1
|
Stone G, Wise M, Utt E. In vitro activity of ceftazidime-avibactam and comparators against OXA-48-like Enterobacterales collected between 2016 and 2020. Microbiol Spectr 2024; 12:e0147323. [PMID: 38329363 PMCID: PMC10913439 DOI: 10.1128/spectrum.01473-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/15/2024] [Indexed: 02/09/2024] Open
Abstract
Oxacillinases (OXA)-48-like β-lactamases are one of the most common resistance determinants among carbapenem-resistant Enterobacterales reported globally. Moreover, there is no standard treatment available against organisms producing OXA-48-like enzymes, and they are sometimes difficult to detect, making treatment challenging. The objective of this study was to evaluate the distribution and antimicrobial susceptibility of blaOXA-48-like Enterobacterales isolates against ceftazidime-avibactam (CAZ-AVI) and a panel of comparators collected worldwide from 2016 to 2020 as a part of the Antimicrobial Testing Leadership and Surveillance program. Among all the Enterobacterales isolates collected, 1.8% (1,690/94,052) carried blaOXA-48-like, and a majority of those were identified as K. pneumoniae (86.5%, 1,462/1,690). Among all the blaOXA-48-like isolates, 88.9% (1,502/1,690) were extended-spectrum β-lactamase (ESBL)-positive, 20.7% (350/1,690) were metallo-β-lactamase (MBL)-positive, and 8.9% (150/1,690) were ESBL- and MBL-negative. There were 10 different variants of the OXA-48-like family of enzymes detected, with the major variant being blaOXA-48 (50.2%, 848/1,690), blaOXA-232 (29.3%, 496/1,690), and blaOXA-181 (18.0%, 304/1,690). Overall, all the blaOXA-48-like isolates showed a susceptibility of 78.6% to CAZ-AVI. Importantly, high susceptibility to CAZ-AVI was shown by all the blaOXA-48 type, MBL-negative isolates (n = 1,380, ≥99.0%), and all the MBL-negative isolates (n = 1,300, ≥97.6%) of the major variants (blaOXA-48, blaOXA-232, and blaOXA-181) studied. Among the comparator agents, all isolates showed good susceptibility to only tigecycline (>95.0%) and colistin (>78.6%). Considering the limited treatment options available, CAZ-AVI could be considered as a potential treatment option against blaOXA-48-like Enterobacterales. However, routine surveillance and appropriate stewardship strategies for these organisms may help identify emerging resistance mechanisms and effective treatment of infections. IMPORTANCE Resistance to carbapenems among Enterobacterales is often due to the production of enzymes that are members of the oxacillinases (OXA)-48-like family. These organisms can also be resistant to other classes of drugs and are difficult to identify and treat. This study evaluated the activity of the drug ceftazidime-avibactam (CAZ-AVI) and other comparator agents against a global collection of Enterobacterales that produce OXA-48-like enzymes. CAZ-AVI was active against blaOXA-48-like Enterobacterales, and only colistin and tigecycline were similarly active among the comparator agents, highlighting the limited treatment options against these organisms. Continued surveillance of the distribution of these OXA 48-like producing Enterobacterales and monitoring of resistance patterns along with the implementation of antimicrobial stewardship measures to guide antibiotic use and appropriate treatment are necessary to avoid drug resistance among these organisms.
Collapse
Affiliation(s)
| | | | - Eric Utt
- Pfizer Inc., Groton, Connecticut, USA
| |
Collapse
|
2
|
Wise M, Stone G, Sahm DF. 1707. In vitro Activities of Ceftazidime-Avibactam and Comparator Agents against Enterobacterales and Pseudomonas aeruginosa Collected < 48 Hours and ≥48 Hours Post-Admission from Hospitalized Adult Patients, ATLAS Global Surveillance Program 2017-2020. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1337] [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: 12/23/2022] Open
Abstract
Abstract
Background
Effective treatments for Gram-negative infections have dwindled with the emergence and dissemination of multi-drug resistant Enterobacterales (Ent) and Pseudomonas aeruginosa (Psa). Fortunately, ceftazidime-avibactam (CAZ-AVI) has activity against Ent and Psa isolates that produce Class A, C and some Class D β-lactamases. This study examined the in vitro activity of CAZ-AVI and comparators against Ent and Psa from presumed community-acquired (CA; cultured < 48 h after hospital admission) and hospital-acquired (HA; cultured ≥48 h post-admission) infections collected from adult patients as part of the ATLAS surveillance program, 2017-2020.
