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Dickey BL, Gore LR, Slebos R, Sirak B, Isaacs-Soriano KA, Kennedy K, Otto K, Wadsworth JT, Chung CH, Giuliano AR. A cross-sectional study of the association of dental health factors with progression and all-cause mortality in men diagnosed with HPV-associated oropharyngeal cancer. BMC Oral Health 2024; 24:433. [PMID: 38594660 PMCID: PMC11005190 DOI: 10.1186/s12903-024-04047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/18/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Human Papillomavirus-associated oropharyngeal cancer (HPV-OPC) incidence is increasing among men in the United States. Poor dental health has previously been associated with risk of head and neck cancers, oral HPV infection, and persistence but it is not understood whether dental health is associated with outcomes. We sought to determine the association of dental health with progression free survival and overall mortality among men with an HPV-OPC. METHODS A cross sectional study of men diagnosed with HPV-OPC between 2014-2020 at Moffitt Cancer Center in Tampa, FL was conducted. Dental records were abstracted for assessment of dental fitness prior to cancer treatment. Five dental factors including number of teeth lost, pocket depth, gingival score, loss of attachment, and bone loss were individually examined. Risk factor and outcome data were collected from a patient risk questionnaire and medical record. Using item response theory, an overall dental fitness score from five dental factors was developed in which missing data were multiply imputed. Cox proportional hazards model was used to assess whether dental factors were associated with progression-free survival or overall mortality. RESULTS Among 206 HPV-OPC cases, median follow-up was 3.4 years (IQR: 2.4-4.4) during which 40 cases involved progression or mortality and 25 deaths occurred. Overall dentition was significantly associated with progression free survival (p = 0.04) and with overall survival (p = 0.03) though findings were not significant after adjustment for age at diagnosis, stage, and smoking history (p = 0.146 and p = 0.120, respectively). A pocket depth of 7 mm or more was associated with overall survival (HR: 5.21; 95% CI: 1.43-19.11) and this remained significant after adjustment for confounding (aHR: 4.14; 95% CI: 1.72-16.26). CONCLUSIONS Among men diagnosed with an HPV-associated OPC in the US, worse dental health was associated with reduced progression free survival and overall survival, but not after adjustment for confounders. Further studies are needed to examine whether dental health is associated with other prognostic factors and subsequent treatment-related outcomes.
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Affiliation(s)
- Brittney L Dickey
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - L Robert Gore
- Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - Robbert Slebos
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Bradley Sirak
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kimberly A Isaacs-Soriano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kayoko Kennedy
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kristen Otto
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - J Trad Wadsworth
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer and Research Institute, Tampa, FL, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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Dukes CW, Potez M, Lancet J, Kuter BJ, Whiting J, Mo Q, Leav B, Wang H, Vanas JS, Cubitt CL, Isaacs-Soriano K, Kennedy K, Rathwell J, Diaz Cobo J, O’Nan W, Sirak B, Dong N, Tan E, Hwu P, Giuliano AR, Pilon-Thomas S. Neutralizing Antibody Response following a Third Dose of the mRNA-1273 Vaccine among Cancer Patients. Vaccines (Basel) 2023; 12:13. [PMID: 38250826 PMCID: PMC10818923 DOI: 10.3390/vaccines12010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Cancer patients are at an increased risk of morbidity and mortality from SARS-CoV-2 infection and have a decreased immune response to vaccination. We conducted a study measuring both the neutralizing and total antibodies in cancer patients following a third dose of the mRNA-1273 COVID-19 vaccine. Immune responses were measured with an enzyme-linked immunosorbent assay (ELISA) and neutralization assays. Kruskal-Wallis tests were used to evaluate the association between patient characteristics and neutralization geometric mean titers (GMTs), and paired t-tests were used to compare the GMTs between different timepoints. Spearman correlation coefficients were calculated to determine the correlation between total antibody and neutralization GMTs. Among 238 adults diagnosed with cancer, a third dose of mRNA-1273 resulted in a 37-fold increase in neutralization GMT 28 days post-vaccination and maintained a 14.6-fold increase at 6 months. Patients with solid tumors or lymphoid cancer had the highest and lowest neutralization GMTs, respectively, at both 28 days and 6 months post-dose 3. While total antibody GMTs in lymphoid patients continued to increase, other cancer types showed decreases in titers between 28 days and 6 months post-dose 3. A strong correlation (p < 0.001) was found between total antibody and neutralization GMTs. The third dose of mRNA-1273 was able to elicit a robust neutralizing antibody response in cancer patients, which remained for 6 months after administration. Lymphoid cancer patients can benefit most from this third dose, as it was shown to continue to increase total antibody GMTs 6 months after vaccination.
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Affiliation(s)
- Christopher W. Dukes
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
| | - Marine Potez
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jeffrey Lancet
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Barbara J. Kuter
- Department of Infectious Diseases, Moderna, Inc., Cambridge, MA 02139, USA
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Qianxing Mo
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Brett Leav
- Department of Infectious Diseases, Moderna, Inc., Cambridge, MA 02139, USA
| | - Haixing Wang
- Department of Infectious Diseases, Moderna, Inc., Cambridge, MA 02139, USA
| | - Julie S. Vanas
- Department of Infectious Diseases, Moderna, Inc., Cambridge, MA 02139, USA
| | | | - Kimberly Isaacs-Soriano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Kayoko Kennedy
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Julie Rathwell
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Julian Diaz Cobo
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Wesley O’Nan
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Bradley Sirak
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Ning Dong
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Elaine Tan
- James A. Haley Veterans Hospital, Tampa, FL 33612, USA
| | - Patrick Hwu
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Shari Pilon-Thomas
- Department of Immunology, Moffitt Cancer Center, Tampa, FL 33612, USA
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL 33612, USA (A.R.G.)
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Dukes CW, Rossetti RAM, Hensel JA, Snedal S, Cubitt CL, Schell MJ, Abrahamsen M, Isaacs-Soriano K, Kennedy K, Mangual LN, Whiting J, Martinez-Brockhus V, Islam JY, Rathwell J, Beatty M, Hall AM, Abate-Daga D, Giuliano AR, Pilon-Thomas S. SARS-CoV-2 antibody response duration and neutralization following natural infection. J Clin Virol Plus 2023; 3:100158. [PMID: 37654784 PMCID: PMC10470471 DOI: 10.1016/j.jcvp.2023.100158] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background The role of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) neutralizing antibody response from natural infection and vaccination, and the potential determinants of this response are poorly understood. Characterizing this antibody response and the factors associated with neutralization can help inform future prevention efforts and improve clinical outcomes in those infected. Objectives The goals of this study were to prospectively evaluate SARS-CoV-2 antibody levels and the neutralizing antibody responses among naturally infected adults and to determine demographic and behavioral factors independently associated with these responses. Methods Serum was collected from seropositive individuals at baseline, four-weeks, and three-months following their first study visit to be evaluated for antibody levels. Detection of neutralizing antibodies was performed at baseline. Participant demographic and behavioral information was collected via web questionnaire prior to their first visit. Results At baseline, higher antibody levels were associated with better neutralization capacity, with 83% of participants having detectable neutralizing antibodies. We found an age-dependent effect on antibody level and neutralization capacity with participants over 65 years having significantly higher levels. Ethnicity, heart disease, autoimmune disease, and COVID symptoms were associated with higher antibody levels, but not with increased neutralization capacity. Work environment during the pandemic correlated with increased neutralization capacity, while kidney or liver disease and traveling out of state after February 2020 correlated with decreased neutralization capacity, however neither correlated with antibody levels. Conclusions Our data show that natural infection by SARS-CoV-2 can induce a humoral response reflected by high antibody levels and neutralization capacity.
