital Library and Archives, Learning Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kevin C Jones
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elysa Widjaja
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Puneet Jain
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
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9
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Nikel KE, Tetreault GR, Marjan P, Hicks KA, Fuzzen MLM, Srikanthan N, McCann EK, Dhiyebi H, Bragg LM, Law P, Celmer-Repin D, Kleywegt S, Cunningham J, Clark T, McMaster ME, Servos MR. Wild fish responses to wastewater treatment plant upgrades in the Grand River, Ontario. Aquat Toxicol 2023; 255:106375. [PMID: 36603368 DOI: 10.1016/j.aquatox.2022.106375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/27/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
Municipal wastewater treatment plant (WWTP) effluent is one of several point sources of contaminants (nutrients, pharmaceuticals, estrogens, etc.) which can lead to adverse responses in aquatic life. Studies of WWTP effluent impacts on rainbow darter (Etheostoma caeruleum) collected downstream of WWTPs in the Grand River, Ontario have reported disruption at multiple levels of biological organization, including altered vitellogenin gene expression, lower levels of in vitro steroid production, and high frequency of intersex. However, major upgrades have occurred at treatment plants in the central Grand River over the last decade. Treatment upgrades to the Waterloo WWTP were initiated in 2009 but due to construction delays, the upgrades came fully on-line in 2017/2018. Responses in rainbow darter have been followed at sites associated with the outfall consistently over this entire time period. The treatment plant upgrade resulted in nitrification of effluent, and once complete there was a major reduction in effluent ammonia, selected pharmaceuticals, and estrogenicity. This study compared several key responses in rainbow darter associated with the Waterloo WWTP outfall prior to and post upgrades. Stable isotopes signatures in fish were used to track exposure to effluent and changed dramatically over time, corresponding to the effluent quality. Disruptions in in vitro steroid production and intersex in the darters that had been identified prior to the upgrades were no longer statistically different from the upstream reference sites after the upgrades. Although annual variations in water temperature and flow can potentially mask or exacerbate the effects of the WWTP effluent, major capital investments in wastewater treatment targeted at improving effluent quality have corresponded with the reduction of adverse responses in fish in the receiving environment.
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Affiliation(s)
- Kirsten E Nikel
- Department of Biology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
| | - Gerald R Tetreault
- Aquatic Contaminants Research Division, Environment and Climate Change Canada, 867 Lakeshore Rd, Burlington, ON L7S 1A1, Canada
| | - Patricija Marjan
- Department of Biology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Keegan A Hicks
- Alberta Environment and Parks, Resource Stewardship Division, 4938 89th St., Edmonton, AB T6E 5K1, Canada
| | - Meghan L M Fuzzen
- Department of Biology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Nivetha Srikanthan
- Department of Biology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Emily K McCann
- Department of Biology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Hadi Dhiyebi
- Department of Biology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Leslie M Bragg
- Department of Biology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Pam Law
- Region of Waterloo, 150 Frederick St, Kitchener, ON N2G 4J3, Canada
| | | | - Sonya Kleywegt
- Ontario Ministry of Environment, Conservation and Parks, 40 St. Clair Ave W, Toronto, ON M4V 1M2, Canada
| | - Jessie Cunningham
- Aquatic Contaminants Research Division, Environment and Climate Change Canada, 867 Lakeshore Rd, Burlington, ON L7S 1A1, Canada
| | - Thomas Clark
- Aquatic Contaminants Research Division, Environment and Climate Change Canada, 867 Lakeshore Rd, Burlington, ON L7S 1A1, Canada
| | - Mark E McMaster
- Aquatic Contaminants Research Division, Environment and Climate Change Canada, 867 Lakeshore Rd, Burlington, ON L7S 1A1, Canada
| | - Mark R Servos
- Department of Biology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
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10
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Bastas D, Brandão LR, Vincelli J, Schneiderman JE, Cunningham J, Avila ML. Physical Activity for Children with Deep Vein Thrombosis and Pulmonary Embolism on Anticoagulation: A Scoping Review. Res Pract Thromb Haemost 2023; 7:100094. [PMID: 37063770 PMCID: PMC10099307 DOI: 10.1016/j.rpth.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
Context There are no clear pediatric guidelines on the return to physical activity following deep vein thrombosis (DVT) or pulmonary embolism (PE), particularly while being treated with anticoagulation. Objective This scoping review aimed to examine the current literature on physical activity beyond simple ambulation for patients with DVT/PE being treated with anticoagulation. Data Sources An electronic search for articles in MEDLINE, Epub Ahead of Print, In-Process, and Other Non-Indexed Citations, Daily (1946 to April 4, 2022), and Embase+Embase Classic (1946 to 2022, week 13) was conducted. Study Selection (1) Patients of any age with DVT/PE, treated with anticoagulation; (2) studies of any design providing information on physical activity (ie, sport, exercise) while on anticoagulation; and (3) studies in English. Data Extraction Data from eligible studies obtained included the study design, population, disease characteristics, and information on physical activity participation. Results A total of 26 eligible studies were included. Only 2 studies were specific to children. Studies recommend a gradual return to participation in noncontact or low-risk activities after the first 3-4 weeks of anticoagulation, with close monitoring of symptoms. Participation in contact sports and activities is typically delayed until after anticoagulants are discontinued. However, personalized anticoagulation with intermittent dosing schedules has been proposed for athletes after the first 3 months of anticoagulation treatment. Conclusions Physical activity participation guidelines for children with DVT/PE being treated with anticoagulation are needed, and the evidence currently available is limited. Largely based on evidence from adult patients, we present evidence-informed options to facilitate clinician recommendations for returning to activity.
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Affiliation(s)
- Denise Bastas
- Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leonardo R. Brandão
- Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Vincelli
- Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jane E. Schneiderman
- Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessie Cunningham
- SickKids Hospital Library, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - M. Laura Avila
- Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Correspondence M. Laura Avila, Division of Paediatrics, Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. @didascalias_TO
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11
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Jain P, Aneja S, Cunningham J, Arya R, Sharma S. Treatment of benzodiazepine-resistant status epilepticus: Systematic review and network meta-analyses. Seizure 2022; 102:74-82. [DOI: 10.1016/j.seizure.2022.09.017] [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: 07/12/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 10/31/2022] Open
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12
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Cunningham J, Zhang L, Claggett B, Abraham W, Jhund P, Kober L, Packer M, Rouleau J, Zile M, Prescott M, Mendelson M, Lefkowitz M, McMurray J, Solomon S, Chutkow W. Aptamer proteomics for biomarker discovery in heart failure with reduced ejection fraction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.917] [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: 11/14/2022] Open
Abstract
Abstract
Background
Though current heart failure (HF) biomarkers are highly prognostic, systematically characterizing associations between circulating proteins and risk of subsequent events may improve clinical risk prediction and illuminate new biological pathways. Large-scale assays measuring thousands of proteins now enable unbiased proteomic investigation in clinical trials.
Purpose
To identify and replicate serum proteins associated with HF events in patients with chronic HF with reduced ejection fraction (HFrEF), and to develop and validate a proteomic risk score.
Methods
Serum levels of 4076 proteins were measured at baseline in the ATMOSPHERE (n=1261, 487 events over 6 years) and PARADIGM-HF (n=1257, 287 events over 4 years) trials of chronic HFrEF using a modified aptamer-based proteomics assay. Proteins associated with the primary endpoint, HF hospitalization or cardiovascular death, were identified in the ATMOSPHERE discovery cohort (false discovery rate<0.05) by Cox regression adjusted for age, sex, treatment arm, and anticoagulant use, and replicated in PARADIGM-HF (Bonferroni-corrected p<0.05). A proteomic risk score was derived in ATMOSPHERE using Cox LASSO penalized regression and evaluated in PARADIGM-HF compared to the MAGGIC clinical risk score and N-terminal pro-B-type natriuretic peptide (NT-proBNP). For proteins associated with the primary endpoint, pathway analysis was conducted using Ingenuity Pathway analysis and an exploratory two-sample Mendelian randomization was performed using genetic and outcome data from both trials and protein quantitative trait loci from deCODE to infer which identified proteins contribute to HF prognosis.
