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Vesco KK, Denoble AE, Lipkind HS, Kharbanda EO, DeSilva MB, Daley MF, Getahun D, Zerbo O, Naleway AL, Jackson L, Williams JTB, Boyce TG, Fuller CC, Weintraub ES, Vazquez-Benitez G. Obstetric Complications and Birth Outcomes After Antenatal Coronavirus Disease 2019 (COVID-19) Vaccination. Obstet Gynecol 2024:00006250-990000000-01060. [PMID: 38626447 DOI: 10.1097/aog.0000000000005583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/07/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE To evaluate the association between antenatal messenger RNA (mRNA) coronavirus disease 2019 (COVID-19) vaccination and risk of adverse pregnancy outcomes. METHODS This was a retrospective cohort study of individuals with singleton pregnancies with live deliveries between June 1, 2021, and January 31, 2022, with data available from eight integrated health care systems in the Vaccine Safety Datalink. Vaccine exposure was defined as receipt of one or two mRNA COVID-19 vaccine doses (primary series) during pregnancy. Outcomes were preterm birth (PTB) before 37 weeks of gestation, small-for-gestational age (SGA) neonates, gestational diabetes mellitus (GDM), gestational hypertension, and preeclampsia-eclampsia-HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Outcomes in individuals vaccinated were compared with those in propensity-matched individuals with unexposed pregnancies. Adjusted hazard ratios (aHRs) and 95% CIs were estimated for PTB and SGA using a time-dependent covariate Cox model, and adjusted relative risks (aRRs) were estimated for GDM, gestational hypertension, and preeclampsia-eclampsia-HELLP syndrome using Poisson regression with robust variance. RESULTS Among 55,591 individuals eligible for inclusion, 23,517 (42.3%) received one or two mRNA COVID-19 vaccine doses during pregnancy. Receipt of mRNA COVID-19 vaccination varied by maternal age, race, Hispanic ethnicity, and history of COVID-19. Compared with no vaccination, mRNA COVID-19 vaccination was associated with a decreased risk of PTB (rate: 6.4 [vaccinated] vs 7.7 [unvaccinated] per 100, aHR 0.89; 95% CI, 0.83-0.94). Messenger RNA COVID-19 vaccination was not associated with SGA (8.3 vs 7.4 per 100; aHR 1.06, 95% CI, 0.99-1.13), GDM (11.9 vs 10.6 per 100; aRR 1.00, 95% CI, 0.90-1.10), gestational hypertension (10.8 vs 9.9 per 100; aRR 1.08, 95% CI, 0.96-1.22), or preeclampsia-eclampsia-HELLP syndrome (8.9 vs 8.4 per 100; aRR 1.10, 95% CI, 0.97-1.24). CONCLUSION Receipt of an mRNA COVID-19 vaccine during pregnancy was not associated with an increased risk of adverse pregnancy outcomes; this information will be helpful for patients and clinicians when considering COVID-19 vaccination in pregnancy.
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Affiliation(s)
- Kimberly K Vesco
- Kaiser Permanente Center for Health Research, Portland, Oregon; the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut; the Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York; HealthPartners Institute, Bloomington, Minnesota; the Institute for Health Research, Kaiser Permanente Colorado, and Ambulatory Care Services, Denver Health, Denver, Colorado; Kaiser Permanente Southern California, Pasadena, and the Kaiser Permanente Vaccine Study Center, Oakland, California; the Kaiser Permanente Washington Health Research Institute, Seattle, Washington; the Marshfield Clinic Research Institute, Marshfield, Wisconsin; the Harvard Pilgrim Health Care Institute, Boston, Massachusetts; and the Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Buhumaid R, Otaki F, Czabanowska K, Stanley A, Ezimokhai M, Jackson L, Ho SB. Professionalism-training in undergraduate medical education in a multi-cultural, multi-ethnic setting in the Gulf Region: an exploration of reflective essays. BMC Med Educ 2024; 24:117. [PMID: 38321450 PMCID: PMC10848390 DOI: 10.1186/s12909-024-05103-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/27/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Despite the established need to prioritize professionalism-training in developing future physicians, very few medical programs in the Gulf Region embed in their curricula discrete contextualized courses aimed at developing the corresponding competencies, while fostering self-directed learning. This study aims at exploring the perception of undergraduate medical students in a multi-cultural, multi-ethnic setting regarding their understanding of, and personal experience with professionalism through their engagement with the content of an innovative curriculum-based professionalism course, offered at a Medical School in Dubai, United Arab Emirates. METHODS The study used a qualitative phenomenological research design. Out of 33 students, 29 students had submitted reflective essays. The content of these essays was inductively analyzed following a six-step framework for conducting thematic analysis. The framework's steps include familiarizing oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. FINDINGS The inductive qualitative analysis generated the Professionalism Learning Journey model. This conceptual model includes four interconnected themes: Awareness, Acknowledgement, Realization, and Application. The generated model depicts the trajectory that the learners appear to experience while they are engaging with the content of the course. CONCLUSION Integrating a professionalism-training course into an undergraduate medical curriculum is likely to be positively appraised by the learners. It raises their awareness, enables them to value the subject matter and the sophistication of its application, and empowers them to put into practice the taught principles, on an individual basis and collectively. This is especially true when the course is entrenched in constructivism experiential learning theory and designed to foster self-directed learning. The introduced conceptual model, in conjunction with the innovative professionalism-training course curriculum, can serve as a template for other competencies and other schools.
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Affiliation(s)
- Rasha Buhumaid
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates.
| | - Farah Otaki
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Department of Health Policy Management, Faculty of Health Care, Institute of Public Health, Jagiellonian University, Kraków, Poland
| | - Adrian Stanley
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Mutairu Ezimokhai
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Lisa Jackson
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Samuel B Ho
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
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Benamer HT, Alsuwaidi L, Khan N, Jackson L, Lakshmanan J, Ho SB, Kellett C, Alsheikh-Ali A, Stanley AG. Clinical learning environments across two different healthcare settings using the undergraduate clinical education environment measure. BMC Med Educ 2023; 23:495. [PMID: 37407987 DOI: 10.1186/s12909-023-04467-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The clinical placements of our medical students are almost equally distributed across private and public sectors. This study aims to assess medical students' perceptions of their Clinical learning Environment (CLE) across these two different healthcare settings, using the Undergraduate Clinical Education Environment Measure (UCEEM). METHODS 76 undergraduate medical students (Year 5 and 6), were invited to participate. Data were collected using an online UCEEM with additional questions related to demographics and case load exposure. The UCEEM consists of two overarching domains of experiential learning and social participation, with four subdomains of learning opportunities, preparedness, workplace interaction, and inclusion. RESULTS 38 questionnaires were received. Of 225 responses to the individual UCEEM items, 51 (22.6%) scored a mean of ≥ 4 (range 4-4.5, representing strong areas), 31 (13.7%) scored a mean of ≤ 3 (range 2.1-3, needing attention) and 143 (63.6%) scored a mean of 3.1-3.9 (areas that could be improved). The majority (63%) of the case load exposure responses scored a mean of ≥ 4 (range 4-4.5). Compared to the private sittings, there is a significant reduction in total UCEEM (p = 0.008), preparedness for student entry (p = 0.003), and overarching dimension of social participation (p = 0.000) scores for the public sector. Similarly, both workplace interaction patterns and student inclusion and equal treatment scored significantly lower for the public sector (p = 0.000 and p = 0.011 respectively). Two out of three case load exposure items scored significantly higher for the public sector (p = 0.000). DISCUSSION The students' CLE perceptions were generally positive. The lower UCEEM ratings in the public sector items were related to student entry preparedness, workplace interactions, student inclusiveness and workforce equity of treatment. In contrast the students were exposed to more variety and larger number of patients in the public sector. These differences indicated some significantly different learning environments between the two sectors.
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Affiliation(s)
- Hani Ts Benamer
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Building 14, Dubai Healthcare City, Dubai, PO Box 505055, UAE.
| | - Laila Alsuwaidi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Building 14, Dubai Healthcare City, Dubai, PO Box 505055, UAE
| | - Nusrat Khan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Building 14, Dubai Healthcare City, Dubai, PO Box 505055, UAE
| | - Lisa Jackson
- Brunel Medical School, College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Jeyaseelan Lakshmanan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Building 14, Dubai Healthcare City, Dubai, PO Box 505055, UAE
| | - Samuel B Ho
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Building 14, Dubai Healthcare City, Dubai, PO Box 505055, UAE
| | - Catherine Kellett
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Building 14, Dubai Healthcare City, Dubai, PO Box 505055, UAE
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Building 14, Dubai Healthcare City, Dubai, PO Box 505055, UAE
| | - Adrian G Stanley
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, United Arab Emirates Building 14, Dubai Healthcare City, Dubai, PO Box 505055, UAE
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Jackson L, Otaki F. Using team-based learning to optimize undergraduate family medicine clerkship training: mixed methods study. BMC Med Educ 2023; 23:422. [PMID: 37291523 DOI: 10.1186/s12909-023-04240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 04/07/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Team-Based Learning (TBL) is an established educational strategy which has become increasingly popular in the training of healthcare professionals. TBL is highly suitable for teaching Family Medicine (FM) especially that teamwork and collaborative care, in this medical discipline, are at the core of safe and effective practice. Despite the established suitability of TBL for teaching FM, there are no empirical studies that capture the students' perception of a TBL in FM undergraduate learning experience in the Middle East and North Africa region (MENA). OBJECTIVE The overall objective of this study was to investigate the perception of students regarding a TBL in FM intervention (in Dubai, United Arab Emirates), that was designed and implemented in alignment with a constructivist learning theory. METHODS A convergent mixed methods study design was utilized to develop a thorough understanding of the students' perceptions. Qualitative and quantitative data were concurrently collected and independently analyzed. The output of thematic analysis was systematically merged with the quantitative descriptive and inferential findings using the iterative joint display process. RESULTS The qualitative findings shed light on the students' perception of TBL in FM, and the interplay between team cohesion and engagement with the course. As for the quantitative findings, they showed that the percentage of the total average of the Satisfaction with TBL in FM score was 88.80%. As for change in impression of FM discipline, the percentage of the total average was 83.10%. The perception of team cohesion, with a mean of agreement of 8.62(1.34), seemed to be significantly associated with the students' perception of the team test phase component, only (P < 0.05). As for the perception of the level of engagement with the course, with a mean of agreement of 9.29(0.84), it turned out to be significantly associated with the change in impression of FM discipline (P < 0.05). Lastly, the joint display analysis showed how the quantitative and qualitative findings built upon each other, revealing how best to leverage TBL in FM trainings. CONCLUSION The current study showed that TBL embedded in a FM clinical clerkship was well-received by students. It is worth leveraging the lessons learned from the first-hand experience reported upon in the current study to optimize the utilization of TBL in FM.
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Affiliation(s)
- Lisa Jackson
- College of Health Medicine and Life Sciences (CHMLS), Brunel Medical School, London, UK.
| | - Farah Otaki
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Greenberg V, Vazquez-Benitez G, Kharbanda EO, Daley MF, Fu Tseng H, Klein NP, Naleway AL, Williams JTB, Donahue J, Jackson L, Weintraub E, Lipkind H, DeSilva MB. Tdap vaccination during pregnancy and risk of chorioamnionitis and related infant outcomes. Vaccine 2023; 41:3429-3435. [PMID: 37117057 PMCID: PMC10466272 DOI: 10.1016/j.vaccine.2023.04.043] [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: 01/12/2023] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION An increased risk of chorioamnionitis in people receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy has been reported. The importance of this association is unclear as additional study has not demonstrated increased adverse infant outcomes associated with Tdap vaccination in pregnancy. METHODS We conducted a retrospective observational cohort study of pregnant people ages 15-49 years with singleton pregnancies ending in live birth who were members of 8 Vaccine Safety Datalink (VSD) sites during October 2016-September 2018. We used a time-dependent covariate Cox model with stabilized inverse probability weights applied to evaluate associations between Tdap vaccination during pregnancy and chorioamnionitis and preterm birth outcomes. We used Poisson regression with robust variance with stabilized inverse probability weights applied to evaluate the association of Tdap vaccination with adverse infant outcomes. We performed medical record reviews on a random sample of patients with ICD-10-CM-diagnosed chorioamnionitis to determine positive predictive values (PPV) of coded chorioamnionitisfor "probable clinical chorioamnionitis," "possible clinical chorioamnionitis," or "histologic chorioamnionitis." RESULTS We included 118,211 pregnant people; 103,258 (87%) received Tdap vaccine during pregnancy; 8098 (7%) were diagnosed with chorioamnionitis. The adjusted hazard ratio for chorioamnionitis in the Tdap vaccine-exposed group compared to unexposed was 0.96 (95% CI 0.90-1.03). There was no association between Tdap vaccine and preterm birth or adverse infant outcomes associated with chorioamnionitis. Chart reviews were performed for 528 pregnant people with chorioamnionitis. The PPV for clinical (probable or possible clinical chorioamnionitis) was 48% and 59% for histologic chorioamnionitis. The PPV for the combined outcome of clinical or histologic chorioamnionitis was 81%. CONCLUSIONS AND RELEVANCE Tdap vaccine exposure during pregnancy was not associated with chorioamnionitis, preterm birth, or adverse infant outcomes. ICD-10 codes for chorioamnionitis lack specificity for clinical chorioamnionitis and should be a recognized limitation when interpreting results.