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Affiliation(s)
- Christopher W Dukes
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Renata AM Rossetti
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Jonathan A Hensel
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Sebastian Snedal
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Christopher L Cubitt
- Immune Monitoring Core Facility, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Michael J Schell
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Martha Abrahamsen
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Kimberly Isaacs-Soriano
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Kayoko Kennedy
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Leslie N Mangual
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Veronica Martinez-Brockhus
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Jessica Y Islam
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Julie Rathwell
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Matthew Beatty
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Amy M Hall
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
| | - Daniel Abate-Daga
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
- Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
| | - Shari Pilon-Thomas
- Department of Immunology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, United States of America
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, Florida, 33612, United States of America
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Giuliano A, Kuter B, Pilon-Thomas S, Whiting J, Mo Q, Leav B, Sirak B, Cubitt C, Dukes C, Isaacs-Soriano K, Kennedy K, Ball S, Dong N, Jain A, Hwu P, Lancet J. Safety and immunogenicity of a third dose of mRNA-1273 vaccine among cancer patients. Cancer Commun (Lond) 2023. [PMID: 37377402 PMCID: PMC10354405 DOI: 10.1002/cac2.12453] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/15/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Compared to the general population, cancer patients are at higher risk of morbidity and mortality following SARS-CoV-2 infection. The immune response to a two-dose regimen of mRNA vaccines in cancer patients is generally lower than in immunocompetent individuals. Booster doses may meaningfully augment immune response in this population. We conducted an observational study with the primary objective of determining the immunogenicity of vaccine dose three (100 μg) of mRNA-1273 among cancer patients and a secondary objective of evaluating safety at 14 and 28 days. METHODS The mRNA-1273 vaccine was administered ∼7 to 9 months after administering two vaccine doses (i.e., the primary series). Immune responses (enzyme-linked immunosorbent assay [ELISA]) were assessed 28 days post-dose three. Adverse events were collected at days 14 (± 5) and 28 (+5) post-dose three. Fisher exact or X2 tests were used to compare SARS-CoV-2 antibody positivity rates, and paired t-tests were used to compare SARS-CoV-2 antibody geometric mean titers (GMTs) across different time intervals. RESULTS Among 284 adults diagnosed with solid tumors or hematologic malignancies, dose three of mRNA-1273 increased the percentage of patients seropositive for SARS-CoV-2 antibody from 81.7% pre-dose three to 94.4% 28 days post-dose three. GMTs increased 19.0-fold (15.8-22.8). Patients with lymphoid cancers or solid tumors had the lowest and highest antibody titers post-dose three, respectively. Antibody responses after dose three were reduced among those who received anti-CD20 antibody treatment, had lower total lymphocyte counts and received anticancer therapy within 3 months. Among patients seronegative for SARS-CoV-2 antibody pre-dose three, 69.2% seroconverted after dose three. A majority (70.4%) experienced mostly mild, transient adverse reactions within 14 days of dose three, whereas severe treatment-emergent events within 28 days were very rare (<2%). CONCLUSION Dose three of the mRNA-1273 vaccine was well-tolerated and augmented SARS-CoV-2 seropositivity in cancer patients, especially those who did not seroconvert post-dose two or whose GMTs significantly waned post-dose two. Lymphoid cancer patients experienced lower humoral responses to dose three of the mRNA-1273 vaccine, suggesting that timely access to boosters is important for this population.
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Affiliation(s)
- Anna Giuliano
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | | | - Junmin Whiting
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | - Qianxing Mo
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Bradley Sirak
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Christopher Dukes
- Department of Immunology, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Kayoko Kennedy
- Non-Therapeutic Research Office (NTRO), Moffitt Cancer Center, Tampa, Florida, USA
| | - Somedeb Ball
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Ning Dong
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Akriti Jain
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Patrick Hwu
- Department of Immunology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jeffrey Lancet
- Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA
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Hall DE, Youk A, Allsup K, Kennedy K, Byard TD, Dhupar R, Chu D, Rahman AM, Wilson M, Cahalin LP, Afilalo J, Forman DE. Preoperative Rehabilitation Is Feasible in the Weeks Prior to Surgery and Significantly Improves Functional Performance. J Frailty Aging 2023; 12:267-276. [PMID: 38008976 PMCID: PMC10683858 DOI: 10.14283/jfa.2022.42] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
BACKGROUND Frailty is a multidimensional state of increased vulnerability. Frail patients are at increased risk for poor surgical outcomes. Prior research demonstrates that rehabilitation strategies deployed after surgery improve outcomes by building strength. OBJECTIVES Examine the feasibility and impact of a novel, multi-faceted prehabilitation intervention for frail patients before surgery. DESIGN Single arm clinical trial. SETTING Veterans Affairs hospital. PARTICIPANTS Patients preparing for major abdominal, urological, thoracic, or cardiac surgery with frailty identified as a Risk Analysis Index≥30. INTERVENTION Prehabilitation started in a supervised setting to establish safety and then transitioned to home-based exercise with weekly telephone coaching by exercise physiologists. Prehabilitation included (a)strength and coordination training; (b)respiratory muscle training (IMT); (c)aerobic conditioning; and (d)nutritional coaching and supplementation. Prehabilitation length was tailored to the 4-6 week time lag typically preceding each participant's normally scheduled surgery. MEASUREMENTS Functional performance and patient surveys were assessed at baseline, every other week during prehabilitation, and then 30 and 90 days after surgery. Within-person changes were estimated using linear mixed models. RESULTS 43 patients completed baseline assessments; 36(84%) completed a median 5(range 3-10) weeks of prehabilitation before surgery; 32(74%) were retained through 90-day follow-up. Baseline function was relatively low. Exercise logs show participants completed 94% of supervised exercise, 78% of prescribed IMT and 74% of home-based exercise. Between baseline and day of surgery, timed-up-and-go decreased 2.3 seconds, gait speed increased 0.1 meters/second, six-minute walk test increased 41.7 meters, and the time to complete 5 chair rises decreased 1.6 seconds(all P≤0.007). Maximum and mean inspiratory and expiratory pressures increased 4.5, 7.3, 14.1 and 13.5 centimeters of water, respectively(all P≤0.041). CONCLUSIONS Prehabilitation is feasible before major surgery and achieves clinically meaningful improvements in functional performance that may impact postoperative outcomes and recovery. These data support rationale for a larger trial powered to detect differences in postoperative outcomes.
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Affiliation(s)
- D E Hall
- Daniel E Hall, UPMC Presbyterian Hospital, Suite F12, 200 Lothrop St, Pittsburgh, PA 15213, P:412.647.0421|F:412.647.1448,
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Dickey BL, Nedjai B, Preece MD, Schell MJ, Boulware D, Whiting J, Sirak B, Abrahamsen M, Isaacs‐Soriano KA, Kennedy K, Chung CH, Giuliano AR. Methylation of HPV16 and EPB41L3 in oral gargles and the detection of early and late oropharyngeal cancer. Cancer Med 2022; 11:3735-3742. [PMID: 35619332 PMCID: PMC9582688 DOI: 10.1002/cam4.4757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/13/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022] Open
Abstract
As oropharyngeal cancer (OPC) associated with human papillomavirus (HPV) increases in men, the need for a screening test to diagnose OPC early is crucial. While HPV-associated OPC has a favorable prognosis, recurrence is likely, and metastatic OPC is often incurable regardless of HPV status. Our previous study of pretreatment, male OPC cases (n = 101) and age- and smoking-matched controls (n = 101) found methylation of the host EPB41L3 tumor suppressor gene and HPV16 in the oral gargle was correlated with these biomarkers in the tumor. Methylation of these genes in the oral gargle was significantly (p < 0.0001) higher among cases compared to controls. To further study the utility of HPV16/EPB41L3 methylation, we expanded the sample size and specifically increased the number of early OPC cases (T1-T2, N0-N1; small tumors with a single ipsilateral node <3 cm) to evaluate these biomarkers in early and late OPC. This study included 228 OPC cases, 92 of which were early cases and frequency matched to 142 healthy controls. In logistic regression, the AUC for HPV16/EPB41L3 methylation for all OPC cases was 0.82. Among early and late OPC cases, the AUC was 0.78 and 0.85, respectively. For early cases, 76% sensitivity was achieved, replicating results from our prior study, with a specificity of 65%, indicating room for improvement. The ability of HPV16/EPB41L3 methylation to distinguish OPC from healthy controls highlights its utility as a potential biomarker for OPC. However, the inability to predict early OPC better than late stage OPC indicates the need for additional biomarkers to improve screening performance.