Results
We identified 377 serum proteins associated with the primary endpoint in ATMOSPHERE and replicated 167 in PARADIGM-HF. Prognostic proteins included known HF biomarkers Growth Differentiation Factor 15, NT-proBNP, and Angiopoietin-2, and also a previously unrecognized HF biomarker: Sushi, Von Willebrand Factor Type A, EGF And Pentraxin Domain Containing 1 (SVEP1) (HR 1.60 [95% CI 1.44–1.79] per standard deviation [SD], p=2x10–17) (Table 1). Proteins related to hepatic fibrosis, granulocyte adhesion, and inhibition of matrix metalloproteinases were over-represented. A 64-protein risk score derived in ATMOSPHERE predicted clinical events in PARADIGM-HF with greater discrimination (c-statistic 0.70) than the MAGGIC clinical score (c-statistic 0.61), NT-proBNP (c-statistic 0.65), or both (c-statistic 0.66) (Figure 1). Genetically predicted levels of NT-proBNP, WISP2, FSTL1, and CTSS were associated with the primary endpoint by Mendelian randomization.
Conclusions
We identify SVEP1, an extracellular matrix protein known to cause inflammation in vascular smooth muscle cells, as a previously unrecognized HF biomarker. A 64-protein score improved risk discrimination compared with NT-proBNP and may assist in identifying high-risk patients for clinical trials or disease management programs.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The ATMOSPHERE and PARADIGM-HF trials were sponsored by Novartis
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Affiliation(s)
- J Cunningham
- Brigham and Women's Hospital , Boston , United States of America
| | - L Zhang
- Novartis Institute for Biomedical Research , Cambridge , United States of America
| | - B Claggett
- Brigham and Women's Hospital , Boston , United States of America
| | - W Abraham
- Ohio State University Wexner Medical Center , Columbus , United States of America
| | - P Jhund
- BHF Glasgow Cardiovascular Research Centre , Glasgow , United Kingdom
| | - L Kober
- University of Copenhagen , Copenhagen , Denmark
| | - M Packer
- Baylor University Medical Center , Dallas , United States of America
| | - J Rouleau
- Montreal Heart Institute , Montreal , Canada
| | - M Zile
- Medical University of South Carolina , Charleston , United States of America
| | - M Prescott
- Novartis , East Hanover , United States of America
| | - M Mendelson
- Novartis Institute for Biomedical Research , Cambridge , United States of America
| | - M Lefkowitz
- Novartis , East Hanover , United States of America
| | - J McMurray
- BHF Glasgow Cardiovascular Research Centre , Glasgow , United Kingdom
| | - S Solomon
- Brigham and Women's Hospital , Boston , United States of America
| | - W Chutkow
- Novartis Institute for Biomedical Research , Cambridge , United States of America
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13
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McDowell K, Simpson J, Jhund PS, Abraham WT, Claggett B, Cunningham J, Desai AS, Kober L, Prescott M, Rouleau JL, Swedberg K, Zile MR, Solomon SD, Packer M, McMurray JJV. A comprehensive study of the incremental prognostic value of novel biomarkers in PARADIGM-HF (Bio-PREDICT-HF). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.914] [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: 11/14/2022] Open
Abstract
Abstract
Background
Although multiple novel biomarkers have individually been shown to predict outcomes in patients with HFrEF, the value of these over and above conventional clinical and laboratory variables, plus natriuretic peptides, is uncertain.
Purpose
To test the incremental predictive value of 11 novel biomarkers added to a recent prognostic model 1 (PREDICT-HF) derived in PARADIGM-HF and validated in ATMOSPHERE and the Swedish heart failure registry. The PREDICT-HF model includes clinical variables, standard laboratory variables, and BNP or NT-proBNP.
Methods
1559 participants enrolled in PARADIGM-HF had all 11 biomarkers of interest measured. These reflected different pathophysiological pathways: (i) myocyte injury (high sensitivity cardiac troponin T), (ii) cardiac remodelling and inflammation (growth stimulation expressed gene 2, growth differentiation factor-15 and galectin-3), (iii) extracellular matrix remodelling (matrix metalloproteinase-2, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1), (iv) neurohormonal pathways (aldosterone) and (v) renal dysfunction and injury (cystatin C, kidney injury molecule-1 and urinary albumin to creatinine ratio). The incremental prognostic value of these biomarkers was evaluated using Harrell's C statistic.
Results
The mean age of participants studied was 67.3 (SD 9.9) years, 1254 (80%) were men and 1103 (71%) were in NYHA class II. During a median follow-up of 31 months, 197 patients died and 300 experienced the primary composite outcome (cardiovascular death or heart failure hospitalization).
When each candidate biomarker (log unit) was added individually to the PREDICT-HF base model, GDF-15, ST2, TIMP1, cystatin C, hsTnT and UACR were independent predictors of all-cause mortality (Table 1). GDF-15, TIMP1, hs-TnT and cystatin C consistently increased the risk of both all-cause mortality and the primary outcome. Individuals who had all 4 biomarkers elevated (compared to none elevated) had the highest risk: HR for all-cause mortality 3.65 (2.01–6.64), p<0.0001. Adding these 4 biomarkers to the baseline PREDICT HF model improved the C statistic for all-cause mortality from 0.726 to 0.745.
Conclusion
Several novel biomarkers provide meaningful additional prognostic information in patients with HFrEF. A multimarker approach incorporating biomarkers reflecting different pathophysiological pathways added most information. This approach may be useful in refining risk and targeting treatment.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The PARADIGM-HF trial was funded by Novartis.J.J.V.M is supported by a British Heart Foundation Centre of Excellence Grant
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Affiliation(s)
- K McDowell
- University of Glasgow, BHF Cardiovascular Research Centre , Glasgow , United Kingdom
| | - J Simpson
- University of Glasgow, BHF Cardiovascular Research Centre , Glasgow , United Kingdom
| | - P S Jhund
- University of Glasgow, BHF Cardiovascular Research Centre , Glasgow , United Kingdom
| | - W T Abraham
- Ohio State University, Davis Heart and Lung Research Institiute, Division of Cardiovascular Medicine , Ohio , United States of America
| | - B Claggett
- Brigham and Women's Hospital, Cardiovascular medicine , Boston , United States of America
| | - J Cunningham
- Brigham and Women's Hospital, Cardiovascular medicine , Boston , United States of America
| | - A S Desai
- Brigham and Women's Hospital, Cardiovascular medicine , Boston , United States of America
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - M Prescott
- Novartis , East Hanover , United States of America
| | - J L Rouleau
- Montreal Heart Institute, Institute of Cardiology , Montreal , Canada
| | - K Swedberg
- University of Gothenburg, Department of Molecular and Clinical Medicine , Gothenburg , Sweden
| | - M R Zile
- Medical University of South Carolina , Charleston , United States of America
| | - S D Solomon
- Brigham and Women's Hospital, Cardiovascular medicine , Boston , United States of America
| | - M Packer
- Baylor University Medical Centre, Baylor Heart and Vascular Institiute , Dallas , United States of America
| | - J J V McMurray
- University of Glasgow, BHF Cardiovascular Research Centre , Glasgow , United Kingdom
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14
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Bell RM, Basalay M, Bøtker HE, Beikoghli Kalkhoran S, Carr RD, Cunningham J, Davidson SM, England TJ, Giesz S, Ghosh AK, Golforoush P, Gourine AV, Hausenloy DJ, Heusch G, Ibanez B, Kleinbongard P, Lecour S, Lukhna K, Ntsekhe M, Ovize M, Salama AD, Vilahur G, Walker JM, Yellon DM. Remote ischaemic conditioning: defining critical criteria for success-report from the 11th Hatter Cardiovascular Workshop. Basic Res Cardiol 2022; 117:39. [PMID: 35970954 PMCID: PMC9377667 DOI: 10.1007/s00395-022-00947-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/31/2023]
Abstract
The Hatter Cardiovascular Institute biennial workshop, originally scheduled for April 2020 but postponed for 2 years due to the Covid pandemic, was organised to debate and discuss the future of Remote Ischaemic Conditioning (RIC). This evolved from the large multicentre CONDI-2-ERIC-PPCI outcome study which demonstrated no additional benefit when using RIC in the setting of ST-elevation myocardial infarction (STEMI). The workshop discussed how conditioning has led to a significant and fundamental understanding of the mechanisms preventing cell death following ischaemia and reperfusion, and the key target cyto-protective pathways recruited by protective interventions, such as RIC. However, the obvious need to translate this protection to the clinical setting has not materialised largely due to the disconnect between preclinical and clinical studies. Discussion points included how to adapt preclinical animal studies to mirror the patient presenting with an acute myocardial infarction, as well as how to refine patient selection in clinical studies to account for co-morbidities and ongoing therapy. These latter scenarios can modify cytoprotective signalling and need to be taken into account to allow for a more robust outcome when powered appropriately. The workshop also discussed the potential for RIC in other disease settings including ischaemic stroke, cardio-oncology and COVID-19. The workshop, therefore, put forward specific classifications which could help identify so-called responders vs. non-responders in both the preclinical and clinical settings.