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Affiliation(s)
| | | | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Hung Fu Tseng
- Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
| | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States
| | | | - James Donahue
- Marshfield Clinic, Research Institute, Marshfield, WI, United States
| | - Lisa Jackson
- Kaiser Permanente Washington, Seattle, WA, United States
| | - Eric Weintraub
- Immunization Safety Office, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
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Branche A, Rouphael N, Diemert D, Falsey A, Losada C, Baden LR, Frey S, Whitaker J, Little S, Anderson E, Walter E, Novak R, Rupp R, Jackson L, Babu T, Kottkamp A, Luetkemeyer A, Immergluck L, Presti R, Backer M, Winokur P, Mahgoub S, Goepfert P, Fusco D, Malkin E, Bethony J, Walsh E, Graciaa D, Samaha H, Sherman A, Walsh S, Abate G, Oikonomopoulou Z, El Sahly H, Martin T, Kamidani S, Smith M, Ladner B, Porterfield L, Dunstan M, Wald A, Davis T, Atmar R, Mulligan M, Lyke K, Posavad C, Meagher M, Stephens D, Neuzil K, Abebe K, Hill H, Albert J, Telu K, Mu J, Lewis T, Giebeig L, Eaton A, Netzl A, Wilks S, Tureli S, Makhene M, Crandon S, Montefiori D, Makowski M, Smith D, Nayak S, Roberts P, Beigel J. Bivalent and Monovalent SARS-CoV-2 Variant Vaccine Boosters Improve coverage of the known Antigenic Landscape: Results of the COVID-19 Variant Immunologic Landscape (COVAIL) Trial. Res Sq 2023:rs.3.rs-2653179. [PMID: 37205592 PMCID: PMC10187423 DOI: 10.21203/rs.3.rs-2653179/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Vaccine protection against COVID-19 wanes over time and has been impacted by the emergence of new variants with increasing escape of neutralization. The COVID-19 Variant Immunologic Landscape (COVAIL) randomized clinical trial (clinicaltrials.gov NCT05289037) compares the breadth, magnitude and durability of antibody responses induced by a second COVID-19 vaccine boost with mRNA (Moderna mRNA-1273 and Pfizer-BioNTech BNT162b2), or adjuvanted recombinant protein (Sanofi CoV2 preS DTM-AS03) monovalent or bivalent vaccine candidates targeting ancestral and variant SARS-CoV-2 spike antigens (Beta, Delta and Omicron BA.1). We found that boosting with a variant strain is not associated with loss in neutralization against the ancestral strain. However, while variant vaccines compared to the prototype/wildtype vaccines demonstrated higher neutralizing activity against Omicron BA.1 and BA.4/5 subvariants for up to 3 months after vaccination, neutralizing activity was lower for more recent Omicron subvariants. Our study, incorporating both antigenic distances and serologic landscapes, can provide a framework for objectively guiding decisions for future vaccine updates.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Susan Little
- Department of Medicine, University of California, San Diego, CA 92903
| | | | | | | | | | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | | | | | | | | | | | - Paul Goepfert
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham
| | | | | | | | | | - Daniel Graciaa
- Department of Medicine, Emory University School of Medicine
| | | | | | | | | | | | | | | | - Satoshi Kamidani
- Center for Childhood Infections and Vaccines (CCIV) of Children's Healthcare of Atlanta and Emory University Department of Pediatrics
| | | | | | | | | | | | | | | | | | - Kirsten Lyke
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine
| | - Christine Posavad
- Department of Laboratory Medicine and Pathology, University of Washington
| | | | | | | | | | | | | | | | | | - Teri Lewis
- 29. Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research
| | - Lisa Giebeig
- 29. Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research
| | | | | | - Sam Wilks
- Centre for Pathogen Evolution, Department of Zoology, University of Cambridge
| | | | - Mamodikoe Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
| | - Sonja Crandon
- Division of Microbiology and Infectious Diseases, NIAID, NIH
| | | | | | | | - Seema Nayak
- Division of Microbiology and Infectious Diseases, NIAID, NIH
| | - Paul Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
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Chavtur C, Staubus WJ, Ho M, Hergott DEB, Seilie AM, Healy S, Duffy P, Jackson L, Talley A, Kappe SHI, Hoffman SL, Richie TL, Kublin JG, Chang M, Murphy SC. Plasmodium 18S Ribosomal RNA Biomarker Clearance After Food and Drug Administration-Approved Antimalarial Treatment in Controlled Human Malaria Infection Trials. Open Forum Infect Dis 2023; 10:ofad202. [PMID: 37265668 PMCID: PMC10230565 DOI: 10.1093/ofid/ofad202] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023] Open
Abstract
Background Sensitive molecular assays, such as quantitative reverse-transcription polymerase chain reaction (qRT-PCR) of Plasmodium 18S ribosomal RNA (rRNA), are increasingly the primary method of detecting infections in controlled human malaria infection (CHMI) trials. However, thick blood smears (TBSs) remain the main method for confirming clearance of parasites after curative treatment, in part owing to uncertainty regarding biomarker clearance rates. Methods For this analysis, 18S rRNA qRT-PCR data were compiled from 127 Plasmodium falciparum-infected participants treated with chloroquine or atovaquone-proguanil in 6 CHMI studies conducted in Seattle, Washington, over the past decade. A survival analysis approach was used to compare biomarker and TBS clearance times among studies. The effect of the parasite density at which treatment was initiated on clearance time was estimated using linear regression. Results The median time to biomarker clearance was 3 days (interquartile range, 3-5 days), while the median time to TBS clearance was 1 day (1-2 days). Time to biomarker clearance increased with the parasite density at which treatment was initiated. Parasite density did not have a significant effect on TBS clearance. Conclusions The Plasmodium 18S rRNA biomarker clears quickly and can be relied on to confirm the adequacy of Food and Drug Administration-approved treatments in CHMI studies at nonendemic sites.
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Affiliation(s)
- Chris Chavtur
- Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Weston J Staubus
- Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Mabel Ho
- Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Dianna E B Hergott
- Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Annette M Seilie
- Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sara Healy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Patrick Duffy
- Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - Stefan H I Kappe
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | | | | | - James G Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Ming Chang
- Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Sean C Murphy
- Malaria Molecular Diagnostic Laboratory, Department of Laboratory Medicine and Pathology and Center for Emerging and Re-emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Seattle Malaria Clinical Trials Center, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Microbiology, University of Washington, Seattle, Washington, USA
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington, USA
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Magnetta D, Jackson L, Zeevi A, Turnquist H, Miller S, West S, Murtagh G, Feingold B. High Sensitivity Troponin-I is Associated with Acute Rejection in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.068] [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: 04/05/2023] Open
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Herman GA, O'Brien MP, Forleo-Neto E, Sarkar N, Isa F, Hou P, Chan KC, Bar KJ, Barnabas RV, Barouch DH, Cohen MS, Hurt CB, Burwen DR, Marovich MA, Musser BJ, Davis JD, Turner KC, Mahmood A, Hooper AT, Hamilton JD, Parrino J, Subramaniam D, Baum A, Kyratsous CA, DiCioccio AT, Stahl N, Braunstein N, Yancopoulos GD, Weinreich DM, Chani A, Adepoju A, Mahmood A, Mortagy A, Dupljak A, Baum A, Brown A, Froment A, Hooper A, Margiotta A, Bombardier A, Islam A, Smith A, Dhillon A, McMillian A, Breazna A, Aslam A, Carpentino B, Kowal B, Siliverstein B, Horel B, Zhu B, Musser B, Bush B, Head B, Snow B, Zhu B, Debray C, Phillips C, Simiele C, Lee C, Nienstedt C, Trbovic C, Chan C(KC, Elliott C, Fish C, Ni C, Polidori C, Enciso C, Caira C, Powell C, Kyratsous CA, Baum C, McDonald C, Leigh C, Pan C, Wolken D, Manganello D, Liu D, Stein D, Weinreich DM, Hassan D, Gulabani D, Fix D, Leonard D, Sarda D, Bonhomme D, Kennedy D, Darcy D, Barron D, Hughes D, Rofail D, Kaur D, Ramesh D, Bianco D, Cohen D, Forleo-Neto E, Jean-Baptiste E, Bukhari E, Doyle E, Bucknam E, Labriola-Tomkins E, Nanna E, Huffman O'Keefe E, Gasparino E, Fung E, Isa F, To FY, Herman G, Yancopoulos GD, Bellingham G, Sumner G, Moggan G, Power G, Zeng H, Mariveles H, Gonzalez H, Kang H, Noor H, Minns I, Heirman I, Peszek I, Donohue J, Rusconi J, Austin J, Parrino J, Yo J, McDonnell J, Hamilton JD, Boarder J, Wei J, Yu J, Malia J, Tucciarone J, Tyler-Gale J, Davis JD, Strein J, Cohen J, Meyer J, Ursino J, Im J, Tramaglini J, Wolken J, Potter K, Scacalossi K, Naidu K, Browning K, Rutkowski K, Yau K, Woloshin K, Lewis-Amezcua K, Turner K, Dornheim K, Chiu K, Mohan K, McGuire K, Macci K, Ringleben K, Mohammadi K, Foster K, Knighton L, Lipsich L, Darling L, Boersma L, Cowen L, Hersh L, Jackson L, Purcell L, Sherpinsky L, Lai L, Faria L, Geissler L, Boppert L, Fiske L, Dickens M, Mancini M, Leigh MC, O'Brien MP, Batchelder M, Klinger M, Partridge M, Tarabocchia M, Wong M, Rodriguez M, Albizem M, O'Byrne M, Braunstein N, Sarkar N, Stahl N, Deitz N, Memblatt N, Shah N, Kumar N, Herrera O, Adedoyin O, Yellin O, Snodgrass P, Floody P, D'Ambrosio P, Gao P(X, Hou P, Hearld P, Li Q, Kitchenoff R, Ali R, Iyer R, Chava R, Alaj R, Pedraza R, Hamlin R, Hosain R, Gorawala R, White R, Yu R, Fogarty R, Dass SB, Bollini S, Ganguly S, DeCicco S, Patel S, Cassimaty S, Somersan-Karakaya S, McCarthy S, Henkel S, Ali S, Geila Shapiro S, Kim S, Nossoughi S, Bisulco S, Elkin S, Long S, Sivapalasingam S, Irvin S, Wilt S, Min T, Constant T, Devins T, DiCioccio T, Norton T, Bernardo T, Chuang TC, Wei V(J, Nuce V, Battini V, Caldwell W, Gao X, Chen X, Tian Y, Khan Y, Zhao Y, Kim Y, Dye B, Hurt CB, Burwen DR, Barouch DH, Burns D, Brown E, Bar KJ, Marovich M, Clement M, Cohen MS, Sista N, Barnabas RV, Zwerski S. Efficacy and safety of a single dose of casirivimab and imdevimab for the prevention of COVID-19 over an 8-month period: a randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2022; 22:1444-1454. [PMID: 35803290 PMCID: PMC9255947 DOI: 10.1016/s1473-3099(22)00416-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is an unmet need for COVID-19 prevention in patient populations who have not mounted or are not expected to mount an adequate immune response to complete COVID-19 vaccination. We previously reported that a single subcutaneous 1200 mg dose of the monoclonal antibody combination casirivimab and imdevimab (CAS + IMD) prevented symptomatic SARS-CoV-2 infections by 81·4% in generally healthy household contacts of SARS-CoV-2-infected individuals over a 1-month efficacy assessment period. Here we present additional results, including the 7-month follow-up period (months 2-8), providing additional insights about the potential for efficacy in pre-exposure prophylaxis settings. METHODS This was a randomised, double-blind, placebo-controlled trial done in the USA, Romania, and Moldova in 2020-2021, before the emergence of omicron (B.1.1.529) and omicron-lineage variants. Uninfected and unvaccinated household contacts of infected individuals, judged by the investigator to be in good health, were randomly assigned (1:1) to receive 1200 mg CAS + IMD or placebo by subcutaneous injection according to a central randomisation scheme provided by an interactive web response system; randomisation was stratified per site by the test results of a local diagnostic assay for SARS-CoV-2 and age group at baseline. COVID-19 vaccines were prohibited before randomisation, but participants were allowed to receive COVID-19 vaccination during the follow-up period. Participants who developed COVID-19 symptoms during the follow-up period underwent RT-PCR testing. Prespecified endpoints included the proportion of previously uninfected and baseline-seronegative participants (seronegative-modified full analysis set) who had RT-PCR-confirmed COVID-19 in the follow-up period (post-hoc for the timepoints of months 2-5 and 6-8 only) and underwent seroconversion (ie, became seropositive, considered a proxy for any SARS-CoV-2 infections [symptomatic and asymptomatic]; prespecified up to day 57, post-hoc for all timepoints thereafter). We also assessed the incidence of treatment-emergent adverse events. This study is registered with ClinicalTrials.gov, NCT04452318. FINDINGS From July 13, 2020, to Oct 4, 2021, 2317 participants who were RT-PCR-negative for SARS-CoV-2 were randomly assigned, of whom 1683 (841 assigned to CAS + IMD and 842 assigned to placebo) were seronegative at baseline. During the entirety of the 8-month study, CAS + IMD reduced the risk of COVID-19 by 81·2% (nominal p<0·0001) versus placebo (prespecified analysis). During the 7-month follow-up period, protection was greatest during months 2-5, with a 100% relative risk reduction in COVID-19 (nominal p<0·0001; post-hoc analysis). Efficacy waned during months 6-8 (post-hoc analysis). Seroconversion occurred in 38 (4·5%) of 841 participants in the CAS + IMD group and in 181 (21·5%) of 842 in the placebo group during the 8-month study (79·0% relative risk reduction vs placebo; nominal p<0·0001). Six participants in the placebo group were hospitalised due to COVID-19 versus none who received CAS + IMD. Serious treatment-emergent adverse events (including COVID-19) were reported in 24 (1·7%) of 1439 participants receiving CAS + IMD and in 23 (1·6%) of 1428 receiving placebo. Five deaths were reported, none of which were due to COVID-19 or related to the study drugs. INTERPRETATION CAS + IMD is not authorised in any US region as of Jan 24, 2022, because data show that CAS + IMD is not active against omicron-lineage variants. In this study, done before the emergence of omicron-lineage variants, a single subcutaneous 1200 mg dose of CAS + IMD protected against COVID-19 for up to 5 months of community exposure to susceptible strains of SARS-CoV-2 in the pre-exposure prophylaxis setting, in addition to the post-exposure prophylaxis setting that was previously shown. FUNDING Regeneron Pharmaceuticals, F Hoffmann-La Roche, US National Institute of Allergy and Infectious Diseases, US National Institutes of Health.
