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Barnidge D, Troske D, North S, Wallis G, Perkins M, Harding S. Endogenous monoclonal immunoglobulins analyzed using the EXENT® solution and LC-MS. J Mass Spectrom Adv Clin Lab 2024; 32:31-40. [PMID: 38405412 PMCID: PMC10891330 DOI: 10.1016/j.jmsacl.2024.02.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction The EXENT® Solution, a fully automated system, is a recent advancement for identifying and quantifying monoclonal immunoglobulins in serum. It combines immunoprecipitation with MALDI-TOF mass spectrometry. Compared to gel-based methods, like SPEP and IFE, it has demonstrated the ability to detect monoclonal immunoglobulins in serum at lower levels. In this study, samples that tested negative using EXENT® were reflexed to LC-MS to determine if the more sensitive LC-MS method could identify monoclonal immunoglobulins missed by EXENT®. Objectives To assess whether monoclonal immunoglobulins that are not detected by EXENT® can be detected by LC-MS using a low flow LC system coupled to a Q-TOF mass spectrometer. Methods Samples obtained from patients confirmed to have multiple myeloma (MM) were diluted with pooled polyclonal human serum and analyzed using EXENT®. If a specific monoclonal immunoglobulin was not detected by EXENT®, the sample was then subjected to analysis by LC-MS. For the LC-MS analysis, the sample eluate, obtained after the MALDI-TOF MS spotting step, was collected and transferred to an autosampler tray for subsequent analysis using LC-MS. Conclusion LC-MS has the capability to detect monoclonal immunoglobulins that are no longer detected by EXENT®. Reflexing samples to LC-MS for analysis does not involve additional sample handling, allowing for a faster time-to-result compared to current approaches, such as Next-Generation Sequencing, Next-Generation Flow, and clonotypic peptide methods. Notably, LC-MS offers equivalent sensitivity in detecting these specific monoclonal immunoglobulins.
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Affiliation(s)
- David Barnidge
- The Binding Site, Part of ThermoFisher Scientific Research and Development Laboratory, 3777 40th Ave NW, Rochester, MN 55906, United States
| | - Derek Troske
- The Binding Site, Part of ThermoFisher Scientific Research and Development Laboratory, 3777 40th Ave NW, Rochester, MN 55906, United States
| | - Simon North
- The Binding Site, Part of ThermoFisher Scientific, The Binding Site Group Ltd, 8 Calthorpe Road Edgbaston, Birmingham, UK
| | - Gregg Wallis
- The Binding Site, Part of ThermoFisher Scientific, The Binding Site Group Ltd, 8 Calthorpe Road Edgbaston, Birmingham, UK
| | - Mark Perkins
- The Binding Site, Part of ThermoFisher Scientific, The Binding Site Group Ltd, 8 Calthorpe Road Edgbaston, Birmingham, UK
| | - Stephen Harding
- The Binding Site, Part of ThermoFisher Scientific, The Binding Site Group Ltd, 8 Calthorpe Road Edgbaston, Birmingham, UK
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2
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Windecker S, Gilard M, Achenbach S, Cribier A, Delgado V, Deych N, Drossart I, Eltchaninoff H, Fraser AG, Goncalves A, Hindricks G, Holborow R, Kappetein AP, Kilmartin J, Kurucova J, Lüscher TF, Mehran R, O'Connor DB, Perkins M, Samset E, von Bardeleben RS, Weidinger F. Device innovation in cardiovascular medicine: a report from the European Society of Cardiology Cardiovascular Round Table. Eur Heart J 2024; 45:1104-1115. [PMID: 38366821 DOI: 10.1093/eurheartj/ehae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Research performed in Europe has driven cardiovascular device innovation. This includes, but is not limited to, percutaneous coronary intervention, cardiac imaging, transcatheter heart valve implantation, and device therapy of cardiac arrhythmias and heart failure. An important part of future medical progress involves the evolution of medical technology and the ongoing development of artificial intelligence and machine learning. There is a need to foster an environment conducive to medical technology development and validation so that Europe can continue to play a major role in device innovation while providing high standards of safety. This paper summarizes viewpoints on the topic of device innovation in cardiovascular medicine at the European Society of Cardiology Cardiovascular Round Table, a strategic forum for high-level dialogue to discuss issues related to the future of cardiovascular health in Europe. Devices are developed and improved through an iterative process throughout their lifecycle. Early feasibility studies demonstrate proof of concept and help to optimize the design of a device. If successful, this should ideally be followed by randomized clinical trials comparing novel devices vs. accepted standards of care when available and the collection of post-market real-world evidence through registries. Unfortunately, standardized procedures for feasibility studies across various device categories have not yet been implemented in Europe. Cardiovascular imaging can be used to diagnose and characterize patients for interventions to improve procedural results and to monitor devices long term after implantation. Randomized clinical trials often use cardiac imaging-based inclusion criteria, while less frequently trials randomize patients to compare the diagnostic or prognostic value of different modalities. Applications using machine learning are increasingly important, but specific regulatory standards and pathways remain in development in both Europe and the USA. Standards are also needed for smart devices and digital technologies that support device-driven biomonitoring. Changes in device regulation introduced by the European Union aim to improve clinical evidence, transparency, and safety, but they may impact the speed of innovation, access, and availability. Device development programmes including dialogue on unmet needs and advice on study designs must be driven by a community of physicians, trialists, patients, regulators, payers, and industry to ensure that patients have access to innovative care.
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Affiliation(s)
- Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Martine Gilard
- Département de Cardiologie, Hospital La Cavale Blanche, La Cavale Blanche Hospital Boulevard Tanguy Prigent, 29200 Brest, France
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen-Nürnberg, Germany
| | - Alain Cribier
- Department of Cardiology, Inserm U1096, Univ Rouen Normandie, F-76000 Rouen, France
| | - Victoria Delgado
- Department of Cardiology, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Nataliya Deych
- Regulatory Affairs, Edwards Lifesciences, Nyon, Switzerland
| | | | - Hélène Eltchaninoff
- Department of Cardiology, University Hospital Charles Nicolle, Rouen, France
| | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Alexandra Goncalves
- Precision Diagnostics, Philips, Cambridge, MA, USA
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto Medical School, Porto, Portugal
| | - Gerhard Hindricks
- Department of Cardiology, German Heart Center Charite, Berlin, Germany
| | | | | | | | - Jana Kurucova
- Transcatheter Heart Valve Division, Edwards Lifesciences, Nyon, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals and Imperial College and King's College, London, UK
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Roxana Mehran
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | | | - Mark Perkins
- GE Healthcare Cardiology Solutions, Harrogate, UK
| | - Eigil Samset
- GE Healthcare Cardiology Solutions, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | | | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstrasse, Vienna, Austria
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3
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Rudnicka Z, Pręgowska A, Glądys K, Perkins M, Proniewska K. Advancements in artificial intelligence-driven techniques for interventional cardiology. Cardiol J 2024; 31:321-341. [PMID: 38247435 DOI: 10.5603/cj.98650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/31/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
This paper aims to thoroughly discuss the impact of artificial intelligence (AI) on clinical practice in interventional cardiology (IC) with special recognition of its most recent advancements. Thus, recent years have been exceptionally abundant in advancements in computational tools, including the development of AI. The application of AI development is currently in its early stages, nevertheless new technologies have proven to be a promising concept, particularly considering IC showing great impact on patient safety, risk stratification and outcomes during the whole therapeutic process. The primary goal is to achieve the integration of multiple cardiac imaging modalities, establish online decision support systems and platforms based on augmented and/or virtual realities, and finally to create automatic medical systems, providing electronic health data on patients. In a simplified way, two main areas of AI utilization in IC may be distinguished, namely, virtual and physical. Consequently, numerous studies have provided data regarding AI utilization in terms of automated interpretation and analysis from various cardiac modalities, including electrocardiogram, echocardiography, angiography, cardiac magnetic resonance imaging, and computed tomography as well as data collected during robotic-assisted percutaneous coronary intervention procedures. Thus, this paper aims to thoroughly discuss the impact of AI on clinical practice in IC with special recognition of its most recent advancements.
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Affiliation(s)
- Zofia Rudnicka
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Agnieszka Pręgowska
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Kinga Glądys
- Jagiellonian University Medical College, Krakow, Poland
| | - Mark Perkins
- Collegium Prometricum, the Business School for Healthcare, Sopot, Poland
- Royal Society of Arts, London, United Kingdom
| | - Klaudia Proniewska
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland.
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Krakow, Poland.
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4
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Leonard C, Crabb N, Glover D, Cooper S, Bouvy J, Wobbe M, Perkins M. Can the UK 'Netflix' Payment Model Boost the Antibacterial Pipeline? Appl Health Econ Health Policy 2023; 21:365-372. [PMID: 36646872 PMCID: PMC9842493 DOI: 10.1007/s40258-022-00786-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 05/03/2023]
Abstract
The silent pandemic of antimicrobial resistance (AMR) is a global issue needing prompt attention. A comprehensive one-health approach across human and animal health, agriculture and the environment is needed to solve this, addressing overuse of antibacterials, and of course, optimising measures for preventing and controlling infection. We also need a robust pipeline of new antibacterials. However, the current pipeline is inadequate and several companies with new antibacterials have gone bankrupt due to low sales, leading to a 'broken market'. To address this, the UK has completed a project using novel approaches to value assessment and reimbursement for two antibacterials. The new funding arrangements for these products commenced on 1st July 2022, delinking reimbursement from volume of sales; a so-called 'pull incentive', with payments based on the added value to the whole-health and social-care system, not just to individual patients. This article describes how the project was devised, developed, and progressed. The learning from this work might help other countries to adopt or adapt the approach to fit with their national systems, and collectively achieve a global incentive to reinvigorate the antibacterial pipeline.
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Affiliation(s)
- Colm Leonard
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK.
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Nick Crabb
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK
| | - David Glover
- NHS England and NHS Improvement, Skipton House, 80 London Road, London, SE1 6LH, UK
| | - Sophie Cooper
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK
| | - Jacoline Bouvy
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK
| | - Milena Wobbe
- National Institute for Health and Care Excellence, Level 1A, City Tower, Manchester, M1 4BT, UK
| | - Mark Perkins
- NHS England and NHS Improvement, Skipton House, 80 London Road, London, SE1 6LH, UK
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5
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Moody J, Bambaranda I, Perkins M, Lennox K, Choudhary M. O-091 From Family Planning to Fertility Planning - ‘FertPlan’ awareness amongst contraceptive healthcare providers and users. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.105] [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: 11/12/2022] Open
Abstract
Abstract
Study question
Are women and healthcare professionals seeking or providing contraception aware of age-related decline in female fertility and information support regarding fertility awareness?