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Affiliation(s)
- R M Bell
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - M Basalay
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - H E Bøtker
- Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - S Beikoghli Kalkhoran
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - R D Carr
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | | | - S M Davidson
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - T J England
- Stroke, Division of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Giesz
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - A K Ghosh
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - P Golforoush
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - A V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, UK
| | - D J Hausenloy
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
- CVMD, Duke-NUS, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
| | - G Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Duisburg-Essen, Duisburg, Germany
| | - B Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), IIS-Fundación Jiménez Díaz University Hospital & CIBERCV, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - P Kleinbongard
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Duisburg-Essen, Duisburg, Germany
| | - S Lecour
- University of Cape Town, Cape Town, South Africa
| | - K Lukhna
- University of Cape Town, Cape Town, South Africa
| | - M Ntsekhe
- University of Cape Town, Cape Town, South Africa
| | - M Ovize
- INSERM U1060, CarMeN Laboratory, Université de Lyon, Groupement Hospitalier Est, Bâtiment B13, F-69500, Bron, France
| | | | - G Vilahur
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain
| | - J M Walker
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - D M Yellon
- The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
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15
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Cunningham J, Bradshaw C, Damani A, Kettley C, Duguid J, Cudiamat E, Santos L, Billings L, Henke C, Higton A, Orchard C, Samarasinghe Y. P181 The effects of linagliptin in patients with a diagnosis of Cystic Fibrosis-Related Diabetes. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00511-2] [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: 10/18/2022]
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16
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Evenepoel P, Cunningham J, Ferrari S, Haarhaus M, Javaid MK, Lafage-Proust MH, Prieto-Alhambra D, Torres PU, Cannata-Andia J. Diagnosis and management of osteoporosis in chronic kidney disease stages 4 to 5D: a call for a shift from nihilism to pragmatism. Osteoporos Int 2021; 32:2397-2405. [PMID: 34129059 DOI: 10.1007/s00198-021-05975-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) CKD-MBD working group, in collaboration with the Committee of Scientific Advisors of the International Osteoporosis Foundation, published a position paper for the diagnosis and management of osteoporosis in patients with CKD stages 4-5D (eGFR < 30 ml/min 1.73 m2). The present article reports and summarizes the main recommendations included in this 2021 document. The following areas are reviewed: diagnosis of osteoporosis; risk factors for fragility fractures; fracture risk assessment; intervention thresholds for pharmacological intervention; general and pharmacological management of osteoporosis; monitoring of treatment, and systems of care, all in patients with CKD stages 4-5D. Guidance is provided for clinicians caring for CKD stages 4-5D patients with osteoporosis, allowing for a pragmatic individualized diagnostic and therapeutic approach as an alternative to current variations in care and treatment nihilism.
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Affiliation(s)
- P Evenepoel
- Division of Nephrology, University Hospitals Leuven, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - J Cunningham
- Centre for Nephrology, Royal Free Campus, UCL Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - S Ferrari
- Service of Bone diseases, Geneva university Hospital Switzerland, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - M Haarhaus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet,, Karolinska University Hospital, Solna, Sweden
| | - M K Javaid
- NDORMS, University of Oxford, Windmill Road, Oxford, OX3 7HE, UK
| | | | - D Prieto-Alhambra
- CSM-NDORMS, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - P U Torres
- AURA Nord Saint Ouen, 108 bis, avenue Gabriel Péri, 93400, Saint Ouen, France
- Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
| | - J Cannata-Andia
- Bone and Mineral Research Unit (ISPA) (REDinREN), Hospital Universitario Central Asturias, Oviedo University, Asturias, Spain
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Farmer G, Bachelor M, Cunningham J. Angiotensin II Signaling in the Median Preoptic Nucleus Persists in Renin KO Rats: an in vitro Sniffer Cell Study. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- George Farmer
- Anatomy and PhysiologyUNT Health Science CenterFort WorthTX
| | | | - J. Cunningham
- Anatomy and PhysiologyUNT Health Science CenterFort WorthTX
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18
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Aikins A, Little J, Cunningham J. Role of A1/A2 Neurons in the Dysregulation of Vasopressin Release and Dilutional Hyponatremia in Liver Disease. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brock C, Bachelor M, Little J, Farmer G, Balaptattabi K, Cunningham J. Sex Specific Effects of Salt Loading in Oxytocin Neurons From The Supraoptic Nucleus. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Courtney Brock
- Physiology and AnatomyUniversity of North Texas Health Science CenterFort WorthTX
| | - Martha Bachelor
- Physiology and AnatomyUniversity of North Texas Health Science CenterFort WorthTX
| | - Joel Little
- Physiology and AnatomyUniversity of North Texas Health Science CenterFort WorthTX
| | - George Farmer
- Physiology and AnatomyUniversity of North Texas Health Science CenterFort WorthTX
| | | | - J. Cunningham
- Physiology and AnatomyUniversity of North Texas Health Science CenterFort WorthTX
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Gusson Shimoura C, Paundralingga O, Cunningham J. PVN ‐ projecting MnPO neurons are involved in blood pressure and sympathetic nerve activity regulation in CIH hypertension. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Obed Paundralingga
- Department of Physiology and AnatomyUNT Health Science Center at Fort WorthFort WorthTX
| | - J. Cunningham
- Department of Physiology and AnatomyUNT Health Science Center at Fort WorthFort WorthTX
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Zafar S, Sharma RK, Cunningham J, Mahalingam P, Attygalle AD, Khan N, Cunningham D, El-Sharkawi D, Iyengar S, Sharma B. Current and future best practice in imaging, staging, and response assessment for Non-Hodgkin's lymphomas: the Specialist Integrated Haematological Malignancy Imaging Reporting (SIHMIR) paradigm shift. Clin Radiol 2021; 76:391.e1-391.e18. [PMID: 33579517 DOI: 10.1016/j.crad.2020.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) encompasses over 40 different haematological malignancies, including low and high-grade neoplasms, such as follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) respectively. A key clinical issue in the context of NHL is delayed and inaccurate diagnosis, which contributes adversely to patient morbidity and mortality. This article will address relevant imaging aspects, with particular reference to advancements in NHL imaging, including computed tomography (CT), integrated positron-emission tomography (PET)-CT, and magnetic resonance imaging (MRI). We provide multiparametric (anato-functional) imaging display items, including histological correlation. We will also introduce our original concept of "Specialist Integrated Haematological Malignancy Imaging Reporting" (SIHMIR), a paradigm shift in lymphoma radiology.
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Affiliation(s)
- S Zafar
- Department of Radiology, The Royal Marsden NHS Trust, London, UK.