Methods
59,904 non-duplicate Ent and 2,504 Psa isolates from adult patients (≥18 y.o.) were collected from 271 sites in 57 countries as part of ATLAS 2017-2020 (excluding North America) for which the length of hospitalization stay was specified. Antimicrobial susceptibility testing was by broth microdilution according to CLSI guidelines and analyzed using CLSI 2022 breakpoints. Ent isolates testing with meropenem MICs >1 µg/mL and Escherichia coli, Klebsiella pneumoniae, K. oxytoca, K. variicola, and Proteus mirabilis testing with ceftazidime and/or aztreonam MICs >1 mg/L were genetically screened for β-lactamases. For Psa, meropenem MIC >2 µg/mL triggered β-lactamase screening. In 2020, approximately 25% of the meropenem non-susceptible isolates were screened.
Results
For Ent, CAZ-AVI was the most active agent examined against both the CA- and HA-infection population of isolates. The percentage of Ent isolates susceptible to CAZ-AVI was 2.6% and 5.3% higher compared to meropenem for the CA- and HA-infection sets, respectively. Considering both the CA- and HA- infection Psa isolates, CAZ-AVI was also the most active agent among comparators, showing %S rates 12.8% and 19.3% higher than meropenem, respectively.
Conclusion
Against Ent and Psa from adult patients, CAZ-AVI exhibited excellent in vitro activity regardless of whether the pathogen was isolated < 48 hrs. or ≥48 hrs. post hospital admission. The slightly decreased susceptibility to CAZ-AVI for the HA Psa isolates as compared to the CA isolates, as well as the relatively low %S rates for comparators, reinforces difficult-to-treat nature of nosocomial infections.
Disclosures
All Authors: No reported disclosures.
Collapse
|
3
|
Wise M, Hackel M, Sahm DF. 1710. In Vitro Activity of Cefepime-Taniborbactam and Comparators Against a Global Collection of Carbapenem-Resistant Enterobacterales and Carbapenem-Resistant Pseudomonas aeruginosa With and Without Carbapenemases. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1340] [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: 12/23/2022] Open
Abstract
Abstract
Background
Carbapenem-resistant Enterobacterales (CRE) and P. aeruginosa (CRPA) present treatment difficulties owing to numerous possible resistance mechanisms, including the carriage of carbapenemases. Taniborbactam is a novel cyclic boronate-based broad-spectrum β-lactamase inhibitor with activity against serine-, and NDM & VIM metallo-β-lactamases (Ambler Classes A, B, C and D). The activity of the investigational combination cefepime-taniborbactam (FTB) and comparator agents was evaluated against a recent global collection of carbapenemase and non-carbapenemase producing CRE and CRPA.
Methods
13,731 Enterobacterales and 4,619 P. aeruginosa isolates collected from 56 countries in 2018-2020 were a part of this study. MICs of cefepime with taniborbactam fixed at 4 µg/mL and comparators were determined according to CLSI guidelines and interpreted using 2022 CLSI breakpoints. CRE and CRPA were defined by resistance to meropenem. Organisms with FTB MIC ≥16 µg/mL were characterized by whole genome sequencing, while those resistant to meropenem were screened for acquired β-lactamase carriage by multiplex PCR followed by Sanger sequencing.
Results
Among the 637 CRE identified, 596 were found to carry a carbapenemase while the remaining 41 did not. For the carbapenemase-positive CRE, 89.8% and 94.5% of isolates were inhibited at ≤8 µg/mL and ≤16 µg/mL FTB, respectively, both values significantly greater than comparators (Table). For carbapenemase-negative CRE, 92.7% of isolates were inhibited at ≤8 µg/mL FTB, and 95.1% were inhibited at ≤16 µg/mL, again higher %s than comparators. Against carbapenemase-negative CRPA (n=703), FTB was the most active agent among the comparators, with 82.6% inhibited at ≤8 µg/mL and 94.9% inhibited at ≤16 µg/mL. Versus CRPA carrying carbapenemases (n=245), 61.9% were inhibited at ≤8 µg/mL FTB and 72.5% were inhibited at ≤16 µg/mL FTB.