Summary answer
89.9% of contraceptive users and 71% of providers stated lack of awareness regarding age and fertility emphasising website as the preferred information resource.
What is known already
The last 50 years has seen an upward trend in the age at which women are giving birth. The birth rate for women aged 35 to 39 has trebled since 1980 and is now at its highest ever level. Delaying childbearing may mean that some women will inevitably leave it too late and become childless involuntarily. Women are also seeking fertility treatment at older ages, however, success rates decrease dramatically with age. It is not clear whether women who delay their fertility are aware of the decline in fertility with age, and whether healthcare professionals discuss fertility planning with women.
Study design, size, duration
We conducted two independent anonymous questionnaire surveys of reproductive age women seeking contraception and healthcare professionals(HCP) providing contraception in the UK following research ethics approval, to determine their awareness of the age-related decline in fertility, information resource and potential barriers to provision of information. . This was a prospective study design conducted over a year period using an online questionnaire. A total of 249 participants completed the survey.
Participants/materials, setting, methods
138 reproductive age women on contraception consented and participated in the study by completing the online questionnaire. Of these, 96.4% were of white origin,1.4% mixed ethnicity, 1.4% Asian origin and 0.7% Black.
111 HCP providing contraceptive advice in family planning clinics or in General practice completed the survey. Of these, 6 were allied healthcare professionals ie specialist nurses. Data was collated and analysed using percentages and descriptive statistics.
Main results and the role of chance
Of the total 138 female contraceptive users, 87 were aged 30-39 years whilst 35 were 40-45 years. 51.4% of women indicated no concern about their future fertility, whilst the remainder gave roughly uniformly distributed ratings of concern from unconcerned to highly concerned. However, one third of all women (31.1%) believed that age-related fertility decline occurred after 40 years. 89.9% of women felt fertility awareness and education is important.
Of the total 111 HCP, ∼one in 10 HCP (11.7%) misconstrued the female age-related decline to begin from 40 years onwards. The contraceptive providers also were misinformed regarding age related decline in IVF success rate with 45% of them citing 40 years or over to be the age that contributed to decline in IVF success. Despite these figures, majority (71.2%) of HCP agreed there was lack of fertility awareness and 33.3% felt fertility education should be commenced as early as school age. 27% HCP always discussed future fertility whilst 33.3% discussed most of the times. The most commonly-stated barriers to providing information were lack of time, self-perceived lack of knowledge, and women not asking.
73.2% of reproductive age contraceptive users and 85.6% HCPs expressed website to be the most preferred option for information resource.
Limitations, reasons for caution
To the best of our knowledge, this is one of the first studies seeking fertility awareness amongst those practising family planning. As this was not a qualitative interview based study, the findings are open to interpretation and one must exercise caution.
Wider implications of the findings
This study highlights clear need for fertility education and awareness amongst contraceptive providers and users. By providing resources to inform, we may increase awareness and confidence amongst both groups thereby empowering women to make informed choices about their future fertility by integrating Fertility planning within Family Planning.
Trial registration number
Not applicable (IRAS 248991 and R&D Ref 8999)
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Affiliation(s)
- J Moody
- County Durham and Darlington Hospitals NHS Trust, Department of Obstetrics and Gynaecology , Darlington, United Kingdom
| | - I Bambaranda
- Newcastle Fertility Centre at Life, Newcastle upon Tyne Hospitals NHS Trust , Newcastle Upon Tyne, United Kingdom
| | - M Perkins
- Newcastle Fertility Centre at Life, Newcastle upon Tyne Hospitals NHS Trust , Newcastle Upon Tyne, United Kingdom
| | - K Lennox
- Newcastle Fertility Centre at Life, Newcastle upon Tyne Hospitals NHS Trust , Newcastle Upon Tyne, United Kingdom
| | - M Choudhary
- Newcastle Fertility Centre at Life, Newcastle upon Tyne Hospitals NHS Trust , Newcastle Upon Tyne, United Kingdom
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6
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Hastie C, Thompson A, Perkins M, Langford VS, Eddleston M, Homer NZM. Selected Ion Flow Tube-Mass Spectrometry (SIFT-MS) as an Alternative to Gas Chromatography/Mass Spectrometry (GC/MS) for the Analysis of Cyclohexanone and Cyclohexanol in Plasma. ACS Omega 2021; 6:32818-32822. [PMID: 34901631 PMCID: PMC8655936 DOI: 10.1021/acsomega.1c03827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/14/2021] [Indexed: 06/14/2023]
Abstract
Self-poisoning with professional agricultural pesticide products is responsible for about 20% of global suicide, with most cases occurring in South Asia and China. Treatment of severe poisoning involves long-term intensive clinical care and is often unsuccessful. Solvent co-formulants (such as cyclohexanone) also contribute to mortality themselves or via more toxic metabolic products (such as cyclohexanol). Faster detection of co-formulants could aid earlier identification of pesticide poisoning and faster intervention, reducing mortality. Conventional analysis of volatiles in blood uses headspace (HS)-GC/MS. This paper evaluates SIFT-MS, a direct MS technique that provides higher sample throughput than GC/MS, as a potential tool for cyclohexanone and cyclohexanol analysis in plasma. Both instruments were calibrated using a conventional approach prior to analysis of each porcine plasma sample on both instruments. Comparative data were evaluated using Bland-Altman plots, demonstrating that the techniques were in good agreement. Compared with GC/MS, SIFT-MS provides fourfold higher sample throughput and shows great promise as an alternative analytical tool.
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Affiliation(s)
- Colin Hastie
- Anatune Ltd, Unit 4, Wellbrook Court, Girton
Road, Cambridge CB3 0NA, United Kingdom
| | - Adrian Thompson
- University/BHF Centre for Cardiovascular
Sciences, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Mark Perkins
- Anatune Ltd, Unit 4, Wellbrook Court, Girton
Road, Cambridge CB3 0NA, United Kingdom
| | | | - Michael Eddleston
- University/BHF Centre for Cardiovascular
Sciences, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Natalie ZM. Homer
- University/BHF Centre for Cardiovascular
Sciences, Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
- Mass
Spectrometry Core, Edinburgh Clinical Research Facility, University/BHF Centre for Cardiovascular Sciences,
Queen’s Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United
Kingdom
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7
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Hollmann B, Perkins M, Chauhan VM, Aylott JW, Hardie KR. Fluorescent nanosensors reveal dynamic pH gradients during biofilm formation. NPJ Biofilms Microbiomes 2021; 7:50. [PMID: 34140515 PMCID: PMC8211749 DOI: 10.1038/s41522-021-00221-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Understanding the dynamic environmental microniches of biofilms will permit us to detect, manage and exploit these communities. The components and architecture of biofilms have been interrogated in depth; however, little is known about the environmental microniches present. This is primarily because of the absence of tools with the required measurement sensitivity and resolution to detect these changes. We describe the application of ratiometric fluorescent pH-sensitive nanosensors, as a tool, to observe physiological pH changes in biofilms in real time. Nanosensors comprised two pH-sensitive fluorophores covalently encapsulated with a reference pH-insensitive fluorophore in an inert polyacrylamide nanoparticle matrix. The nanosensors were used to analyse the real-time three-dimensional pH variation for two model biofilm formers: (i) opportunistic pathogen Pseudomonas aeruginosa and (ii) oral pathogen Streptococcus mutans. The detection of sugar metabolism in real time by nanosensors provides a potential application to identify therapeutic solutions to improve oral health.
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Affiliation(s)
- Birte Hollmann
- Biodiscovery Institute, School of Life Sciences, University Park, University of Nottingham, Nottingham, UK
- Advanced Materials & Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Mark Perkins
- Biodiscovery Institute, School of Life Sciences, University Park, University of Nottingham, Nottingham, UK
- Advanced Materials & Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Veeren M Chauhan
- Advanced Materials & Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Jonathan W Aylott
- Advanced Materials & Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Kim R Hardie
- Biodiscovery Institute, School of Life Sciences, University Park, University of Nottingham, Nottingham, UK.
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8
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White JC, Fornaroli R, Hill MJ, Hannah DM, House A, Colley I, Perkins M, Wood PJ. Long-term river invertebrate community responses to groundwater and surface water management operations. Water Res 2021; 189:116651. [PMID: 33248332 DOI: 10.1016/j.watres.2020.116651] [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: 05/02/2020] [Revised: 10/18/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
River flow regimes have been transformed by groundwater and surface water management operations globally, prompting widespread ecological responses. Yet, empirical evidence quantifying the simultaneous effects of groundwater and surface water management operations on freshwater ecosystems remains limited. This study combines a multi-decadal freshwater invertebrate dataset (1995-2016) with groundwater model outputs simulating the effects of different anthropogenic flow alterations (e.g. groundwater abstraction, effluent water returns) and river discharges. A suite of flow alteration- and flow-ecology relationships were modelled that tested different invertebrate community responses (taxonomic, functional, flow response guilds, individual taxa). Most flow alteration-ecology relationships were not statistically significant, highlighting the absence of consistent, detectable ecological responses to long-term water management operations. A small number of significant statistical models provided insights into how flow alterations transformed specific ecological assets; including Ephemeroptera, Plecoptera and Trichoptera taxa which are rheophilic in nature being positively associated with groundwater abstraction effects reducing river discharges by 0-15%. This represents a key finding from a water resource management operation perspective given that such flow alteration conditions were observed on average in over two-thirds of the study sites examined. In a small number of instances, specific invertebrate responses displayed relative declines associated with the most severe groundwater abstraction effects and artificial hydrological inputs (predominantly effluent water returns). The strongest flow-ecology relationships were recorded during spring months, when invertebrate communities were most responsive to antecedent minimum and maximum discharges, and average flow conditions in the preceding summer months. Results from this study provide new evidence indicating how groundwater and surface water resources can be managed to conserve riverine ecological assets. Moreover, the ensemble of flow alteration- and flow-ecology relationships established in this study could be used to guide environmental flow strategies. Such findings are of global importance given that future climatic change and rising societal water demands are likely to further transform river flow regimes and threaten freshwater ecosystems.