| | - R K Sharma
- College of Medicine and Health, University of Exeter, UK
| | - J Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - P Mahalingam
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - A D Attygalle
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - N Khan
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - D Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - D El-Sharkawi
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - S Iyengar
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | - B Sharma
- Department of Radiology, The Royal Marsden NHS Trust, London, UK; The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
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Cunningham J, Dawson S, Carolan C, Davids I, Wildman M. P234 CFHealthHub a digital learning health system supporting virtual clinics and self-care across 60% of UK adult CF centres: a survey to understand benefits amongst the national CFDigiCare community. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01259-5] [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: 10/21/2022]
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Carolan C, Dawson S, Cunningham J, Choyce J, Tugwell A, Faulkner J, Barnett T, Thomas M, Gledhill H, Anderson A, Tature D, Szczepanski R, Lowther M, Pickering N, Daniels T, Galey P, Wildman M. P217 Delivering quality improvement coaching in a virtual world: the use of digital technology to empower and engage CFDigiCare clinicians to undertake quality improvement activities nationally. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01242-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: 12/01/2022]
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Hildebrand S, Cunningham J. Is there a role for bisphosphonates in vascular calcification in chronic kidney disease? Bone 2021; 142:115751. [PMID: 33188959 DOI: 10.1016/j.bone.2020.115751] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 01/15/2023]
Abstract
Theoretically bisphosphonates could accelerate or retard vascular calcification. In subjects with low GFR, the position is further confounded by a combination of uncertain pharmacokinetics (GI absorption is poor and inconsistent at all levels of renal function and the effect of low GFR generally is to increase bioavailability) and a highly variable skeletal substrate with extremes of turnover that increase unpredictably further. Although bisphosphonates reduce bone formation by 70-90% in subjects with normal GFR and reduce the ability of bone to buffer exogenous calcium fluxes, in bisphosphonate treated postmenopausal women accelerated vascular calcification has not been documented. The kidneys assist with this buffering, but the capacity to modulate calcium excretion declines as GFR falls, increasing the risk of hypercalcaemia in the event of high calcium influx. In the ESRD patient, decreased buffering capacity substantially increases the risk of transient hypercalcaemia, especially in the setting of dialysis, and as such may promote vascular calcification which is highly prevalent in the CKD population. Low bone turnover may thus be less of a vascular problem in patients with preserved renal function and a bigger problem when the GFR is low. In patients with stage 4 and 5 CKD, adynamic bone disease associates with the severity and progression of arterial calcification, including coronary artery calcification, and further suppression of bone turnover by a bisphosphonate might exacerbate an already high predisposition to vascular calcification. No convincing signal of harm has emerged from clinical studies thus far. For example 51 individuals with CKD stage 3-4 treated with either alendronate 70 mg per week or placebo for 18 months showed no difference in the rate of vascular calcifications. Conversely an observational study of women with stage 3-4 CKD with pre-existing cardiovascular disease found an increased risk of mortality with a hazard ratio of 1.22 (1.04-1.42) in those given bisphosphonates. Direct suppression of vascular calcification by bisphosphonates is probably confined to etidronate - treatment of soft tissue calcification was a recognized indication for this drug and etidronate markedly reduced progression of vascular calcification in CKD patients. Bisphosphonates are analogues of pyrophosphate, a potent calcification inhibitor in bone and soft tissue. Thus the efficacy of etidronate as treatment for soft tissue calcification brought with it a problematic tendency to cause osteomalacia. In contrast, conventional doses of nitrogen-containing bisphosphonates fail to yield circulating concentrations sufficient to exert direct anti-calcifying effects, at least in patients with good renal function and studies using alendronate and ibandronate have yielded inconsistent vascular outcomes.
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Affiliation(s)
- S Hildebrand
- Centre for Nephrology, Royal Free Hospital, London, UK.
| | - J Cunningham
- Centre for Nephrology, Royal Free Hospital, London, UK
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25
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Norwood TA, Encisa C, Wang X, Seliske L, Cunningham J, De P. A Bayesian shared components modeling approach to develop small area indicators of social determinants of health with measures of uncertainty. Can J Public Health 2020; 111:342-357. [PMID: 32500336 PMCID: PMC7352027 DOI: 10.17269/s41997-020-00321-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Existing Canadian social determinants of health (SDOH) indicators do not quantify uncertainty to identify priority areas. The objectives of this methodologic study were: (1) to estimate and map small area (dissemination area) shared and variable-specific SDOH indicators with measures of uncertainty using a Bayesian model that accounts for spatial dependence; (2) to quantify geographic variation in the SDOH indicators and their contribution to a shared indicator; and (3) to assess the SDOH indicators' associations with behavioural risk factors and their consistency with the Ontario Marginalization Index (ON-Marg). METHODS Lower education-, income-, unemployment-, living alone- and visible minority-related variables used in existing Canadian SDOH indices were fit as dependent variables to a Bayesian model to produce area-based SDOH indicators that were mapped with measures of uncertainty in two study areas. The fractions of spatial variation explained by the model components were computed. Bayesian analysis of variance was used to examine the SDOH indicator associations with behavioural risk factors and their consistency with ON-Marg examined using Pearson's correlation coefficient. RESULTS The shared component was strongly associated with material deprivation (i.e., income) in each study area; however, variable-specific SDOH indicators were important too. The SDOH indicators were associated with behavioural risk factors for chronic disease, particularly alcohol consumption and smoking, and the shared component estimates were consistent with the ON-Marg material deprivation. CONCLUSIONS The Bayesian approach to produce SDOH indicators met the three study objectives and as such provides a new approach to prioritize areas that may experience health inequalities.
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Affiliation(s)
- Todd A Norwood
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Clarissa Encisa
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Xiaotian Wang
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Laura Seliske
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Prithwish De
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
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Cunningham J, Orchard C, Higton A. P220 Starting Symkevi for all eligible patients within 30 days of NHS England’s funding announcement: dedicated Symkevi initiation clinic. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dubrovsky B, Weingarten JA, Cunningham J, Howladar A, Chin W, Gikashvili L. 0736 Self-reported Sleep In OSA Patients: Roles Of Polysomnographic Measures And Depressive Symptoms. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Sleep fragmentation is typical in OSA, which is commonly co-morbid with insomnia and depression. A complex interaction between these conditions may be also gender-dependent. Moreover, self-report measures of sleep quality and insomnia, such as PSQI and ISI, may relate to depression symptoms more than polysomnographic sleep disturbance. The present aim is to ascertain relative contributions of polysomnographic variables and depression symptoms to PSQI and ISI in a large sample of OSA patients. The interaction between depressive symptomatology and gender in their relationships with subjective sleep is also analyzed.
Methods
A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI and PSQI. ISI and PSQI were separately regressed onto age, sex and BMI, followed by PSG variables meeting p<0.1 criterion when tested individually, followed by CESDR and CESDR-by-sex interaction.
Results
Mean AHI=29.6±34.7, range 0-167/hr, 72.3% of patients had AHI≥5. The PSQI final model included total sleep time (TST), sleep efficiency (SEF), WASO, PLM index, CESDR and CESDR-by-sex. Only CESDR and CESDR-by-sex were significant (p<0.001, p=0.023, respectively). Higher CESDR predicted higher PSQI in both sexes (both p<0.001), accounting for a greater portion of PSQI variance in men (R2=39%) than in women (R2=29%). The ISI final model included TST, N3%, REM%, SEF, WASO, total arousal index, AHI, PLM index, CESDR and CESDR-by-sex. Higher ISI related to lower TST (p=0.042, R2<1%), higher REM% (p=0.016, R2<1%), and higher CESDR (p<0.001, R2=42%). CESDR-by-sex was not significant.
Conclusion
In this large sample, after controlling for demographic variables, PSG parameters had only minimal relationship with self-report insomnia and sleep quality measures. Higher depressive symptomatology was associated with higher subjective sleep disturbance on PSQI and worse insomnia symptoms on ISI in both sexes, accounting for 29-42% of the variance.
Support
none
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Affiliation(s)
- B Dubrovsky
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J A Weingarten
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J Cunningham
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - A Howladar
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - W Chin
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - L Gikashvili
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
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Dubrovsky B, Inamac A, Gikashvili L, Weingarten J, Cunningham J. 0712 CPAP Compliance: Roles Of Depressive Symptoms, Polysomnographic And Self-report Sleep Measures. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
OSA poses major health risks; however, CPAP compliance is often suboptimal. Comorbid insomnia and depression contributed to poor CPAP compliance in different studies. Presently, PSG variables, self-report measures of insomnia, sleep quality and depression were tested simultaneously as predictors of compliance in new CPAP users who at 180 days of therapy had any non-zero use of CPAP.
Methods
PSG-diagnosed 47 patients (18-79 y.o., 24 women) were titrated in the lab and initiated on CPAP. Compliance was assessed during days 1-30 and 151-180. For each period, percentage of days with >4hrs of CPAP use (%>4h-days30, %>4h-days180) and the average hours-per-day use (Tav30, Tav180) were measured. After regressing each compliance variable on age, sex and BMI, one at a time were tested: PSG variables from the diagnostic and titration studies, subjective reactions to CPAP after titration (sleep better vs. same/worse than usual; will vs. won’t use CPAP at home), pre-treatment ISI, PSQI, ESS, and Center for Epidemiologic Studies Depression Scale-Revised (CESDR).
Results
AHI ranged 6/hr-101/hr (M=24.2±19.5); %>4h-days30, 0-100% (M=68%±32%); Tav30, 0.0-9.8 hours (M=5.2±2.5); %>4h-days180, 0-100% (M=64%±34%); Tav180, 0.2-10.5 hours (M=4.7±2.8). PSG variables from both diagnostic and titration studies, reactions to CPAP, ESS and CESDR were not significant predictors of compliance (all p>0.1). ISI was marginally inversely related to %>4h-days30 (p=0.087) and Tav30 (p=0.075). Higher pre-treatment PSQI was related to lower %>4h-days30 (p=0.003, R2=19%) and Tav30 (p=0.011, R2=15%). Entered alone, PSQI was related to %>4h-days180 (p=0.042) and Tav180 (p=0.043); however, when the 1-30-day compliance was accounted for, PSQI no longer related to the 151-180-day compliance. The 1-30-day compliance strongly predicted respective 151-180-day measures (%>4h-days, p<0.001, R2=55%; Tav, p<0.001, R2=68%).
