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Hancox J, Ayling K, Bedford L, Vedhara K, Roberston JFR, Young B, das Nair R, Sullivan FM, Schembri S, Mair FS, Littleford R, Kendrick D. Psychological impact of lung cancer screening using a novel antibody blood test followed by imaging: the ECLS randomized controlled trial. J Public Health (Oxf) 2023; 45:e275-e284. [PMID: 35285902 PMCID: PMC10273385 DOI: 10.1093/pubmed/fdac032] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The Early CDT®-Lung antibody blood test plus serial computed tomography scans for test-positives (TPGs) reduces late-stage lung cancer presentation. This study assessed the psychological outcomes of this approach. METHODS Randomized controlled trial (n = 12 208) comparing psychological outcomes 1-12 months post-recruitment in a subsample (n = 1032) of TPG, test-negative (TNG) and control groups (CG). RESULTS Compared to TNG, TPG had lower positive affect (difference between means (DBM), 3 months (3m: -1.49 (-2.65, - 0.33)), greater impact of worries (DBM 1m: 0.26 (0.05, 0.47); 3m: 0.28 (0.07, 0.50)), screening distress (DBM 1m: 3.59 (2.28, 4.90); 3m: 2.29 (0.97, 3.61); 6m: 1.94 (0.61, 3.27)), worry about tests (odds ratio (OR) 1m: 5.79 (2.66, 12.63) and more frequent lung cancer worry (OR 1m: 2.52 (1.31, 4.83); 3m: 2.43 (1.26, 4.68); 6m: 2.87 (1.48, 5.60)). Compared to CG, TPG had greater worry about tests (OR 1m: 3.40 (1.69, 6.84)). TNG had lower negative affect (log-transformed DBM 3m: -0.08 (-0.13, -0.02)), higher positive affect (DBM 1m: 1.52 (0.43, 2.61); 3m: 1.43 (0.33, 2.53); 6m: 1.27 (0.17, 2.37)), less impact of worries (DBM 3m: -0.27 (-0.48, -0.07)) and less-frequent lung cancer worry (OR 3m: 0.49 (0.26, 0.92)). CONCLUSIONS Negative psychological effects in TPG and positive effects in TNG were short-lived and most differences were small.
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Affiliation(s)
- J Hancox
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
| | - K Ayling
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
| | - L Bedford
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - K Vedhara
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
| | - J F R Roberston
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, DE22 3DT Derby, UK
| | - B Young
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
| | - R das Nair
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, NG7 2TU Nottingham, UK
| | - F M Sullivan
- School of Medicine, University of St Andrews, KY16 9TF St Andrews, UK
| | - S Schembri
- Respiratory Medicine, NHS Tayside, DD2 1UB Dundee UK
| | - F S Mair
- Institute of Health & Wellbeing, University of Glasgow, G12 8RZ Glasgow, UK
| | - R Littleford
- Centre for Clinical Research, University of Queensland, 4072 Saint Lucia, Australia
| | - D Kendrick
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Applied Health Research Building, University Park, Nottingham, NG7 2RD
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Sung BYC, Tang EHM, Bedford L, Wong CKH, Tse ETY, Yu EYT, Cheung BMY, Lam CLK. Change in framingham cardiovascular disease risk between 2003 and 2014 in the hong kong population health survey. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Framingham Risk model estimates a person's 10-year cardiovascular disease (CVD) risk.
Purpose
We aimed to calculate the change in sex-age specific Framingham CVD risk in the Hong Kong Population Health Survey (PHS) 2014/15 in comparison with the survey in 2003–05 (PHS2003/2004 & Heart Health Survey (HHS) 2004/2005).
Methods
Subjects aged 30–74 years from PHS2014/15 (n=1,662, n=4,445,869 after population weighing) and PHS2003/2004 & HHS2004/2005 (n=818, n=3,495,074 after population weighing) with complete data for the calculation of Framingham CVD predicted risk were included. The sex-specific CVD risks of participants were calculated based on their age, total cholesterol and high-density lipoprotein, mean systolic blood pressure, smoking habits, diabetic status, and treatment for hypertension. The mean sex-age specific CVD risks were then calculated, and the differences in CVD risk between the two surveys were analysed using ANOVA.