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Affiliation(s)
- J C White
- River Restoration Centre, Cranfield University, Cranfield, Bedfordshire MK43 0AL, UK; Centre for Hydrological and Ecosystem Science, Geography and Environment, Loughborough University, Loughborough, Leicestershire, LE11 3TU, United Kingdom.
| | - R Fornaroli
- DISAT, Università degli Studi di Milano-Bicocca, Piazza della Scienza 1, 20126 Milano, Italy.
| | - M J Hill
- School of Applied Sciences University of Huddersfield, Huddersfield, HD1 3DH, UK.
| | - D M Hannah
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - A House
- Wessex Water, Claverton, Bath, BA2 7WW, United Kingdom.
| | - I Colley
- Wessex Water, Claverton, Bath, BA2 7WW, United Kingdom.
| | - M Perkins
- Environment Agency, Rivers House, Sunrise Business Park, Blandford, Dorset DT11 8ST, United Kingdom.
| | - P J Wood
- Centre for Hydrological and Ecosystem Science, Geography and Environment, Loughborough University, Loughborough, Leicestershire, LE11 3TU, United Kingdom.
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9
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Thomson R, Parr JB, Cheng Q, Chenet S, Perkins M, Cunningham J. Prevalence of Plasmodium falciparum lacking histidine-rich proteins 2 and 3: a systematic review. Bull World Health Organ 2020; 98:558-568F. [PMID: 32773901 PMCID: PMC7411324 DOI: 10.2471/blt.20.250621] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 01/07/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To calculate prevalence estimates and evaluate the quality of studies reporting Plasmodium falciparum lacking histidine-rich proteins 2 and 3, to inform an international response plan. Methods We searched five online databases, without language restriction, for articles reporting original data on Plasmodium falciparum-infected patients with deletions of the pfhrp2 and/or pfhrp3 genes (pfhrp2/3). We calculated prevalence estimates of pfhrp2/3 deletions and mapped the data by country. The denominator was all P. falciparum-positive samples testing positive by microscopy and confirmed positive by species-specific polymerase chain reaction testing (PCR). If microscopy was not performed, we used the number of samples based on a different diagnostic method or PCR alone. We scored studies for risk of bias and the quality of laboratory methods using a standardized scoring system. Findings A total of 38 articles reporting 55 studies from 32 countries and one territory worldwide were included in the review. We found considerable heterogeneity in the populations studied, methods used and estimated prevalence of P. falciparum parasites with pfhrp2/3 deletions. The derived prevalence of pfhrp2 deletions ranged from 0% to 100%, including focal areas in South America and Africa. Only three studies (5%) fulfilled all seven criteria for study quality. Conclusion The lack of representative surveys or consistency in study design impairs evaluations of the risk of false-negative results in malaria diagnosis due to pfhrp2/3 deletions. Accurate mapping and strengthened monitoring of the prevalence of pfhrp2/3 deletions is needed, along with harmonized methods that facilitate comparisons across studies.
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Affiliation(s)
| | - Jonathan B Parr
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, United States of America
| | - Qin Cheng
- Australian Defence Force Malaria and Infectious Disease Institute, Queensland, Australia
| | - Stella Chenet
- Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas, Peru
| | - Mark Perkins
- Department of Emergency Preparedness, World Health Organization, Geneva, Switzerland
| | - Jane Cunningham
- Global Malaria Programme, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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10
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Jiao S, Hazebroek JP, Chamberlin MA, Perkins M, Sandhu AS, Gupta R, Simcox KD, Yinghong L, Prall A, Heetland L, Meeley RB, Multani DS. Chitinase-like1 Plays a Role in Stalk Tensile Strength in Maize. Plant Physiol 2019; 181:1127-1147. [PMID: 31492738 PMCID: PMC6836851 DOI: 10.1104/pp.19.00615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/29/2019] [Indexed: 05/22/2023]
Abstract
Stalk lodging in maize (Zea mays) causes significant yield losses due to breaking of stalk tissue below the ear node before harvest. Here, we identified the maize brittle stalk4 (bk4) mutant in a Mutator F2 population. This mutant was characterized by highly brittle aerial parts that broke easily from mechanical disturbance or in high-wind conditions. The bk4 plants displayed a reduction in average stalk diameter and mechanical strength, dwarf stature, senescence at leaf tips, and semisterility of pollen. Histological studies demonstrated a reduction in lignin staining of cells in the bk4 mutant leaves and stalk, and deformation of vascular bundles in the stalk resulting in the loss of xylem and phloem tissues. Biochemical characterization showed a significant reduction in p-coumaric acid, Glc, Man, and cellulose contents. The candidate gene responsible for bk4 phenotype is Chitinase-like1 protein (Ctl1), which is expressed at its highest levels in elongated internodes. Expression levels of secondary cell wall cellulose synthase genes (CesA) in the bk4 single mutant, and phenotypic observations in double mutants combining bk4 with bk2 or null alleles for two CesA genes, confirmed interaction of ZmCtl1 with CesA genes. Overexpression of ZmCtl1 enhanced mechanical stalk strength without affecting plant stature, senescence, or fertility. Biochemical characterization of ZmCtl1 overexpressing lines supported a role for ZmCtl1 in tensile strength enhancement. Conserved identity of CTL1 peptides across plant species and analysis of Arabidopsis (Arabidopsis thaliana) ctl1-1 ctl2-1 double mutants indicated that Ctl1 might have a conserved role in plants.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Alan Prall
- Corteva Agriscience, Johnston, Iowa 50131
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11
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Wonderly B, Jones S, Gatton ML, Barber J, Killip M, Hudson C, Carter L, Brooks T, Simpson AJH, Semper A, Urassa W, Chua A, Perkins M, Boehme C. Comparative performance of four rapid Ebola antigen-detection lateral flow immunoassays during the 2014-2016 Ebola epidemic in West Africa. PLoS One 2019; 14:e0212113. [PMID: 30845203 PMCID: PMC6405069 DOI: 10.1371/journal.pone.0212113] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/28/2019] [Indexed: 11/23/2022] Open
Abstract
Background Without an effective vaccine, as was the case early in the 2014–2016 Ebola Outbreak in West Africa, disease control depends entirely on interrupting transmission through early disease detection and prompt patient isolation. Lateral Flow Immunoassays (LFI) are a potential supplement to centralized reference laboratory testing for the early diagnosis of Ebola Virus Disease (EVD). The goal of this study was to assess the performance of commercially available simple and rapid antigen detection LFIs, submitted for review to the WHO via the Emergency Use Assessment and Listing procedure. The study was performed in an Ebola Treatment Centre laboratory involved in EVD testing in Sierra Leone. In light of the current Ebola outbreak in May 2018 in the Democratic Republic of Congo, which highlights the lack of clarity in the global health community about appropriate Ebola diagnostics, our findings are increasingly critical. Methods A cross-sectional study was conducted to assess comparative performance of four LFIs for detecting EVD. LFIs were assessed against the same 328 plasma samples and 100 whole EDTA blood samples, using the altona RealStar Filovirus Screen real-time RT-PCR as the bench mark assay. The performance of the Public Health England (PHE) in-house Zaire ebolavirus-specific real time RT-PCR Trombley assay was concurrently assessed. Statistical analysis using generalized estimating equations was conducted to compare LFI performance. Findings Sensitivity and specificity varied between the LFIs, with specificity found to be significantly higher for whole EDTA blood samples compared to plasma samples in at least 2 LFIs (P≤0.003). Using the altona RT-PCR assay as the bench mark, sensitivities on plasma samples ranged from 79.53% (101/127, 95% CI: 71.46–86.17%) for the DEDIATEST EBOLA (SD Biosensor) to 98.43% (125/127, 95% CI: 94.43–99.81%) for the One step Ebola test (Intec). Specificities ranged from 80.20% (158/197, 95% CI: 74.07–88.60%) for plasma samples using the ReEBOV Antigen test Kit (Corgenix) to 100.00% (98/98, 95% CI: 96.31–100.00%) for whole blood samples using the DEDIATEST EBOLA (SD Biosensor) and SD Ebola Zaire Ag (SD Biosensor). Results also showed the Trombley RT-PCR assay had a lower limit of detection than the altona assay, with some LFIs having higher sensitivity than the altona assay when the Trombley assay was the bench mark. Interpretation All of the tested EVD LFIs may be considered suitable for use in an outbreak situation (i.e. rule out testing in communities), although they had variable performance characteristics, with none possessing both high sensitivity and specificity. The non-commercial Trombley Zaire ebolavirus RT-PCR assay warrants further investigation, as it appeared more sensitive than the current gold standard, the altona Filovirus Screen RT-PCR assay.