Conclusion
In this limited sample of naive CPAP users, higher pre-treatment sleep disturbance reported on PSQI was a useful predictor of lower 1-30-day CPAP compliance. Neither depressive symptoms nor PSG variables from diagnostic and titration studies predicted compliance. As the initial 30-day compliance is the best predictor of later CPAP use, early interventions are crucial.
Support
none
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Affiliation(s)
- B Dubrovsky
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - A Inamac
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - L Gikashvili
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J Weingarten
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J Cunningham
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
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Weingarten JA, Dubrovsky B, Cunningham J, Chin W, Howladar A, Gikashvili L. 0733 Retrospective Pain Reports In OSA Patients: Roles Of Depressive Symptoms, Polysomnographic And Self-report Sleep Measures. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Exploring the relationship between OSA and pain, some studies showed hyperalgesia, and others, hypoalgesia. It was proposed that apnea-related sleep fragmentation causes hyperalgesia, and hypoxemia, hypoalgesia. However, SpO2 nadir had opposite relationships with pain measures in different studies. A 2018 review of over 1000 studies reported lack of consistent relationship between OSA and pain variables. Further, OSA was shown to relate to depressed mood, which may alter pain perception. Presently, retrospective reports of pain are analyzed as a function of polysomnographic and self-report sleep variables and depressive symptomatology in patients evaluated for OSA.
Methods
A total of 1,166 patients (923 women, 1136 minorities, 18-97 y.o., age M=53.1±15.2, BMI M=34.4±8.7) undergoing an overnight PSG filled out the Center for Epidemiologic Studies Depression Scale-Revised (CESDR), ISI, PSQI, ESS, and Chronic Pain Grade Scale yielding pain intensity (PI) and functional effect (FE) scores. PI and FE were separately regressed onto age, sex and BMI, followed by PSG and self-report variables meeting p<0.1 criterion. AHI and SpO2nadir were forced into the models.
Results
Mean AHI=29.6±34.7, range 0-167/hr, 72.3% had AHI≥5. Higher PI related to higher AHI (p=0.005, R2<1%), lower total arousal index (TAI, p=0.006, R2<1%), higher total sleep time (TST, p=0.003, R2<1%), higher PSQI (p<0.001, R2=5%), and higher CESD (p=0.001, R2<1%), without interactions with sex. Higher FE related to higher AHI (p=0.004, R2<1%), lower TAI (p<0.001, R2=1%), higher PSQI (p<0.001, R2=3%, and higher CESD (p<0.001, R2=2%). Sex had a significant interaction only with AHI (p=0.032); the FE-AHI relationship was significant in women (p=0.012), but not in men.
Conclusion
On retrospective reports of pain in this large sample, higher AHI related to greater pain intensity in both sexes and to greater functional effect in women only. Unexpectedly, higher pain measures were also related to lower TAI and higher TST. Higher depressive symptomatology and subjective sleep disturbance on PSQI were related to greater pain intensity and its functional effect. Only a small portion of the variance in pain measures was accounted for by PSG and self-report variables.
Support
none
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Affiliation(s)
- J A Weingarten
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - B Dubrovsky
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J Cunningham
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - W Chin
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - A Howladar
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - L Gikashvili
- New York-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
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Taji L, Battistella M, Grill AK, Cunningham J, Hemmelgarn BL, Quinn KM, Thomas A, Brimble KS. Medications Used Routinely in Primary Care to be Dose-Adjusted or Avoided in People With Chronic Kidney Disease: Results of a Modified Delphi Study. Ann Pharmacother 2020; 54:625-632. [DOI: 10.1177/1060028019897371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Chronic kidney disease (CKD) affects up to 18% of those over the age of 65 years. Potentially inappropriate medication prescribing in people with CKD is common. Objectives: Develop a pragmatic list of medications used in primary care that required dose adjustment or avoidance in people with CKD, using a modified Delphi panel approach, followed by a consensus workshop. Methods: We conducted a comprehensive literature search to identify potential medications. A group of 17 experts participated in a 3-round modified Delphi panel to identify medications for inclusion. A subsequent consensus workshop of 8 experts reviewed this list to prioritize medications for the development of point-of-care knowledge translation materials for primary care. Results: After a comprehensive literature review, 59 medications were included for consideration by the Delphi panel, with a further 10 medications added after the initial round. On completion of the 3 Delphi rounds, 66 unique medications remained, 63 requiring dose adjustment and 16 medications requiring avoidance in one or more estimated glomerular filtration rate categories. The consensus workshop prioritized this list further to 24 medications that must be dose-adjusted or avoided, including baclofen, metformin, and digoxin, as well as the newer SGLT2 inhibitor agents. Conclusion and Relevance: We have developed a concise list of 24 medications commonly used in primary care that should be dose-adjusted or avoided in people with CKD to reduce harm. This list incorporates new and frequently prescribed medications and will inform an updated, easy to access source for primary care providers.
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Affiliation(s)
- Leena Taji
- Ontario Renal Network, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Marisa Battistella
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Allan K. Grill
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Jessie Cunningham
- Ontario Renal Network, Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Ann Thomas
- Ontario Renal Network, Cancer Care Ontario, Toronto, Ontario, Canada
| | - K. Scott Brimble
- Ontario Renal Network, Cancer Care Ontario, Toronto, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
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Collister D, Pyne L, Cunningham J, Donald M, Molnar A, Beaulieu M, Levin A, Brimble KS. Multidisciplinary Chronic Kidney Disease Clinic Practices: A Scoping Review. Can J Kidney Health Dis 2019; 6:2054358119882667. [PMID: 31666978 PMCID: PMC6801876 DOI: 10.1177/2054358119882667] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/27/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Multidisciplinary chronic kidney disease (CKD) clinics improve patient
outcomes but their optimal design is unclear. Objective: To perform a scoping review to identify and describe current practices
(structure, function) associated with multidisciplinary CKD clinics. Design: Scoping review. Setting: Databases included Medline, EMBASE, Cochrane, and CINAHL. Patients: Patients followed in multidisciplinary CKD clinics globally. Measurements: Multidisciplinary CKD clinic composition, entry criteria, follow-up, and
outcomes. Methods: We systematically searched the literature to identify randomized controlled
trials, non-randomized interventional studies, or observational studies of
multidisciplinary CKD clinics defined by an outpatient setting where two or
more allied health members (with or without a nephrologist) provided
longitudinal care to 50 or more adult or pediatric patients with CKD.
Included studies were from 2002 to present. Searches were completed on
August 10, 2018. Title, abstracts, and full texts were screened
independently by two reviewers with disagreements resolved by a third. We
abstracted data from included studies to summarize multidisciplinary CKD
clinic team composition, entry criteria, follow-up, and processes. Results: 40 studies (8 randomized controlled trials and 32 non-randomized
interventional studies or observational studies) involving 23 230
individuals receiving multidisciplinary CKD care in 12 countries were
included. Thirty-eight focused on adults (27 with CKD, 10 incident dialysis
patients, one conservative therapy) while two studies focused on adolescents
or children with CKD. The multidisciplinary team included a mean of 4.6 (SD
1.5) members consisting of a nephrologist, nurse, dietician, social worker,
and pharmacist in 97.4%, 86.8%, 84.2%, 57.9%, and 42.1% of studies
respectively. Entry criteria to multidisciplinary CKD clinics ranged from
glomerular filtration rates of 20 to 70 mL/min/1.73m2 or CKD
stages 1 to 5 without any proteinuria or risk equation-based criteria.
Frequency of follow-up was variable by severity of kidney disease. Team
member roles and standardized operating procedures were infrequently
reported. Limitations: Unstandardized definition of multidisciplinary CKD care, studies limited to
CKD defined by glomerular filtration rate, and lack of representation from
countries other than Canada, Taiwan, the United States, and the United
Kingdom. Conclusions: There is heterogeneity in multidisciplinary CKD team composition, entry
criteria, follow-up, and processes with inadequate reporting of this complex
intervention. Additional research is needed to determine the best model for
multidisciplinary CKD clinics. Trial registration: Not applicable.