Results
There was no significant difference in 10-year CVD risks between the 2003–2005 and 2014/15 study populations (10.2% vs. 10.6%, p=0.29). After adjusting to a standard population (US Census 2000), the age-standardized CVD risk was lower in 2014–2015 than in 2003–05 (10.0% vs. 10.7%, p=0.017). More participants aged 65–74 were classified as high risk during 2003/04 (PHS2003/2004 & HHS2004/2005: 66.8% vs. PHS2014/15: 53.1%, p=0.026). This might be due to the decrease in the proportion of smokers among men (2003–2005: 30.5% vs. 24.0% in 2014–15, p<0.001).
Conclusions
Between 2003/04 and 2014/15, there was a small decrease in age-standardized 10-year CVD risk, which might be related to the reduction in smoking. However, more effort in targeting multiple CVD risk factors simultaneously is needed to achieve a greater reduction in CVD risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Y C Sung
- The University of Hong Kong, Hong Kong, China
| | - E H M Tang
- The University of Hong Kong, Hong Kong, China
| | - L Bedford
- The University of Hong Kong, Hong Kong, China
| | - C K H Wong
- The University of Hong Kong, Hong Kong, China
| | - E T Y Tse
- The University of Hong Kong, Hong Kong, China
| | - E Y T Yu
- The University of Hong Kong, Hong Kong, China
| | | | - C L K Lam
- The University of Hong Kong, Hong Kong, China
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Bedford L, Walther J, Barthakur U, Davis A, Donickey S. PD-0888 How timely is timely when it comes to palliative radiotherapy? 14 days or is it Urgent Plus? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07167-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bedford L, Parker SE, Davis E, Salzman E, Hillier SL, Foxman B, Harlow BL. Characteristics of the vaginal microbiome in women with and without clinically confirmed vulvodynia. Am J Obstet Gynecol 2020; 223:406.e1-406.e16. [PMID: 32135142 PMCID: PMC10027365 DOI: 10.1016/j.ajog.2020.02.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/15/2020] [Accepted: 02/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vulvodynia (idiopathic vulvar pain) affects up to 8% of women by age 40 years, has a poorly understood etiology, and has variable treatment efficacy. Several risk factors are associated with vulvodynia from a history of yeast infections to depression and allergies. Recent work suggests an altered immune inflammatory mechanism plays a role in vulvodynia pathophysiology. Because the vaginal microbiome plays an important role in local immune-inflammatory responses, we evaluated the vaginal microbiome among women with vulvodynia compared with controls as 1 component of the immune system. OBJECTIVE The objective of the study was to characterize the vaginal microbiome in women with clinically confirmed vulvodynia and age-matched controls and assess its overall association with vulvodynia and how it may serve to modify other factors that are associated with vulvodynia as well. STUDY DESIGN We conducted a case-control study of 234 Minneapolis/Saint Paul-area women with clinically confirmed vulvodynia and 234 age-matched controls clinically confirmed with no history of vulvar pain. All participants provided vulvovaginal swab samples for culture-based and non-culture (sequencing)-based microbiological assessments, background and medical history questionnaires on demographic characteristics, sexual and reproductive history, and history of psychosocial factors. Vaginal microbiome diversity was assessed using the Shannon alpha diversity Index. Data were analyzed using logistic regression. RESULTS Culture and molecular-based analyses of the vaginal microbiome showed few differences between cases and controls. However, among women with alpha diversity below the median (low), there was a strong association between increasing numbers of yeast infections and vulvodynia onset, relative to comparable time periods among controls (age-adjusted odds ratio, 8.1, 95% confidence interval, 2.9-22.7 in those with 5 or more yeast infections). Also among women with low-diversity microbiomes, we observed a strong association between moderate to severe childhood abuse, antecedent anxiety, depression, and high levels of rumination and vulvodynia with odds ratios from 1.83 to 2.81. These associations were not observed in women with high-diversity microbiomes. CONCLUSION Although there were no overall differences in microbiome profiles between cases and controls, vaginal microbiome diversity influenced associations between environmental and psychosocial risk factors and vulvodynia. However, it is unclear whether vaginal diversity modifies the association between the risk factors and vulvodynia or is altered as a consequence of the associations.
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Affiliation(s)
- Lisa Bedford
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Elyse Davis
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Elizabeth Salzman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sharon L Hillier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, and the Magee-Women's Research Institute, Pittsburgh, PA
| | - Betsy Foxman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, MA.