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Affiliation(s)
- Betsy Wonderly
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Sophie Jones
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Michelle L Gatton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - John Barber
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Marian Killip
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Chris Hudson
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Lisa Carter
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Tim Brooks
- Public Health England, Porton Down, United Kingdom
| | | | | | | | - Arlene Chua
- Médecins Sans Frontières International, Geneva, Switzerland
| | - Mark Perkins
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
| | - Catharina Boehme
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
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Blunk B, Perkins M, Walsh D, Chauhan V, Camara M, Williams P, Aylott J, Hardie K. Use of nanosensor technology to investigate biofilm formation and resulting malodour in washing machines. Access Microbiol 2019. [DOI: 10.1099/acmi.ac2019.po0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Birte Blunk
- 1Centre for Biomolecular Sciences, University of Nottingham, Nottingham, United Kingdom
- 2Boots Science Building, University of Nottingham, Nottingham, United Kingdom
| | - Mark Perkins
- 2Boots Science Building, University of Nottingham, Nottingham, United Kingdom
- 1Centre for Biomolecular Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Dean Walsh
- 2Boots Science Building, University of Nottingham, Nottingham, United Kingdom
- 1Centre for Biomolecular Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Veeren Chauhan
- 2Boots Science Building, University of Nottingham, Nottingham, United Kingdom
| | - Miguel Camara
- 1Centre for Biomolecular Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Paul Williams
- 1Centre for Biomolecular Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Jonathan Aylott
- 2Boots Science Building, University of Nottingham, Nottingham, United Kingdom
| | - Kim Hardie
- 1Centre for Biomolecular Sciences, University of Nottingham, Nottingham, United Kingdom
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Perkins M, Blunk B, Walsh D, Chauhan V, Aylott J, Hardie K. Mapping 4D pH evolution in Streptococcus mutans biofilms using fluorescent ratiometric pH-sensitive nanosensors. Access Microbiol 2019. [DOI: 10.1099/acmi.ac2019.po0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mark Perkins
- University of Nottingham, Nottingham, United Kingdom
| | - Birte Blunk
- University of Nottingham, Nottingham, United Kingdom
| | - Dean Walsh
- University of Nottingham, Nottingham, United Kingdom
| | | | | | - Kim Hardie
- University of Nottingham, Nottingham, United Kingdom
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Vandenberg A, Bender A, Kemp C, Ball M, Perkins M. “I WISH SOMEONE COULD TELL ME HOW IT FEELS (TO DIE)”: COMMUNICATION ABOUT DEATH AND DYING IN ASSISTED LIVING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - A Bender
- Emory University School of Medicine, Atlanta, GA, United States
| | - C Kemp
- The Gerontology Institute, Georgia State University
| | - M Ball
- Emory University School of Medicine
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Jason K, Kemp C, Perkins M. BALANCING RISK AND RESILIENCE: STUDYING AFRICAN AMERICANS’ CARE CONVOYS IN ASSISTED LIVING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Jason
- Universtiy of North Carolina at Charlotte
| | - C Kemp
- The Gerontology Institute, Georgia State University
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Perkins M, Vandenberg A, Ball M, Kemp C, Bender A. CARE OF ASSISTED LIVING RESIDENTS APPROACHING END OF LIFE: A PROCESS OF NEGOTIATING RISKS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - M Ball
- Emory University School of Medicine
| | - C Kemp
- The Gerontology Institute, Georgia State University
| | - A Bender
- Emory University School of Medicine, Atlanta, GA United States
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17
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Coyle M, Perkins M, Robert M, Quest T, Bender A. CHARACTERIZING THE USE AND DOCUMENTATION OF ADVANCED DIRECTIVES IN FOUR DIVERSE ASSISTED LIVING FACILITIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - M Robert
- Emory University School of Medicine
| | - T Quest
- Emory University Palliative Care Center
| | - A Bender
- Emory University School of Medicine
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18
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Duplessis C, Biswas B, Hanisch B, Perkins M, Henry M, Quinones J, Wolfe D, Estrella L, Hamilton T. Refractory Pseudomonas Bacteremia in a 2-Year-Old Sterilized by Bacteriophage Therapy. J Pediatric Infect Dis Soc 2018; 7:253-256. [PMID: 28992111 DOI: 10.1093/jpids/pix056] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/15/2017] [Indexed: 11/15/2022]
Abstract
Here, we report a complex case that involved a pediatric patient who experienced recalcitrant multidrug-resistant Pseudomonas aeruginosa infection complicated by bacteremia/sepsis; our antibacterial options were limited because of resistance, allergies, and suboptimal source control. A cocktail of 2 bacteriophages targeting the infectious organism introduced on 2 separate occasions sterilized the bacteremia.
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Affiliation(s)
- C Duplessis
- Enteric Disease Department, Infectious Disease Directorate, Naval Medical Research Center, Silver Spring, Maryland
| | - B Biswas
- Biological Defense Research Directorate, Naval Medical Research Center, Fort Detrick, Maryland.,Henry M. Jackson Foundation, Bethesda, Maryland
| | - B Hanisch
- Pediatric Infectious Diseases, Children's National Medical Center, Washington, DC.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - M Perkins
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - M Henry
- Biological Defense Research Directorate, Naval Medical Research Center, Fort Detrick, Maryland
| | - J Quinones
- Biological Defense Research Directorate, Naval Medical Research Center, Fort Detrick, Maryland
| | - D Wolfe
- Biological Defense Research Directorate, Naval Medical Research Center, Fort Detrick, Maryland
| | - L Estrella
- Biological Defense Research Directorate, Naval Medical Research Center, Fort Detrick, Maryland
| | - T Hamilton
- Biological Defense Research Directorate, Naval Medical Research Center, Fort Detrick, Maryland
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19
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Lawrie SR, Faircloth DC, Smith JD, Sarmento TM, Whitehead MO, Wood T, Perkins M, Macgregor J, Abel R. Recent H - diagnostics, plasma simulations, and 2X scaled Penning ion source developments at the Rutherford Appleton Laboratory. Rev Sci Instrum 2018; 89:052101. [PMID: 29864892 DOI: 10.1063/1.5011714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A vessel for extraction and source plasma analyses is being used for Penning H- ion source development at the Rutherford Appleton Laboratory. A new set of optical elements including an einzel lens has been installed, which transports over 80 mA of H- beam successfully. Simultaneously, a 2X scaled Penning source has been developed to reduce cathode power density. The 2X source is now delivering a 65 mA H- ion beam at 10% duty factor, meeting its design criteria. The long-term viability of the einzel lens and 2X source is now being evaluated, so new diagnostic devices have been installed. A pair of electrostatic deflector plates is used to correct beam misalignment and perform fast chopping, with a voltage rise time of 24 ns. A suite of four quartz crystal microbalances has shown that the cesium flux in the vacuum vessel is only increased by a factor of two, despite the absence of a dedicated cold trap. Finally, an infrared camera has demonstrated good agreement with thermal simulations but has indicated unexpected heating due to beam loss on the downstream electrode. These types of diagnostics are suitable for monitoring all operational ion sources. In addition to experimental campaigns and new diagnostic tools, the high-performance VSim and COMSOL software packages are being used for plasma simulations of two novel ion thrusters for space propulsion applications. In parallel, a VSim framework has been established to include arbitrary temperature and cesium fields to allow the modeling of surface physics in H- ion sources.
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Affiliation(s)
- S R Lawrie
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Oxfordshire, United Kingdom
| | - D C Faircloth
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Oxfordshire, United Kingdom
| | - J D Smith
- Tech-X UK Ltd., The Innovation Centre, Sci-Tech Daresbury, Cheshire, United Kingdom
| | - T M Sarmento
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Oxfordshire, United Kingdom
| | - M O Whitehead
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Oxfordshire, United Kingdom
| | - T Wood
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Oxfordshire, United Kingdom
| | - M Perkins
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Oxfordshire, United Kingdom
| | - J Macgregor
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Oxfordshire, United Kingdom
| | - R Abel
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Oxfordshire, United Kingdom
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20
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Affiliation(s)
- Mark Perkins
- ODI Library, Portland House, Stag Place, London SWIE 5DP, United Kingdom
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21
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Agua-Agum J, Allegranzi B, Ariyarajah A, Aylward RB, Blake IM, Barboza P, Bausch D, Brennan RJ, Clement P, Coffey P, Cori A, Donnelly CA, Dorigatti I, Drury P, Durski K, Dye C, Eckmanns T, Ferguson NM, Fraser C, Garcia E, Garske T, Gasasira A, Gurry C, Hamblion E, Hinsley W, Holden R, Holmes D, Hugonnet S, Jaramillo Gutierrez G, Jombart T, Kelley E, Santhana R, Mahmoud N, Mills HL, Mohamed Y, Musa E, Naidoo D, Nedjati-Gilani G, Newton E, Norton I, Nouvellet P, Perkins D, Perkins M, Riley S, Schumacher D, Shah A, Tang M, Varsaneux O, Van Kerkhove MD. After Ebola in West Africa--Unpredictable Risks, Preventable Epidemics. N Engl J Med 2016; 375:587-96. [PMID: 27509108 DOI: 10.1056/nejmsr1513109] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
The obstacles to the use of the Internet as a solution to development problems are not only technical, but political, social, cultural and institutional.
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23
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Benedetti LR, Holder JP, Perkins M, Brown CG, Anderson CS, Allen FV, Petre RB, Hargrove D, Glenn SM, Simanovskaia N, Bradley DK, Bell P. Advances in x-ray framing cameras at the National Ignition Facility to improve quantitative precision in x-ray imaging. Rev Sci Instrum 2016; 87:023511. [PMID: 26931853 DOI: 10.1063/1.4941754] [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] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 01/25/2016] [Indexed: 06/05/2023]
Abstract
We describe an experimental method to measure the gate profile of an x-ray framing camera and to determine several important functional parameters: relative gain (between strips), relative gain droop (within each strip), gate propagation velocity, gate width, and actual inter-strip timing. Several of these parameters cannot be measured accurately by any other technique. This method is then used to document cross talk-induced gain variations and artifacts created by radiation that arrives before the framing camera is actively amplifying x-rays. Electromagnetic cross talk can cause relative gains to vary significantly as inter-strip timing is varied. This imposes a stringent requirement for gain calibration. If radiation arrives before a framing camera is triggered, it can cause an artifact that manifests as a high-intensity, spatially varying background signal. We have developed a device that can be added to the framing camera head to prevent these artifacts.
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Affiliation(s)
- L R Benedetti
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J P Holder
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Perkins
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C G Brown
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C S Anderson
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - F V Allen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R B Petre
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Hargrove
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S M Glenn
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Simanovskaia
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D K Bradley
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P Bell
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
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Wood T, Faircloth DC, Lawrie SR, Letchford AP, Whitehead MO, Pike T, Perkins M. The ISIS pre-injector reconfiguration. Rev Sci Instrum 2016; 87:02B121. [PMID: 26932003 DOI: 10.1063/1.4934658] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
With the introduction of a new "low energy beams" group at ISIS, the decision was taken to expand the ion source area. This paper will explain what actions were taken, how this has improved the present working environment and how the space will be used to accommodate a medium energy beam transport (MEBT) section after the existing radio-frequency quadrupole. The MEBT will incorporate three 202.5 MHz re-bunching cavities and will achieve a transmission of 96% with minimal emittance growth.