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Affiliation(s)
- Brittney L. Dickey
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Belinda Nedjai
- Centre for Cancer PreventionWolfson Institute of Preventive Medicine, Queen Mary UniversityLondonUK
| | - Matthew D. Preece
- Centre for Cancer PreventionWolfson Institute of Preventive Medicine, Queen Mary UniversityLondonUK
| | - Michael J. Schell
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer and Research InstituteTampaFloridaUSA
| | - David Boulware
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer and Research InstituteTampaFloridaUSA
| | - Junmin Whiting
- Department of Biostatistics and BioinformaticsH. Lee Moffitt Cancer and Research InstituteTampaFloridaUSA
| | - Bradley Sirak
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Martha Abrahamsen
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Kimberly A. Isaacs‐Soriano
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Kayoko Kennedy
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Christine H. Chung
- Department of Head and Neck‐Endocrine OncologyH. Lee Moffitt Cancer and Research InstituteTampaFloridaUSA
| | - Anna R. Giuliano
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
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7
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Becker F, Marcantonio F, Datta S, Wichterich C, Cizmas L, Surber J, Kennedy K, Bowles E. Tracking the source of contaminant lead in children's blood. Environ Res 2022; 212:113307. [PMID: 35447155 DOI: 10.1016/j.envres.2022.113307] [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] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 06/14/2023]
Abstract
Pb isotope ratios are used for apportioning the sources of Pb in the blood of children (ages 1-6) screened for high blood Pb levels (>5 μg/dL) surrounding urban areas of Kansas City, MO. We compared Pb isotope ratios measured in the child's blood with those of the most likely sources of Pb in that child's home environment. The environmental sources sampled consisted of topsoils, paints, occupational sources (e.g., oil rig workers' uniforms, mechanics' clothes), indoor air filters, dusts, and dietary sources (e.g., spices). Blood lead levels (BLL) ranged from 2.9 to 12.7 μg/dL in children from the five homes participating in this study. Measurements of 206Pb/204Pb, 207Pb/204Pb and 208Pb/204Pb isotope ratios were made by multi-collector ICP-MS. Comparison of the Pb isotope ratios in home environment samples versus those in the child's blood in each home allowed the identification of possible sources of a child's Pb exposure in three homes. In five homes investigated, children's blood Pb levels were most likely to be derived from dusts inside, and topsoil outside, the homes, or a mixture thereof. In one case, blood Pb was derived from turmeric spice and, in another, the Pb was derived from paint. It is not always possible to directly link high BLLs to the environmental sources collected when Pb isotope ratios of the environmental samples did not overlap with those of the blood.
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Affiliation(s)
- F Becker
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA
| | - F Marcantonio
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA.
| | - S Datta
- Department of Earth and Planetary Sciences, University of Texas, San Antonio, TX, USA
| | - C Wichterich
- Department of Geology and Geophysics, Texas A&M University, College Station, TX, USA
| | - L Cizmas
- School of Public Health, Texas A&M University, College Station, TX, USA
| | - J Surber
- Department of Geology, Kansas State University, Manhattan, KS, USA
| | - K Kennedy
- Children's Mercy Kansas City Environmental Health Program, Kansas City, MO, USA
| | - E Bowles
- Children's Mercy Kansas City Environmental Health Program, Kansas City, MO, USA
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Giuliano AR, Pilon-Thomas S, Schell MJ, Abrahamsen M, Islam JY, Isaacs-Soriano K, Kennedy K, Dukes CW, Whiting J, Rathwell J, Hensel JA, Mangual LN, Schonbrunn E, Bikowitz M, Grassie D, Yang Y. SARS-CoV-2 Period Seroprevalence and Related Factors, Hillsborough County, Florida, October 2020-March 2021. Emerg Infect Dis 2022; 28:556-563. [PMID: 35081021 PMCID: PMC8888241 DOI: 10.3201/eid2803.211495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Estimating the actual extent of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging because virus test positivity data undercount the actual number and proportion of persons infected. SARS-CoV-2 seroprevalence is a marker of past SARS-CoV-2 infection regardless of presence or severity of symptoms and therefore is a robust biomarker of infection period prevalence. We estimated SARS-CoV-2 seroprevalence among residents of Hillsborough County, Florida, USA, to determine factors independently associated with SARS-CoV-2 antibody status overall and among asymptomatic antibody-positive persons. Among 867 participants, SARS-CoV-2 period prevalence (October 2020–March 2021) was 19.5% (asymptomatic seroprevalence was 8%). Seroprevalence was 2-fold higher than reported SARS-CoV-2 virus test positivity. Factors related to social distancing (e.g., essential worker status, not practicing social distancing, contact with a virus-positive person, and length of contact exposure time) were consistently associated with seroprevalence but did not differ by time since suspected or known infection (<6 months vs. >6 months).
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9
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Abstract
Abstract
Background
The COVID-19 pandemic accelerated adoption of a telehealth model to replace outpatient visits. We studied quality indicators and clinical outcomes associated with virtual visits in comparison to in-person ambulatory visits for patients with atrial fibrillation (AF) seen by electrophysiology providers.
Methods
Quality indicators and outcomes for patients with primary diagnosis of AF seen by electrophysiology providers (6 physicians and 4 nurse practitioners) for the 12 week period of March 22–June 13, 2020 were compared with those from the 12 week period of March 24–June 15, 2019.
Result
We identified 2340 clinic visits for AF (1081 in 2019 and 1259 in 2020). Telehealth was not used in 2019, and was used in 90.5% of the 2020 visits. On multivariate analysis during 120 days following each encounter, there was no difference in hospital admissions between 2019 and 2020 (OR 0.89; 95% CI 0.69–1.14; p=0.3624), and there was trend towards lower emergency department visits in 2020 compared with 2019 (OR 0.77; 95% CI 0.6–1; p=0.0509). There were 36 deaths at 120 days, mortality was similar in 2020 as compared with 2019 (OR 1.5; 95% CI 0.74–3.03; p=0.2601). There was no difference in completed procedures including permanent pacemakers, cardiac resynchronization therapy devices, implantable cardioverter-defibrillators and catheter ablations. There was a significant difference in anticoagulant (OR 0.71; 95% CI 0.52–0.99; p=0.0412) and antiarrhythmic (OR 0.78; 95% CI 0.61–0.99; p=0.0384) dose adjustment or new prescriptions in 2019 compared with 2020.
Conclusion
Telehealth was associated with similar intermediate-term clinical outcomes when compared to traditional ambulatory encounters. However, adjusting or providing new prescriptions for anticoagulant or anti-arrhythmic medications was more common with in-person than with virtual visits.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Shatla
- University of Missouri Kansas City, Internal Medicine, kansas, United States of America
| | - Y Sammour
- University of Missouri Kansas City, Internal Medicine, kansas, United States of America
| | - K Kennedy
- St. Luke's Mid America Heart Institute, Kansas City, United States of America
| | - A P Wimmer
- St. Luke's Mid America Heart Institute, Kansas City, United States of America
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10
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Marques E, Kennedy K, Nishimura K, Giroux D, Cilento V, Fang W, Ugalde P. OA11.03 Oncologic Outcomes of Patients with Resected T3N0M0 Non-small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.070] [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: 10/20/2022]
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11
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Furqan M, Malhotra J, Liu L, Wang H, Pasquinelli M, Sisel E, Kennedy K, Shergill A, Feldman L. FP04.04 A Phase Ib/II Study of Imprime PGG and Pembrolizumab in Pretreated Patients With Advanced Stage Non-Small Cell Lung Cancer: BTCRC-LUN15-017. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.218] [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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12
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Sisel E, Furqan M, Malhotra J, Shergill A, Kennedy K, Liu L, Pasquinelli M, Feldman L. P77.05 Phase II Study of Imprime PGG and Pembrolizumab in Stage IV NSCLC After Progression on First-Line Therapy: BTCRC-LUN15-017. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1163] [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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13
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Lima F, Kennedy K, Parulkar A, Sheikh W, Sharma E, Chu A. Hospital readmissions after catheter ablation for atrial fibrillation among patients with heart failure in the United States. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0443] [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
Catheter ablation for atrial fibrillation may improve quality of life and long-term mortality among patients with heart failure.
Purpose
The rates of hospital readmission after catheter ablation for atrial fibrillation among patients with an established diagnosis of heart failure are largely unknown. We aimed to assess the rates and causes of 30-day readmission among patients with heart failure undergoing catheter ablation vs. medical therapy for atrial fibrillation in the United States.
Methods
The 2016 Nationwide Readmissions Database was screened for patients with diagnosis of heart failure and atrial fibrillation using the 10th Revision of International Classification of Diseases codes. Patients undergoing catheter ablation for atrial fibrillation were grouped separately from those treated medically for atrial fibrillation. Thirty-day readmissions were assessed for both groups.
Results
The analytical cohort included 749,776 (national estimate of 1,421,673) patients with heart failure and atrial fibrillation. This included 2,204 patients that underwent catheter ablation. Patients treated with catheter ablation had lower 30-day readmissions compared to the medical therapy group (16.8% vs 20.1%, p<0.001). Fifty-five percent of all readmissions among the catheter ablation cohort were related to cardiac events. Heart failure exacerbation (40%) and arrhythmia (36%) were the most common cardiac causes for readmission after catheter ablation (Figure).
Conclusions
In a contemporary nationwide analysis of patients with heart failure and atrial fibrillation, compared to medical therapy those treated with catheter ablation for atrial fibrillation had fewer 30-day readmissions after index hospital discharge. The most common cause for readmission among patients treated with catheter ablation was heart failure exacerbation and arrhythmia.