Conclusion
FTB displayed substantial in vitro activity against CRE and CRPA regardless of whether they harbored carbapenemases. More isolates of each group were inhibited by FTB at ≤8 µg/mL than were susceptible to all tested β-lactam/β-lactamase inhibitor combinations. These data support the continued development of FTB as a potential new therapeutic antibacterial agent.
Disclosures
All Authors: No reported disclosures.
Collapse
|
4
|
Wise M, Stone G, Sahm DF. 1708. In vitro Activities of Ceftazidime-Avibactam and Comparator Agents against Enterobacterales and Pseudomonas aeruginosa Collected < 48 Hours and ≥48 Hours Post-Admission from Hospitalized Pediatric Patients, ATLAS Global Surveillance Program 2017-2020. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1338] [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: 12/23/2022] Open
Abstract
Abstract
Background
Ceftazidime-avibactam (CAZ-AVI) is a β-lactam combined with a diazabicyclooctane-β-lactamase inhibitor for treatment of infections caused by Gram-negative pathogens. Ceftazidime-avibactam is active against Enterobacterales (Ent) and P. aeruginosa (Psa) isolates that produce Class A, C and some Class D β-lactamases. This study examined the in vitro activity of CAZ-AVI and comparators against Ent and Psa from presumed community-acquired (CA; cultured < 48 h after hospital admission) and hospital-acquired (HA; cultured ≥48 h post-admission) infections collected from pediatric patients as part of the ATLAS surveillance program, 2017-2020.
Methods
5765 non-duplicate Ent and 1987 Psa isolates from pediatric patients (≤17 y.o.) were collected from 241 sites in 54 countries as part of ATLAS 2017-2020 (excluding North America) for which the length of hospitalization stay was specified. Antimicrobial susceptibility testing was by broth microdilution according to CLSI guidelines and analyzed using CLSI 2022 breakpoints. Ent isolates testing with meropenem MICs >1 µg/mL and Escherichia coli, Klebsiella pneumoniae, K. oxytoca, K. variicola, and Proteus mirabilis testing with ceftazidime and/or aztreonam MICs >1 mg/L were genetically screened for β-lactamases. For Psa, meropenem MIC >2 µg/mL triggered β-lactamase screening. In 2020, approximately 25% of the meropenem non-susceptible isolates were screened.
Results
Against Ent, the in vitro activity of CAZ-AVI exceeded that of meropenem and other tested agents for both the presumed CA- and HA-infection sets. The addition of AVI to CAZ increased the %S from 76.1% to 97.5% for the CA-infection population, and from 62.2% to 96.1% for the HA-infection population. For Psa There was a larger difference between the %S to CAZ-AVI of the presumed CA set (93.3% S) and the HA set (89.8% S). For both Psa populations, CAZ-AVI was the most active drug among the comparators.
Conclusion
CAZ-AVI demonstrated potent in vitro activity against Enterobacterales and P. aeruginosa isolates collected globally from pediatric patients in 2017-2020, regardless of whether is infection was community-or hospital-acquired.
Disclosures
All Authors: No reported disclosures.
Collapse
|
5
|
Wise M, Stone G, Sahm DF. 1709. In Vitro Activity of Ceftazidime-Avibactam and Comparator Agents Against MDR Enterobacterales and Pseudomonas aeruginosa Collected in Latin America, ATLAS Global Surveillance Program 2018-2020. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1339] [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: 12/23/2022] Open
Abstract
Abstract
Background
Multidrug-resistant (MDR) Gram-negative bacteria are an increasing worldwide problem. Ceftazidime-avibactam (CAZ-AVI) is a β-lactam/non-β-lactam β-lactamase inhibitor combination that can inhibit class A, C, and some class D β-lactamases, enzymes that contribute to MDR. This study examined the in vitro activity of CAZ-AVI and comparators against MDR Enterobacterales and Pseudomonas aeruginosa isolates collected from patients in Latin America.