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Owonikoko TK, Niu H, Nackaerts K, Csoszi T, Ostoros G, Mark Z, Baik C, Joy AA, Chouaid C, Jaime JC, Kolek V, Majem M, Roubec J, Santos ES, Chiang AC, Speranza G, Belani CP, Chiappori A, Patel MR, Czebe K, Byers L, Bahamon B, Li C, Sheldon-Waniga E, Kong EF, Williams M, Badola S, Shin H, Bedford L, Ecsedy JA, Bryant M, Jones S, Simmons J, Leonard EJ, Ullmann CD, Spigel DR. Randomized Phase II Study of Paclitaxel plus Alisertib versus Paclitaxel plus Placebo as Second-Line Therapy for SCLC: Primary and Correlative Biomarker Analyses. J Thorac Oncol 2019; 15:274-287. [PMID: 31655296 DOI: 10.1016/j.jtho.2019.10.013] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION We assessed the Aurora A kinase inhibitor, alisertib, plus paclitaxel (henceforth referred to as alisertib/paclitaxel) as second-line treatment for SCLC. METHODS In this double-blind study, patients with relapsed or refractory SCLC were stratified by relapse type (sensitive versus resistant or refractory) and brain metastases and randomized 1:1 to alisertib/paclitaxel or placebo plus paclitaxel (henceforth referred to as placebo/paclitaxel) in 28-day cycles. The primary end point was progression-free survival (PFS). Associations of c-Myc expression in tumor tissue (prespecified) and genetic alterations in circulating tumor DNA (retrospective) with clinical outcome were evaluated. RESULTS A total of 178 patients were enrolled (89 in each arm). The median PFS was 3.32 months with alisertib/paclitaxel versus 2.17 months with placebo/paclitaxel (hazard ratio [HR] = 0.77, 95% confidence limit [CI]: 0.557-1.067, p = 0.113 in the intent-to-treat population versus HR = 0.71, 95% CI: 0.509-0.985, p = 0.038 with corrected analysis applied). Among 140 patients with genetic alternations, patients with cell cycle regulator mutations (cyclin-dependent kinase 6 gene [CDK6], retinoblastoma-like 1 gene [RBL1], retinoblastoma-like 2 gene [RBL2], and retinoblastoma 1 gene [RB1]) had significantly improved PFS with alisertib/paclitaxel versus with placebo/paclitaxel (3.68 versus 1.80 months, respectively [HR = 0.395, 95% CI: 0.239-0.654, p = 0.0003]), and overall survival (7.20 versus 4.47 months, respectively [HR = 0.427, 95% CI: 0.259-0.704, p = 0.00085]). A subset of patients with c-Myc expression showed significantly improved PFS with alisertib/paclitaxel. The incidence of grade 3 or higher drug-related adverse events was 67% (58 patients) with alisertib/paclitaxel versus 22% (25 patients) with placebo/paclitaxel. Twelve patients (14%) versus 11 (12%) died on study, including four versus zero treatment-related deaths. CONCLUSIONS Efficacy signals were seen with alisertib/paclitaxel in relapsed or refractory SCLC. c-Myc expression and mutations in cell cycle regulators may be potential predictive biomarkers of alisertib efficacy; further prospective validations are warranted.
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Affiliation(s)
| | - Huifeng Niu
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | | | | | - Gyula Ostoros
- Orszagos Koranyi TBC es Pulmonologiai Intezet, Budapest, Hungary
| | | | - Christina Baik
- University of Washington Seattle Cancer Care Alliance, Seattle, Washington
| | - Anil Abraham Joy
- University of Alberta, Cross Cancer Institute, Edmonton, Alberta, Canada
| | | | | | | | | | - Jaromir Roubec
- Fakultni Nemocnice Ostrava, Ostrava Poruba, Czech Republic
| | - Edgardo S Santos
- Lynn Cancer Institute/Boca Raton Regional Hospital, Boca Raton, Florida
| | - Anne C Chiang
- Yale University School of Medicine, New Haven, Connecticut
| | - Giovanna Speranza
- Université de Sherbrooke, Centre intégré de cancérologie de la Montéregie, Hôpital Charles Le Moyne, Greenfield Park, Quebec City, Canada
| | | | | | - Manish R Patel
- Florida Cancer Specialists/Sarah Cannon Research Institute, Sarasota, Florida
| | | | - Lauren Byers
- Tudogyogyintezet Torokbalint, Törökbálint, Hungary
| | - Brittany Bahamon
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Cong Li
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Emily Sheldon-Waniga
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Eric F Kong
- University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Miguel Williams
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Sunita Badola
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Hyunjin Shin
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Lisa Bedford
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Jeffrey A Ecsedy
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Matthew Bryant
- University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Sian Jones
- University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - John Simmons
- University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - E Jane Leonard
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Claudio Dansky Ullmann
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
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Chakrabortty SK, Kitchen RR, Coticchia CM, Tadigotla VR, Eitan E, Castellanos-Rizaldos E, Bedford L, Badola S, Valentino MD, Colafemina N, Uchiyama H, Morken M, Williams M, Vincent S, Danaee H, Yu S, Skog J. Abstract LB-226: Exosomal liquid biopsy reveals mRNA and lincRNA biomarkers in early stage breast cancer patient plasma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-lb-226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Breast cancer is the most prevalent cancer in women, with approximately 250,000 diagnoses per year in the US. Non-invasive detection of breast cancer is of critical importance but has proven challenging due to the rate of false-positive diagnoses with current tests. Liquid biopsies including circulating tumor cells (CTCs) or cell-free DNA (cfDNA) have struggled with the detection of early stage disease. For example, a recent multi-analyte (cfDNA+protein) analysis, ‘cancerSEEK', achieved a sensitivity of just 33% in breast cancer, highlighting the challenges facing the development of more sensitive and specific diagnostics for this disease.