Causes of readmission
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Lima
- Brown University, Providence, United States of America
| | - K Kennedy
- St. Luke's Mid America Heart Institute, Kansas City, United States of America
| | - A Parulkar
- Brown University, Providence, United States of America
| | - W Sheikh
- Brown University, Providence, United States of America
| | - E Sharma
- Brown University, Providence, United States of America
| | - A Chu
- Brown University, Providence, United States of America
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14
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Johnson W, Bloschichak A, Biniek J, Kennedy K, Kurowski D. Bench‐Marking the Prices Paid By Commercial Insurers for Professional Services. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13329] [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: 11/29/2022] Open
Affiliation(s)
- W. Johnson
- Health Care Cost Institute Washington DC United States
| | | | - J.F. Biniek
- Health Care Cost Institute Washington DC United States
| | - K. Kennedy
- Health Care Cost Institute Washington DC United States
| | - D. Kurowski
- Health Care Cost Institute Washington DC United States
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15
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Kennedy K, Cal R, Casey R, Lopez C, Adelfio A, Molloy B, Wall AM, Holton TA, Khaldi N. The anti-ageing effects of a natural peptide discovered by artificial intelligence. Int J Cosmet Sci 2020; 42:388-398. [PMID: 32453870 DOI: 10.1111/ics.12635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Received: 01/20/2020] [Revised: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE As skin ages, impaired extracellular matrix (ECM) protein synthesis and increased action of degradative enzymes manifest as atrophy, wrinkling and laxity. There is mounting evidence for the functional role of exogenous peptides across many areas, including in offsetting the effects of cutaneous ageing. Here, using an artificial intelligence (AI) approach, we identified peptide RTE62G (pep_RTE62G), a naturally occurring, unmodified peptide with ECM stimulatory properties. The AI-predicted anti-ageing properties of pep_RTE62G were then validated through in vitro, ex vivo and proof of concept clinical testing. METHODS A deep learning approach was applied to unlock pep_RTE62G from a plant source, Pisum sativum (pea). Cell culture assays of human dermal fibroblasts (HDFs) and keratinocytes (HaCaTs) were subsequently used to evaluate the in vitro effect of pep_RTE62G. Distinct activities such as cell proliferation and ECM protein production properties were determined by ELISA assays. Cell migration was assessed using a wound healing assay, while ECM protein synthesis and gene expression were analysed, respectively, by immunofluorescence microscopy and PCR. Immunohistochemistry of human skin explants was employed to further investigate the induction of ECM proteins by pep_RTE62G ex vivo. Finally, the clinical effect of pep_RTE626 was evaluated in a proof of concept 28-day pilot study. RESULTS In vitro testing confirmed that pep_RTE62G is an effective multi-functional anti-ageing ingredient. In HaCaTs, pep_RTE62G treatment significantly increases both cellular proliferation and migration. Similarly, in HDFs, pep_RTE62G consistently induced the neosynthesis of ECM protein elastin and collagen, effects that are upheld in human skin explants. Lastly, in our proof of concept clinical study, application of pep_RTE626 over 28 days demonstrated anti-wrinkle and collagen stimulatory potential. CONCLUSION pep_RTE62G represents a natural, unmodified peptide with AI-predicted and experimentally validated anti-ageing properties. Our results affirm the utility of AI in the discovery of novel, functional topical ingredients.
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Affiliation(s)
- K Kennedy
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - R Cal
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - R Casey
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - C Lopez
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - A Adelfio
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - B Molloy
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - A M Wall
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - T A Holton
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
| | - N Khaldi
- Nuritas Ltd, Joshua Dawson House, Dawson St, Dublin 2, D02 RY95, Ireland
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16
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Lehenbauer K, Qarajeh R, Shatla I, Singh A, Patel K, Peri-Okonny P, Kennedy K, Torres N, Myadam R, Sperry B, Saeed I, Thompson R, McGhie A, Bateman T. Multimodality Imaging: Coronary Calcium Scoring And Myocardial Blood Flow Reserve To Predict Underlying Multivessel Coronary Artery Disease. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Ali H, Ehsan A, Kennedy K, Riley P, Seo A, Bajaj N, Singh A, Sellke F, Levine D, Kiernan M, Yousefzai R. The Cost and Length of Stay Associated with Biventricular Assist Devices in the United States (2009-2015). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.142] [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: 10/24/2022] Open
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18
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Rogers PL, Staruszkiewicz W, Adams A, Atienza B, Berg RJ, Chin H, DesJardins C, Gilgan M, Hansen LB, Hummer W, Jahncke M, Jester E, Kennedy K, Krzynowek J, McLachlan D, Mowdy D, Newton RT, Personeau JC, Rorberg JA, Shum G, Thomas TS, Wagner R, Whitby C, Yuen G. Gas Chromatographic Method for Putrescine and Cadaverine in Canned Tuna and Mahimahi and Fluorometric Method for Histamine (Minor Modification of AOAC Official Method 977.13): Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.591] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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]
Abstract
Abstract
A collaborative study was conducted to test a modification to the AOAC fluorometric method for histamine (AOAC® Official Method 977.13) that substitutes 75% methanol as the extracting solvent. All other steps remain unchanged. The extracts prepared with 75% methanol were also used to collaboratively test a gas chromatographic (GC) method for determination of putrescine and cadaverine in seafood. In the GC method, the extracted diamines are converted to fluorinated derivatives, the reaction mixtures are passed through solid-phase extraction columns, and the derivatives are quantitated by electron capture GC after separation on an OV-225 column. Fourteen laboratories using the GC method for putrescine and cadaverine and 16 laboratories using the fluorometric method for histamine analyzed 14 canned tuna and raw mahimahi (including blind duplicates and a spike) containing 0.2-2.6 ppm putrescine, 0.6-9.1 ppm cadaverine, and 0.6-154 ppm histamine. At the 5 ppm level, recoveries ranged from 71 to 102% for putrescine and 77 to 112% for cadaverine; the respective repeatability relative standard deviations (RSDr) were 5.2 and 15%, and the respective reproducibility relative standard deviations (RSDR) were 8.8 and 18%. At the 50 ppm level, histamine recoveries ranged from 84 to 125%, RSDr was 3.6%, and RSDR was 9.4%. The GC method for determination of putrescine in canned tuna and cadaverine in canned tuna and mahimahi has been adopted first action by AOAC INTERNATIONAL, and the AOAC Official Method 977.13, Histamine in Seafood, Fluorometric Method, has been modified
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Affiliation(s)
- Patricia L Rogers
- U.S. Food and Drug Administration, Office of Seafood, 200 C St, SW, Washington, DC 20204
| | - Walter Staruszkiewicz
- U.S. Food and Drug Administration, Office of Seafood, 200 C St, SW, Washington, DC 20204
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19
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Keighley C, Chen SCA, Marriott D, Pope A, Chapman B, Kennedy K, Bak N, Underwood N, Wilson HL, McDonald K, Darvall J, Halliday C, Kidd S, Nguyen Q, Hajkowicz K, Sorrell TC, Van Hal S, Slavin MA. Candidaemia and a risk predictive model for overall mortality: a prospective multicentre study. BMC Infect Dis 2019; 19:445. [PMID: 31113382 PMCID: PMC6528341 DOI: 10.1186/s12879-019-4065-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/02/2019] [Indexed: 01/21/2023] Open
Abstract
Background Candidaemia is associated with high mortality. Variables associated with mortality have been published previously, but not developed into a risk predictive model for mortality. We sought to describe the current epidemiology of candidaemia in Australia, analyse predictors of 30-day all-cause mortality, and develop and validate a mortality risk predictive model. Methods Adults with candidaemia were studied prospectively over 12 months at eight institutions. Clinical and laboratory variables at time of blood culture-positivity were subject to multivariate analysis for association with 30-day all-cause mortality. A predictive score for mortality was examined by area under receiver operator characteristic curves and a historical data set was used for validation. Results The median age of 133 patients with candidaemia was 62 years; 76 (57%) were male and 57 (43%) were female. Co-morbidities included underlying haematologic malignancy (n = 20; 15%), and solid organ malignancy in (n = 25; 19%); 55 (41%) were in an intensive care unit (ICU). Non-albicans Candida spp. accounted for 61% of cases (81/133). All-cause 30-day mortality was 31%. A gastrointestinal or unknown source was associated with higher overall mortality than an intravascular or urologic source (p < 0.01). A risk predictive score based on age > 65 years, ICU admission, chronic organ dysfunction, preceding surgery within 30 days, haematological malignancy, source of candidaemia and antibiotic therapy for ≥10 days stratified patients into < 20% or ≥ 20% predicted mortality. The model retained accuracy when validated against a historical dataset (n = 741). Conclusions Mortality in patients with candidaemia remains high. A simple mortality risk predictive score stratifying patients with candidaemia into < 20% and ≥ 20% 30-day mortality is presented. This model uses information available at time of candidaemia diagnosis is easy to incorporate into decision support systems. Further validation of this model is warranted. Electronic supplementary material The online version of this article (10.1186/s12879-019-4065-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia. .,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia. .,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia.