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Wang G, Stapleton JT, Baker AW, Rouphael N, Creech CB, El Sahly HM, Stout JE, Jackson L, Charbek E, Leyva FJ, Tomashek KM, Tibbals M, Miller A, Frey S, Niemotka S, Wiemken TL, Beydoun N, Alaaeddine G, Turner N, Walter EB, Chamberland R, Abate G. Clinical features and treatment outcomes of pulmonary Mycobacterium avium-intracellulare complex with and without co-infections. Open Forum Infect Dis 2022; 9:ofac375. [PMID: 35959208 PMCID: PMC9361173 DOI: 10.1093/ofid/ofac375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022] Open
Abstract
Coinfections are more common in patients with cystic fibrosis and bronchiectasis. Infiltrates on imaging studies are seen more commonly in patients with coinfections, but coinfections did not affect treatment outcomes of pulmonary Mycobacterium avium complex.
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Affiliation(s)
- Grace Wang
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Jack T Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Arthur W Baker
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Nadine Rouphael
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hana M El Sahly
- Baylor College of Medicine, Human Vaccine Institute, Houston, Texas, USA
| | - Jason E Stout
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Edward Charbek
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Francisco J Leyva
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Kay M Tomashek
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Melinda Tibbals
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Aaron Miller
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Sharon Frey
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Samson Niemotka
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Timothy L Wiemken
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Nour Beydoun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ghina Alaaeddine
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nicholas Turner
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Robin Chamberland
- Department of Pathology, Division of Clinical Pathology, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Getahun Abate
- Correspondence: Getahun Abate, MD, PhD, Department of Internal Medicine, Saint Louis University, 1100 S Grand Blvd, Saint Louis, MO 63104, USA ()
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Jackson L, Mcneeley E, Techarukpong NC, Mugeta F, Aaron K, Mudano A, Merchant J, Warren K, Foster J, Saag K, Danila M. POS1147 CHALLENGES IN CONDUCTING PRAGMATIC CARE STRATEGY STUDIES IN OSTEOPOROSIS: PATIENT PERCEPTIONS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLarge pragmatic osteoporosis studies to improve outcomes are needed. Direct-to-patient studies have highest generalizability but achieving sufficient sample size is difficult; recruitment challenges represent an important consideration given limited participant eligibility and interest. The Fracture Liaison Service (FLS), a team approach to post-fracture care, is a secondary fracture prevention method that has significantly improved outcomes internationally.ObjectivesOur goal was to evaluate the interest, barriers, and lessons learned in recruiting participants for a future trial assessing remote FLS approaches for post-fracture care.MethodsWe used ICD10 fracture codes to identify patients > 50 years of age with a documented hip/pelvis, spine, humerus, or wrist fracture in the previous 1 year. We excluded patients with i) prescriptions for osteoporosis medications (e.g., bisphosphonates, parathyroid hormone analogs, denosumab, romosozumab, raloxifene) in the prior 1 year; ii) an ICD10 code for end-stage renal disease, non-osteoporotic metabolic bone disease, malignant neoplasm, or motor vehicle accident. In December 2021, research assistants reviewed electronic health records (EHR) of potentially eligible patients for evidence of additional serious illness limiting life expectancy to < 1 year or non-ambulatory status prior to fracture. Research assistants called preliminary eligible patients that met inclusion and exclusion criteria and asked them to complete a survey by phone. Interest in a FLS future clinical trial was evaluated using a Likert scale (1=“Definitely would not volunteer”, to 5=“Definitely would volunteer”). We used descriptive statistics to analyze baseline demographic, clinical characteristics, and interest. This pilot was approved by the UAB Institutional Review Board (IRB-300008310-005).ResultsWe identified 1,577 patients > 50 years of age with a fracture. After applying exclusion criteria, we identified 869 preliminary eligible patients. Over 3 weeks, we screened the medical records of a random sample of half of the preliminary eligible patient cohort (n=414), of whom we contacted 271 patients determined potentially eligible, and successfully reached 141 (52% of those contacted) by phone. A total of 108 (77% of those reached) persons, mean (SD) age 69.5 (11.5) years, 40% men, 21% Black or non-white Hispanics completed the survey. Among those contacted, 68 (63%, interest rate) said they would be very or highly interested in participating in a future clinical trial evaluating FLS approaches. Among the 40 (37%) people who said they were not sure, unlikely or very unlikely to volunteer the most common reasons cited were “I don’t want to participate in a study” (33%); “I don’t feel well enough to participate” (10%); “I don’t understand what the study is for” (3%). From this pilot, we calculated a refined eligibility/interest rate of 9.1% among those patients preliminarily identified as eligible using administrative data alone.ConclusionBased on our pilot, we estimate that approximately 9% of eligible patients with fractures will be interested in enrolling in a future comparative effectiveness study to prevent recurrent fragility fractures. We identified several potential modifiable barriers to clinical trial recruitment. Patient perceptions collected from this pilot will inform enrollment strategies, which can be incorporated early when planning direct-to-patient pragmatic osteoporosis studies to achieve recruitment goals.Disclosure of InterestsLesley Jackson: None declared, Ellen McNeeley: None declared, Norma C. Techarukpong: None declared, Faith Mugeta: None declared, Kiara Aaron: None declared, Amy Mudano: None declared, Jeanne Merchant: None declared, Kellie Warren: None declared, Jeff Foster: None declared, Kenneth Saag Grant/research support from: Amgen, Horizon, LG Chem, Radius, SOBI, Maria Danila Grant/research support from: Pfizer, Horizon
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Yokose C, Mccormick N, Lu N, Joshi A, Jackson L, Kohler M, Yinh J, Zhang Y, Saag K, Choi H. POS1171 TRIPLE THE RATE OF EMERGENCY ROOM VISITS AND HOSPITALIZATIONS FOR GOUT AMONG US BLACKS VS WHITES – 2019 NATIONWIDE ANALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGout is a highly prevalent inflammatory arthritis with increasing global disease burden in recent years.1,2 Gout prevalence has been reported to be higher among Blacks compared to Whites,3 and that they are less likely to receive allopurinol in outpatient care.4 The potential nationwide impact of these racial disparities on emergency department (ED) visits and hospitalizations is unknown.ObjectivesTo examine the contemporary racial disparities in ED visits and hospitalizations with a primary discharge diagnosis of gout in the US (2019).MethodsWe compared ED visits and hospitalizations between Blacks and Whites in the latest data (2019) from the US National Emergency Department Sample (NEDS) and National Inpatient Sample (NIS). We focused on encounters for which the primary diagnosis was gout based on ICD codes (M1A.xx, M10.xx). We calculated annual population rates of ED visits and hospitalizations for gout (per 100,000 US adults) using the 2019 US census adult population (>18 years) according to race.ResultsThere were a total of 160,759 ED visits and 9,560 hospitalizations among White and Blacks with a gout diagnosis in the US in 2019. The mean age (58.2 years vs. 56.5 years) and male proportion (78.0% vs. 74.8%) tended to be higher among Whites, while more Blacks tended to live in the South (40.7% vs. 66.5%) and reported a median household income of < $50,000 (30.7% vs. 57.1%). Compared to Whites, Blacks had 2.7- and 3.2-fold higher rates of gout ED visits and hospitalizations, respectively, after adjusting for age, sex, payer, region, and household income (Table 1 & Figure 1). Black women, in particular, had 3.4- and 4.0-fold higher rates of ED visits and hospitalizations compared to White women, while the corresponding rate ratios for men were 2.5 and 2.8, respectively. The mean costs per gout ED visit were similar for Blacks compared to Whites (adjusted difference, -$7.6 [95% CI, -25.4 to 1.0]), while hospitalizations were more costly (adjusted difference, $1,055.3 [95% CI, 553.1 to 1557.5]). The duration of ED visits and hospitalizations was also higher among Blacks than Whites (adjusted difference of 0.41 days [95% CI, 0.19 to 0.63] and 0.59 days [95% CI, 0.25 to 0.94], respectively).Table 1.Racial Disparities in Emergency Department Visits and Hospitalizations with Primary Diagnosis of Gout in 2019Emergency Department VisitsHospitalizationsRaceWhiteBlackWhiteBlackAll6801196524521330198510434519150Visits, N888107194962003360Rate per 100,000130.6293.431.274.4Rate Ratio (95% CI)*1.0 (ref)2.81 (2.63, 3.00)1.0 (ref)3.08 (2.79, 3.40)Rate Ratio (95% CI)**1.0 (ref)2.66 (2.50, 2.82)1.0 (ref)3.17 (2.86, 3.50)Women3785136914363031110390932647105Visits, N195671816317701145Rate per 100,00051.7126.516.043.3Rate Ratio (95% CI)*1.0 (ref)3.68 (3.39, 3.99)1.0 (ref)4.01 (3.40, 4.73)Rate Ratio (95% CI)**1.0 (ref)3.36 (3.11, 3.62)1.0 (ref)4.02 (3.39, 4.78)Men301561011015657388098151871620Visits, N692285378344302215Rate per 100,000229.6529.550.3118.3Rate Ratio (95% CI)*1.0 (ref)2.59 (2.42, 2.78)1.0 (ref)2.66 (2.36, 3.00)Rate Ratio (95% CI)**1.0 (ref)2.47 (2.32, 2.64)1.0 (ref)2.77 (2.45, 3.14)*Adjusted for age and sex for all, adjusted for age for sex-specific rate ratios**Adjusted for age, sex, payment, region, and household incomeConclusionThese latest national data indicate that ED visits and hospitalization due to gout are both 3 times higher among Blacks than Whites; this disparity was particularly prominent among women with gout. Higher risk of developing gout3 and suboptimal care4 both translate to these avoidable costly healthcare utilizations, calling for improved primary prevention and gout care.References[1]Safiri et al., PMID 32755051[2]Xia et al., PMID 31624843[3]Chen-Xu et al., PMID 30618180[4]Krishnan et al., PMID 18260174Disclosure of InterestsChio Yokose: None declared, Natalie McCormick: None declared, Na Lu: None declared, Amit Joshi: None declared, Lesley Jackson: None declared, Minna Kohler Speakers bureau: Lilly, Consultant of: Mymee, Novartis, Grant/research support from: Setpoint Medical, Janeth Yinh: None declared, Yuqing Zhang: None declared, Kenneth Saag Consultant of: Arthrosi, Atom Bioscience, Horizon Therapeutics, LG Pharma, Mallinkrodt, SOBI, Takeda, Grant/research support from: Horizon Therapeutics, SOBI, Shanton, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, and Vaxart, Grant/research support from: Ironwood and Horizon
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Anderson E, Jackson L, Rouphael N, Widge A, Montefiori D, Doria-Rose N, Suthar M, Cohen K, O'Connell S, Makowski M, Makhene M, Buchanan W, Spearman P, Creech CB, O'Dell S, Schmidt S, Leav B, Bennett H, Pajon R, Posavad C, Hural J, Beigel J, Albert J, Abebe K, Eaton A, Rostad C, Rebolledo P, Kamidani S, Graciaa D, Coler R, McDermott A, Ledgerwood J, Mascola J, DeRosa S, Neuzil K, McElrath MJ, Roberts P. Safety and Immunogenicity of a Third Dose of SARS-CoV-2 mRNA Vaccine - An Interim Analysis. Res Sq 2022:rs.3.rs-1222037. [PMID: 35547849 PMCID: PMC9094107 DOI: 10.21203/rs.3.rs-1222037/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Waning immunity after two SARS-CoV-2 mRNA vaccinations and the emergence of variants precipitated the need for a third dose of vaccine. We evaluated early safety and immunogenicity after a third mRNA vaccination in adults who received the mRNA-1273 primary series in the Phase 1 trial approximately 9 to 10 months earlier. The booster vaccine formulations included 100 mcg of mRNA-1273, 50 mcg of mRNA-1273.351 that encodes Beta variant spike protein, and bivalent vaccine of 25 mcg each of mRNA-1273 and mRNA-1273.351. A third dose of mRNA vaccine appeared safe with acceptable reactogenicity. Vaccination induced rapid increases in binding and neutralizing antibody titers to D614G, Beta, and Delta variants that were similar or greater than peak responses after the second dose. Spike-specific CD4+ and CD8+ T cells increased to similar levels as after the second dose. A third mRNA vaccination was well tolerated and generated robust humoral and T cell responses. ClinicalTrials.gov numbers NCT04283461 (mRNA-1273 Phase 1) and NCT04785144 (mRNA-1273.351 Phase 1).
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Affiliation(s)
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute
| | | | - Alicia Widge
- National Institute of Allergy and Infectious Diseases/Vaccine Research Center
| | | | | | | | | | - Sarah O'Connell
- Vaccine Research Center (VRC), National Institute of Allergy and Infectious Diseases (NIAID), NIH
| | | | - Mamodikoe Makhene
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
| | - Wendy Buchanan
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
| | | | | | | | | | | | | | | | - Christine Posavad
- Department of Laboratory Medicine and Pathology, University of Washington
| | | | | | | | | | | | | | | | - Satoshi Kamidani
- Center for Childhood Infections and Vaccines (CCIV) of Children's Healthcare of Atlanta and Emory University Department of Pediatrics
| | - Daniel Graciaa
- Department of Medicine, Emory University School of Medicine
| | - Rhea Coler
- Center for Global Infectious Disease Research (CGIDR), Seattle Children's Research Institute
| | | | | | - John Mascola
- National Institute of Allergy and Infectious Diseases
| | - Stephen DeRosa
- Fred Hutchinson Cancer Research Center and the University of Washington
| | | | | | - Paul Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH)
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15
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Pegu A, O’Connell SE, Schmidt SD, O’Dell S, Talana CA, Lai L, Albert J, Anderson E, Bennett H, Corbett KS, Flach B, Jackson L, Leav B, Ledgerwood JE, Luke CJ, Makowski M, Nason MC, Roberts PC, Roederer M, Rebolledo PA, Rostad CA, Rouphael NG, Shi W, Wang L, Widge AT, Yang ES, Beigel JH, Graham BS, Mascola JR, Suthar MS, McDermott AB, Doria-Rose NA. Durability of mRNA-1273 vaccine-induced antibodies against SARS-CoV-2 variants. Science 2021; 373:1372-1377. [PMID: 34385356 PMCID: PMC8691522 DOI: 10.1126/science.abj4176] [Citation(s) in RCA: 353] [Impact Index Per Article: 117.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations may diminish vaccine-induced protective immune responses, particularly as antibody titers wane over time. Here, we assess the effect of SARS-CoV-2 variants B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), B.1.429 (Epsilon), B.1.526 (Iota), and B.1.617.2 (Delta) on binding, neutralizing, and angiotensin-converting enzyme 2 (ACE2)–competing antibodies elicited by the messenger RNA (mRNA) vaccine mRNA-1273 over 7 months. Cross-reactive neutralizing responses were rare after a single dose. At the peak of response to the second vaccine dose, all individuals had responses to all variants. Binding and functional antibodies against variants persisted in most subjects, albeit at low levels, for 6 months after the primary series of the mRNA-1273 vaccine. Across all assays, B.1.351 had the lowest antibody recognition. These data complement ongoing studies to inform the potential need for additional boost vaccinations.