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Affiliation(s)
- T Wood
- ISIS Pulsed Spallation Neutron and Muon Facility, Science and Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Oxford, Oxfordshire, United Kingdom
| | - D C Faircloth
- ISIS Pulsed Spallation Neutron and Muon Facility, Science and Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Oxford, Oxfordshire, United Kingdom
| | - S R Lawrie
- ISIS Pulsed Spallation Neutron and Muon Facility, Science and Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Oxford, Oxfordshire, United Kingdom
| | - A P Letchford
- ISIS Pulsed Spallation Neutron and Muon Facility, Science and Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Oxford, Oxfordshire, United Kingdom
| | - M O Whitehead
- ISIS Pulsed Spallation Neutron and Muon Facility, Science and Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Oxford, Oxfordshire, United Kingdom
| | - T Pike
- ISIS Pulsed Spallation Neutron and Muon Facility, Science and Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Oxford, Oxfordshire, United Kingdom
| | - M Perkins
- ISIS Pulsed Spallation Neutron and Muon Facility, Science and Technology Facilities Council, Rutherford Appleton Laboratory, Harwell Oxford, Oxfordshire, United Kingdom
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Laabei M, Uhlemann AC, Lowy FD, Austin ED, Yokoyama M, Ouadi K, Feil E, Thorpe HA, Williams B, Perkins M, Peacock SJ, Clarke SR, Dordel J, Holden M, Votintseva AA, Bowden R, Crook DW, Young BC, Wilson DJ, Recker M, Massey RC. Evolutionary Trade-Offs Underlie the Multi-faceted Virulence of Staphylococcus aureus. PLoS Biol 2015; 13:e1002229. [PMID: 26331877 PMCID: PMC4558032 DOI: 10.1371/journal.pbio.1002229] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 05/21/2015] [Accepted: 07/20/2015] [Indexed: 12/15/2022] Open
Abstract
Bacterial virulence is a multifaceted trait where the interactions between pathogen and host factors affect the severity and outcome of the infection. Toxin secretion is central to the biology of many bacterial pathogens and is widely accepted as playing a crucial role in disease pathology. To understand the relationship between toxicity and bacterial virulence in greater depth, we studied two sequenced collections of the major human pathogen Staphylococcus aureus and found an unexpected inverse correlation between bacterial toxicity and disease severity. By applying a functional genomics approach, we identified several novel toxicity-affecting loci responsible for the wide range in toxic phenotypes observed within these collections. To understand the apparent higher propensity of low toxicity isolates to cause bacteraemia, we performed several functional assays, and our findings suggest that within-host fitness differences between high- and low-toxicity isolates in human serum is a contributing factor. As invasive infections, such as bacteraemia, limit the opportunities for onward transmission, highly toxic strains could gain an additional between-host fitness advantage, potentially contributing to the maintenance of toxicity at the population level. Our results clearly demonstrate how evolutionary trade-offs between toxicity, relative fitness, and transmissibility are critical for understanding the multifaceted nature of bacterial virulence. This study shows that, contrary to expectation, toxin secretion inversely correlates with disease severity for the major human pathogen Staphylococcus aureus. Global efforts to counter the growing problem of antibiotic resistance and develop alternative treatment strategies rely on a fuller understanding of when and why opportunistic pathogens cause disease. Recent advances in DNA sequencing technologies have opened up new opportunities to study infectious organisms, yet identifying the genetic variants that explain differences in disease remains challenging. Here we aimed to understand the complex relationship between toxicity—a known risk factor for disease in many bacteria—and infection severity for the major human pathogen S. aureus. Against expectations, we found that the bacteria that caused the most severe disease were the least toxic strains. We were able to determine the mutations responsible for the differences in toxicity and identified a number of novel toxicity-affecting genes. We further discovered that bacterial fitness in human serum could explain the unexpected association of low-toxicity isolates with severe, invasive disease. Invasive S. aureus infections are usually considered a dead end for these bacteria, as these infections are rarely transmitted to another person. Here we show using a simple mathematical model that this might in fact favour transmission of highly toxic bacteria on a population level and thus contribute to their global success. Our work therefore highlights the complexity of bacterial infection and should aid in devising new treatment and control strategies against this important pathogen.
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Affiliation(s)
- Maisem Laabei
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Anne-Catrin Uhlemann
- Department of Medicine, Columbia University, New York, New York, United States of America
| | - Franklin D. Lowy
- Department of Medicine, Columbia University, New York, New York, United States of America
| | - Eloise D. Austin
- Department of Medicine, Columbia University, New York, New York, United States of America
| | - Maho Yokoyama
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Khadija Ouadi
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Edward Feil
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Harry A. Thorpe
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Barnabas Williams
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Mark Perkins
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | - Sharon J. Peacock
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Stephen R. Clarke
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Janina Dordel
- Pathogen Genomics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Matthew Holden
- Pathogen Genomics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
- School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, Fife, United Kingdom
| | - Antonina A. Votintseva
- Nuffield Dept. of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rory Bowden
- Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom
| | - Derrick W. Crook
- Nuffield Dept. of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Bernadette C. Young
- Nuffield Dept. of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Daniel J. Wilson
- Nuffield Dept. of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom
| | - Mario Recker
- Centre for Mathematics and the Environment, University of Exeter, Penryn Campus, Penryn, United Kingdom
| | - Ruth C. Massey
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
- * E-mail:
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O'Hare AM, Wong SP, Yu MK, Wynar B, Perkins M, Liu CF, Lemon JM, Hebert PL. Trends in the Timing and Clinical Context of Maintenance Dialysis Initiation. J Am Soc Nephrol 2015; 26:1975-81. [PMID: 25700539 DOI: 10.1681/asn.2013050531] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/23/2014] [Indexed: 11/03/2022] Open
Abstract
Whether secular trends in eGFR at dialysis initiation reflect changes in clinical presentation over time is unknown. We reviewed the medical records of a random sample of patients who initiated maintenance dialysis in the Department of Veterans Affairs (VA) in fiscal years 2000-2009 (n=1691) to characterize trends in clinical presentation in relation to eGFR at initiation. Between fiscal years 2000-2004 and 2005-2009, mean eGFR at initiation increased from 9.8±5.8 to 11.0±5.5 ml/min per 1.73 m(2) (P<0.001), the percentage of patients with an eGFR of 10-15 ml/min per 1.73 m(2) increased from 23.4% to 29.9% (P=0.002), and the percentage of patients with an eGFR>15 ml/min per 1.73 m(2) increased from 12.1% to 16.3% (P=0.01). The proportion of patients who were acutely ill at the time of initiation and the proportion of patients for whom the decision to initiate dialysis was based only on level of kidney function did not change over time. Frequencies of documented clinical signs and/or symptoms were similar during both time periods. The adjusted odds of initiating dialysis at an eGFR of 10-15 or >15 ml/min per 1.73 m(2) (versus <10 ml/min per 1.73 m(2)) during the later versus earlier time period were 1.43 (95% confidence interval [95% CI], 1.13 to 1.81) and 1.46 (95% CI, 1.09 to 1.97), respectively. In conclusion, trends in eGFR at dialysis initiation at VA medical centers do not seem to reflect changes in the clinical context in which dialysis is initiated.
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Affiliation(s)
- Ann M O'Hare
- Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments of Medicine and Group Health Research Institute, Seattle, Washington
| | - Susan P Wong
- Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments of Medicine and
| | - Margaret K Yu
- Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments of Medicine and
| | - Bruce Wynar
- Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
| | - Mark Perkins
- Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
| | - Chuan-Fen Liu
- Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; Health Services, University of Washington, Seattle, Washington; and
| | - Jaclyn M Lemon
- Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
| | - Paul L Hebert
- Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; Health Services, University of Washington, Seattle, Washington; and
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Rinne ST, Wong ES, Lemon JM, Perkins M, Bryson CL, Liu CF. Survey nonresponders incurred higher medical utilization and lower medication adherence. Am J Manag Care 2015; 21:e1-e8. [PMID: 25880264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To compare healthcare costs, utilization, and medication adherence between diabetic responders and nonresponders to a patient satisfaction survey. STUDY DESIGN We performed a retrospective cohort study of 40,766 patients with diabetes who had been randomly selected to receive the 2006 Veterans Affairs' Survey of Healthcare Experiences of Patients. Outcomes were measured during the following year. METHODS We used multivariable models to compare healthcare costs (generalized linear models), utilization (negative binomial regression), and adherence to oral hypoglycemic medications (logistic regression) between survey responders and nonresponders. RESULTS There were 26,051 patients (64%) who responded to the survey. Survey nonresponders incurred significantly higher healthcare costs (incremental effect, $792; 95% CI, $599-$986; P < .01). Nonresponders had a modest increase in primary care (incidence rate ratio [IRR], 1.06; 95% CI, 1.05-1.08; P < .01) and specialty care visits (IRR, 1.17; 95% CI, 1.12-1.22; P < .01), but more substantial increases in mental health visits (IRR, 1.74; 95% CI, 1.62-1.87; P < .01) and hospitalizations (IRR, 1.60; 95% CI, 1.46-1.75; P < .01). Medication adherence was significantly lower among survey nonresponders (odds ratio, 0.68; 95% CI, 0.65-0.74; P < .01). CONCLUSIONS Nonresponders to a patient satisfaction survey incurred higher healthcare costs and utilization, but had lower medication adherence. Understanding these characteristics helps to assess the impact of nonresponse bias on patient satisfaction surveys and identifies clinical practices to improve care delivery.
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Affiliation(s)
- Seppo T Rinne
- 1100 Olive Way, Ste 1400, Seattle, WA 98104-3801. E-mail:
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Hsu C, Lemon JM, Wong ES, Carson-Cheng E, Perkins M, Nordstrom MS, Liu CF, Sprague C, Bryson CL. Factors affecting medication adherence: patient perspectives from five veterans affairs facilities. BMC Health Serv Res 2014; 14:533. [PMID: 25391694 PMCID: PMC4239388 DOI: 10.1186/s12913-014-0533-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 01/16/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United States, more than 25 million people have diabetes. Medication adherence is known to be important for disease control. However, factors that consistently predict medication adherence are unclear and the literature lacks patient perspectives on how health care systems affect adherence to oral hypoglycemic agents (OHAs). This study explored facilitators and barriers to OHA adherence by obtaining the perspectives of Veterans Affairs (VA) patients with OHA prescriptions. METHODS A total of 45 patients participated in 12 focus groups that explored a wide range of issues that might affect medication adherence. Participants were patients at clinics in Seattle, Washington; San Antonio, Texas; Portland, Oregon; Salem, Oregon, and Warrenton, Oregon. RESULTS Key system-level facilitators of OHA adherence included good overall pharmacy service and several specific mechanisms for ordering and delivering medications (automated phone refill service, Web-based prescription ordering), as well as providing pillboxes and printed lists of current medications to patients. Barriers mirrored many of the facilitators. Poor pharmacy service quality and difficulty coordinating multiple prescriptions emerged as key barriers. CONCLUSIONS VA patient focus groups provided insights on how care delivery systems can encourage diabetes medication adherence by minimizing the barriers and enhancing the facilitators at both the patient and system levels. Major system-level factors that facilitated adherence were overall pharmacy service quality, availability of multiple systems for reordering medications, having a person to call when questions arose, counseling about the importance of adherence and providing tools such as pillboxes and updated medication lists.
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Affiliation(s)
- Clarissa Hsu
- Center for Community Health and Evaluation, Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1448, USA. .,Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA.
| | - Jaclyn M Lemon
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA.
| | - Edwin S Wong
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. .,Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA.
| | - Elizabeth Carson-Cheng
- Center for Community Health and Evaluation, Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1448, USA.
| | - Mark Perkins
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA.
| | - Margaret S Nordstrom
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA.
| | - Chuan-Fen Liu
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. .,Department of Health Services, School of Public Health and Community Medicine, University of Washington, 1959 NE Pacific St. Magnuson Health Sciences Center, Box 357660, Seattle, WA, 98195, USA.
| | - Carol Sprague
- Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA. .,Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239-3098, USA.
| | - Christopher L Bryson
- VA Puget Sound Health Care System, Northwest Center for Outcomes Research in Older Adults, 1660 South Columbian Way, Seattle, WA, 98108, USA. .,Department of Medicine, University of Washington, Box 356420, , 1959 NE Pacific Street, Seattle, WA, 98195, USA.