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - D Marriott
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - A Pope
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,School of Mathematics and Statistics, University of NSW, Sydney, NSW, Australia
| | - B Chapman
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - K Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - N Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - N Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - H L Wilson
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - K McDonald
- Department of Microbiology and Infectious Diseases, St. Vincent's Hospital, Sydney, NSW, Australia
| | - J Darvall
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - C Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, Darcy Rd, 3rd Level, ICPMR Building, Westmead, Sydney, New South Wales, 2145, Australia
| | - S Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Q Nguyen
- National Centre for Clinical Excellence on Emerging Drugs of Concern (NCCRED), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, Australia
| | - K Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - T C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, NSW, Australia.,Department of Infectious Diseases, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - S Van Hal
- Department of Infectious Diseases and Microbiology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, National Centre for Infections in Cancer, Melbourne, VIC, Australia
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20
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Grandin E, Gulati G, Kennedy K, Cabezas F, Birati E, Rame J, Atluri P, Pagani F, Kirklin J, Naftel D, Kormos R, Teuteberg J, Kiernan M. Post-Implant Phosphodiesterase-5 Inhibitor Use is Associated with Increased Rates of Late Right Heart Failure after LVAD: An INTERMACS Analysis. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.564] [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: 10/27/2022] Open
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21
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Heaney C, Fernandez H, Lima B, Taylor J, Vuthoori R, Navarro J, Davidson K, Jelcic Y, Majure D, Kennedy K, Stevens G, Maybaum S. Subjective Assessment Underestimates Frailty in Patients with Heart Failure Referred for Advanced Therapies. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1131] [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: 10/27/2022] Open
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22
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Navarro J, Miller E, Heaney C, Vuthoori R, Majure D, Lin K, Wang P, Kennedy K, Fernandez H, Lima B, Maybaum S. Reduction in Plasma Macrophage Migration Inhibitory Factor and Angiopoietin-2 Levels during Venoarterial Extracorporeal Membrane Oxygenation Support. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1096] [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: 11/30/2022] Open
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23
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Kennedy K, Applebaum B, Bowblis J. WILL SHE STAY OR WILL SHE GO? FACILITY-LEVEL IMPACTS ON NURSE AIDES’ RETENTION AND TURNOVER RATES IN OHIO NURSING HOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1995] [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)
- K Kennedy
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University
| | - B Applebaum
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University
| | - J Bowblis
- Department of Economics and Scripps Gerontology Center
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24
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Kennedy K, Hua C, Nelson M. MOVING BEYOND PLANS FOR EMERGENCY PREPAREDNESS: ORGANIZATIONAL RESILIENCE IN RESIDENTIAL CARE FACILITIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1323] [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: 11/14/2022] Open
Affiliation(s)
- K Kennedy
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University
| | | | - M Nelson
- Scripps Gerontology Center, Miami University
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25
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Capucilli P, Kennedy K, Kazatsky A, Cianferoni A, Spergel J. A SQUEEZABLE CASE OF ANAPHYLAXIS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Kennedy K, Ruffner M, Muir A. MULTIPHASIC TREATMENT MODALITY FOR PEDIATRIC EOSINOPHILIC GASTROENTERITIS, A SINGLE CENTER EXPERIENCE. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Cafone J, Kennedy K, Corry J, Lee J. A COMMON THERAPY FOR ALLERGIC REACTION YET A RARELY SUSPECTED CAUSE OF HYPERSENSITIVITY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.260] [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: 10/27/2022]
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28
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Sigurdson S, Biagi J, Langley H, Kennedy K, Mahmud A. Integration of Ongoing Quality Assurance Measures in Colorectal Cancer Survivorship Care Plans. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Noor Z, Goldman J, Lawler W, Melancon D, Telivala B, Braiteh F, Dicarlo B, Kennedy K, Martinez D, Adams B, Wang X, Jones B, Garon E. P2.13-39 A Phase Ib Trial of the HSP90 Inhibitor AUY922 in Combination with Pemetrexed in Metastatic Non-Squamous, Non-Small Cell Lung Cancer Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1434] [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: 10/28/2022]
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Mahony C, Vandermolen K, Otto-Bruc A, Naciff J, Kennedy K, Daston G. In vitro alternatives for assessing human safety of botanical mixtures. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.773] [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: 11/17/2022]
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Bell A, Conway N, Courtney J, Kennedy K, Raubenheimer Z, Rice N, Kevans D, Donohoe CL, Reynolds JV. Point Prevalence of Adult Intestinal Failure in Republic Of Ireland. Ir Med J 2018; 111:688. [PMID: 29952437] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parenteral Nutrition (PN) is a life-saving treatment used for patients with Intestinal Failure (IF). PN is complex and demands highly specialised care to avoid serious complications in the home setting. All tertiary centres in the Republic of Ireland (ROI) were contacted to assess the prevalence of IF requiring PN and complications, over a one year period. Sixty-seven patients were treated across 15 centres: a period prevalence of 14.6 and 9.6 patients per million for long-term PN and home PN respectively. Three-quarters of patients experienced at least one major complication with 18% mortality rate over the study period. There were 2.86 admissions per HPN patient, each lasting mean 13.4 days. One-third experienced catheter-related infections. There was a reduced length of stay during emergency re-admissions in high volume centres (mean 31 v 43 days, p=0.17). The establishment of a National Centre for IF/HPN in ROI is integral to reducing PN-associated complications.
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Affiliation(s)
- A Bell
- School of Medicine, Trinity College Dublin
| | - N Conway
- School of Medicine, Trinity College Dublin
| | - J Courtney
- School of Medicine, Trinity College Dublin
| | - K Kennedy
- School of Medicine, Trinity College Dublin
| | | | - N Rice
- Irish Society for Clinical Nutrition and Metabolism (IrSPEN)
| | - D Kevans
- Dept of Gastroenterology, St James' Hospital, Dublin 8
| | - C L Donohoe
- Dept of Surgery, St James' Hospital, Dublin 8
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Kennedy K, DeFelice M, Abraham S. P328 History of milk or soy protein intolerance in infancy in patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kinsley C, Kennedy K, Crolla A. A combined reed bed/freezing bed technology for septage treatment and reuse in cold climate regions. Water Sci Technol 2017; 76:286-293. [PMID: 28726695 DOI: 10.2166/wst.2017.189] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A combined reed bed-freezing bed (RB-FB) technology was effective at treating septage under Canadian climatic conditions over a 5-year period with average loading rates of 82-104 kg TS/m2/y. Varying hydraulic and solid loading rates as well as the increasing sludge cake with time had little to no effect on treatment efficiency, with almost complete removal of organic matter, solids, heavy metals and nutrients. Filtrate concentrations varied significantly between the freeze-thaw and growing seasons for many parameters, although the differences were not important from a treatment or reuse perspective with filtrate quality similar to a low to medium strength domestic wastewater. The potential to reuse the filtrate as a source of irrigation water will depend upon local regulations. The dewatered sludge cake consistently met biosolids land application standards in terms of pathogen and metals content, with Escherichia coli numbers declining with time as sludge cake depth increased. A combined RB-FB technology can provide a cost-effective solution for septage management in northern rural communities with potential for beneficial reuse of both the filtrate and dewatered sludge cake.