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Affiliation(s)
- Amarendra Pegu
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sarah E. O’Connell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Stephen D. Schmidt
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sijy O’Dell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Chloe A. Talana
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lilin Lai
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | - Evan Anderson
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | - Kizzmekia S. Corbett
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Britta Flach
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | | | - Julie E. Ledgerwood
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Catherine J. Luke
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Martha C. Nason
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Paul C. Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mario Roederer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Paulina A. Rebolledo
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Decatur, GA 30030, USA
| | - Christina A. Rostad
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nadine G. Rouphael
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Decatur, GA 30030, USA
| | - Wei Shi
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lingshu Wang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alicia T. Widge
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Eun Sung Yang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - The mRNA-1273 Study Group§
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
- Emmes Company, Rockville, MD 20850, USA
- Moderna, Inc., Cambridge, MA 02139, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
- Hope Clinic, Department of Medicine, Emory University School of Medicine, Decatur, GA 30030, USA
| | - John H. Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Barney S. Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - John R. Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mehul S. Suthar
- Department of Pediatrics, Division of Infectious Disease, Emory Vaccine Center, Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Adrian B. McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nicole A. Doria-Rose
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Razzaghi H, Meghani M, Pingali C, Crane B, Naleway A, Weintraub E, Kenigsberg TA, Lamias MJ, Irving SA, Kauffman TL, Vesco KK, Daley MF, DeSilva M, Donahue J, Getahun D, Glenn S, Hambidge SJ, Jackson L, Lipkind HS, Nelson J, Zerbo O, Oduyebo T, Singleton JA, Patel SA. COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy - Eight Integrated Health Care Organizations, United States, December 14, 2020-May 8, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:895-899. [PMID: 34138834 PMCID: PMC8220952 DOI: 10.15585/mmwr.mm7024e2] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
COVID-19 vaccines are critical for ending the COVID-19 pandemic; however, current data about vaccination coverage and safety in pregnant women are limited. Pregnant women are at increased risk for severe illness and death from COVID-19 compared with nonpregnant women of reproductive age, and are at risk for adverse pregnancy outcomes, such as preterm birth (1-4). Pregnant women are eligible for and can receive any of the three COVID-19 vaccines available in the United States via Emergency Use Authorization.* Data from Vaccine Safety Datalink (VSD), a collaboration between CDC and multiple integrated health systems, were analyzed to assess receipt of ≥1 dose (first or second dose of the Pfizer-BioNTech or Moderna vaccines or a single dose of the Janssen [Johnson & Johnson] vaccine) of any COVID-19 vaccine during pregnancy, receipt of first dose of a 2-dose COVID-19 vaccine (initiation), or completion of a 1- or 2-dose COVID-19 vaccination series. During December 14, 2020-May 8, 2021, a total of 135,968 pregnant women were identified, 22,197 (16.3%) of whom had received ≥1 dose of a vaccine during pregnancy. Among these 135,968 women, 7,154 (5.3%) had initiated and 15,043 (11.1%) had completed vaccination during pregnancy. Receipt of ≥1 dose of COVID-19 vaccine during pregnancy was highest among women aged 35-49 years (22.7%) and lowest among those aged 18-24 years (5.5%), and higher among non-Hispanic Asian (Asian) (24.7%) and non-Hispanic White (White) women (19.7%) than among Hispanic (11.9%) and non-Hispanic Black (Black) women (6.0%). Vaccination coverage increased among all racial and ethnic groups over the analytic period, likely because of increased eligibility for vaccination† and increased availability of vaccine over time. These findings indicate the need for improved outreach to and engagement with pregnant women, especially those from racial and ethnic minority groups who might be at higher risk for severe health outcomes because of COVID-19 (4). In addition, providing accurate and timely information about COVID-19 vaccination to health care providers, pregnant women, and women of reproductive age can improve vaccine confidence and coverage by ensuring optimal shared clinical decision-making.
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Pegu A, O’Connell S, Schmidt SD, O’Dell S, Talana CA, Lai L, Albert J, Anderson E, Bennett H, Corbett KS, Flach B, Jackson L, Leav B, Ledgerwood JE, Luke CJ, Makowski M, Roberts PC, Roederer M, Rebolledo PA, Rostad CA, Rouphael NG, Shi W, Wang L, Widge AT, Yang ES, Beigel JH, Graham BS, Mascola JR, Suthar MS, McDermott A, Doria-Rose NA. Durability of mRNA-1273-induced antibodies against SARS-CoV-2 variants. bioRxiv 2021:2021.05.13.444010. [PMID: 34031659 PMCID: PMC8142657 DOI: 10.1101/2021.05.13.444010] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
SARS-CoV-2 mutations may diminish vaccine-induced protective immune responses, and the durability of such responses has not been previously reported. Here, we present a comprehensive assessment of the impact of variants B.1.1.7, B.1.351, P.1, B.1.429, and B.1.526 on binding, neutralizing, and ACE2-blocking antibodies elicited by the vaccine mRNA-1273 over seven months. Cross-reactive neutralizing responses were rare after a single dose of mRNA-1273. At the peak of response to the second dose, all subjects had robust responses to all variants. Binding and functional antibodies against variants persisted in most subjects, albeit at low levels, for 6 months after the primary series of mRNA-1273. Across all assays, B.1.351 had the greatest impact on antibody recognition, and B.1.1.7 the least. These data complement ongoing studies of clinical protection to inform the potential need for additional boost vaccinations. ONE-SENTENCE SUMMARY Most mRNA-1273 vaccinated individuals maintained binding and functional antibodies against SARS-CoV-2 variants for 6 months.
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Affiliation(s)
- Amarendra Pegu
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Sarah O’Connell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Stephen D Schmidt
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Sijy O’Dell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Chloe A. Talana
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Lilin Lai
- Department of Medicine, Center for Childhood Infections and Vaccines (CCIV) of Children’s Healthcare of Atlanta, Emory Vaccine Center, and Emory University Department of Pediatrics, Emory University School of Medicine; Atlanta, GA, USA
| | | | - Evan Anderson
- Department of Medicine, Center for Childhood Infections and Vaccines (CCIV) of Children’s Healthcare of Atlanta, Emory Vaccine Center, and Emory University Department of Pediatrics, Emory University School of Medicine; Atlanta, GA, USA
| | | | - Kizzmekia S. Corbett
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Britta Flach
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute; Seattle, WA, USA
| | | | - Julie E. Ledgerwood
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Catherine J. Luke
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda, MD, USA
| | | | - Paul C. Roberts
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda, MD, USA
| | - Mario Roederer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Paulina A. Rebolledo
- Hope Clinic, Department of Medicine, Emory University School of Medicine; Decatur, GA, USA
| | - Christina A. Rostad
- Department of Medicine, Center for Childhood Infections and Vaccines (CCIV) of Children’s Healthcare of Atlanta, Emory Vaccine Center, and Emory University Department of Pediatrics, Emory University School of Medicine; Atlanta, GA, USA
| | - Nadine G. Rouphael
- Hope Clinic, Department of Medicine, Emory University School of Medicine; Decatur, GA, USA
| | - Wei Shi
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Lingshu Wang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Alicia T. Widge
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Eun Sung Yang
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | | | - John H. Beigel
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda, MD, USA
| | - Barney S. Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - John R Mascola
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Mehul S. Suthar
- Department of Medicine, Center for Childhood Infections and Vaccines (CCIV) of Children’s Healthcare of Atlanta, Emory Vaccine Center, and Emory University Department of Pediatrics, Emory University School of Medicine; Atlanta, GA, USA
| | - Adrian McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
| | - Nicole A. Doria-Rose
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Bethesda MD, USA
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Nair A, Jalal R, Liu J, Tsang T, McDonald NM, Jackson L, Ponting C, Jeste SS, Bookheimer SY, Dapretto M. Altered Thalamocortical Connectivity in 6-Week-Old Infants at High Familial Risk for Autism Spectrum Disorder. Cereb Cortex 2021; 31:4191-4205. [PMID: 33866373 DOI: 10.1093/cercor/bhab078] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/07/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022] Open
Abstract
Converging evidence from neuroimaging studies has revealed altered connectivity in cortical-subcortical networks in youth and adults with autism spectrum disorder (ASD). Comparatively little is known about the development of cortical-subcortical connectivity in infancy, before the emergence of overt ASD symptomatology. Here, we examined early functional and structural connectivity of thalamocortical networks in infants at high familial risk for ASD (HR) and low-risk controls (LR). Resting-state functional connectivity and diffusion tensor imaging data were acquired in 52 6-week-old infants. Functional connectivity was examined between 6 cortical seeds-prefrontal, motor, somatosensory, temporal, parietal, and occipital regions-and bilateral thalamus. We found significant thalamic-prefrontal underconnectivity, as well as thalamic-occipital and thalamic-motor overconnectivity in HR infants, relative to LR infants. Subsequent structural connectivity analyses also revealed atypical white matter integrity in thalamic-occipital tracts in HR infants, compared with LR infants. Notably, aberrant connectivity indices at 6 weeks predicted atypical social development between 9 and 36 months of age, as assessed with eye-tracking and diagnostic measures. These findings indicate that thalamocortical connectivity is disrupted at both the functional and structural level in HR infants as early as 6 weeks of age, providing a possible early marker of risk for ASD.
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Affiliation(s)
- Aarti Nair
- Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, CA 92354, USA
| | - Rhideeta Jalal
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90095, USA
| | - Janelle Liu
- Interdepartmental Neuroscience Program, University of California, Los Angeles, CA 90095, USA
| | - Tawny Tsang
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - Nicole M McDonald
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90095, USA
| | - Lisa Jackson
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90095, USA
| | - Carolyn Ponting
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
| | - Shafali S Jeste
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90095, USA
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90095, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90095, USA
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Abate G, Stapleton JT, Rouphael N, Creech B, Stout JE, El Sahly HM, Jackson L, Leyva FJ, Tomashek KM, Tibbals M, Watson N, Miller A, Charbek E, Siegner J, Sokol-Anderson M, Nayak R, Dahlberg G, Winokur P, Alaaeddine G, Beydoun N, Sokolow K, Kown NP, Phillips S, Baker AW, Turner N, Walter E, Guy E, Frey S. Variability in the Management of Adults With Pulmonary Nontuberculous Mycobacterial Disease. Clin Infect Dis 2021; 72:1127-1137. [PMID: 32198521 PMCID: PMC8028102 DOI: 10.1093/cid/ciaa252] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/10/2019] [Accepted: 03/09/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The increasing global prevalence of pulmonary nontuberculous mycobacteria (NTM) disease has called attention to challenges in NTM diagnosis and management. This study was conducted to understand management and outcomes of patients with pulmonary NTM disease at diverse centers across the United States. METHODS We conducted a 10-year (2005-2015) retrospective study at 7 Vaccine and Treatment Evaluation Units to evaluate pulmonary NTM treatment outcomes in human immunodeficiency virus-negative adults. Demographic and clinical information was abstracted through medical record review. Microbiologic and clinical cure were evaluated using previously defined criteria. RESULTS Of 297 patients diagnosed with pulmonary NTM, the most frequent NTM species were Mycobacterium avium-intracellulare complex (83.2%), M. kansasii (7.7%), and M. abscessus (3.4%). Two hundred forty-five (82.5%) patients received treatment, while 45 (15.2%) were followed without treatment. Eighty-six patients had available drug susceptibility results; of these, >40% exhibited resistance to rifampin, ethambutol, or amikacin. Of the 138 patients with adequate outcome data, 78 (56.5%) experienced clinical and/or microbiologic cure. Adherence to the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) treatment guidelines was significantly more common in patients who were cured (odds ratio, 4.5, 95% confidence interval, 2.0-10.4; P < .001). Overall mortality was 15.7%. CONCLUSIONS Despite ATS/IDSA Guidelines, management of pulmonary NTM disease was heterogeneous and cure rates were relatively low. Further work is required to understand which patients are suitable for monitoring without treatment and the impact of antimicrobial therapy on pulmonary NTM morbidity and mortality.
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Affiliation(s)
- Getahun Abate
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Jack T Stapleton
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Nadine Rouphael
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Buddy Creech
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Jason E Stout
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Francisco J Leyva
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Kay M Tomashek
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Melinda Tibbals
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Nora Watson
- The Emmes Corporation, Rockville, Maryland, USA
| | - Aaron Miller
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Edward Charbek
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Joan Siegner
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | | | - Ravi Nayak
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
| | - Greta Dahlberg
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Pat Winokur
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ghina Alaaeddine
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nour Beydoun
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katherine Sokolow
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Naomi Prashad Kown
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Shanda Phillips
- Division of Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Arthur W Baker
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Nicholas Turner
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Emmanuel Walter
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Sharon Frey
- Department of Internal Medicine, Saint Louis University, St Louis, Missouri, USA
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20
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Gilsenan A, Harris D, Reynolds M, McSorley D, Midkiff K, Jackson L, Muldavin B, Kellier-Steele N, Andrews E. Long-term cancer surveillance: results from the Forteo Patient Registry Surveillance Study. Osteoporos Int 2021; 32:645-651. [PMID: 33151378 PMCID: PMC8026426 DOI: 10.1007/s00198-020-05718-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/26/2020] [Indexed: 10/26/2022]
Abstract
UNLABELLED The Forteo Patient Registry estimated the incidence of osteosarcoma in US patients treated with teriparatide and enrolled in the study between 2009 and 2019. No incident cases of osteosarcoma were identified among patients registered, and the crude incidence rate was 0 (95% confidence interval [CI], 0-10.2) cases per million person-years. PURPOSE The prospective, voluntary Forteo Patient Registry was established to estimate the incidence of osteosarcoma in patients who have received treatment with teriparatide (Forteo). METHODS Information on US adults prescribed teriparatide and enrolled in the Forteo Patient Registry 2009-2019 was linked with data from participating state cancer registries annually (2010-2019) to identify incident osteosarcoma cases using a standardized linkage algorithm. Teriparatide exposure was ascertained from self-reported data that included teriparatide initiation and demographics necessary to complete linkage. Osteosarcoma cases diagnosed on or after January 1, 2009, were identified by participating state cancer registries. The crude incidence rate (IR) and standardized incidence ratio (SIR) of observed cases to the expected number of cases adjusted to the background rate (3 per million person-years) and corresponding 95% CIs for the occurrence of osteosarcoma were calculated whereby the cumulative amount of person-time observed was adjusted for mortality. RESULTS Data for 75,247 enrolled patients (representing 361,763 cumulative person-years) were linked to each of 42 participating state cancer registries (covering 93% of the US population), which included information on 6180 cases of osteosarcoma. No matches with incident cases of osteosarcoma following registry enrollment were found. The crude IR was 0 (95% CI, 0-10.2) cases per million person-years and the SIR was 0 (95% CI, 0-3.0). CONCLUSIONS The ability to draw conclusions about the incidence of osteosarcoma among patients participating in the registry was limited due to the smaller than expected amount of patient follow-up time and the fact that no cases were identified.