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Affiliation(s)
- David Collister
- St. Joseph's Healthcare Hamilton, ON, Canada.,Ontario Renal Network, Toronto, Canada
| | - Lonnie Pyne
- St. Joseph's Healthcare Hamilton, ON, Canada
| | | | | | - Amber Molnar
- St. Joseph's Healthcare Hamilton, ON, Canada.,Ontario Renal Network, Toronto, Canada
| | - Monica Beaulieu
- British Columbia Renal Agency, Vancouver, Canada.,The University of British Columbia, Vancouver, Canada
| | - Adeera Levin
- British Columbia Renal Agency, Vancouver, Canada.,The University of British Columbia, Vancouver, Canada
| | - K Scott Brimble
- St. Joseph's Healthcare Hamilton, ON, Canada.,Ontario Renal Network, Toronto, Canada
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Keeley J, Bertling K, Rubino PL, Lim YL, Taimre T, Qi X, Kundu I, Li LH, Indjin D, Rakić AD, Linfield EH, Davies AG, Cunningham J, Dean P. Detection sensitivity of laser feedback interferometry using a terahertz quantum cascade laser. Opt Lett 2019; 44:3314-3317. [PMID: 31259948 DOI: 10.1364/ol.44.003314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
We report on the high detection sensitivity of a laser feedback interferometry scheme based on a terahertz frequency quantum cascade laser (QCL). We show that variations on the laser voltage induced by optical feedback to the laser can be resolved with the reinjection of powers as low as ∼-125 dB of the emitted power. Our measurements demonstrate a noise equivalent power of ∼1.4 pW/√Hz, although, after accounting for the reinjection losses, we estimate that this corresponds to only ∼1 fW/√Hz being coupled to the QCL active region.
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Paulos M, Flynn M, Miner M, Cunningham J. Comparing Extra Virgin Olive Oils Differing in Phenol Content for Improving Glycemic Control. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.08.045] [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: 11/27/2022]
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Dubrovsky B, Weingarten JA, Cunningham J, Abdelrahman M, DeMilt N, Ferreira A, Inamac A. 0578 Self-reported Sleep Quality And Daytime Sleepiness In Obstructive Sleep Apnea Patients: The Role Of Depressive Symptoms. Sleep 2018. [DOI: 10.1093/sleep/zsy061.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Dubrovsky
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J A Weingarten
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J Cunningham
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - M Abdelrahman
- Hunter College of the City University of New York, Psychology Department, New York, NY
| | - N DeMilt
- Hunter College of the City University of New York, Psychology Department, New York, NY
| | - A Ferreira
- Hunter College of the City University of New York, Psychology Department, New York, NY
| | - A Inamac
- Hunter College of the City University of New York, Psychology Department, New York, NY
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Dubrovsky B, Weingarten JA, Cunningham J, Inamac A, Ferreira A, DeMilt N, Abdelrahman M. 0576 Self-reported Pain Experience In Obstructive Sleep Apnea Patients: The Role Of Depressive Symptoms. Sleep 2018. [DOI: 10.1093/sleep/zsy061.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Dubrovsky
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J A Weingarten
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - J Cunningham
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Medicine, Division of Pulmonary and Critical Care, Center for Sleep Disorders, Brooklyn, NY
| | - A Inamac
- Hunter College of the City University of New York, Psychology Department, New York, NY
| | - A Ferreira
- Hunter College of the City University of New York, Psychology Department, New York, NY
| | - N DeMilt
- Hunter College of the City University of New York, Psychology Department, New York, NY
| | - M Abdelrahman
- Hunter College of the City University of New York, Psychology Department, New York, NY
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Garvey G, Cunningham J, Janda M, Yf He V, Valery PC. Psychological distress among Indigenous Australian cancer survivors. Support Care Cancer 2017; 26:1737-1746. [PMID: 29243167 DOI: 10.1007/s00520-017-3995-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/24/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study is to identify the level of and factors associated with distress in 155 Indigenous Australian cancer survivors approximately 6 months post-diagnosis. METHODS The distress thermometer (DT) was used to assess clinically significant distress (defined as having a DT score ≥ 4). Logistic regression was used to identify sociodemographic and clinical factors associated with clinically significant distress. RESULTS The mean distress score was 2.7 (SD 2.9), with about one in three Indigenous cancer survivors reporting clinically significant distress (35%; n = 54). After adjusting for age and sex, clinically significant distress was more likely among those who were separated/divorced/widowed than those who were married (odds ratio (OR) = 2.99, 95% confidence intervals (95% CI) 1.21-7.35, p = 0.017) and less likely among those residing in remote areas than those in major cities (OR = 0.23, 95% CI 0.08-0.71, p = 0.001) and in those receiving non-surgical treatment only compared with surgery only (OR = 0.24, 95% CI 0.08-0.68, p = 0.008). CONCLUSIONS Despite increased screening for distress in cancer care, this is, to our knowledge, the first published assessment of distress among Indigenous Australian cancer survivors. The characteristics of Indigenous cancer survivors associated with greater likelihood of clinically significant distress indicate at-risk subgroups who would benefit from screening and early intervention. Further research is required to identify the specific aetiologies of distress. Our findings indicate a need to identify psychological distress and for survivorship care to include culturally sensitive and tailored psychological support for Indigenous cancer survivors.
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Affiliation(s)
- Gail Garvey
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia.
| | - J Cunningham
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia
| | - M Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, 147 Wharf St Spring Hill, Brisbane, QLD, 4000, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane, QLD, 4006, Australia
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Burgun A, Bernal-Delgado E, Kuchinke W, van Staa T, Cunningham J, Lettieri E, Mazzali C, Oksen D, Estupiñan F, Barone A, Chène G. Health Data for Public Health: Towards New Ways of Combining Data Sources to Support Research Efforts in Europe. Yearb Med Inform 2017; 26:235-240. [PMID: 29063571 PMCID: PMC6239221 DOI: 10.15265/iy-2017-034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 08/18/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives: To present the European landscape regarding the re-use of health administrative data for research. Methods: We present some collaborative projects and solutions that have been developed by Nordic countries, Italy, Spain, France, Germany, and the UK, to facilitate access to their health data for research purposes. Results: Research in public health is transitioning from siloed systems to more accessible and re-usable data resources. Following the example of the Nordic countries, several European countries aim at facilitating the re-use of their health administrative databases for research purposes. However, the ecosystem is still a complex patchwork, with different rules, policies, and processes for data provision. Conclusion: The challenges are such that with the abundance of health administrative data, only a European, overarching public health research infrastructure, is able to efficiently facilitate access to this data and accelerate research based on these highly valuable resources.
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Affiliation(s)
- A. Burgun
- Inserm, UMR 1138, Centre de Recherche des Cordeliers, AP-HP, Paris Descartes University, Paris, France
| | - E. Bernal-Delgado
- Institute for Health Sciences in Aragon (IACS), BridgeHealth Consortium, Zaragoza, Spain
| | - W. Kuchinke
- University of Dusseldorf, Dusseldorf, Germany
| | - T. van Staa
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
| | - J. Cunningham
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
| | | | | | - D. Oksen
- Public Health Institute, Inserm, AVIESAN, Paris, France
| | - F. Estupiñan
- Institute for Health Sciences in Aragon (IACS), BridgeHealth Consortium, Zaragoza, Spain
| | - A. Barone
- Lombardia Informatica, Milano, Italy
| | - G. Chène
- Inserm, UMR 1219, CIC1401-EC, Univ. Bordeaux, ISPED, CHU Bordeaux, Bordeaux, France
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Barr ELM, Cunningham J, Tatipata S, Dunbar T, Kangaharan N, Guthridge S, Li SQ, Condon JR, Shaw JE, O'Dea K, Maple-Brown LJ. Associations of mortality and cardiovascular disease risks with diabetes and albuminuria in urban Indigenous Australians: the DRUID follow-up study. Diabet Med 2017; 34:946-957. [PMID: 28375555 DOI: 10.1111/dme.13360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Accepted: 03/28/2017] [Indexed: 12/01/2022]
Abstract
AIM To assess the relationships of diabetes and albuminuria with all-cause mortality and cardiovascular disease outcomes in a population without prior cardiovascular disease using data from the Darwin Region Urban Indigenous Diabetes (DRUID) study. METHODS We conducted a prospective cohort study of 706 participants (aged 15-81 years, 68% women) without prior cardiovascular disease who underwent a 75-g oral glucose tolerance test. Deaths and fatal or non-fatal cardiovascular disease were determined over 7 years, and hazard ratios with 95% CIs and population attributable risks were estimated for baseline glycaemia and albuminuria. RESULTS Compared with normoglycaemia and after adjustment for age, sex, hypertension, dyslipidaemia and smoking, known diabetes was associated with an adjusted hazard ratio of 4.8 (95% CI 1.5-14.7) for all-cause mortality and 5.6 (95% CI 2.1-15.2) for cardiovascular disease. Compared with normoalbuminuria, the respective adjusted risks for macroalbuminuria were 10.9 (95% CI 3.7-32.1) and 3.9 (95% CI 1.4-10.8). The Adjusted all-cause mortality and cardiovascular disease estimated population attributable risks for diabetes were 27% and 32%, and for albuminuria they were 32% and 21%, respectively. CONCLUSIONS In our study population, the burden of mortality and cardiovascular disease was largely driven by diabetes and albuminuria. This finding on the influence of diabetes and albuminuria is consistent with reports in other high-risk Indigenous populations and should be better reflected in risk scores and intervention programmes.