Exosome-based liquid biopsy is a promising approach for minimally-invasive and highly sensitive diagnostics and it has been demonstrated that combining exosomal RNA and cfDNA greatly enhances mutation detection compared to profiling cfDNA alone. While most liquid biopsies profile mutations, studying RNA abundance in exosomes adds a new dimension to these non-invasive diagnostics. To date, much of the focus on exosomal RNA expression profiling has been on the small-RNA fraction. Here we demonstrate that whole-transcriptome profiling of mRNAs and lincRNAs greatly expands the landscape of potential biomarkers to clinically actionable genes.
Results
We have developed a novel platform designed to perform long-RNA sequencing on transcripts obtained from exosomes. We used this platform to compare expression profiles of total plasma exosomes versus subpopulations enriched for breast cancer-derived exosomes (CDE) versus depleted of non-cancer exosomes (NCE). The NCE-depleted and CDE-enriched exosomes equally outperformed total plasma exosomes, each detecting significantly more genes exhibiting breast cancer vs. healthy expression differences.
We performed NCE-depletion on 1.5 mL of input plasma from 15 stage I & II ER+/Her2- breast cancer patients and 12 healthy women matched for age & menopausal-status. RNA-seq data from these samples detected over 10,000 mRNAs and over 1,000 lincRNAs. Of these, we observed significantly increased abundance in over 100 mRNAs and lincRNAs in these early stage breast cancer patients. These mRNAs are enriched for gene-sets including those previously implicated in ‘breast cancer', ‘chromatin remodeling', and ‘immune response'.
We also performed RNA-seq on formalin-fixed paraffin-embedded (FFPE) samples from healthy and matched breast cancer tissue. The >100 genes found to be more abundant in breast cancer plasma exosomes significantly (p<0.05) separate the FFPE samples into two clusters corresponding to breast cancer patients and normal individuals, lending confidence to the exosomal signature.
Conclusions
This preliminary analysis highlights the exciting potential of exosomal long RNA based liquid biopsy for non-invasive early-stage detection of breast cancer. The platform is readily applicable to other disease areas and other biofluids such as urine or CSF.
Citation Format: Sudipto K. Chakrabortty, Robert R. Kitchen, Christine M. Coticchia, Vasisht R. Tadigotla, Erez Eitan, Elena Castellanos-Rizaldos, Lisa Bedford, Sunita Badola, Michael D. Valentino, Nicholas Colafemina, Hidefumi Uchiyama, Mario Morken, Miguel Williams, Sylvie Vincent, Hadi Danaee, Seth Yu, Johan Skog. Exosomal liquid biopsy reveals mRNA and lincRNA biomarkers in early stage breast cancer patient plasma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-226.