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Affiliation(s)
- A Gilsenan
- RTI Health Solutions, Research Triangle Park, NC, USA.
| | - D Harris
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - M Reynolds
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - D McSorley
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - K Midkiff
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - L Jackson
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - B Muldavin
- RTI International, Research Triangle Park, NC, USA
| | | | - E Andrews
- RTI Health Solutions, Research Triangle Park, NC, USA
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21
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Jackson L, Saund J, Donnelly G. 70 Improving the Documentation of DNACPR Decisions Following the Transition to Electronic Record Keeping. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This quality improvement project was based at The Royal Bolton Hospital across our four Complex Care wards.
Introduction
We have recently transferred to electronic record keeping. At these points of transition there may be an adverse impact on the quality of patient care and safety. We recognised on our own ward there were inaccuracies between the required paper form and electronic documentation of DNACPR decisions. Consequently, we wanted to review and improve the accuracy of our DNACPR documentation to ensure safe and effective patient care.
Methods
To gauge the scope of the problem we audited 87 patient’s electronic and paper notes, with no exclusion criteria. We reviewed whether each patient had a formal resuscitation decision, and if a DNACPR decision had been made whether we met our hospital policy by having:
93% of the 87 patient’s had an active decision regarding resuscitation, with a DNACPR decision documented for 50 patients. Of these 50 patients only 11 had all three forms of documentation. More worryingly, there were discrepancies in the documented DNACPR decisions for 11 patients across paper and electronic records.
Interventions
We escalated our concerns to the Clinical Governance team who sent out a trust wide SBAR highlighting this as an urgent clinical issue. On a directorate level we incorporated DNACPR decision documentation into our afternoon safety huddle and arranged informal teaching for medical, nursing and administrative staff.
Results
Reassuringly, the subsequent re-audit of 90 patient’s notes showed only one patient to have a discrepancy between paper and electronic documentation. We saw an improvement to 98% having paper forms in the right bedside notes and 100% having a documented electronic DNACPR decision.
Conclusion
Through local education and trust-wide dissemination of our expected standards we have seen some improvement. We recognise the importance of maintaining this, and importantly that there is still work to be done. The electronic “Resuscitation and treatment escalation plan” is still rarely completed and provides important information on escalation of care and thus will be the focus of a further educational intervention.
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Affiliation(s)
- L Jackson
- Geriatric Medicine, The Royal Bolton Hospital
| | - J Saund
- Geriatric Medicine, The Royal Bolton Hospital
| | - G Donnelly
- Geriatric Medicine, The Royal Bolton Hospital
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22
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Zerbo O, Modaressi S, Goddard K, Lewis N, Fireman B, Jackson L, Irving S, Daley MF, Gethaun D, Qian L, Donahue J, Klein NP. 177. Safety of Measles and Pertussis-containing Vaccines in School-age Children Previously Diagnosed with Autism Spectrum Disorders. Open Forum Infect Dis 2020. [PMCID: PMC7777369 DOI: 10.1093/ofid/ofaa439.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Some parents, especially those of children with autism spectrum disorders (ASD), are uncertain about the safety of childhood immunization. We compared rates of fever, febrile seizure and emergency room (ER) visits following measles and pertussis-containing vaccines recommended between ages 4–6 years among children with and without ASD.
Methods
The study included children who were born between 1995–2012, aged 4–7 years at vaccination, and members of six integrated healthcare delivery systems within the Vaccine Safety Datalink. Children with ASD were defined based on receipt of two separate International Classification of Diseases (ICD)-9 or 10 codes. Outcomes (fever, febrile seizures, and ER visits) were identified in electronic health records. To minimize confounding by unmeasured factors related both to avoidance of vaccination and to outcomes of interest, we compared rates of each outcome between children with and without ASD, in risk and control intervals, by estimating the difference-in-differences on a log scale (i.e. the ratio of rate ratios) using logistic regressions. We also conducted risk interval analyses comparing rates of outcomes in risk intervals and control intervals within each group.
Results
The study included 14,947 children with ASD and 1,650,041 children without ASD. After measles or pertussis-containing vaccination, there were no differences in association between the two groups for fever or ER visits (Table). There were no febrile seizures identified among children with ASD. Within the ASD group, rates of fever, seizure or ER visits did not differ significantly between the risk and control intervals after vaccination. However, among the non-ASD group, measles and pertussis-containing vaccines were associated with higher rates of fever and seizure in risk intervals compared to controls intervals. Pertussis-containing vaccines were associated with increased risk of ER visits in risk interval compared to control interval (Table).
Conclusion
We found no difference in the risk of fever, and ER visits comparing children with autism to children without autism after measles or pertussis-containing vaccines. The study provides some reassurance that these vaccines are not less safe in children with ASD.
Disclosures
Lei Qian, PhD, GlaxoSmithKlein (Research Grant or Support) Nicola P. Klein, MD, PhD, GSK group of companies (Research Grant or Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support)Protein Science (now SP) (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)
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Affiliation(s)
- Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | | | | | - Ned Lewis
- Kaiser Permanente Northern California, Oakland, California
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Oakland, California, Oakland, California
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | | | - Darios Gethaun
- 5Kaiser Permanente Department of Research and Evaluation, Pasadena, California, Pasadena, California
| | - Lei Qian
- Kaiser Permanente Southern California, Pasadena, California
| | - James Donahue
- Marshfield Clinic Research Institute, Marshfield, Wisconsin, Marshfield, Wisconsin
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California, United States, Oakland, California
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23
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Liu J, Tsang T, Ponting C, Jackson L, Jeste SS, Bookheimer SY, Dapretto M. Lack of neural evidence for implicit language learning in 9-month-old infants at high risk for autism. Dev Sci 2020; 24:e13078. [PMID: 33368921 DOI: 10.1111/desc.13078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
Word segmentation is a fundamental aspect of language learning, since identification of word boundaries in continuous speech must occur before the acquisition of word meanings can take place. We previously used functional magnetic resonance imaging (fMRI) to show that youth with autism spectrum disorder (ASD) are less sensitive to statistical and speech cues that guide implicit word segmentation. However, little is known about the neural mechanisms underlying this process during infancy and how this may be associated with ASD risk. Here, we examined early neural signatures of language-related learning in 9-month-old infants at high (HR) and low familial risk (LR) for ASD. During natural sleep, infants underwent fMRI while passively listening to three speech streams containing strong statistical and prosodic cues, strong statistical cues only, or minimal statistical cues to word boundaries. Compared to HR infants, LR infants showed greater activity in the left amygdala for the speech stream containing statistical and prosodic cues. While listening to this same speech stream, LR infants also showed more learning-related signal increases in left temporal regions as well as increasing functional connectivity between bilateral primary auditory cortex and right anterior insula. Importantly, learning-related signal increases at 9 months positively correlated with expressive language outcome at 36 months in both groups. In the HR group, greater signal increases were additionally associated with less severe ASD symptomatology at 36 months. These findings suggest that early differences in the neural networks underlying language learning may predict subsequent language development and altered trajectories associated with ASD risk.
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Affiliation(s)
- Janelle Liu
- Interdepartmental Neuroscience Program, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tawny Tsang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carolyn Ponting
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.,Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lisa Jackson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA.,Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shafali S Jeste
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susan Y Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA
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Seymour-Smith S, Brown DJ, Burton A, Shopland N, Khan M, Thompson R, Thompson L, Jackson L, Marston W, Allen R. Joint allies: Benefits and tensions of co-producing a prostate cancer app for, and with, the Black British African-Caribbean community. Qualitative Research in Psychology 2020. [DOI: 10.1080/14780887.2020.1861491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - David J. Brown
- Nottingham Trent University, Computing and Technology Team, Interactive Systems Research Group, College of Science and Technology, Nottingham, UK
| | - Andy Burton
- Nottingham Trent University, Computing and Technology Team, Interactive Systems Research Group, College of Science and Technology, Nottingham, UK
| | - Nick Shopland
- Nottingham Trent University, Computing and Technology Team, Interactive Systems Research Group, College of Science and Technology, Nottingham, UK
| | - Masood Khan
- Leicester General Hospital, Department of Urology, Leicester, UK
| | - Rose Thompson
- BME Cancer Communities Charity, Foxhall Lodge, Nottingham
| | | | - Lisa Jackson
- BME Cancer Communities Charity, Mon0lisa Productions, Nottingham
| | - Wayne Marston
- Friends & Bredrins Prostate Cancer Support Group (FAB), Nottingham, UK
| | - Roydon Allen
- Friends & Bredrins Prostate Cancer Support Group (FAB), Nottingham, UK
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25
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Laharwani H, Manucha V, Jefferson G, Jackson L. Utilization of P16 in Head and Neck Cytology and Surgical Specimens After the Release of CAP Guidelines. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
HPV-positive oropharyngeal squamous cell carcinoma is biologically and clinically unique and has a survival advantage over other head and neck squamous cell carcinomas. In December 2017 College of American Pathologist published guidelines for testing HPV status in head and neck cancer. It was recommended that pathologists perform HR-HPV testing on head and neck squamous cell carcinomas from all patients with known oropharyngeal SCC not previously tested for HR-HPV, with suspected oropharyngeal SCC, or with metastatic SCC of unknown primary. The aim of this study was to determine the compliance of pathologists following the CAP guidelines.
Methods
Cases that underwent HPV testing using p16 immunohistochemistry for the years 2017 and 2019 were retrieved. Based on the guidelines, p16 testing was designated as “indicated” or “not indicated”.
Results
There were 196 cases in which p16 testing was performed in a period of 3 consecutive years. Of these, 175 were FNA/ biopsies and 21 were surgical resections. In 69 cases (56 FNAs and 13 biopsies) the biopsy was performed on neck masses with unknown primary. The compliance for p16 testing in OPC and Lymph nodes with metastatic SCC of unknown primary was 100%. In 34 (17.3%) cases p16 testing was not indicated, the most common reason being wrong site (85%) including the larynx, oral tongue, the floor of the mouth, buccal mucosa, and nasal mass. Of the unindicated p16s, 20 (58%) were received in consultation for continuity of care.
Conclusion
Not being clear about the site of the tumor is the most common reason for unindicated p16 testing. A clear designation of biopsy site and proper communication between pathologist and surgeon can improve utilization of p16 testing in head and neck carcinomas.
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Affiliation(s)
- H Laharwani
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - V Manucha
- Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - G Jefferson
- University of Mississippi Medical Center, Jackson, Mississippi
| | - L Jackson
- University of Mississippi Medical Center, Jackson, Mississippi
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Jackson L, Otaki F, Powell L, Ghiglione E, Zary N. Study of a COVID-19 induced transition from Face-to-Face to Online Team-Based Learning in Undergraduate Family Medicine. MedEdPublish (2016) 2020; 9:232. [PMID: 38058946 PMCID: PMC10697564 DOI: 10.15694/mep.2020.000232.1] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
This article was migrated. The article was marked as recommended. INTRODUCTION The COVID-19 pandemic has been presenting new challenges for medical schools worldwide. Medical educators are coming-up with creative solutions to address those unprecedented challenges. The purpose of this study is to reflect upon an experience of an online TBL in a Family Medicine Clerkship. METHODS This study relied on a qualitative descriptive design. A phenomenological approach was adapted to capture the perception of students regarding online TBL as part of Family Medicine clerkship, using a survey of open-ended questions. The data were inductively analysed using thematic analysis. RESULTS The results of the study revealed that the students, overall, reacted positively to the experience. Five themes of text fragments emerged from the analysis: Equivalency of experience, Efficiency and Ease-of-use, Organization, Novelty, and Design. The students also noted some minor difficulties, that they faced at the beginning of their experience, indicating the existence of a learning curve. They also identified a few opportunities for improvement. DISCUSSION This study demonstrated that combining videoconferencing and lesson delivery software together for TBL enables remote facilitation of the Family Medicine curriculum, and that the students value the experience as such. From the COI perspective, all three factors, namely: social presence, teaching presence, and cognitive presence, are met by such a set-up for distance learning. The students also felt validated and that their voice is heard. The central coordination of the TBL process proved to be crucial to ensure continuity, and also to support individuals' mental health and team spirit. CONCLUSION This study concludes that TBL enables rapid transition to distance learning; it promotes analytical and self-directed learning even in extreme circumstances. Moreover, the TBL sessions allow for the facilitators, including the Discipline Lead, to get to know the students, on a personal level, and to monitor and evaluate their performance, over time.