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Rinne ST, Feemster LC, Collins BF, Au DH, Perkins M, Bryson CL, O’Riordan TG, Liu CF. Thiazolidinediones and the risk of asthma exacerbation among patients with diabetes: a cohort study. Allergy Asthma Clin Immunol 2014; 10:34. [PMID: 25024717 PMCID: PMC4094895 DOI: 10.1186/1710-1492-10-34] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/19/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thiazolidinediones are oral diabetes medications that selectively activate peroxisome proliferator-activated receptor gamma and have potent anti-inflammatory properties. While a few studies have found improvements in pulmonary function with exposure to thiazolidinediones, there are no studies of their impact on asthma exacerbations. Our objective was to assess whether exposure to thiazolidinediones was associated with a decreased risk of asthma exacerbation. METHODS We performed a cohort study of diabetic Veterans who had a diagnosis of asthma and were taking oral diabetes medications during the period of 10/1/2005 - 9/30/2006. The risk of asthma exacerbations and oral steroid use during 10/1/2006 - 9/30/2007 was compared between patients who were prescribed thiazolidinediones and patients who were on alternative oral diabetes medications. Multivariable logistic regression and negative binomial regression analyses were used to characterize this risk. A sensitivity analysis was performed, restricting our evaluation to patients who were adherent to diabetes therapy. RESULTS We identified 2,178 patients who were on thiazolidinediones and 10,700 who were not. Exposure to thiazolidinediones was associated with significant reductions in the risk of asthma exacerbation (OR = 0.79, 95% CI, 0.62 - 0.99) and oral steroid prescription (OR = 0.73, 95% CI 0.63 - 0.84). Among patients who were adherent to diabetes medications, there were more substantial reductions in the risks for asthma exacerbation (OR = 0.64, 95% CI 0.47 - 0.85) and oral steroid prescription (OR = 0.68, 95% CI 0.57 - 0.81). CONCLUSIONS Thiazolidinediones may provide a novel anti-inflammatory approach to asthma management by preventing exacerbations and decreasing the use of oral steroids.
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Affiliation(s)
- Seppo T Rinne
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA
| | - Laura C Feemster
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA
| | - Bridget F Collins
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA
| | - David H Au
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Pulmonary and Cri Care, University of Washington, Seattle, WA, USA
| | - Mark Perkins
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
| | - Christopher L Bryson
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Chuan-Fen Liu
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, 1100 Olive Way Suite 1400, 98104-3801 Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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Wong ES, Hebert PL, Maciejewski ML, Perkins M, Bryson CL, Au DH, Liu CF. Does Favorable Selection Among Medicare Advantage Enrollees Affect Measurement of Hospital Readmission Rates? Med Care Res Rev 2014; 71:367-83. [PMID: 24811933 DOI: 10.1177/1077558714533823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/13/2014] [Indexed: 11/16/2022]
Abstract
Literature indicates favorable selection among Medicare Advantage (MA) enrollees compared with fee-for-service (FFS) enrollees. This study examined whether favorable selection into MA affected readmission rates among Medicare-eligible veterans following hospitalization for congestive heart failure in the Veterans Affairs Health System (VA). We measured total (VA + Medicare FFS) 30-day all-cause readmission rates across hospitals and all of VA. We used Heckman's correction to adjust readmission rates to be representative of all Medicare-eligible veterans, not just FFS-enrolled veterans. The adjusted all-cause readmission rate among FFS veterans was 27.1% (95% confidence interval [CI] = 26.5% to 27.7%), while the adjusted readmission rate among Medicare-eligible veterans was 25.3% (95% CI = 23.6% to 27.1%) after correcting for favorable selection. Readmission rate estimates among FFS veterans generalize to all Medicare-eligible veterans only after accounting for favorable selection into MA. Estimation of quality metrics should carefully consider sample selection to produce valid policy inferences.
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Affiliation(s)
- Edwin S Wong
- VA Puget Sound Health Care System, Seattle, WA, USA University of Washington, Seattle, WA, USA
| | - Paul L Hebert
- VA Puget Sound Health Care System, Seattle, WA, USA University of Washington, Seattle, WA, USA
| | | | - Mark Perkins
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - Chris L Bryson
- VA Puget Sound Health Care System, Seattle, WA, USA University of Washington, Seattle, WA, USA
| | - David H Au
- VA Puget Sound Health Care System, Seattle, WA, USA University of Washington, Seattle, WA, USA
| | - Chuan-Fen Liu
- VA Puget Sound Health Care System, Seattle, WA, USA University of Washington, Seattle, WA, USA
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Lawrie SR, Faircloth DC, Letchford AP, Perkins M, Whitehead MO, Wood T, Gabor C, Back J. Development of the front end test stand and vessel for extraction and source plasma analyses negative hydrogen ion sources at the Rutherford Appleton Laboratory. Rev Sci Instrum 2014; 85:02B127. [PMID: 24593567 DOI: 10.1063/1.4826109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The ISIS pulsed spallation neutron and muon facility at the Rutherford Appleton Laboratory (RAL) in the UK uses a Penning surface plasma negative hydrogen ion source. Upgrade options for the ISIS accelerator system demand a higher current, lower emittance beam with longer pulse lengths from the injector. The Front End Test Stand is being constructed at RAL to meet the upgrade requirements using a modified ISIS ion source. A new 10% duty cycle 25 kV pulsed extraction power supply has been commissioned and the first meter of 3 MeV radio frequency quadrupole has been delivered. Simultaneously, a Vessel for Extraction and Source Plasma Analyses is under construction in a new laboratory at RAL. The detailed measurements of the plasma and extracted beam characteristics will allow a radical overhaul of the transport optics, potentially yielding a simpler source configuration with greater output and lifetime.
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Affiliation(s)
- S R Lawrie
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - D C Faircloth
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - A P Letchford
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - M Perkins
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - M O Whitehead
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - T Wood
- STFC ISIS Pulsed Spallation Neutron and Muon Facility, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - C Gabor
- ASTeC Intense Beams Group, Rutherford Appleton Laboratory, Harwell Oxford, Harwell, United Kingdom
| | - J Back
- High Energy Physics Department, University of Warwick, Coventry, United Kingdom
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Proudfoot L, Powell A, Ayis S, Barbarot S, Baselga Torres E, Deleuran M, Fölster-Holst R, Gelmetti C, Hernández-Martin A, Middelkamp-Hup M, Oranje A, Logan K, Perkins M, Patrizi A, Rovatti G, Schofield O, Spuls P, Svensson Å, Vestergaard C, Wahlgren CF, Schmitt J, Flohr C. The European treatment of severe atopic eczema in children taskforce (TREAT) survey. Br J Dermatol 2013; 169:901-9. [DOI: 10.1111/bjd.12505] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- L.E. Proudfoot
- St John's Institute of Dermatology; Guy's and St Thomas' NHS Foundation Trust; London SE1 9RT U.K
| | - A.M. Powell
- St John's Institute of Dermatology; Guy's and St Thomas' NHS Foundation Trust; London SE1 9RT U.K
| | - S. Ayis
- Division of Health and Social Care Research; Guy's and St Thomas' NHS Foundation Trust; London SE1 9RT U.K
| | - S. Barbarot
- Department of Dermatology; CHU Hôtel-Dieu; 44035 Nantes France
| | - E. Baselga Torres
- Pediatric Dermatology Unit; Department of Dermatology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - M. Deleuran
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - R. Fölster-Holst
- Department of Dermatology; University Hospital Schleswig-Holstein; Kiel Germany
| | - C. Gelmetti
- Department of Pathophysiology and Transplantation; University of Milan and Fondazione IRCCS Ca' Granda; Ospedale Maggiore Policlinico; Milan Italy
| | | | - M.A. Middelkamp-Hup
- Department of Dermatology; Academic Medical Center; Amsterdam the Netherlands
| | - A.P. Oranje
- Department of Dermatology; Maasstadziekenhuis; Rotterdam the Netherlands
| | - K. Logan
- Division of Asthma, Allergy and Lung Biology; Department of Paediatric Allergy; King's College London; London U.K
| | - M. Perkins
- Division of Asthma, Allergy and Lung Biology; Department of Paediatric Allergy; King's College London; London U.K
| | - A. Patrizi
- Dermatology, Department of Specialised, Experimental and Diagnostic Medicine; University of Bologna; Bologna Italy
| | - G. Rovatti
- Department of Pathophysiology and Transplantation; University of Milan and Fondazione IRCCS Ca' Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - O. Schofield
- Department of Dermatology; Royal Infirmary of Edinburgh; Edinburgh U.K
| | - P. Spuls
- Department of Dermatology; Academic Medical Center; Amsterdam the Netherlands
| | - Å. Svensson
- Department of Dermatology; Institute of Clinical Research in Malmö; Skåne University Hospital; Lund University; Malmö Sweden
| | - C. Vestergaard
- Department of Dermatology; Aarhus University Hospital; Aarhus Denmark
| | - C.-F. Wahlgren
- Dermatology Unit; Department of Medicine Solna; Karolinska Institutet; Stockholm Sweden
| | - J. Schmitt
- Centre for Evidence-Based Healthcare; University of Dresden; Dresden Germany
- Department of Social and Occupational Medicine; University of Dresden; Dresden Germany
| | - C. Flohr
- St John's Institute of Dermatology; Guy's and St Thomas' NHS Foundation Trust; London SE1 9RT U.K
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Doherty-Bone TM, Ndifon RK, Nyingchia ON, Landrie FE, Yonghabi FT, Duffus ALJ, Price S, Perkins M, Bielby J, Kome NB, LeBreton M, Gonwouo LN, Cunningham AA. Morbidity and mortality of the Critically Endangered Lake Oku clawed frog Xenopus longipes. ENDANGER SPECIES RES 2013. [DOI: 10.3354/esr00514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Patients who have access to different health care systems, such as Medicare-eligible veterans, may obtain services in either or both health systems. We examined whether quality of diabetes care was associated with care continuity or veterans’ usual source of primary care in a retrospective cohort study of 1,867 Medicare-eligible veterans with diabetes in 2001 to 2004. Underprovision of quality of diabetes care was more common than overprovision. In adjusted analyses, veterans who relied only on Medicare fee-for-service (FFS) for primary care were more likely to be underprovided HbA1c testing than veterans who relied only on Veteran Affairs (VA) for primary care. Dual users of VA and Medicare FFS primary care were significantly more likely to be overprovided HbA1c and microalbumin testing than VA-only users. VA and Medicare providers may need to coordinate more effectively to ensure appropriate diabetes care to Medicare-eligible veterans, because VA reliance was a stronger predictor than care continuity.