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Affiliation(s)
| | | | | | | | | | | | - Lisa Bedford
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | - Sunita Badola
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | | | | | - Hidefumi Uchiyama
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | | | - Miguel Williams
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | - Sylvie Vincent
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | - Hadi Danaee
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | - Seth Yu
- 1ExosomeDx,Inc., Waltham, MA
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Bedford L, Aliyu S, Brown N, Cerny P, Haynes S, Thaxter R, Enoch D. Multi-disciplinary review is an effective tool in reducing Clostridium difficile infection in hospitals. J Hosp Infect 2018; 98:44-45. [DOI: 10.1016/j.jhin.2017.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 11/29/2022]
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Young B, Bedford L, Vedhara K, Nair RD, Robertson J, Kendrick D. MA 18.04 Changes in Smoking Behavior in the Early Cancer Detection Test Lung Cancer Scotland (ECLS) Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.624] [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: 11/24/2022]
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Kohler G, Sampalli T, Ryer A, Porter J, Wood L, Bedford L, Higgins-Bowser I, Edwards L, Christian E, Dunn S, Gibson R, Ryan Carson S, Vallis M, Zed J, Tugwell B, Van Zoost C, Canfield C, Rivoire E. Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes. Int J Health Policy Manag 2017; 6:661-668. [PMID: 29179292 PMCID: PMC5675584 DOI: 10.15171/ijhpm.2017.27] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/20/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice.
Methods: The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach.
Results: The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide.
Conclusion: This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.
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Affiliation(s)
- Graeme Kohler
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Tara Sampalli
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Ashley Ryer
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Judy Porter
- Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Les Wood
- Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lisa Bedford
- Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Irene Higgins-Bowser
- Diabetes Management Centre, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lynn Edwards
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Erin Christian
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Susan Dunn
- Public Engagement, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Rick Gibson
- Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Michael Vallis
- Behaviour Change Institute, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Joanna Zed
- Dalhousie Family Medicine, Halifax, NS, Canada
| | - Barna Tugwell
- Endocrinology, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Colin Van Zoost
- General Internal Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | | | - Eleanor Rivoire
- Canadian Foundation Healthcare Improvement, Ottawa, ON, Canada
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Clark M, Bedford L, Young B, Nair RD, Robertson J, Vedhara K, Kendrick D. OA 06.08 Is Lung Cancer Screening Associated with a Negative Psychological Impact? J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.360] [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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Chakrabortty SK, Bedford L, Uchiyama H, Tadigotla V, Valentino MD, Grimm D, Chan D, Badola S, Brock G, Skog J. Abstract 5686: Long RNA sequencing of human plasma exosomes reveals full coverage of diverse protein coding and long non coding RNA. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Growing research in oncology implicates exosomes in cell-to-cell communication and various cancer patho-physiologies. Vesicle-mediated signaling is thought to occur via both protein and RNA transport. However, there is a fundamental lack of understanding regarding the long RNA cargo within exosomes. Previous RNASeq studies on exosomes have largely focused on the small RNA fraction, although the clinical biomarker space remains dominated by mRNA. These studies have reported a relatively small proportion and poor transcript coverage of long RNA which has led many to conclude that exosomes only carry short fragments of mRNA and ncRNA.
To address this, we have developed a novel platform specifically designed to perform RNASeq on long RNA from exosomes to efficiently interrogate these as RNA biomarkers. Paired-end sequencing revealed the presence of a wider diversity of annotated mRNA and ncRNAs than previously recognized in exosomes. Employing our whole transcriptome unique molecular indexing strategy, we were able to accurately quantify the number of unique RNA molecules. We detected a total of over 1.4 million unique RNA molecules in our libraries, with 271,308 mapped to protein-coding regions from as little as 2 ml of plasma. We observed that even at a shallow sequencing depth (15 million read pairs), we could detect more than 10,000 genes, composed of 40,000 mRNA and 37,000 ncRNA annotated transcripts. ERCC spike-in analysis indicates that our RNASeq platform is highly sensitive, detecting as few as 8 copies of RNA. Long non-coding RNAs dominated the ncRNA classes and accounted for over 95% of all uniquely detected ncRNAs. We also observed a bimodal distribution of transcript coverage, similar to cellular and tissue derived RNA. In excess of 15,000 transcripts were detected with ≥80% coverage and of these high-coverage transcripts, more than 25% were over 1kb in length, the longest being 17.6kb. Taken together, these findings suggest exosomes harbor more than just small RNA transcripts and short fragments of mRNAs as was previously thought and is a treasure trove of RNA biomarkers.
Current research in the liquid biopsy space has been limited to variant detection in cell-free DNA and circulating tumor cells but transcriptional dysregulation is also an important feature of cancer. Our results shed new light on the biology of exosomes and indicate that, in addition to well-recognized small RNA cargo, plasma exosomes carry an abundance of long RNAs that can be interrogated by our optimized workflow. As exosomes provide a rich and protected source of RNA in biofluids, sequencing both long and small RNA from exosomes has the potential to identify biomarkers without the need for invasive tissue biopsies and allow us to have a more complete picture of how the RNA transcriptome in plasma changes in health and disease.