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Affiliation(s)
- Lisa Jackson
- Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU)
| | - Farah Otaki
- Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU)
| | - Leigh Powell
- Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU)
| | | | - Nabil Zary
- Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU)
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Vikulova D, Trinder M, Brown C, Jackson L, Pimstone S, Brunham L. GENETICALLY CONFIRMED FAMILIAL HYPERCHOLESTEROLEMIA IN PATIENTS WITH PREMATURE CORONARY ARTERY DISEASE. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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28
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Ekambaram K, Frampton R, Jackson L. Adapting load limiter deployment for frontal crash diversity. Traffic Inj Prev 2020; 20:S43-S49. [PMID: 31906716 DOI: 10.1080/15389588.2019.1702648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
Objective: Current European restraint systems may not realize their full protection potential in real-world frontal crashes because they are highly optimized for specific conditions. This research sought to quantify the potential benefit of adapting seat belt load limit thresholds to a wider range of occupant and crash characteristics.Methods: Numerical simulations using Hybrid III dummies were conducted to determine how varying load limiter thresholds could affect occupant kinematics and injury outcome in frontal impacts. Occupant-compartment models were developed with a restraint system consisting of a frontal airbag and a 3-point belt with retractor, buckle pretensioner, and load limiting at the shoulder. Load limiting threshold was varied in 5 frontal impact scenarios, covering as wide a range of real frontal crash conditions as possible. The simulated thoracic injury risks were converted into injury probability values using Abbreviated Injury Scale (AIS) 2+ age-dependent thoracic risk curves. These values were then applied to a British real-world frontal impact sample to determine the injury reduction potential of optimized load limiting, taking into account occupant seating position, impact scenario, occupant size, and occupant age and assuming that an appropriate adaptive system was fitted to all cars.Results: In low-severity impacts, a low load limit provided the best chest protection, without increasing risk to other body regions, for both the 50th and 95th percentile dummies in both front seating positions. In high-severity impacts, the low limit was not recommended because it allowed the driver dummy to move into close proximity with the vehicle interior, although there appeared to be some benefit of lower load limiting for the 50th percentile front passenger dummy, due to the increased ride down space in that seating position. Adapting the load limit showed no injury reduction potential for 5th percentile drivers. Utilizing the best load limit threshold in real-world crashes could reduce the number of occupants with AIS 2+ chest injuries from belt loading from 377 to 251 (a 33% reduction), correspondingly reducing the number of occupants with AIS 2+ chest injuries (from all sources) in the whole frontal impact population from 496 to 370. This is a reduction in injury rate from 6.4% to 4.8%.Conclusions: The concept of an adaptive load limiter shows most promise in low-speed frontal crashes where it could lower the AIS 2+ chest injury risk for most front seat occupants, except the smallest of drivers. Generally, adaptive limiters show less potential effectiveness with increased crash severities. Overall, an intelligent adjustment of load limiting threshold could result in a reduction of at least a third of front seat occupants with AIS 2+ chest injuries associated with restraining loads and an overall reduction in AIS 2+ chest injury rate in frontal crashes from 6.4% to 4.8.
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Affiliation(s)
| | | | - Lisa Jackson
- Aeronautical and Automotive Engineering Department, Loughborough University, Loughborough, UK
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29
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Ladva CN, Belongia E, Monto A, Martin ET, Gaglani M, Reis M, Jackson ML, Jackson L, Zimmerman R, Nowalk MP, McLean H, Patel M, Fry AM, Flannery B. 2734. Lack of Influence of Early Exposure to Influenza A(H3N2) Viruses on Vaccine Effectiveness Against A(H3N2)-Associated Illness in US Children <18 Years, 2016–2018. Open Forum Infect Dis 2019. [PMCID: PMC6810229 DOI: 10.1093/ofid/ofz360.2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
During 2017–2018, influenza vaccine effectiveness (VE) against A(H3N2) illness was highest among children <5 years compared with all other ages. A child’s first influenza infection can shape later immune responses. The emergence of antigenically distinct influenza A(H3N2) viruses in 2014–2015 provided an opportunity to explore potential effects of first virus infection on vaccine effects. We compared VE against influenza A(H3N2) during 2016–2017 and 2017–2018 among children born after and before 2014.
Methods
Outpatient children aged 6 months–17 years with acute respiratory illness with cough were enrolled in the United States Influenza VE Network and tested for influenza infection by RT–PCR. Vaccination status was derived through medical records and immunization registries. Children with partial or unknown vaccination status were excluded. We used a test-negative design to estimate VE and 95% confidence intervals (CI) from logistic regression, adjusting for potential confounders. Cohorts were defined by birth after or before June 2014; we assumed exposure to the new A(H3N2) virus among children born after June 2014.
Results
During 2016–2017, among 2,545 children, 445 (18%) tested positive for A(H3N2) and 1,809 (71%) tested negative. VE against A(H3N2) did not differ among children born after June 2014 and among those born before June 2014 [49% (95% CI: −12%, 77%) vs. 43% (27%, 55%); interaction P < 0.75]. During 2017–2018, among 2,936 patients, 631 (22%) tested positive for A(H3N2), and 1,852 (63%) tested negative. VE against A(H3N2) was 59% (36%, 74%) among children born after June 2014 vs. 20% (−1%, 37%) among those born before June 2014 (interaction P < 0.01).
Conclusion
We did not consistently see differences in VE against A(H3N2) between children potentially exposed to different A(H3N2) viruses. However, error in exposure assignment to A(H3N2) viruses and few seasons since the emergence of the new A(H3N2) viruses limit our interpretation. Future study will include additional A(H3N2) seasons as initial exposures to current circulating viruses increase among young children. Alternative explanations for age-related differences will also be explored, such as prior seasonal vaccination.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
| | | | - Arnold Monto
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | | | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Richard Zimmerman
- University of Pittsburgh Schools of Health Sciences, Pittsburgh, Pennsylvania
| | | | - Huong McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Manish Patel
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Hanson KE, McLean H, Marin M, Panagiotakopoulos L, Weintraub E, Daley MF, Groom H, Jackson L, Jacobsen SJ, Klein N, Nordin JD, Belongia E. 2763. Uptake and Safety of Measles-Mumps-Rubella (MMR) Vaccine in Adolescents and Adults in the Vaccine Safety Datalink. Open Forum Infect Dis 2019. [PMCID: PMC6809901 DOI: 10.1093/ofid/ofz360.2440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
MMR vaccine is given routinely to young children but may be given at other ages. We described MMR use in adolescent and adult populations in the Vaccine Safety Datalink (VSD) and estimated the incidence of medically-attended outcomes after MMR to inform future studies estimating vaccine-associated risk.
Methods
The study population included adolescents (9–17 years) and adults (≥18 years) in VSD who received at least one MMR vaccine from 2010 through 2016. Outcomes were pre-specified based on previous vaccine safety studies and categorized as clinically serious (anaphylaxis, encephalitis/myelitis, GBS, meningitis, seizure) or non-serious (allergic reaction, arthropathy, fever, injection site reaction, lymphadenopathy, nonspecific reaction, parotitis, rash, syncope). Outcomes were identified by searching for ICD-9 and ICD-10 diagnosis codes in post-vaccination exposure windows. Medical records were reviewed for all serious outcomes to verify incident diagnoses. Incidence and 95% confidence intervals were calculated for validated serious and all non-serious outcomes.
Results
146,503 adolescents and adults received 162,992 MMR vaccines during the study period. The mean age at vaccination was 33.7 years, 65% were female, and 53% received at least one other vaccine simultaneously. Demographic and vaccination characteristics varied across age groups (Table 1). The analysis of post-vaccination outcomes included 162,053 MMR vaccinations. The incidence of validated serious outcomes was low, ranging from 0 to 6.8 per 100,000 vaccinations. Only one serious outcome (anaphylaxis) was noted to be vaccine-associated in the medical record. Incidence of clinically non-serious outcomes varied from 0.4 to 56.0 per 10,000 vaccinations. Injection site reactions were more common among adolescents (118.1 per 10,000 vaccinations), who also had a higher frequency of simultaneous vaccination (80%).
Conclusion
Clinically serious outcomes were rare following MMR vaccination. Rates of clinically non-serious outcomes varied but were similar to or lower than previous reports in children. This descriptive analysis did not evaluate the association between MMR and adverse events. Future analysis with an appropriate comparison group is needed for risk estimation.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Kayla E Hanson
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Huong McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Mona Marin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Eric Weintraub
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Holly Groom
- Kaiser Permanente Northwest, Portland, Oregon
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Nicola Klein
- Kaiser Permanente Northern California, Oakland, California
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31
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Hayatigolkhatmi K, Padroni G, Su W, Fang L, Gómez-Castañeda E, Hsieh YC, Jackson L, Pellicano F, Burley GA, Jørgensen HG. An investigation of targeted inhibition of transcription factor activity with pyrrole imidazole polyamide (PA) in chronic myeloid leukemia (CML) blast crisis cells. Bioorg Med Chem Lett 2019; 29:2622-2625. [PMID: 31378570 DOI: 10.1016/j.bmcl.2019.07.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/28/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
Tyrosine kinase inhibitor (TKI) therapy is the standard treatment for chronic phase (CP)-chronic myeloid leukemia (CML), yet patients in blast crisis (BC) phase of CML are unlikely to respond to TKI therapy. The transcription factor E2F1 is a down-stream target of the tyrosine kinase BCR-ABL1 and is up-regulated in TKI-resistant leukemia stem cells (LSC). Pyrrole imidazole polyamides (PA) are minor groove binders which can be programmed to target DNA sequences in a gene-selective manner. This manuscript describes such an approach with a PA designed to down-regulate E2F1 controlled gene expression by targeting a DNA sequence within 100 base pairs (bp) upstream of the E2F1 consensus sequence. Human BC-CML KCL22 cells were assessed after treatment with PA, TKI or their combination. Our PA inhibited BC-CML cell expansion based on cell density analysis compared to an untreated control after a 48-hour time-course of PA treatment. However, no evidence of cell cycle arrest was observed among BC-CML cells treated with PA, with respect to their no drug control counterparts. Thus, this work demonstrates that PAs are effective in inhibiting E2F1 TF activity which results in a temporal reduction in BC-CML cell number. We envisage that PAs could be used in the future to map genes under E2F1 control in CML LSCs.
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MESH Headings
- Antineoplastic Agents/chemical synthesis
- Antineoplastic Agents/chemistry
- Antineoplastic Agents/pharmacology
- Blast Crisis/drug therapy
- Blast Crisis/metabolism
- Blast Crisis/pathology
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Dose-Response Relationship, Drug
- Drug Screening Assays, Antitumor
- E2F1 Transcription Factor/antagonists & inhibitors
- E2F1 Transcription Factor/genetics
- E2F1 Transcription Factor/metabolism
- Humans
- Imidazoles/chemistry
- Imidazoles/pharmacology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Molecular Structure
- Nylons/chemistry
- Nylons/pharmacology
- Protein Kinase Inhibitors/chemical synthesis
- Protein Kinase Inhibitors/chemistry
- Protein Kinase Inhibitors/pharmacology
- Pyrroles/chemistry
- Pyrroles/pharmacology
- Structure-Activity Relationship
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Affiliation(s)
- K Hayatigolkhatmi
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - G Padroni
- Department of Pure and Applied Chemistry, University of Strathclyde, Thomas Graham Building, Glasgow, UK
| | - W Su
- Guangdong Key Laboratory of Nanomedicine, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, PR China
| | - L Fang
- Guangdong Key Laboratory of Nanomedicine, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, PR China
| | - E Gómez-Castañeda
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Y C Hsieh
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - L Jackson
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - F Pellicano
- Drug Discovery Program, Cancer Research UK Beatson Institute, Garscube Estate, Glasgow, UK
| | - G A Burley
- Department of Pure and Applied Chemistry, University of Strathclyde, Thomas Graham Building, Glasgow, UK
| | - H G Jørgensen
- Paul O'Gorman Leukaemia Research Centre, Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
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Trinder M, Li X, DeCastro M, Cermakova L, Sadananda S, Jackson L, Azizi H, Mancini G, Francis G, Frohlich J, Brunham L. Monogenic Familial Hypercholesterolemia, Polygenic Hypercholesterolemia, And The Risk Of Premature Atherosclerotic Cardiovascular Disease. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.265] [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: 11/26/2022]
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Cook AJ, Wellman RD, Marsh T, Shoaibi A, Tiwari R, Nguyen M, Boudreau D, Weintraub ES, Jackson L, Nelson JC. Applying sequential surveillance methods that use regression adjustment or weighting to control confounding in a multisite, rare-event, distributed setting: Part 2 in-depth example of a reanalysis of the measles-mumps-rubella-varicella combination vaccine and seizure risk. J Clin Epidemiol 2019; 113:114-122. [PMID: 31055178 DOI: 10.1016/j.jclinepi.2019.04.019] [Citation(s) in RCA: 1] [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] [Received: 12/22/2017] [Revised: 03/01/2019] [Accepted: 04/05/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In-depth example of two new group sequential methods for postmarket safety monitoring of new medical products. STUDY DESIGN AND SETTING Existing trial-based group sequential approaches have been extended to adjust for confounders, accommodate rare events, and address privacy-related constraints on data sharing. Most adaptations have involved design-based confounder strategies, for example, self-controlled or exposure matching, while analysis-based approaches like regression and weighting have received less attention. We describe the methodology of two new group sequential approaches that use analysis-based confounder adjustment (GS GEE) and weighting (GS IPTW). Using data from the Food and Drug Administration's Sentinel network, we apply both methods in the context of a known positive association: the measles-mumps-rubella-varicella vaccine and seizure risk in infants. RESULTS Estimates from both new approaches were similar and comparable to prior studies using design-based methods to address confounding. The time to detection of a safety signal was considerably shorter for GS IPTW, which estimates a risk difference, compared to GS GEE, which provides relative estimates of excess risk. CONCLUSION Future group sequential safety surveillance efforts should consider analysis-based confounder adjustment techniques that evaluate safety signals on the risk difference scale to achieve greater statistical power and more timely results.