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Affiliation(s)
- C Kinsley
- Department of Civil Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario, Canada K1N 6N5 E-mail: ; Ontario Rural Wastewater Centre, Université de Guelph - Campus d'Alfred, 31 St. Paul St., Alfred, Ontario, Canada K0B1A0
| | - K Kennedy
- Department of Civil Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, Ontario, Canada K1N 6N5 E-mail:
| | - A Crolla
- Ontario Rural Wastewater Centre, Université de Guelph - Campus d'Alfred, 31 St. Paul St., Alfred, Ontario, Canada K0B1A0
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Grandin E, Mooney D, Kennedy K, Kiernan M, Kociol R, Teuteberg J, Pagani F, Gaffey A, Atluri P, Birati E, Myers S, Naftel D, Oliveira G, Simpson K, Yeh R, Kirklin J, Kormos R, Rame J. The Duration of Inotropic Support and Survival After Left Ventricular Assist Device. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Biswas C, Chen SCA, Halliday C, Kennedy K, Playford EG, Marriott DJ, Slavin MA, Sorrell TC, Sintchenko V. Identification of genetic markers of resistance to echinocandins, azoles and 5-fluorocytosine in Candida glabrata by next-generation sequencing: a feasibility study. Clin Microbiol Infect 2017; 23:676.e7-676.e10. [PMID: 28344162 DOI: 10.1016/j.cmi.2017.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/03/2017] [Accepted: 03/18/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Multi-antifungal drug resistance in Candida glabrata is increasing. We examined the feasibility of next-generation sequencing (NGS) to investigate the presence of antifungal drug resistance markers in C. glabrata. METHODS The antifungal susceptibility of 12 clinical isolates and one ATCC strain of C. glabrata was determined using the Sensititre YeastOne® YO10 assay. These included three isolate pairs where the second isolate of each pair had developed a rise in drug MICs. Single nucleotide polymorphisms (SNPs) in genes known to be linked to echinocandin, azole and 5-fluorocytosine resistance were analysed in all isolates through NGS. RESULTS High-quality non-synonymous SNPs in antifungal resistance genes such as FKS1, FKS2, CgCDR1, CgPDR1 and FCY2 were identified. For two of three isolate pairs, there was a >60-fold rise in MICs to all echinocandins in the second isolate from each pair; one echinocandin-resistant isolate harboured a mutation in FKS1 (S629P) and the other in FKS2 (S663P). Of the third pair, both the 5-fluorocytosine-susceptible, and resistant isolates had a mutation in FCY2 (A237T). SNPs in CgPDR1 were found in pan-azole-resistant isolates. SNPs in other genes linked to azole resistance (CgCDR1, ERG9 and CgFLR1) were present in both azole-susceptible and azole-resistant isolates. SNPs were also identified in Candida adhesin genes EPA1, EPA6, PWP2 and PWP5 but their presence was not associated with higher drug MICs. CONCLUSIONS Genome-wide analysis of antifungal resistance markers was feasible and simultaneously revealed mutation patterns of genes implicated in resistance to different antifungal drug classes.
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Affiliation(s)
- C Biswas
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, Australia.
| | - S C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - C Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, Australia
| | - K Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, Australia
| | - E G Playford
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
| | - D J Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, Australia
| | - M A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T C Sorrell
- Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - V Sintchenko
- Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Sydney, Australia; Centre for Infectious Diseases and Microbiology-Public Health, Westmead Hospital, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
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Wolf S, Morris J, Kennedy K, Lawn M, Mcloughlin T, Feane K, Uprichard J, Weaver A, Allard S, Green L. The impact of providing blood to the scene of an accident on transfusion laboratory practice. Transfus Med 2017; 28:56-59. [PMID: 28295747 DOI: 10.1111/tme.12397] [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: 05/08/2016] [Revised: 01/07/2017] [Accepted: 02/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Haemorrhage is the leading cause of mortality during trauma. In 2012, London's Air Ambulance introduced Blood on Board (BOB), transfusing group O red cells (RBC) to trauma patients at the scene. OBJECTIVES This study assessed the impact of BOB on the number of mixed field samples received by the laboratory, the number of group O RBC transfused to non-group O patients and the ratio of RBC to fresh frozen plasma (FFP) transfused in the initial 24 h. METHODS Three major trauma centres collected data on patients for whom the major haemorrhage protocol was activated between August 2008 and February 2012 pre-BOB and March 2012 and December 2013 post-BOB. RESULTS A total of 233 trauma patients were identified pre-BOB and 119 post-BOB. There was no significant difference in the percentage of group O units transfused to non-group O patients (75 vs 82%, P = 0·21) or the RBC : FFP ratio (pre-BOB mean 1·6 [interquartile range (IQR) 1·0-2·0]; post-BOB mean 1·7 [IQR 1·1-2·2], P = 0·24). There was no significant difference in the percentage of mixed field samples received (23% vs 27%, P = 0·3). CONCLUSION The introduction of BOB did not change the proportion of group O RBC transfused or the RBC : FFP ratio; however, the proportion of acceptable samples decreased. This is largely due to an increase in blood samples not received from the post-BOB cohort, which we believe is probably due to patients who died at the scene. We have introduced robust systems to indicate reasons for not obtaining samples.
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Affiliation(s)
- S Wolf
- Department of Hematology, Barts Health NHS Trust, London, UK
| | - J Morris
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - K Kennedy
- Department of Hematology, Barts Health NHS Trust, London, UK
| | - M Lawn
- Kings College Hospital, London, UK
| | - T Mcloughlin
- Department of Hematology, Barts Health NHS Trust, London, UK
| | - K Feane
- St George's Healthcare NHS Trust, London, UK
| | - J Uprichard
- St George's Healthcare NHS Trust, London, UK
| | - A Weaver
- Department of Hematology, Barts Health NHS Trust, London, UK
| | - S Allard
- Department of Hematology, Barts Health NHS Trust, London, UK.,NHS Blood and Transplant, London, UK
| | - L Green
- Department of Hematology, Barts Health NHS Trust, London, UK.,Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,NHS Blood and Transplant, London, UK
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Kennedy K, Cunningham-Rundles C, Morsheimer M. O011 Immunoglobulin management approaches in American patients with common variable immune deficiency and autoimmunity. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fewtrell MS, Kennedy K, Ahluwalia JS, Nicholl R, Lucas A, Burton P. Predictors of expressed breast milk volume in mothers expressing milk for their preterm infant. Arch Dis Child Fetal Neonatal Ed 2016; 101:F502-F506. [PMID: 26936878 DOI: 10.1136/archdischild-2015-308321] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 09/21/2015] [Accepted: 02/10/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND An understanding of predictors of breast milk production may enable the provision of better advice and support to mothers with preterm infants who may need to express milk for long periods. OBJECTIVE To investigate factors predicting the amount of milk expressed by mothers for their preterm infant (1) during the first 10 days and (2) during the infant's whole hospital stay. METHODS 62 mothers with preterm infants <34 weeks who participated in a randomised trial comparing two breast pumps completed 10-day diaries including weight of milk expressed and questionnaires giving their opinion of the breast pump; 47 mothers provided data on milk expression up to the infant's hospital discharge. RESULTS Significant predictors of 10-day milk weight in multivariate models were the number of episodes of 'breast feeding' (17 g (95% CI 8 to 26, p=0.001) increase per episode), the use of double versus single pumping (109 (31-186, p=0.007) g/day more) and the number of complete daily records (17 (1-33, p=0.04) g increase/day). Significant multivariate predictors of total milk production were double versus single pumping (491 (55) mL/day vs 266 (44) mL/day), expressing 500 mL/day by day 10 (525 (53) mL/day vs 232 (43) mL/day) and a higher score for breast pump 'comfort' (best=489 (39) mL/day, middle=335 (57) mL/day, worst=311 (78) mL/day). CONCLUSIONS These results suggest that relatively simple, modifiable factors can favourably impact milk production in the neonatal intensive care unit setting and emphasise the importance of double pumping, early establishment of milk production and design features of the breast pump that promote comfort. TRIAL REGISTRATION NUMBER NCT00887991.
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Affiliation(s)
- M S Fewtrell
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - K Kennedy
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - J S Ahluwalia
- Neonatal Intensive Care Unit, Addenbrookes Hospital, Cambridge, UK
| | - R Nicholl
- Neonatal Intensive Care Unit (NICU), Northwick Park Hospital, Harrow, Middlesex, UK
| | - A Lucas
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
| | - P Burton
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK
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Kennedy K, Auret K. Is parenteral chemotherapy safe in rural hospitals? A prospective audit of neutropenic fever in Albany Hospital, a regional West Australian cancer centre. Intern Med J 2016; 47:177-182. [PMID: 27753283 DOI: 10.1111/imj.13301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/11/2016] [Accepted: 10/09/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neutropenic fever is a life-threatening complication of chemotherapy. The widely dispersed population of Australia creates challenges for rural patients in accessing healthcare services. Cancer treatment is particularly, burdensome with patients being forced to relocate to the city for treatment or to endure long and repeated journeys to the city. This study aimed to assess the safety of chemotherapy in a rural centre with a general physician-led model, by analysing neutropenic fever in Albany Hospital, a regional cancer centre in Western Australia. METHODS A prospective audit of patients undergoing parenteral chemotherapy was undertaken from March 2014 to March 2015. Cases of neutropenic fever as a consequence of parenteral chemotherapy were analysed and recorded by the Albany Hospital medical registrar. RESULTS There were 1294 cycles of chemotherapy administered to 192 patients during the study period. There were 19 cases of neutropenic fever in 16 patients, meaning 8.33% of patients undergoing parenteral chemotherapy had their treatment complicated by neutropenic fever (n = 16/192). The incidence of neutropenic fever was 1.47% per cycle of chemotherapy (n = 19/1294). There were no deaths in the study period. As per guidelines, antibiotics were given within 60 min of arrival in 73.68% of cases (n = 14/19). CONCLUSIONS The rate of neutropenic fever observed was similar to rates in other centres worldwide, and the mortality rate was lower than average, with no deaths in the study population. These results provide reassurance with regards to the safe delivery of parenteral chemotherapy in this rural centre with a general physician-led model.