Citation Format: Sudipto K. Chakrabortty, Lisa Bedford, Hidefumi Uchiyama, Vasisht Tadigotla, Michael D. Valentino, Dominik Grimm, Dalin Chan, Sunita Badola, Graham Brock, Johan Skog. Long RNA sequencing of human plasma exosomes reveals full coverage of diverse protein coding and long non coding RNA [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5686. doi:10.1158/1538-7445.AM2017-5686
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Affiliation(s)
| | - Lisa Bedford
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | - Hidefumi Uchiyama
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | | | | | | | - Dalin Chan
- 1Exosome Diagnostics, Inc., Cambridge, MA
| | - Sunita Badola
- 2Takeda Pharmaceuticals International Co. Translational and Biomarker Research, Cambridge, MA
| | | | - Johan Skog
- 1Exosome Diagnostics, Inc., Cambridge, MA
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Young B, Bedford L, Kendrick D, Vedhara K, Robertson JFR, das Nair R. Factors influencing the decision to attend screening for cancer in the UK: a meta-ethnography of qualitative research. J Public Health (Oxf) 2017; 40:315-339. [DOI: 10.1093/pubmed/fdx026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 02/24/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - L Bedford
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - D Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - K Vedhara
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - J F R Robertson
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | - R das Nair
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
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Aggarwal C, Badola S, Shin H, Bedford L, Collins S, Derk B, Fostel J, Ecsedy J, Evans T, Bauml J, Cohen R, Vachani A, Langer C, Niu H. PUB140 A Pilot Study to Assess Circulating Tumor Cells, Circulating Tumor Cell DNA and Cell Free DNA in Patients with Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.2111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bahamon B, Bedford L, Li C, Xu Q, Park J, Badola S, Ecsedy J, Danaee H. Comparison of protein and mRNA immunophenotyping platforms in formalin-fixed paraffin-embedded (FFPE) non-small cell lung cancer (NSCLC) and melanoma samples. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32896-9] [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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Pai S, Bedford L, Ruramayi R, Aliyu SH, Sule J, Maslin D, Enoch DA. Pseudomonas aeruginosa meningitis/ventriculitis in a UK tertiary referral hospital. QJM 2016; 109:85-9. [PMID: 25991873 DOI: 10.1093/qjmed/hcv094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa is a rare cause of meningitis and ventriculitis but is generally associated with significant morbidity and mortality. AIM We sought to determine the epidemiology, risk factors and outcome of meningitis and ventriculitis due to P. aeruginosa at our institution in order to inform preventive strategies and treatment guidelines. METHODS Retrospective study of all patients with a positive cerebrospinal fluid (CSF) culture admitted to a tertiary care hospital over 18 years. Clinical details, demographic, microbiological and antibiotic data were obtained from laboratory and medical records. RESULTS Twenty-four episodes occurred in 21 patients over 18 years. Pyrexia (75%), fluctuating mental status (50%) and headache (41%) were the most frequent presenting symptoms. Nineteen of the 21 patients had previously undergone a neurosurgical procedure and seven had extra-ventricular devices in situ. Twelve (57%) patients had P. aeruginosa isolated from another site prior to their episode. Most (89%) CSF samples demonstrated a neutrophilia; the CSF protein, when measured, was raised in all cases. Gram-negative bacilli were visible on CSF microscopy in only three isolates. There were relatively low rates of resistance to most antimicrobials tested and combination treatment of intravenous with intrathecal antibiotics was often used. No patients died within 28 days. CONCLUSION Pseudomonas aeruginosa meningitis and ventriculitis are predominantly nosocomial and related to prior neurosurgery. It can be difficult to diagnose as CSF Gram-film and meningism are insensitive markers. Appropriate empirical treatment, neurosurgical prophylaxis and surveillance can aid in managing this infection.
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Affiliation(s)
- S Pai
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - L Bedford
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - R Ruramayi
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - S H Aliyu
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - J Sule
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - D Maslin
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
| | - D A Enoch
- From the Cambridge Laboratory, Public Health England, Clinical Microbiology & Public Health Laboratory, Box 236, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0QW, UK
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Sampalli T, Edwards L, Christian E, Kohler G, Bedford L, Demmons J, Verma J, Gibson R, Carson SR. A Patient-Centred Redesign Framework to Support System-Level Process Changes for Multimorbidities and Chronic Conditions. Healthc Q 2015; 18:34-42. [PMID: 26718252 DOI: 10.12927/hcq.2015.24433] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Recent trends show an increase in the prevalence and costs associated with managing individuals with multimorbidities. Enabling better care for these individuals requires system-level changes such as the shift from a focus on a single disease or single service to multimorbidities and integrated systems of care. In this paper, a novel patient-centred redesign framework that was developed to support system-level process changes in four service areas has been discussed. The novelty of this framework is that it is embedded in patient perspectives and in the chronic care model as the theoretical foundation. The aims of this paper are to present an application of the framework in the context of four chronic disease prevention and management services, and to discuss early results from the pilot initiative along with an overview of the spread opportunities for this initiative.