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Affiliation(s)
- Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA.
| | - Robert D Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Tracey Marsh
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Azadeh Shoaibi
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Ram Tiwari
- Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Michael Nguyen
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Denise Boudreau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Eric S Weintraub
- Division of Health Care Quality Promotion, Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer C Nelson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
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Liu J, Tsang T, Jackson L, Ponting C, Jeste SS, Bookheimer SY, Dapretto M. Altered lateralization of dorsal language tracts in 6-week-old infants at risk for autism. Dev Sci 2019; 22:e12768. [PMID: 30372577 PMCID: PMC6470045 DOI: 10.1111/desc.12768] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/31/2022]
Abstract
Altered structural connectivity has been identified as a possible biomarker of autism spectrum disorder (ASD) risk in the developing brain. Core features of ASD include impaired social communication and early language delay. Thus, examining white matter tracts associated with language may lend further insight into early signs of ASD risk and the mechanisms that underlie language impairments associated with the disorder. Evidence of altered structural connectivity has previously been detected in 6-month-old infants at high familial risk for developing ASD. However, as language processing begins in utero, differences in structural connectivity between language regions may be present in the early infant brain shortly after birth. Here we investigated key white matter pathways of the dorsal language network in 6-week-old infants at high (HR) and low (LR) risk for ASD to identify atypicalities in structural connectivity that may predict altered developmental trajectories prior to overt language delays and the onset of ASD symptomatology. Compared to HR infants, LR infants showed higher fractional anisotropy (FA) in the left superior longitudinal fasciculus (SLF); in contrast, in the right SLF, HR infants showed higher FA than LR infants. Additionally, HR infants showed more rightward lateralization of the SLF. Across both groups, measures of FA and lateralization of these pathways at 6 weeks of age were related to later language development at 18 months of age as well as ASD symptomatology at 36 months of age. These findings indicate that early differences in the structure of language pathways may provide an early predictor of future language development and ASD risk.
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Affiliation(s)
- Janelle Liu
- Interdepartmental Neuroscience Program, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tawny Tsang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lisa Jackson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA
- Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carolyn Ponting
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shafali S. Jeste
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susan Y. Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
- Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Center for Cognitive Neurosciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mirella Dapretto
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles, Los Angeles, CA, USA
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Guk E, Venkatesan V, Sayan Y, Jackson L, Kim JS. Spring Based Connection of External Wires to a Thin Film Temperature Sensor Integrated Inside a Solid Oxide Fuel Cell. Sci Rep 2019; 9:2161. [PMID: 30770848 PMCID: PMC6377679 DOI: 10.1038/s41598-019-39518-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/22/2019] [Indexed: 11/01/2022] Open
Abstract
Thermal management of SOFCs (solid oxide fuel cell) is important for helping to minimise high temperature-related performance losses and maximising cell/stack lifetime. Thin film sensor technology is proposed as an excellent candidate to measure the cell temperature during operation due to its negligible mass, minimal disturbance to normal operation and higher temporal and spatial resolutions. However, the effective application of such sensors in SOFC systems is a challenging endeavour and predicated on incorporating the external wire attachments to complete the electrical circuit. This is because of the high sensitivity of SOFC materials to any interference to operation, limited available space and harsh operating conditions. In this paper, a new concept of packaging external wire attachments to the thin film sensor is described to enable the integration of the sensor in the SOFC system. Temperature measurements have been monitored under OCV and operating condition with the thin film sensor directly from SOFC cathode surface via proposed spring-based wire connection, from room temperature to SOFC operating temperature. The impact of the parameters including contact resistance (Rc) between sensor pads and attached wire on monitored temperature has also been analysed with the contribution of conductive paste. High temporal and spatial resolutions have been obtained with the implemented sensor.
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Affiliation(s)
- Erdogan Guk
- Aeronautical & Automotive Engineering Department, Loughborough University, Loughborough, LE11 3TU, United Kingdom.,Bozok Üniversitesi Mühendislik-Mimarlık Fakültesi Erdoğan AKDAĞ Kampüsü Atatürk Yolu 7. km, Yozgat, Turkey
| | - Vijay Venkatesan
- Aeronautical & Automotive Engineering Department, Loughborough University, Loughborough, LE11 3TU, United Kingdom
| | - Yunus Sayan
- Aeronautical & Automotive Engineering Department, Loughborough University, Loughborough, LE11 3TU, United Kingdom
| | - Lisa Jackson
- Aeronautical & Automotive Engineering Department, Loughborough University, Loughborough, LE11 3TU, United Kingdom
| | - Jung-Sik Kim
- Aeronautical & Automotive Engineering Department, Loughborough University, Loughborough, LE11 3TU, United Kingdom.
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Adamson V, Barrass E, McConville S, Irikok C, Taylor K, Pitt S, Van Duyn R, Bennett S, Jackson L, Carroll J, Andrews M, Parker A, Wright C, Greathead K, Price D. Implementing the access and waiting time standard for early intervention in psychosis in the United Kingdom: An evaluation of referrals and post-assessment outcomes over the first year of operation. Early Interv Psychiatry 2018; 12:979-986. [PMID: 29582556 DOI: 10.1111/eip.12548] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/06/2017] [Revised: 11/30/2017] [Accepted: 02/04/2018] [Indexed: 11/25/2022]
Abstract
AIM Improving timely access to evidence-based treatment for people aged 14-65 years experiencing a first episode psychosis (FEP) or an at-risk mental state (ARMS) for psychosis is a national priority within the United Kingdom. An early intervention in psychosis (EIP) access and waiting time standard has been set which has extended the age range and acceptance criteria for services. METHODS This descriptive evaluation reports upon the referrals and access to treatment times within an EIP service over the first year of operating in line with the access and waiting time standard. Patient pathways and post-assessment status are also described. RESULTS The service received 406 referrals, of which 88% (n = 357) were assessed. The mean length of time to treatment was 1.5 weeks, with 88% being seen within 2 weeks. Of those who engaged in an assessment, 34% (n = 138) were identified as ARMS cases and 30% (n = 123) were identified as FEP. Over 35 year olds accounted for 22% (n = 80) of the total accepted cases. CONCLUSIONS The findings indicate clinical and operational issues, which will need careful consideration in the future planning of services. The high number of ARMS cases highlights the importance of clear treatment pathways and targeted interventions and may suggest a need to commission distinct ARMS services. The number of people who met the extended age and service acceptance criteria may suggest a need to adapt or redesign clinical services to meet the age-specific needs of over 35 year olds and those with an ARMS. It is unclear how changes to the remit of EIP services will impact upon future clinical outcomes.
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Affiliation(s)
- Vidyah Adamson
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Emma Barrass
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Stephen McConville
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Chantelle Irikok
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Kim Taylor
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Steve Pitt
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Rob Van Duyn
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Susan Bennett
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Lisa Jackson
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Jon Carroll
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Mark Andrews
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Ann Parker
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Caroline Wright
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Katie Greathead
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - David Price
- Early Intervention in Psychosis Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
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Stewart RJ, Flannery B, Chung JR, Gaglani M, Reis M, Zimmerman RK, Nowalk MP, Jackson L, Jackson ML, Monto AS, Martin ET, Belongia EA, McLean HQ, Fry AM, Havers FP. Influenza Antiviral Prescribing for Outpatients With an Acute Respiratory Illness and at High Risk for Influenza-Associated Complications During 5 Influenza Seasons-United States, 2011-2016. Clin Infect Dis 2018; 66:1035-1041. [PMID: 29069334 PMCID: PMC6018951 DOI: 10.1093/cid/cix922] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 04/11/2017] [Accepted: 10/20/2017] [Indexed: 11/14/2022] Open
Abstract
Background Influenza causes millions of illnesses annually; certain groups are at higher risk for complications. Early antiviral treatment can reduce the risk of complications and is recommended for outpatients at increased risk. We describe antiviral prescribing among high-risk outpatients for 5 influenza seasons and explore factors that may influence prescribing. Methods We analyzed antiviral prescription and clinical data for high-risk outpatients aged ≥6 months with an acute respiratory illness (ARI) and enrolled in the US Influenza Vaccine Effectiveness Network during the 2011-2012 through 2015-2016 influenza seasons. We obtained clinical information from interviews and electronic medical records and tested all enrollees for influenza with real-time reverse-transcription polymerase chain reaction (rRT-PCR). We calculated the number of patients with ARI that must be treated to treat 1 patient with influenza. Results Among high-risk outpatients with ARI who presented to care within 2 days of symptom onset (early), 15% (718/4861) were prescribed an antiviral medication, including 472 of 1292 (37%) of those with rRT-PCR-confirmed influenza. Forty percent of high-risk outpatients with influenza presented to care early. Earlier presentation was associated with antiviral treatment (odds ratio [OR], 4.1; 95% confidence interval [CI], 3.5-4.8), as was fever (OR, 3.2; 95% CI, 2.7-3.8), although 25% of high-risk outpatients with influenza were afebrile. Empiric treatment of 4 high-risk outpatients with ARI was needed to treat 1 patient with influenza. Conclusions Influenza antiviral medications were infrequently prescribed for high-risk outpatients with ARI who would benefit most. Efforts to increase appropriate antiviral prescribing are needed to reduce influenza-associated complications.
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Affiliation(s)
- Rebekah J Stewart
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan Flannery
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessie R Chung
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University Health Science Center College of Medicine, Temple
| | - Michael Reis
- Baylor Scott & White Health, Texas A&M University Health Science Center College of Medicine, Temple
| | | | | | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute), Seattle
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute (formerly Group Health Research Institute), Seattle
| | - Arnold S Monto
- University of Michigan School of Public Health, Ann Arbor
| | - Emily T Martin
- University of Michigan School of Public Health, Ann Arbor
| | | | | | - Alicia M Fry
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fiona P Havers
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Sukumaran L, McCarthy NL, Kharbanda EO, Vazquez-Benitez G, Lipkind HS, Jackson L, Klein NP, Naleway AL, McClure DL, Hechter RC, Kawai AT, Glanz JM, Weintraub ES. Infant Hospitalizations and Mortality After Maternal Vaccination. Pediatrics 2018; 141:peds.2017-3310. [PMID: 29463582 PMCID: PMC6586222 DOI: 10.1542/peds.2017-3310] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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] [Accepted: 12/01/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The Advisory Committee on Immunization Practices currently recommends pregnant women receive influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. There are limited studies of the long-term safety in infants for vaccines administered during pregnancy. We evaluate whether maternal receipt of influenza and Tdap vaccines increases the risk of infant hospitalization or death in the first 6 months of life. METHODS We included singleton, live birth pregnancies in the Vaccine Safety Datalink between 2004 and 2014. Outcomes were infant hospitalizations and mortality in the first 6 months of life. We performed a case-control study matching case patients and controls 1:1 and used conditional logistic regression to estimate odds ratios for maternal exposure to influenza and/or Tdap vaccines in pregnancy. RESULTS There were 413 034 live births in our population. Of these, 25 222 infants had hospitalizations and 157 infants died in the first 6 months of life. We found no association between infant hospitalization and maternal influenza (adjusted odds ratio: 1.00; 95% confidence interval [CI]: 0.96-1.04) or Tdap (adjusted odds ratio: 0.94; 95% CI: 0.88-1.01) vaccinations. We found no association between infant mortality and maternal influenza (adjusted odds ratio: 0.96; 95% CI: 0.54-1.69) or Tdap (adjusted odds ratio: 0.44; 95% CI: 0.17-1.13) vaccinations. CONCLUSIONS We found no association between vaccination during pregnancy and risk of infant hospitalization or death in the first 6 months of life. These findings support the safety of current recommendations for influenza and Tdap vaccination during pregnancy.
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Affiliation(s)
- Lakshmi Sukumaran
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | - Natalie L. McCarthy
- lmmunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Lisa Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Nicola P. Klein
- Division of Research, Kaiser Permanente of Northern California, Oakland, California
| | - Allison L. Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Rulin C. Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Alison T. Kawai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Eric S. Weintraub
- lmmunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Shah N, Jackson L, Phelan J, Corton M. 16: Anterior and medial thigh anatomy in female cadavers: Clinical applications to transobturator tape sling excision. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.200] [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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40
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Vears DF, Sénécal K, Clarke AJ, Jackson L, Laberge AM, Lovrecic L, Piton A, Van Gassen KLI, Yntema HG, Knoppers BM, Borry P. Points to consider for laboratories reporting results from diagnostic genomic sequencing. Eur J Hum Genet 2018; 26:36-43. [PMID: 29184171 PMCID: PMC5839050 DOI: 10.1038/s41431-017-0043-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/31/2017] [Indexed: 11/09/2022] Open
Abstract
Although NGS technologies are well-embedded in the clinical setting for identification of genetic causes of disease, guidelines issued by professional bodies are inconsistent regarding some aspects of reporting results. Most recommendations do not give detailed guidance about whether variants of uncertain significance (VUS) should be reported by laboratory personnel to clinicians, and give conflicting messages regarding whether unsolicited findings (UF) should be reported. There are also differences both in their recommendations regarding whether actively searching for secondary findings (SF) is appropriate, and in the extent to which they address the duty (or lack thereof) to reanalyse variants when new information arises. An interdisciplinary working group considered the current guidelines, their own experiences, and data from a recent qualitative study to develop a set of points to consider for laboratories reporting results from diagnostic NGS. These points to consider fall under six categories: (i) Testing approaches and technologies used, (ii) Approaches for VUS; (iii) Approaches for reporting UF, (iv) Approaches regarding SF; (v) Reanalysis of data & re-contact; and vi) Minors. While it is unclear whether uniformity in reporting across all laboratories is desirable, we hope these points to consider will be useful to diagnostic laboratories as they develop their processes for making decisions about reporting VUS and UF from NGS in the diagnostic context.
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Affiliation(s)
- D F Vears
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Leuven Institute for Human Genetics and Society, Leuven, Belgium.
| | - K Sénécal
- Centre of Genomics and Policy, McGill University, Montreal, Canada
| | - A J Clarke
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - L Jackson
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - A M Laberge
- Department of Pediatrics, Université de Montréal, Medical Genetics, CHU Sainte-Justine; CHU Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - L Lovrecic
- Clinical Institute of Medical Genetics, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - A Piton
- Molecular diagnostic laboratory, Strasbourg University Hospitals, Strasbourg, France
| | - K L I Van Gassen
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H G Yntema
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B M Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Canada
| | - P Borry
- Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Leuven Institute for Human Genetics and Society, Leuven, Belgium
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Turner BJ, Rodriguez N, Valerio MA, Liang Y, Winkler P, Jackson L. Less Exercise and More Drugs: How a Low-Income Population Manages Chronic Pain. Arch Phys Med Rehabil 2017; 98:2111-2117. [PMID: 28341586 PMCID: PMC5990366 DOI: 10.1016/j.apmr.2017.02.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate chronic pain management in a multistate, low-income Hispanic population, and to examine predictors of exercising and prescription pain medication (PPM) use. DESIGN Online survey administered to a representative sample of Hispanic adults in June 2015. SETTING Five southwestern states. PARTICIPANTS Among all online panel members who were Hispanic (N=1007), aged 35 to 75 years from 5 states, representing 11,016,135 persons, the survey was completed by 516 members (51%). Among these, 102 participants were identified with chronic noncancer pain representing 1,140,170 persons. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Exercising or using PPM for chronic pain in past year. RESULTS Most participants reported using PPM (58%) and exercise (54%) to manage pain. Compared with annual household incomes >$75,000, adjusted odds ratios [AORs] for exercising were .20 for <$10,000 (P=.12); .40 for $10,000 to $34,999 (P=.22); and .15 for $35,000 to $74,999 (P=.015). Conversely, AORs for PPM were over 4-fold higher for lower-income groups as follows: 14.2, 4.79, and 4.85, respectively (all P<.065). PPM users rated the importance of accessing a gym to manage pain lower (P=.01), while exercisers rated the feasibility of gym access to manage pain higher (P=.001). CONCLUSIONS In a Hispanic population-based sample with chronic pain, lower-income groups tended to exercise less but use PPM more. Barriers to gym access and use may play a role in these disparities.