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Affiliation(s)
- K Kennedy
- Royal Perth Hospital, Perth, Western Australia, Australia.,Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - K Auret
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
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Lara-Pompa N, Williams J, Macdonald S, Fawbert K, Valente J, Shaw V, Kennedy K, Wells J, Hill S, Fewtrell M. MON-P147: Estimating Height in Paediatric Patients with Cystic Fibrosis: Accuracy of Tibia Length Measurements. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30781-6] [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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Abstract
HIV infection, particularly associated with AIDS, is often used by migrant screening nations to exclude entry into the country. The unique feature of the Canadian immigration HIV screening programme is that it was not primarily for determining inadmissibility of HIV-positive applicants, but for health promotion and disease prevention purposes. All applicants over 15 years of age for permanent residency or temporary residency from designated countries are HIV antibody tested. This includes persons seeking asylum from within Canada. The highest rates of HIV infection were found in migrant applicants from high prevalence areas of the world and reflected the demographic profile of the source region (predominately women). The majorities of HIV-positive persons are exempt from exclusion from Canada due to class of application (refugee, family) or are already in Canada (refugee claimant). Significant issues in notification, reporting and programme management have been identified as a consequence of this programme.
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Affiliation(s)
- M Zencovich
- Medical Services Branch, Citizenship and Immigration Canada, Ottawa, Canada.
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42
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Kennedy K. MO-C-BRB-05: Medical Physics - Adding Value in Industry. Med Phys 2016. [DOI: 10.1118/1.4957199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Noor S, Gilson A, Kennedy K, Swanson A, Vanny V, Mony K, Chaudhry T, Gollogly J. Pre-packing of cost effective antibiotic cement beads for the treatment of traumatic osteomyelitis in the developing world - an in-vitro study based in Cambodia. Injury 2016; 47:805-10. [PMID: 26899719 DOI: 10.1016/j.injury.2016.01.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 02/02/2023]
Abstract
The developing world often lacks the resources to effectively treat the most serious injuries including osteomyelitis following open fractures or surgical fracture treatment. Antibiotic cement beads are a widely accepted method of delivering antibiotics locally to the infected area following trauma. This study is based in Cambodia, a low income country struggling to recover from a recent genocide. The study aims to test the effectiveness of locally made antibiotic beads and analyse their effectiveness after being gas sterilised, packaged and kept in storage Different antibiotic beads were manufactured locally using bone cement and tested against MRSA bacteria grown from a case of osteomyelitis. Each antibiotic was tested before and after a process of gas sterilisation as well as later being tested after storage in packaging up to 42 days. The gentamicin, vancomycin, amikacin and ceftriaxone beads all inhibited growth of the MRSA on the TSB and agar plates, both before and after gas sterilisation. All four antibiotics continued to show similar zones of inhibition after 42 days of storage. The results show significant promise to produce beads with locally obtainable ingredients in an austere environment and improve cost effectiveness by storing them in a sterilised condition.
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Affiliation(s)
- S Noor
- Childrens Surgical Centre, Cambodia.
| | - A Gilson
- Childrens Surgical Centre, Cambodia
| | | | | | - V Vanny
- Childrens Surgical Centre, Cambodia
| | - K Mony
- Childrens Surgical Centre, Cambodia
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Perraton L, Machotka Z, Gibbs C, Mahar C, Kennedy K, Grimmer K. Evidence-based Practice Intentions and Long-term Behaviours of Physiotherapy Graduates Following an Intensive Education Programme. Physiother Res Int 2016; 22. [PMID: 26916106 DOI: 10.1002/pri.1666] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/21/2015] [Accepted: 08/28/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Assisting physiotherapists to implement research evidence into clinical practice is essential to ensure the quality of practice and encourage lifelong learning and professional progression. However, many physiotherapists report barriers to implementing research, and there is little evidence regarding the sustainability of intended evidence-based practice (EBP) behaviours following EBP education programmes. This paper reports on intended and actual long-term EBP behaviours of physiotherapy students who completed an intensive EBP training programme embedded within a post-graduate coursework programme. METHODS An intensive 3-week course in quantitative health research methods and EBP was delivered annually from 2007 to 2014 as part of the programme to national and international students. Following the course, students were asked about their intention of using evidence to inform their future clinical practice. An online survey was used to evaluate EBP behaviours of graduates. RESULTS Of a possible total of 202 students, contact details for 193 students were sourced, and 65 students responded to the survey (34% response rate). At course completion, 174 students (86%) indicated that they intended to use research to guide their clinical decisions at least once a week. At follow-up, most graduates reported frequently using research to inform their clinical practice; indicated by a mean score of 6.5 (±1.9) from a possible range of 0 (not at all) to 10 (all the time). On average, students reported spending 2.2 (±2.2) hours accessing and reading research evidence per week. The most common barriers to implementing evidence were lack of time, limited access to evidence sources and a perceived lack of generalizability of research findings to specific patient groups. CONCLUSION Graduates of an intensive EBP training programme embedded within an existing post-graduate physiotherapy programme regularly implemented EBP in clinical practice. Barriers to evidence implementation were time, access to research and perceived lack of generalizability of research findings. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- L Perraton
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia.,School of Exercise Science, Australian Catholic University, Melbourne, Australia
| | - Z Machotka
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia
| | - C Gibbs
- Library, University of South Australia, Adelaide, Australia
| | - C Mahar
- Library, University of South Australia, Adelaide, Australia
| | - K Kennedy
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia
| | - K Grimmer
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia
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Perraton L, Machotka Z, Grimmer K, Gibbs C, Mahar C, Kennedy K. Embedding Evidence-based Practice Education into a Post-graduate Physiotherapy Program: Eight Years of pre-Post Course Evaluations. Physiother Res Int 2016; 22. [PMID: 26892003 DOI: 10.1002/pri.1659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/28/2015] [Revised: 06/11/2015] [Accepted: 08/28/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Little has been published about the effectiveness of training postgraduate physiotherapy coursework students in research methods and evidence-based practice (EBP) theory. Graduate qualities in most universities include lifelong learning. Inclusion of EBP in post-graduate coursework students' training is one way for students to develop the knowledge and skills needed to implement current best evidence in their clinical practice after graduation, thereby facilitating lifelong learning. This paper reports on change in confidence and anxiety in knowledge of statistical terminology and concepts related to research design and EBP in eight consecutive years of post-graduate physiotherapy students at one Australian university. METHODS Pre-survey/post-survey instruments were administered to students in an intensive 3-week post-graduate course, which taught health research methods, biostatistics and EBP. This course was embedded into a post-graduate physiotherapy programme from 2007 to 2014. The organization and delivery of the course was based on best pedagogical evidence for effectively teaching adult physiotherapists. The course was first delivered each year in the programme, and no other course was delivered concurrently. RESULTS There were significant improvements in confidence, significantly decreased anxiety and improvements in knowledge of statistical terminology and concepts related to research design and EBP, at course completion. Age, gender and country of origin were not confounders on learning outcomes, although there was a (non-significant) trend that years of practice negatively impacted on learning outcomes (p = 0.09). There was a greater improvement in confidence in statistical terminology than in concepts related to research design and EBP. CONCLUSION An intensive teaching programme in health research methods and biostatistics and EBP, based on best practice adult physiotherapy learning principles, is effective immediately post-course, in decreasing anxiety and increasing confidence in the terminology used in research methods and EBP. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- L Perraton
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia, Australia.,School of Exercise Science, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Z Machotka
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia, Australia
| | - K Grimmer
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia, Australia
| | - C Gibbs
- Library, University of South Australia, Adelaide, South Australia, Australia
| | - C Mahar
- Library, University of South Australia, Adelaide, South Australia, Australia
| | - K Kennedy
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia, Australia
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Price J, Tee BC, Vig K, Shanker S, Kennedy K, Sun Z. Growth characteristics underlying the lack of a chin in pigs: a histomorphometric study. Orthod Craniofac Res 2015; 18:232-41. [PMID: 26250613 DOI: 10.1111/ocr.12101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite similar mandibular growth to that of humans, pigs lack a chin projection as shown in most humans. To understand whether this divergence is contributed to differences in local symphyseal growth, this project characterized bone modeling activities at the symphyseal surfaces of juvenile pigs. MATERIAL AND METHODS Symphyseal specimens from two age groups (4- and 6-month-old, n = 10) were processed into histological sections with and without decalcification, which were assessed for surface mineral apposition and bone resorption, respectively. In a blinded fashion, measurements of four parameters (MAR: mineral apposition rate, MAZ: mineral apposition zone, ES/BS: eroded surface and OC.N/BS: osteoclast number) were obtained and tested by a multivariate two-way mixed-model analyses of variance (manova) for the differences between symphyseal regions and ages. RESULTS Qualitatively, pig symphyseal labial and lingual surfaces were horizontally oriented and characterized by mineral apposition and bone resorption, respectively. Quantitatively, labial mineral apposition tended to be greater rostrally than caudally at 4 months, which became greater caudally than rostrally at 6 months (region/age interactions: p = 0.127 for MAR, p = 0.012 for MAZ). Lingual bone resorption tended to be greater caudally than rostrally, but only ES/BS measurements were significant (p = 0.039) regardless of age, while OC.N/BS measurements varied with ages and regions (age/region interaction, p = 0.087). CONCLUSIONS Insufficient differential in symphyseal surface modeling between the labial-caudal and labial-rostral regions contributes to the lack of chin projection in the pig.