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Affiliation(s)
- Tara Sampalli
- Assistant director of quality, research and knowledge management in primary healthcare, Nova Scotia Health Authority, Halifax, Nova Scotia. She is also assistant professor in the Department of Medical Informatics at Dalhousie University, in Halifax, Nova Scotia
| | - Lynn Edwards
- Senior Director responsible for primary healthcare and chronic disease management at Nova Scotia Health Authority, Halifax, Nova Scotia (previously known as Capital District Health Authority)
| | - Erin Christian
- project lead in primary health care at Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Graeme Kohler
- Health services manager in primary healthcare at Nova Scotia Health Authority, Halifax, Nova Scotia(previously know as Capital District Health Authority)
| | - Lisa Bedford
- Executive Training for Research Application (EXTRA) Fellow, is a health services manager in primary healthcare at Nova Scotia Health Authority, in Halifax, Nova Scotia
| | - Jillian Demmons
- Program Coordinator for The INSPIRED COPD Outreach ProgramTM at Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Jennifer Verma
- Senior Director, Collaboration for Innovation and Improvement at the Canadian Foundation for Healthcare Improvement, Canada
| | - Rick Gibson
- Family physician and chief of the Department of Family Practice at Nova Scotia Health Authority, Halifax, Nova Scotia
| | - Shannon Ryan Carson
- Executive Training for Research Application (EXTRA) fellow, is a health services manager in primary healthcare at Nova Scotia Health Authority, Halifax, Nova Scotia (previously known as Capital District Health Authority)
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Bedford L, Fonseka S, Boren T, Ranallo RT, Suvarnapunya AE, Lee JE, Barnoy S, Venkatesan MM. Further characterization of Shigella sonnei live vaccine candidates WRSs2 and WRSs3-plasmid composition, invasion assays and Sereny reactions. Gut Microbes 2012; 2:244-51. [PMID: 21983066 DOI: 10.4161/gmic.2.4.17042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Lisa Bedford
- Division of Bacterial & Rickettsial Diseases, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Rogers N, Paine S, Bedford L, Layfield R. Review: the ubiquitin-proteasome system: contributions to cell death or survival in neurodegeneration. Neuropathol Appl Neurobiol 2010; 36:113-24. [PMID: 20202119 DOI: 10.1111/j.1365-2990.2010.01063.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The significance of the accumulation of ubiquitin-positive intraneuronal inclusions in the brains of those affected with different neurodegenerative diseases is currently unclear. While one interpretation is that the disease mechanism(s) involves dysfunction of an ubiquitin-mediated process, such as the ubiquitin-proteasome system, the inclusions are also found in surviving neurones, suggesting a possible neuroprotective role. Here we review recent evidence in support of these seemingly opposing notions gleaned from cell and animal models as well as investigations of patient samples, with particular emphasis on studies relevant to Parkinson's disease.
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Affiliation(s)
- N Rogers
- School of Biomedical Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
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Rezvani Z, Bedford L, Mayer R. P2.018 Recapitulation of neurodegenerative disease and apoptotic neuronal cell death caused by 26S proteasome dysfunction. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70369-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Watson WH, Bedford L, Chabot CC. Rhythms of locomotion expressed by Limulus polyphemus, the American horseshoe crab: II. Relationship to circadian rhythms of visual sensitivity. Biol Bull 2008; 215:46-56. [PMID: 18723636 DOI: 10.2307/25470682] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In the laboratory, horseshoe crabs express a circadian rhythm of visual sensitivity as well as daily and circatidal rhythms of locomotion. The major goal of this investigation was to determine whether the circadian clock underlying changes in visual sensitivity also modulates locomotion. To address this question, we developed a method for simultaneously recording changes in visual sensitivity and locomotion. Although every animal (24) expressed consistent circadian rhythms of visual sensitivity, rhythms of locomotion were more variable: 44% expressed a tidal rhythm, 28% were most active at night, and the rest lacked statistically significant rhythms. When exposed to artificial tides, 8 of 16 animals expressed circatidal rhythms of locomotion that continued after tidal cycles were stopped. However, rhythms of visual sensitivity remained stable and showed no tendency to be influenced by the imposed tides or locomotor activity. These results indicate that horseshoe crabs possess at least two biological clocks: one circadian clock primarily used for modulating visual sensitivity, and one or more clocks that control patterns of locomotion. This arrangement allows horseshoe crabs to see quite well while mating during both daytime and nighttime high tides.