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Affiliation(s)
- E L M Barr
- Menzies School of Health Research, Darwin, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J Cunningham
- Menzies School of Health Research, Darwin, Australia
| | - S Tatipata
- Menzies School of Health Research, Darwin, Australia
| | - T Dunbar
- Charles Darwin University, Darwin, Australia
| | | | - S Guthridge
- Menzies School of Health Research, Darwin, Australia
- Health Gains Planning, Northern Territory Department of Health, Darwin, Australia
| | - S Q Li
- Health Gains Planning, Northern Territory Department of Health, Darwin, Australia
| | - J R Condon
- Menzies School of Health Research, Darwin, Australia
| | - J E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - K O'Dea
- University of South Australia, Adelaide, Australia
- University of Melbourne, Melbourne, Australia
| | - L J Maple-Brown
- Menzies School of Health Research, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
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Dubrovsky B, Weingarten JA, Cunningham J, DeMilt N, Bartalis R, Desai G, Nicholas D, Ramirez N, Rengifo MC. 0883 RELATIONSHIP BETWEEN PAIN AND POLYSOMNOGRAPHIC MEASURES IN PEDIATRIC OBSTRUCTIVE SLEEP APNEA PATIENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.882] [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: 11/12/2022] Open
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Dubrovsky B, Weingarten J, Cunningham J, DeMilt N, Bartalis R, Abdelrahman M, Wasylenko J. 0610 SUBJECTIVE SLEEP QUALITY RELATES TO DEPRESSIVE SYMPTOMATOLOGY IN OBSTRUCTIVE SLEEP APNEA PATIENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dasgupta R, Strausbaugh B, Thatcher F, Timbadia PJ, Reddy V, Cunningham J, Dasgupta A. 0551 BILEVEL PAP EXPERIENCE IN A COMMUNITY SLEEP CENTER. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Weingarten JA, Dubrovsky B, Cunningham J, DeMilt N, Bartalis R, Ferreira A, Hernandez R, Inamac AK, Jimenez A. 0609 RELATIONSHIP BETWEEN PAIN AND POLYSOMNOGRAPHIC MEASURES IN ADULTS WITH OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Merkouris SS, Rodda SN, Austin D, Lubman DI, Harvey P, Battersby M, Cunningham J, Lavis T, Smith D, Dowling NA. GAMBLINGLESS: FOR LIFE study protocol: a pragmatic randomised trial of an online cognitive-behavioural programme for disordered gambling. BMJ Open 2017; 7:e014226. [PMID: 28235970 PMCID: PMC5337748 DOI: 10.1136/bmjopen-2016-014226] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for alternative treatment delivery models that capitalise on advances in communication technology, and use self-directed activity that can complement existing services has been identified. As such, the primary aim of this study is to evaluate an online self-directed cognitive-behavioural programme for disordered gambling (GamblingLess: For Life). METHODS AND ANALYSIS The study will be a 2-arm, parallel group, pragmatic randomised trial. Participants will be randomly allocated to a pure self-directed (PSD) or guided self-directed (GSD) intervention. Participants in both groups will be asked to work through the 4 modules of the GamblingLess programme over 8 weeks. Participants in the GSD intervention will also receive weekly emails of guidance and support from a gambling counsellor. A total of 200 participants will be recruited. Participants will be eligible if they reside in Australia, are aged 18 years and over, have access to the internet, have adequate knowledge of the English language, are seeking help for their own gambling problems and are willing to take part in the intervention and associated assessments. Assessments will be conducted at preintervention, and at 2, 3 and 12 months from preintervention. The primary outcome is gambling severity, assessed using the Gambling Symptom Assessment Scale. Secondary outcomes include gambling frequency, gambling expenditure, psychological distress, quality of life and additional help-seeking. Qualitative interviews will also be conducted with a subsample of participants and the Guides (counsellors). ETHICS AND DISSEMINATION The study has been approved by the Deakin University Human Research and Eastern Health Human Research Ethics Committees. Findings will be disseminated via report, peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12615000864527; results.
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Affiliation(s)
- S S Merkouris
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - S N Rodda
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Turning Point, Eastern Health, Fitzroy, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Auckland University of Technology, Auckland, New Zealand
| | - D Austin
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - D I Lubman
- Turning Point, Eastern Health, Fitzroy, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - P Harvey
- School of Medicine, Flinders University, Adelaide, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - M Battersby
- School of Medicine, Flinders University, Adelaide, Australia
| | - J Cunningham
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
- Research School of Population Health, Australian National University, Canberra, Australia
| | - T Lavis
- School of Medicine, Flinders University, Adelaide, Australia
| | - D Smith
- School of Medicine, Flinders University, Adelaide, Australia
| | - N A Dowling
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Melbourne Graduate School of Education, University of Melbourne, Parkville, Australia
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Burgun A, Oksen DV, Kuchinke W, Prokosch HU, Ganslandt T, Buchan I, van Staa T, Cunningham J, Gjerstorff ML, Dufour JC, Gibrat JF, Nikolski M, Verger P, Cambon-Thomsen A, Masella C, Lettieri E, Bertele P, Salokannel M, Thiebaut R, Persoz C, Chêne G, Ohmann C. Linking health and administrative data for maternal, child and young adult health. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw168.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cunningham J, Fraser M, Castles D. Can you distinguish naturally occurring from refined dietary fibre? Journal of Nutrition & Intermediary Metabolism 2016. [DOI: 10.1016/j.jnim.2015.12.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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46
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Peddi PF, Hurvitz SA, Fasching PA, Wang L, Cunningham J, Weinshilboum RM, Liu D, Quinaux E, Fourmanoir H, Robert NJ, Valero V, Crown J, Falkson C, Brufsky A, Pienkowski T, Eiermann W, Martin M, Bee V, Slamon DJ. Abstract P6-03-09: Genetic polymorphism and correlation with treatment induced cardiotoxicity and prognosis in HER2 amplified early breast cancer patients. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-03-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Small studies have indicated a possible correlation between a HER2 gene polymorphism at codon 655 and trastuzumab-associated cardiotoxicity. Association between a synonymous coding variant rs7853758 within the SLC28A3 gene and anthracycline induced cardiotoxicity has also been reported. This study aimed to validate these correlations and assess for any relationship with prognosis.
Methods: Genomic DNA was isolated from 666 patients enrolled in a large trial of adjuvant chemotherapy in HER2 amplified early breast cancer (BCIRG 006). Genotyping was conducted using Sequenom MassARRAY System for HER2 G->A polymorphism at amino acid codon 655 (rs1136201) and variant rs7853758 (L461L) within the SLC28A3 gene.