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Affiliation(s)
- Matthew L. Maciejewski
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Virginia Wang
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - James F. Burgess
- Center for Organization, Leadership & Management Research, VA Boston Healthcare System, Boston, MA, USA
- Boston University, MA, USA
| | - Chris L. Bryson
- Northwest Center for Outcomes Research in Older Adults, Department of Veterans Affairs, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Mark Perkins
- Northwest Center for Outcomes Research in Older Adults, Department of Veterans Affairs, Seattle, WA, USA
| | - Chuan-Fen Liu
- Northwest Center for Outcomes Research in Older Adults, Department of Veterans Affairs, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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Bielby J, Bovero S, Angelini C, Favelli M, Gazzaniga E, Perkins M, Sotgiu G, Tessa G, Garner TWJ. Geographic and taxonomic variation inBatrachochytrium dendrobatidisinfection and transmission within a highly endemic amphibian community. DIVERS DISTRIB 2013. [DOI: 10.1111/ddi.12085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - S. Bovero
- Zirichiltaggi S. W. C. Non-profit Association for Wildlife Conservation; Strada Vicinale; Filigheddu 62/C; 07100; Sassari; Italy
| | - C. Angelini
- Zirichiltaggi S. W. C. Non-profit Association for Wildlife Conservation; Strada Vicinale; Filigheddu 62/C; 07100; Sassari; Italy
| | - M. Favelli
- Zirichiltaggi S. W. C. Non-profit Association for Wildlife Conservation; Strada Vicinale; Filigheddu 62/C; 07100; Sassari; Italy
| | - E. Gazzaniga
- Zirichiltaggi S. W. C. Non-profit Association for Wildlife Conservation; Strada Vicinale; Filigheddu 62/C; 07100; Sassari; Italy
| | - M. Perkins
- The Institute of Zoology; The Zoological Society of London; Regent's Park; London; NW1 4RY; UK
| | - G. Sotgiu
- Zirichiltaggi S. W. C. Non-profit Association for Wildlife Conservation; Strada Vicinale; Filigheddu 62/C; 07100; Sassari; Italy
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Bryson CL, Au DH, Maciejewski ML, Piette JD, Fihn SD, Jackson GL, Perkins M, Wong ES, Yano EM, Liu CF. Wide clinic-level variation in adherence to oral diabetes medications in the VA. J Gen Intern Med 2013; 28:698-705. [PMID: 23371383 PMCID: PMC3631064 DOI: 10.1007/s11606-012-2331-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 05/04/2012] [Revised: 12/05/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND While there has been extensive research into patient-specific predictors of medication adherence and patient-specific interventions to improve adherence, there has been little examination of variation in clinic-level medication adherence. OBJECTIVE We examined the clinic-level variation of oral hypoglycemic agent (OHA) medication adherence among patients with diabetes treated in the Department of Veterans Affairs (VA) primary care clinics. We hypothesized that there would be systematic variation in clinic-level adherence measures, and that adherence within organizationally-affiliated clinics, such as those sharing local management and support, would be more highly correlated than adherence between unaffiliated clinics. DESIGN Retrospective cohort study. SETTING VA hospital and VA community-based primary care clinics in the contiguous 48 states. PATIENTS 444,418 patients with diabetes treated with OHAs and seen in 158 hospital-based clinics and 401 affiliated community primary care clinics during fiscal years 2006 and 2007. MAIN MEASURES Refill-based medication adherence to OHA. KEY RESULTS Adjusting for patient characteristics, the proportion of patients adherent to OHAs ranged from 57 % to 81 % across clinics. Adherence between organizationally affiliated clinics was high (Pearson Correlation = 0.82), and adherence between unaffiliated clinics was low (Pearson Correlation = 0.04). CONCLUSION The proportion of patients adherent to OHAs varied widely across VA primary care clinics. Clinic-level adherence was highly correlated to other clinics in the same organizational unit. Further research should identify which factors common to affiliated clinics influence medication adherence.
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Affiliation(s)
- Chris L Bryson
- Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, Seattle, WA, USA.
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Straumann A, Hoesli S, Bussmann C, Stuck M, Perkins M, Collins LP, Payton M, Pettipher R, Hunter M, Steiner J, Simon HU. Anti-eosinophil activity and clinical efficacy of the CRTH2 antagonist OC000459 in eosinophilic esophagitis. Allergy 2013; 68:375-85. [PMID: 23379537 DOI: 10.1111/all.12096] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic, Th2-type inflammatory disease. Chemoattractant receptor-homologous molecule on Th2 cells (CRTH2) is a prostaglandin D(2) (PGD(2)) receptor, expressed by Th2 cells and other inflammatory cells, including eosinophils and basophils, that mediates chemotaxis and activation. OC000459 is a selective CRTH2 antagonist and would be expected to suppress eosinophilic tissue inflammation. The purpose of this study was to evaluate the efficacy and safety of an OC000459 monotherapy in adult patients with active, corticosteroid-dependent or corticosteroid-refractory EoE. METHODS In this randomized, double-blind, placebo-controlled trial, 26 adult patients (m/f = 22/4; mean age 41 years, range 22-69 years) with active EoE, dependent or resistant to corticosteroids, were treated either with 100 mg OC000459 (n = 14) or placebo (n = 12) twice daily. Pre- and post-treatment disease activity was assessed clinically, endoscopically, histologically, and via biomarkers. The primary end point was the reduction in esophageal eosinophil infiltration. RESULTS After an 8-week OC000459 treatment, the esophageal eosinophil load decreased significantly, from 114.83 to 73.26 eosinophils per high-power field [(eos/hpf), P = 0.0256], whereas no reduction was observed with placebo (102.80-99.47 eos/hpf, P = 0.870). With OC000459, the physician's global assessment of disease activity improved from 7.13 to 5.18 (P = 0.035). OC000459 likewise reduced extracellular deposits of eosinophil peroxidase and tenascin C, the effects not seen with placebo. No serious adverse events were observed. CONCLUSIONS An 8-week treatment with the CRTH2-antagonist, OC000459, exerts modest, but significant, anti-eosinophil and beneficial clinical effects in adult patients with active, corticosteroid-dependent or corticosteroid-refractory EoE and is well tolerated.
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Affiliation(s)
- A. Straumann
- Swiss EoE Clinic and EoE Research Network; Olten
| | - S. Hoesli
- Institute of Pharmacology; University of Bern; Bern
| | - Ch. Bussmann
- Institute of Pathology; General Hospital Lucerne; Lucerne; Switzerland
| | - M. Stuck
- Institute of Pharmacology; University of Bern; Bern
| | | | | | | | | | | | - J. Steiner
- Oxford Therapeutics Consulting Ltd; Brightwell cum Sotwell; Oxon; UK
| | - H.-U. Simon
- Institute of Pharmacology; University of Bern; Bern
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Doherty-Bone TM, Gonwouo NL, Hirschfeld M, Ohst T, Weldon C, Perkins M, Kouete MT, Browne RK, Loader SP, Gower DJ, Wilkinson MW, Rödel MO, Penner J, Barej MF, Schmitz A, Plötner J, Cunningham AA. Batrachochytrium dendrobatidis in amphibians of Cameroon, including first records for caecilians. Dis Aquat Organ 2013; 102:187-194. [PMID: 23446968 DOI: 10.3354/dao02557] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Amphibian chytrid fungus Batrachochytrium dendrobatidis (Bd) has been hypothesised to be an indigenous parasite of African amphibians. In Cameroon, however, previous surveys in one region (in the northwest) failed to detect this pathogen, despite the earliest African Bd having been recorded from a frog in eastern Cameroon, plus one recent record in the far southeast. To reconcile these contrasting results, we present survey data from 12 localities across 6 regions of Cameroon from anurans (n = 1052) and caecilians (n = 85) of ca. 108 species. Bd was detected in 124 amphibian hosts at 7 localities, including Mt. Oku, Mt. Cameroon, Mt. Manengouba and lowland localities in the centre and west of the country. None of the hosts were observed dead or dying. Infected amphibian hosts were not detected in other localities in the south and eastern rainforest belt. Infection occurred in both anurans and caecilians, making this the first reported case of infection in the latter order (Gymnophiona) of amphibians. There was no significant difference between prevalence and infection intensity in frogs and caecilians. We highlight the importance of taking into account the inhibition of diagnostic qPCR in studies on Bd, based on all Bd-positive hosts being undetected when screened without bovine serum albumin in the qPCR mix. The status of Bd as an indigenous, cosmopolitan amphibian parasite in Africa, including Cameroon, is supported by this work. Isolating and sequencing strains of Bd from Cameroon should now be a priority. Longitudinal host population monitoring will be required to determine the effects, if any, of the infection on amphibians in Cameroon.
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Affiliation(s)
- T M Doherty-Bone
- Department of Life Sciences, The Natural History Museum, London, UK
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Abstract
PURPOSE We examined how the choice of historic medication use criteria for identifying prevalent users may bias estimated adherence changes associated with a medication copayment increase. METHODS From pharmacy claims data in a retrospective cohort study, we identified 6,383 prevalent users of oral diabetes medications from four VA Medical Centers. Patients were included in this prevalent cohort if they had one fill both 3 months prior and 4-12 months prior to the index date, defined as the month in which medication copayments increased. To determine whether these historic medication use criteria introduced bias in the estimated response to a $5 medication copayment increase, we compared adherence trends from cohorts defined from different medication use criteria and from different index dates of copayment change. In an attempt to validate the prior observation of an upward trend in adherence prior to the date of the policy change, we replicated time series analyses varying the index dates prior to and following the date of the policy change, hypothesizing that the trend line associated with the policy change would differ from the trend lines that were not. RESULTS Medication adherence trends differed when different medication use criteria were applied. Contrary to our expectations, similar adherence trends were observed when the same medication use criteria were applied at index dates when no copayment changes occurred. CONCLUSION To avoid introducing bias due to study design in outcomes assessments of medication policy changes, historic medication use inclusion criteria must be chosen carefully when constructing cohorts of prevalent users. Furthermore, while pharmacy data have enormous potential for population research and monitoring, there may be inherent logical flaws that limit cohort identification solely through administrative pharmacy records.