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Affiliation(s)
- Barbara J Turner
- Department of Medicine, UT Health San Antonio, San Antonio, TX; Center for Research to Advance Community Health, UT Health San Antonio, San Antonio, TX.
| | - Natalia Rodriguez
- Center for Research to Advance Community Health, UT Health San Antonio, San Antonio, TX
| | - Melissa A Valerio
- Center for Research to Advance Community Health, UT Health San Antonio, San Antonio, TX; Department of Health Promotion and Behavioral Science, University of Texas School of Public Health in San Antonio, San Antonio, TX
| | - Yuanyuan Liang
- Center for Research to Advance Community Health, UT Health San Antonio, San Antonio, TX; Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, TX
| | - Paula Winkler
- Center for Research to Advance Community Health, UT Health San Antonio, San Antonio, TX; South Central Area Health Education Center, UT Health San Antonio, San Antonio, TX
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Petrylak D, Heath E, Sonpavde G, George S, Morgans A, Eigl B, Picus J, Cheng S, Hotte S, Gartner E, Vincent M, Chu R, Anand B, Morrison K, Jackson L, Melhem-Bertrandt A, Yu E. Interim analysis of a phase I dose escalation trial of the antibody drug conjugate (ADC) AGS15E (ASG-15ME) in patients (Pts) with metastatic urothelial cancer (mUC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maldonado P, Jackson L, Florian-Rodriguez M, Wai C. 51: Comparisons of functional support with sacrohysteropexy versus sacrocolpopexy: A cadaveric study. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.082] [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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Hodgetts J, Flint L, Davey C, Forde S, Jackson L, Harju V, Skelton A, Fox A. Identification of ‘
Candidatus
Phytoplasma fragariae’ (16Sr XII‐E) infecting
Corylus avellana
(hazel) in the United Kingdom. ACTA ACUST UNITED AC 2015. [DOI: 10.5197/j.2044-0588.2015.032.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- J. Hodgetts
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - L.J. Flint
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - C. Davey
- Animal and Plant Health AgencyPlant Health and Seeds InspectorateRoom 6 Timberham House, World Cargo CentreGatwick AirportWest SussexRH6 0EY
| | - S. Forde
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - L. Jackson
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - V. Harju
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - A. Skelton
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
| | - A. Fox
- The Food and Environment Research AgencySand HuttonYorkYO41 1LZUK
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Christensen DR, Landes RD, Jackson L, Marsch LA, Mancino M, Chopra MP, Bickel WK. Adding an Internet-delivered treatment to an efficacious treatment package for opioid dependence. J Consult Clin Psychol 2014; 82:964-72. [PMID: 25090043 PMCID: PMC4244262 DOI: 10.1037/a0037496] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [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: 11/08/2022]
Abstract
OBJECTIVE To examine the benefit of adding an Internet-delivered behavior therapy to a buprenorphine medication program and voucher-based motivational incentives. METHOD A block-randomized, unblinded, parallel, 12-week treatment trial was conducted with 170 opioid-dependent adult patients (mean age = 34.3 years; 54.1% male; 95.3% White). Participants received an Internet-based community reinforcement approach intervention plus contingency management (CRA+) and buprenorphine or contingency management alone (CM-alone) plus buprenorphine. The primary outcomes, measured over the course of treatment, were longest continuous abstinence, total abstinence, and days retained in treatment. RESULTS Compared to those receiving CM-alone, CRA+ recipients exhibited, on average, 9.7 total days more of abstinence (95% confidence interval [CI = 2.3, 17.2]) and had a reduced hazard of dropping out of treatment (hazard ratio = 0.47; 95% CI [0.26, 0.85]). Prior treatment for opioid dependence significantly moderated the additional improvement of CRA+ for longest continuous days of abstinence. CONCLUSIONS These results provide further evidence that an Internet-based CRA+ treatment is efficacious and adds clinical benefits to a contingency management/medication based program for opioid dependence.
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Affiliation(s)
| | - Reid D. Landes
- University of Arkansas for Medical Sciences – Little Rock, AR
| | - Lisa Jackson
- University of Arkansas for Medical Sciences – Little Rock, AR
| | | | - Michael Mancino
- University of Arkansas for Medical Sciences – Little Rock, AR
| | - Mohit P. Chopra
- Boston University School of Medicine and Harvard Medical School – Boston, MA
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46
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McLean HQ, Thompson MG, Sundaram ME, Kieke BA, Gaglani M, Murthy K, Piedra PA, Zimmerman RK, Nowalk MP, Raviotta JM, Jackson ML, Jackson L, Ohmit SE, Petrie JG, Monto AS, Meece JK, Thaker SN, Clippard JR, Spencer SM, Fry AM, Belongia EA. Influenza vaccine effectiveness in the United States during 2012-2013: variable protection by age and virus type. J Infect Dis 2014; 211:1529-40. [PMID: 25406334 PMCID: PMC4407759 DOI: 10.1093/infdis/jiu647] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [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: 09/15/2014] [Accepted: 11/10/2014] [Indexed: 11/14/2022] Open
Abstract
Background. During the 2012–2013 influenza season, there was cocirculation of influenza A(H3N2) and 2 influenza B lineage viruses in the United States. Methods. Patients with acute cough illness for ≤7 days were prospectively enrolled and had swab samples obtained at outpatient clinics in 5 states. Influenza vaccination dates were confirmed by medical records. The vaccine effectiveness (VE) was estimated as [100% × (1 − adjusted odds ratio)] for vaccination in cases versus test-negative controls. Results. Influenza was detected in 2307 of 6452 patients (36%); 1292 (56%) had influenza A(H3N2), 582 (25%) had influenza B/Yamagata, and 303 (13%) had influenza B/Victoria. VE was 49% (95% confidence interval [CI], 43%–55%) overall, 39% (95% CI, 29%–47%) against influenza A(H3N2), 66% (95% CI, 58%–73%) against influenza B/Yamagata (vaccine lineage), and 51% (95% CI, 36%–63%) against influenza B/Victoria. VE against influenza A(H3N2) was highest among persons aged 50–64 years (52%; 95% CI, 33%–65%) and persons aged 6 months–8 years (51%; 95% CI, 32%–64%) and lowest among persons aged ≥65 years (11%; 95% CI, −41% to 43%). In younger age groups, there was evidence of residual protection from receipt of the 2011–2012 vaccine 1 year earlier. Conclusions. The 2012–2013 vaccines were moderately effective in most age groups. Cross-lineage protection and residual effects from prior vaccination were observed and warrant further investigation.
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Affiliation(s)
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Manjusha Gaglani
- Baylor Scott and White Health, Texas A&M Health Science Center College of Medicine, Temple
| | - Kempapura Murthy
- Baylor Scott and White Health, Texas A&M Health Science Center College of Medicine, Temple
| | | | | | | | | | | | | | | | | | | | | | - Swathi N Thaker
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sarah M Spencer
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia M Fry
- Centers for Disease Control and Prevention, Atlanta, Georgia
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47
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Sheffer CE, Christensen DR, Landes R, Carter LP, Jackson L, Bickel WK. Delay discounting rates: a strong prognostic indicator of smoking relapse. Addict Behav 2014; 39:1682-1689. [PMID: 24878037 DOI: 10.1016/j.addbeh.2014.04.019] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 01/16/2014] [Accepted: 04/03/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent evidence suggests that several dimensions of impulsivity and locus of control are likely to be significant prognostic indicators of relapse. METHOD One-hundred and thirty-one treatment seeking smokers were enrolled in six weeks of multi-component cognitive-behavioral therapy with eight weeks of nicotine replacement therapy. ANALYSIS Cox proportional hazard regressions were used to model days to relapse with each of the following: delay discounting of $100, delay discounting of $1000, six subscales of the Barratt Impulsiveness Scale (BIS), Rotter's Locus of Control (RLOC), Fagerstrom's Test for Nicotine Dependence (FTND), and the Perceived Stress Scale (PSS). Hazard ratios for a one standard deviation increase were estimated with 95% confidence intervals for each explanatory variable. Likelihood ratios were used to examine the level of association with days to relapse for different combinations of the explanatory variables while accounting for nicotine dependence and stress level. RESULTS These analyses found that the $100 delay discounting rate had the strongest association with days to relapse. Further, when discounting rates were combined with the FTND and PSS, the associations remained significant. When the other measures were combined with the FTND and PSS, their associations with relapse non-significant. CONCLUSIONS These findings indicate that delay discounting is independently associated with relapse and adds to what is already accounted for by nicotine dependence and stress level. They also signify that delay discounting is a productive new target for enhancing treatment for tobacco dependence. Consequently, adding an intervention designed to decrease discounting rates to a comprehensive treatment for tobacco dependence has the potential to decrease relapse rates.
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48
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Jarmolowicz DP, Landes RD, Christensen DR, Jones BA, Jackson L, Yi R, Bickel WK. Discounting of money and sex: effects of commodity and temporal position in stimulant-dependent men and women. Addict Behav 2014; 39:1652-1657. [PMID: 24857686 DOI: 10.1016/j.addbeh.2014.04.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [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: 02/14/2014] [Revised: 04/22/2014] [Accepted: 04/30/2014] [Indexed: 11/16/2022]
Abstract
Research on delay discounting has contributed to the understanding of numerous addiction-related phenomena. For example, studies have shown that substance dependent individuals discount their addictive substances (e.g., cocaine) more rapidly than they do other commodities (e.g., money). Recent research has shown that substance dependent individuals discount delayed sex more rapidly than delayed money, and their discounting rates for delayed sex were higher than those of non-addicted individuals. The particular reason that delay discounting rates for sex are higher than those for money, however, are unclear. Do individuals discount delayed sex rapidly because immediate sex is particularly appealing or because delayed sex does not retain its value? Moreover, do the same factors influence men and women's choices? The current study examined delay discounting in four conditions (money now versus money later; sex now versus sex later; money now, versus sex later; sex now versus money later) in cocaine dependent men and women. The procedures used isolated the role of the immediate versus delayed commodity. For men, the higher rates of delay discounting for sex were because delayed sex did not retain its value, whereas both the immediate and delayed commodity influenced the female participants' decisions.
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Affiliation(s)
- David P Jarmolowicz
- Department of Applied Behavioral Science, University of Kansas, United States.
| | - Reid D Landes
- College of Public Health, University of Arkansas for Medical Sciences, United States
| | | | - Bryan A Jones
- Department of Psychology, Kent State University at Ashtabula, United States
| | - Lisa Jackson
- Translational Research Institute, University of Arkansas for Medical Sciences, United States
| | - Richard Yi
- Center for Addictions, Personality and Emotion Research, University of Maryland, United States
| | - Warren K Bickel
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, United States
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49
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Bernstein DI, Jackson L, Patel SM, El Sahly HM, Spearman P, Rouphael N, Rudge TL, Hill H, Goll JB. Immunogenicity and safety of four different dosing regimens of anthrax vaccine adsorbed for post-exposure prophylaxis for anthrax in adults. Vaccine 2014; 32:6284-93. [PMID: 25239484 DOI: 10.1016/j.vaccine.2014.08.076] [Citation(s) in RCA: 10] [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: 06/10/2014] [Revised: 08/13/2014] [Accepted: 08/27/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Strategies to implement post exposure prophylaxis (PEP) in case of an anthrax bioterror event are needed. To increase the number of doses of vaccine available we evaluated reducing the amount of vaccine administered at each of the vaccinations, and reducing the number of doses administered. METHODS Healthy male and non-pregnant female subjects between the ages of 18 and 65 were enrolled and randomized 1:1:1:1 to one of four study arms to receive 0.5 mL (standard dose) of vaccine subcutaneously (SQ) at: (A) days 0, 14; (B) days 0 and 28; (C) days 0, 14, and 28; or (D) 0.25 mL at days 0, 14, and 28. A booster was provided on day 180. Safety was assessed after each dose. Blood was obtained on days 0, 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 84, 100, 180, and 201 and both Toxin Neutralizing antibody and anti-PA IgG antibody measured. RESULTS Almost all subjects developed some local reactions with 46-64% reported to be of moderate severity and 3.3% severe during the primary series. Vaccine groups that included a day 14 dose induced a ≥ 4 fold antibody rise in more subjects on days 21, 28, and 35 than the arm without a day 14 dose. However, schedules with a full day 28 dose induced higher peak levels of antibody that persisted longer. The half dose regimen did not induce antibody as well as the full dose study arms. CONCLUSION Depending on the extent of the outbreak, effectiveness of antibiotics and availability of vaccine, the full dose 0, 28 or 0, 14, 28 schedules may have advantages.
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Affiliation(s)
- David I Bernstein
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Ave., Cincinnati, OH 45229, USA.
| | - Lisa Jackson
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | | | | | - Paul Spearman
- Emory University School of Medicine, Atlanta, GA, USA
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Alyeshmerni D, Jackson L, Palma-Davis L, DuRussel-Weston J, Eagle K. A university health system partners with community schools to focus on health and wellness. Am J Med 2014; 127:687-8. [PMID: 24548807 DOI: 10.1016/j.amjmed.2014.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | - Kim Eagle
- University of Michigan Health System, Ann Arbor
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