Results: Of the 666 patients analyzed, 216 patients were treated with anthracycline based therapy, 226 with trastuzumab based therapy, and 224 with regimens containing both an anthracycline and trastuzumab. Compared with the overall results of the BCIRG006 study (N=3,222), in the subset of patients genotyped in this analysis, a less robust improvement in disease free survival (DFS) was observed for the trastuzumab arms than control arm (HR, 0.821). When stratified for prognostic features, the hazard ratio in favor of trastuzumab was consistent with that of the overall study (HR, 0.674). Samples from 662 patients were successfully genotyped for rs1136201. Of these, 424 (64%) were AA, 30 (4.5%) were GG, 208 (31%) were AG genotype. Samples from 665 patients were successfully genotyped for rs7853758. Of these, 19 (3%) were AA, 475 (71%) were GG, and 171 (26%) were AG genotype. There was no correlation seen between mean left ventricular ejection fraction (LVEF) and HER2 genotype at codon 655 in patients treated with trastuzumab. Of patients tested for the HER2 polymorphism, cardiac dysfunction [defined as > 10% decline in LVEF or clinical congestive heart failure (CHF)] developed in 16% of patients with AA, 17% of patients with GG and 20% of patients with AG. There was also no correlation between mean LVEF and variant rs7853758 in patients treated with anthracyclines. The percentage of patients who developed cardiac dysfunction was 13%, 17% and 21% in AA, GG, and AG genotypes respectively. No correlation between disease free survival and any of the genotypes was seen.
Conclusion: In the largest analysis to date to evaluate for relationship between cardiac toxicity and HER2 polymorphism, we did not find a correlation with rs1136201 HER2 polymorphism and trastuzumab induced cardiac toxicity. Our study also did not show a correlation between variant rs7853758 (L461L) and anthracycline induced cardiotoxicity. Neither polymorphism correlated with prognosis.
Citation Format: Peddi PF, Hurvitz SA, Fasching PA, Wang L, Cunningham J, Weinshilboum RM, Liu D, Quinaux E, Fourmanoir H, Robert NJ, Valero V, Crown J, Falkson C, Brufsky A, Pienkowski T, Eiermann W, Martin M, Bee V, Slamon DJ. Genetic polymorphism and correlation with treatment induced cardiotoxicity and prognosis in HER2 amplified early breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-03-09.
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Affiliation(s)
- PF Peddi
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - SA Hurvitz
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - PA Fasching
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - L Wang
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - J Cunningham
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - RM Weinshilboum
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - D Liu
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - E Quinaux
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - H Fourmanoir
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - NJ Robert
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - V Valero
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - J Crown
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - C Falkson
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - A Brufsky
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - T Pienkowski
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - W Eiermann
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - M Martin
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - V Bee
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
| | - DJ Slamon
- University of California, Los Angeles; University Hospital Erlangen; Mayo Clinic; IDDI; Hospital General Universitario Gregorio Marañón; University of Pittsburgh Medical Center; St Vincent's Hospital; Trio Oncology; US Oncology; MD Anderson; Univ of Alabama At Birmingham; Postgraduate Medical Center. European Health Center; Redcross Women Hosp
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Garvey G, Cunningham J, He VY, Janda M, Baade P, Sabesan S, Martin JH, Fay M, Adams J, Kondalsamy-Chennakesavan S, Valery PC. Health-related quality of life among Indigenous Australians diagnosed with cancer. Qual Life Res 2016; 25:1999-2008. [PMID: 26831052 DOI: 10.1007/s11136-016-1233-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Health-related quality of life (HRQoL) and associated factors were assessed among 155 Indigenous Australian adult cancer patients 6 months post-diagnosis. METHODS The Assessment of Quality of Life-4D Questionnaire was used to assess HRQoL. Differences in the median utility score among subgroups of interest were examined using nonparametric tests. Factors associated with excellent HRQoL were assessed through logistic regression. RESULTS Participants' mean age was 52 years (range 20-78), and the majority were female (60 %), unemployed (72 %), and recruited from outpatients clinics (64 %). Breast cancer (27 %) was the most common diagnosis. The median HRQoL score was 0.62; 14 % of participants reported excellent HRQoL (>0.90). After adjusting for age, admission status, and treatment, excellent HRQoL was more likely among participants of Torres Strait Islander origin [adjusted odds ratio (AOR) 3.68; 95 % CI 1.23-11.01], those living in regional areas (AOR 5.59; 95 % CI 1.42-22.06), and those whose main language spoken at home was not English (AOR 3.60; 95 % CI 1.08-11.99) and less likely among those reporting less contact with Indigenous people (AOR 0.23; 95 % CI 0.68-0.81). CONCLUSION Assessing HRQoL is important to identifying and improving the length and quality of cancer survivorship, especially in groups that have significantly poorer cancer outcomes, such as Indigenous Australians. Acknowledging the study's observational nature, we found HRQoL was lower than reported for other Australians, and we identified some socio-demographic factors that were associated with excellent HRQoL. Such assessments are an important component of identifying and evaluating appropriate interventions to improve the health and well-being of Indigenous cancer patients.
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Affiliation(s)
- G Garvey
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia.
| | - J Cunningham
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - M Janda
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - P Baade
- Cancer Council Queensland, Brisbane, Australia
| | - S Sabesan
- College of Medicine and Dentistry, James Cook University and Townsville Hospital, Townsville, Australia
| | - J H Martin
- University of Newcastle School of Medicine and Public Health, Newcastle, Australia
| | - M Fay
- University of Newcastle School of Medicine and Public Health, Newcastle, Australia
| | - J Adams
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | | | - P C Valery
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
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Boyle JA, Cunningham J, Norman RJ, Dunbar T, O'Dea K. Polycystic ovary syndrome and metabolic syndrome in Indigenous Australian women. Intern Med J 2015; 45:1247-54. [DOI: 10.1111/imj.12910] [Citation(s) in RCA: 12] [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] [Received: 05/24/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 12/01/2022]
Affiliation(s)
- J. A. Boyle
- Monash Centre for Health Research Implementation, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Obstetrics and Gynaecology; Monash Health; Melbourne Victoria Australia
| | - J. Cunningham
- Menzies School of Health Research; Darwin Northern Territory Australia
| | - R. J. Norman
- The Robinson Institute; University of Adelaide; Adelaide South Australia Australia
| | - T. Dunbar
- Charles Darwin University; Darwin Northern Territory Australia
| | - K. O'Dea
- The Sansom Institute; University of South Australia; Adelaide South Australia Australia
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Naidoo J, Cunningham J, Woo K, Hellmann M, Postow M, Drilon A, Chaft J, Lesokhin A, Segal N, Callahan M, Rudin C, Iyriboz T, Wolchok J. 503 Pneumonitis with anti-PD-1/PD-L1 therapy. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30305-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Laurie G, Ainsworth J, Cunningham J, Dobbs C, Jones KH, Kalra D, Lea NC, Sethi N. On moving targets and magic bullets: Can the UK lead the way with responsible data linkage for health research? Int J Med Inform 2015; 84:933-40. [PMID: 26342668 PMCID: PMC4595999 DOI: 10.1016/j.ijmedinf.2015.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
Abstract
We explore key elements of good governance in health linkage. Adaptive reflexive governance models are essential. Two examples illustrate how we can achieve standardisation of practice. Distinct elements of governance compiled in a composite fashion tend to challenges.
Purpose To provide an overview of essential elements of good governance of data linkage for health-related research, to consider lessons learned so far and to examine key factors currently impeding the delivery of good governance in this area. Given the considerable hurdles which must be overcome and the changing landscape of health research and data linkage, a principled, proportionate, risk-based approach to governance is advocated. Discussion In light of the considerable value of data linkage to health and well-being, the United Kingdom aspires to design and deliver good governance in health-related research. A string of projects have been asking: what does good governance look like in data linkage for health research? It is argued here that considerable progress can and must be made in order to develop the UK’s contribution to future health and wealth economies, particularly in light of mis-start initiatives such as care.data in NHS England. Discussion centres around lessons learned from previous successful health research initiatives, identifying those governance mechanisms which are essential to achieving good governance. Conclusion This article suggests that a crucial element in any step-increase of research capability will be the adoption of adaptive governance models. These must recognise a range of approaches to delivering safe and effective data linkage, while remaining responsive to public and research user expectations and needs as these shift and change with time and experience. The targets are multiple and constantly moving. There is not – nor should we seek – a single magic bullet in delivering good governance in health research.
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Affiliation(s)
- G Laurie
- Mason Institute, School of Law, University of Edinburgh, UK
| | - J Ainsworth
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - J Cunningham
- Centre for Health Informatics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - C Dobbs
- Swansea University Medical School, UK
| | - K H Jones
- Swansea University Medical School, UK
| | - D Kalra
- Centre for Health Informatics and Multiprofessional Education, University College London, UK
| | - N C Lea
- Centre for Health Informatics and Multiprofessional Education, University College London, UK
| | - N Sethi
- Mason Institute, School of Law, University of Edinburgh, UK.
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