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Affiliation(s)
- J Price
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - B C Tee
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - K Vig
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - S Shanker
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - K Kennedy
- Division of Oral and Maxillofacial Surgery, College of Dentistry, The Ohio State University, Columbus, OH, USA
| | - Z Sun
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH, USA
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Slavin M, van Hal S, Sorrell T, Lee A, Marriott D, Daveson K, Kennedy K, Hajkowicz K, Halliday C, Athan E, Bak N, Cheong E, Heath C, Orla Morrissey C, Kidd S, Beresford R, Blyth C, Korman T, Owen Robinson J, Meyer W, Chen SA. Invasive infections due to filamentous fungi other than Aspergillus: epidemiology and determinants of mortality. Clin Microbiol Infect 2015; 21:490.e1-10. [DOI: 10.1016/j.cmi.2014.12.021] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/18/2014] [Accepted: 12/30/2014] [Indexed: 11/30/2022]
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Kamala T, Devi SI, Sharma KC, Kennedy K. Phylogeny and taxonomical investigation of Trichoderma spp. from Indian region of Indo-Burma Biodiversity hot spot region with special reference to Manipur. Biomed Res Int 2015; 2015:285261. [PMID: 25699268 PMCID: PMC4324893 DOI: 10.1155/2015/285261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/14/2014] [Accepted: 11/16/2014] [Indexed: 11/18/2022]
Abstract
Towards assessing the genetic diversity and occurrence of Trichoderma species from the Indian region of Indo-Burma Biodiversity hotspot, a total of 193 Trichoderma strains were isolated from cultivated soils of nine different districts of Manipur comprising 4 different agroclimatic zones. The isolates were grouped based on the morphological characteristics. ITS-RFLP of the rDNA region using three restriction digestion enzymes: Mob1, Taq1, and Hinf1, showed interspecific variations among 65 isolates of Trichoderma. Based on ITS sequence data, a total of 22 different types of representative Trichoderma species were reported and phylogenetic analysis showed 4 well-separated main clades in which T. harzianum was found to be the most prevalent spp. among all the Trichoderma spp. Combined molecular and phenotypic data leads to the development of a taxonomy of all the 22 different Trichoderma spp., which was reported for the first time from this unique region. All these species were found to produce different extrolites and enzymes responsible for the biocontrol activities against the harmful fungal phytopathogens that hamper in food production. This potential indigenous Trichoderma spp. can be targeted for the development of suitable bioformulation against soil and seedborne pathogens in sustainable agricultural practice.
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Affiliation(s)
- Th. Kamala
- Institute of Bioresources and Sustainable Development, Ministry of Science & Technology, Government of India, Takyelpat Institutional Area, Imphal, Manipur 795001, India
| | - S. Indira Devi
- Institute of Bioresources and Sustainable Development, Ministry of Science & Technology, Government of India, Takyelpat Institutional Area, Imphal, Manipur 795001, India
| | - K. Chandradev Sharma
- Institute of Bioresources and Sustainable Development, Ministry of Science & Technology, Government of India, Takyelpat Institutional Area, Imphal, Manipur 795001, India
| | - K. Kennedy
- Institute of Bioresources and Sustainable Development, Ministry of Science & Technology, Government of India, Takyelpat Institutional Area, Imphal, Manipur 795001, India
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Ara E, Sartaj M, Kennedy K. Effect of microwave pre-treatment of thickened waste activated sludge on biogas production from co-digestion of organic fraction of municipal solid waste, thickened waste activated sludge and municipal sludge. Waste Manag Res 2014; 32:1200-1209. [PMID: 25398411 DOI: 10.1177/0734242x14554641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Anaerobic co-digestion of organic fraction of municipal solid waste, with thickened waste activated sludge and primary sludge has the potential to enhance biodegradation of solid waste, increase longevity of existing landfills and lead to more sustainable development by improving waste to energy production. This study reports on mesophilic batch and continuous studies using different concentrations and combinations (ratios) of organic fraction of municipal solid waste, thickened waste activated sludge (microwave pre-treated and untreated) and primary sludge to assess the potential for improved biodegradability and specific biogas production. Improvements in specific biogas production for batch assays, with concomitant improvements in total chemical oxygen demand and volatile solid removal, were obtained with organic fraction of municipal solid waste:thickened waste activated sludge:primary sludge mixtures at a ratio of 50:25:25 (with and without thickened waste activated sludge microwave pre-treatment). This combination was used for continuous digester studies. At 15 d hydraulic retention times, the co-digestion of organic fraction of municipal solid waste:organic fraction of municipal solid waste:primary sludge and organic fraction of municipal solid waste:thickened waste activated sludge microwave:primary sludge resulted in a 1.38- and 1.46-fold increase in biogas production and concomitant waste stabilisation when compared with thickened waste activated sludge:primary sludge (50:50) and thickened waste activated sludge microwave:primary sludge (50:50) digestion at the same hydraulic retention times and volumetric volatile solid loading rate, respectively. The digestion of organic fraction of municipal solid waste with primary sludge and thickened waste activated sludge provides beneficial effects that could be implemented at municipal wastewater treatment plants that are operating at loading rates of less than design capacity.
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Affiliation(s)
- E Ara
- Civil Engineering, University of Ottawa, ON, Canada
| | - M Sartaj
- Civil Engineering, University of Ottawa, ON, Canada
| | - K Kennedy
- Civil Engineering, University of Ottawa, ON, Canada
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Kaserzon SL, Hawker DW, Kennedy K, Bartkow M, Carter S, Booij K, Mueller JF. Characterisation and comparison of the uptake of ionizable and polar pesticides, pharmaceuticals and personal care products by POCIS and Chemcatchers. Environ Sci Process Impacts 2014; 16:2517-26. [PMID: 25208684 DOI: 10.1039/c4em00392f] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Growing concern about the environmental impact of ionizable and polar organic chemicals such as pesticides, pharmaceuticals and personal care products has lead to the inclusion of some in legislative and regulatory frameworks. It is expected that future monitoring requirements for these chemicals in aquatic environments will increase, along with the need for low cost monitoring and risk assessment strategies. In this study the uptake of 13 neutral and 6 ionizable pesticides, pharmaceuticals and personal care products by modified POCIS (with Strata™-X sorbent) and Chemcatchers™ (SDB-RPS or SDB-XC) was investigated under controlled conditions at pH = 6.5 for 26 days. The modified POCIS and Chemcatcher™ (SDB-RPS) samplers exhibited similar performance with the uptake of the majority of the 19 chemicals of interest categorised as linear over the 26 day deployment. Only a few ionized herbicides (picloram and dicamba) and triclosan showed negligible accumulation. Chemcatcher™ with SDB-XC sorbent performed relatively poorly with only carbamazepine having a linear accumulation profile, and 8 compounds showing no measurable accumulation. Differences in the uptake behavior of chemicals were not easily explained by their physico-chemical properties, strengthening the requirement for detailed calibration data. PES membranes accumulated significant amount of some compounds (i.e. triclosan and diuron), even after extended deployment (i.e. 26 days). At present there is no way to predict which compounds will demonstrate this behavior. Increasing membrane pore size from 0.2 to 0.45 μm for Chemcatcher™ (SBD-RPS) caused an average increase in Rs of 24%.
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Affiliation(s)
- S L Kaserzon
- The University of Queensland, The National Research Centre for Environmental Toxicology, 39 Kessels Rd., Coopers Plains QLD 4108, Australia.
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