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Affiliation(s)
- Winsor H Watson
- Zoology Department, University of New Hampshire, Durham, New Hampshire 03824, USA.
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Rothschild BM, Hershkovitz I, Bedford L, Latimer B, Dutour O, Rothschild C, Jellema LM. Identification of childhood arthritis in archaeological material: juvenile rheumatoid arthritis versus juvenile spondyloarthropathy. Am J Phys Anthropol 1997; 102:249-64. [PMID: 9066903 DOI: 10.1002/(sici)1096-8644(199702)102:2<249::aid-ajpa7>3.0.co;2-t] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The opportunity to examine the defleshed skeleton of an individual diagnosed in life (Hamann-Todd collection, individual 2036) afforded a unique opportunity to demonstrate the bone damage characteristic of at least one form of juvenile rheumatoid arthritis (JRA). Characteristics helpful for recognition of JRA in archaeological material include peripheral articular marginal and subchondral erosions, axial (e.g., zygapophyseal or sacroiliac) joint erosions, fusion of axial (cervical zygapophyseal) and/or peripheral joints, premature epiphyseal closure and/or ballooned epiphyses, growth retardation with underdeveloped (short and overtubulated) long bones, short mandibular rami with underdeveloped condyles and concomitant micrognathia, and demineralization (osteopenia). Distinguishing between JRA and juvenile spondyloarthropathy, however, is not always possible, as illustrated by this case.
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Affiliation(s)
- B M Rothschild
- Arthritis Center of Northeast Ohio, Youngstown 44512, USA
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Raine AE, Bedford L, Simpson AW, Ashley CC, Brown R, Woodhead JS, Ledingham JG. Hyperparathyroidism, platelet intracellular free calcium and hypertension in chronic renal failure. Kidney Int 1993; 43:700-5. [PMID: 8455369 DOI: 10.1038/ki.1993.100] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To investigate possible relationships between hyperparathyroidism, alterations in intracellular free calcium concentration ([Ca2+]i) and hypertension in chronic renal failure, serum concentrations of intact parathyroid hormone (PTH) were measured by two-site immunometric assay, and platelet ([Ca2+]i) was assessed using the fluorescent indicator fura-2. Thirty-six patients with chronic renal failure were studied, 10 with normal serum PTH concentrations (mean 8.0 +/- 0.6 pmol/liter), 17 with elevated serum PTH (35.0 +/- 7.2 pmol/liter) and 9 patients with elevated PTH (36.2 +/- 5.9 pmol/liter) who were receiving nifedipine. Platelet [Ca2+]i was increased in patients with elevated PTH, compared with those in whom PTH was normal (138 +/- 16 vs. 83 +/- 7 nmol/liter, P < 0.01). A linear relation was observed between serum PTH and platelet [Ca2+]i in these patients (r = 0.818, P < 0.001). In contrast, platelet [Ca2+]i was not elevated (84 +/- 9 nmol/liter) in the patients with elevated PTH who were receiving nifedipine. A linear relation was also present between both serum PTH (r = 0.616, P < 0.001) and platelet [Ca2+]i (r = 0.576, P < 0.005) and mean blood pressure. Nine patients with hyperparathyroidism were restudied after treatment with the vitamin D analogue alfacalcidol. This resulted in significant decreases in serum PTH (P < 0.01), platelet [Ca2+]i (P < 0.02), and mean blood pressure (P < 0.05). These studies indicate that [Ca2+]i may be increased early in renal failure, and that this increase occurs in association with both hyperparathyroidism and hypertension. Furthermore, treatment of hyperparathyroidism with alfacalcidol may result in reductions in both [Ca2+]i and blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A E Raine
- Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, England, United Kingdom
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Bedford L. The electron microscopy and cytochemistry of oogenesis and the cytochemistry of embryonic development of the prosobranch gastropod Bembicium nanum L. J Embryol Exp Morphol 1966; 15:15-37. [PMID: 5915169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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