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Affiliation(s)
- Matthew L Maciejewski
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC 27705, USA.
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40
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Kocarnik BM, Liu CF, Wong ES, Perkins M, Maciejewski ML, Yano EM, Au DH, Piette JD, Bryson CL. Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence? BMC Health Serv Res 2012; 12:391. [PMID: 23148570 PMCID: PMC3537712 DOI: 10.1186/1472-6963-12-391] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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: 05/18/2012] [Accepted: 11/04/2012] [Indexed: 11/30/2022] Open
Abstract
Background Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a patient-centered medical home and may have a positive influence on medication use. We examined whether the presence of pharmacists in primary care clinics was associated with higher OHA adherence. Methods This retrospective cohort study analyzed 280,603 diabetes patients in 196 primary care clinics within the Veterans Affairs healthcare system. Pharmacists presence, number of pharmacist full-time equivalents (FTEs), and the degree to which pharmacy services are perceived as a bottleneck in each clinic were obtained from the 2007 VA Clinical Practice Organizational Survey—Primary Care Director Module. Patient-level adherence to OHAs using medication possession ratios (MPRs) were constructed using refill data from administrative pharmacy databases after adjusting for patient characteristics. Clinic-level OHA adherence was measured as the proportion of patients with MPR >= 80%. We analyzed associations between pharmacy measures and clinic-level adherence using linear regression. Results We found no significant association between pharmacist presence and clinic-level OHA adherence. However, adherence was lower in clinics where pharmacy services were perceived as a bottleneck. Conclusions Pharmacist presence, regardless of the amount of FTE, was not associated with OHA medication adherence in primary care clinics. The exact role of pharmacists in clinics needs closer examination in order to determine how to most effectively use these resources to improve patient-centered outcomes including medication adherence.
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Affiliation(s)
- Beverly Mielke Kocarnik
- Division of General Internal Medicine, University of Washington, 329 NinthAve, Campus Box 359780, Seattle, WA 98104, USA
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González IJ, Polley S, Hopkins H, Sutherland C, Mori Y, Perkins M, Bell D. Molecular diagnosis for screening and elimination of malaria: performance of the first commercially-available malaria LAMP test. Malar J 2012. [PMCID: PMC3472261 DOI: 10.1186/1475-2875-11-s1-o30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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42
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Faircloth D, Lawrie S, Gabor C, Letchford A, Whitehead M, Wood T, Perkins M. Optimizing the front end test stand high performance H- ion source at RAL. Rev Sci Instrum 2012; 83:02A701. [PMID: 22380210 DOI: 10.1063/1.3655526] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The aim of the front end test stand project is to demonstrate that chopped low energy H(-) beams of high quality can be produced. The beam line currently consists of the ion source, a 3 solenoid low energy beam transport and a suite of diagnostics. A brief status report of the radio frequency quadrupole is given. This paper details the work to optimize the ion source performance. A new high power pulsed discharge power supply with greater reliability has been developed to allow long term, stable operation at 50 Hz with a 60 A, 2.2 ms discharge pulse and up to 100 A at 1.2 ms. The existing extraction power supply has been modified to operate up to 22 kV. Results from optical spectroscopy measurements and their application to source optimization are summarized. Source emittances and beam currents of 60 mA are reported.
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Affiliation(s)
- D Faircloth
- STFC, Rutherford Appleton Laboratory, Chilton, Oxfordshire OX11 0QX, United Kingdom.
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Burgess JF, Maciejewski ML, Bryson CL, Chapko M, Fortney JC, Perkins M, Sharp ND, Liu CF. Importance of health system context for evaluating utilization patterns across systems. Health Econ 2011; 20:239-251. [PMID: 20169587 DOI: 10.1002/hec.1588] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Measuring health services provided to patients can be difficult when patients see providers across multiple health systems and all visits are rarely captured in a single data source covering all systems where patients receive care. Studies that account for only one system will omit the out-of-system health-care use at the patient level. Combining data across systems and comparing utilization patterns across health systems creates complications for both aggregation and accuracy because data-generating processes (DGPs) tend to vary across systems. We develop a hybrid methodology for aggregation across systems, drawing on the strengths of the DGP in each system, and demonstrate its validity for answering research questions requiring cross-system assessments of health-care utilization. Positive and negative predictive probabilities can be useful to assess the impact of the hybrid methodology. We illustrate these issues comparing public sector (administrative records from the US Department of Veterans Affairs system) and private sector (billing records from the US Medicare system) patient level data to identify primary-care utilization. Understanding the context of a particular health system and its effect on the DGP is important in conducting effective valid evaluations.
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Affiliation(s)
- James F Burgess
- Center for Organization, Leadership and Management Research, Department of Veterans Affairs, Boston, MA, USA.
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Banoo S, Bell D, Bossuyt P, Herring A, Mabey D, Poole F, Smith PG, Sriram N, Wongsrichanalai C, Linke R, O'Brien R, Perkins M, Cunningham J, Matsoso P, Nathanson CM, Olliaro P, Peeling RW, Ramsay A. Evaluation of diagnostic tests for infectious diseases: general principles. Nat Rev Microbiol 2010; 8:S17-S29. [PMID: 21548184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
BACKGROUND Temporary, antegrade amnesia is one of the core desirable endpoints of general anesthesia. Multiple lines of evidence support a role for the hippocampal θ rhythm, a synchronized rhythmic oscillation of field potentials at 4-12 Hz, in memory formation. Previous studies have revealed a disruption of the θ rhythm at surgical levels of anesthesia. We hypothesized that θ-rhythm modulation would also occur at subhypnotic but amnestic concentrations. Therefore, we examined the effect of three inhaled agents on properties of the θ rhythm considered critical for the formation of hippocampus-dependent memories. METHODS We studied the effects of halothane and nitrous oxide, two agents known to modulate different molecular targets (GABAergic [γ-aminobutyric acid] vs. non-GABAergic, respectively) and isoflurane (GABAergic and non-GABAergic targets) on fear-conditioned learning and θ oscillations in freely behaving rats. RESULTS All three anesthetics slowed θ peak frequency in proportion to their inhibition of fear conditioning (by 1, 0.7, and 0.5 Hz for 0.32% isoflurane, 60% N2O, and 0.24% halothane, respectively). Anesthetics inconsistently affected other characteristics of θ oscillations. CONCLUSIONS At subhypnotic amnestic concentrations, θ-oscillation frequency was the parameter most consistently affected by these three anesthetics. These results are consistent with the hypothesis that modulation of the θ rhythm contributes to anesthetic-induced amnesia.
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Affiliation(s)
- Misha Perouansky
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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47
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Parker A, Rigby-Singleton S, Perkins M, Bates D, Le Roux D, Roberts CJ, Madden-Smith C, Lewis L, Teagarden DL, Johnson RE, Ahmed SS. Determination of the Influence of Primary Drying Rates on the Microscale Structural Attributes and Physicochemical Properties of Protein Containing Lyophilized Products. J Pharm Sci 2010; 99:4616-29. [DOI: 10.1002/jps.22185] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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48
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Crean B, Parker A, Roux DL, Perkins M, Luk SY, Banks SR, Melia CD, Roberts CJ. Elucidation of the internal physical and chemical microstructure of pharmaceutical granules using X-ray micro-computed tomography, Raman microscopy and infrared spectroscopy. Eur J Pharm Biopharm 2010; 76:498-506. [DOI: 10.1016/j.ejpb.2010.08.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/05/2010] [Accepted: 08/22/2010] [Indexed: 10/19/2022]
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49
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Liu CF, Chapko M, Bryson CL, Burgess JF, Fortney JC, Perkins M, Sharp ND, Maciejewski ML. Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics. Health Serv Res 2010; 45:1268-86. [PMID: 20831716 DOI: 10.1111/j.1475-6773.2010.01123.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. DATA SOURCES/STUDY SETTING VA administrative and Medicare claims data from 2001 to 2004. STUDY DESIGN Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary care patients. PRINCIPAL FINDINGS A significant proportion of VA patients used Medicare-reimbursed primary care (>30 percent) and specialty care (>60 percent), but not mental health care (3-4 percent). Community-based patients had 17 percent fewer VA primary care visits (p<.001), 9 percent more Medicare-reimbursed visits (p<.001), and 6 percent fewer total visits (p<.05) than hospital-based patients. Community-based patients had 22 percent fewer VA specialty care visits (p<.0001) and 21 percent more Medicare-reimbursed specialty care visits (p<.0001) than hospital-based patients, but no difference in total visits (p=.80). CONCLUSIONS Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care.
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Affiliation(s)
- Chuan-Fen Liu
- Northwest Center for Outcomes Research in Older Adults, Department of Veterans Affairs, HSR&D, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
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Lawson B, Howard T, Kirkwood JK, Macgregor SK, Perkins M, Robinson RA, Ward LR, Cunningham AA. Epidemiology of salmonellosis in garden birds in England and Wales, 1993 to 2003. Ecohealth 2010; 7:294-306. [PMID: 20945078 DOI: 10.1007/s10393-010-0349-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Revised: 07/12/2010] [Accepted: 07/12/2010] [Indexed: 05/30/2023]
Abstract
Salmonellosis has been reported as an important cause of mortality of garden birds in several countries, including Norway and Scotland. We investigated the frequency of the disease in garden birds submitted for postmortem examination by members of the public in England and Wales between 1993 and 2003, inclusive. We found salmonellosis to be the most frequent cause of death due to infectious disease in the garden birds submitted. This disease was confirmed in 7 of the 45 bird species that were examined postmortem, with the greenfinch (Carduelis chloris) and the house sparrow (Passer domesticus) most frequently affected. Salmonella Typhimurium definitive phage type (DT) 40, DT56 variant(v), and DT160 accounted for the majority of isolates. Salmonellosis incidents chiefly occurred in the English Midlands, the English/Welsh border region, and southern England. Variation in the temporal and spatial distribution of the phage types occurred over the study period. While birds were examined throughout the year, there was a marked winter seasonality in salmonellosis. A significant sex bias was observed in affected greenfinches, with males more frequently diagnosed with salmonellosis than females. No sex bias was observed for other affected species. Further research is required to determine if salmonellosis is an important constraint to the populations of affected species and if disease outbreaks are driven by human factors, such as provisioning.
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Affiliation(s)
- B Lawson
- Institute of Zoology, Zoological Society of London, Regents Park, London, UK
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