Methods
9193 non-duplicate Enterobacterales (Ent) and 3225 P. aeruginosa (Psa) isolates from were collected from 36 sites in 10 Latin American countries as part of ATLAS 2018-2020. Antimicrobial susceptibility testing was by broth microdilution according to CLSI guidelines and analyzed using CLSI 2022 breakpoints. MDR was defined as resistant (R) to ≥3 of 7 sentinel drugs: amikacin (AMK), aztreonam (ATM), cefepime (FEP), colistin (CST), levofloxacin (LVX), meropenem (MEM), and piperacillin-tazobactam (TZP). Ent isolates testing with meropenem MICs >1 µg/mL and Escherichia coli, Klebsiella pneumoniae, K. oxytoca, K. variicola, and Proteus mirabilis testing with ceftazidime and/or aztreonam MICs >1 mg/L were genetically screened for β-lactamases. Psa with meropenem MIC >2 µg/mL were screened in 2018-2019. In 2020, approximately 25% of qualifying Psa were screened.
Results
The activity of CAZ-AVI and comparators against all isolates and the MDR subsets is shown in the table. CAZ-AVI was active against the full collection of Enterobacterales isolates with 96.7% of the population susceptible and an MIC90 value of 1 µg/mL, and maintained considerable activity against the MDR subset, inhibiting 86.5% of the isolates, a value higher than comparator agents. For the full collection of Psa, 86.6% of the isolates were susceptible to CAZ-AVI, again the highest %S among the comparator drugs. Versus the MDR subset of Psa, CAZ-AVI displayed a 45.8% susceptibility rate, approximately 10% higher than the nearest comparator, amikacin.
Conclusion
The in vitro data suggest that CAZ-AVI can be an effective therapeutic for infections caused by MDR Enterobacterales in Latin America. MDR among P. aeruginosa remains challenging, although a significant percentage are inhibited by CAZ-AVI.
Disclosures
All Authors: No reported disclosures.
Collapse
|
6
|
Hackel M, Wise M, Sahm DF. 1672. Antimicrobial Activity of Cefepime-Taniborbactam and Comparators Against Clinical Isolates from ICU and Non-ICU Patients; 2018-2020 Global Surveillance. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1302] [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: 12/23/2022] Open
Abstract
Abstract
Background
Taniborbactam is a novel cyclic boronate-based broad-spectrum β-lactamase inhibitor with selective direct inhibitory activity against both serine- and metallo-β-lactamases. Taniborbactam restores the activity of cefepime against many difficult to treat organisms, including cephalosporin- and carbapenem-resistant Enterobacterales (EB) and P. aeruginosa (PA). The activity of cefepime-taniborbactam (FTB) and comparator agents was evaluated against clinical isolates of EB and PA from a 2018-2020 global surveillance study.
Methods
16,742 isolates of EB and PA were collected from patients in wards designated ICU and non-ICU in 2018-2020. MICs of FTB and comparators were determined by the CLSI reference method. Resistant (R) phenotypes were based on 2022 CLSI breakpoints. Multidrug resistant (MDR) was defined as resistance to at least one agent from ≥3 drug classes. Provisional susceptible (S) breakpoints of ≤8 µg/mL and ≤16 µg/mL were applied for FTB for comparative purposes only.
Results
FTB had potent activity against EB, with MIC90s of 0.25 µg/mL for isolates from non-ICU patients and 0.5 µg/mL for isolates from ICU patients (Table). At least 99.2% of all EB from both wards were inhibited by ≤8 µg/mL FTB. FTB maintained activity against R phenotypes of EB in both ward types, with 90.3% to 98.1% of isolates inhibited at ≤8 µg/mL. FTB had potent activity against PA, with MIC90 values of 8 µg/mL and inhibiting ≥94.0% of isolates at ≤8 µg/mL for both ICU and non-ICU isolates. FTB maintained activity against R phenotypes of PA in both ward types, with 71.0% to 83.7% of isolates inhibited at ≤8 µg/mL and 84.7% to 92.5% inhibited at ≤16 µg/mL. %S to comparator agents against the R subsets ranged from 1.6% to 92.6% for EB, and 36.0% to 68.4% for PA. Against the particularly challenging subset of MDR PA from ICU patients, FTB was the most active agent tested as it inhibited 73.5/84.7% of isolates at ≤8/≤16 µg/mL compared to 43.1%S to CZA and 36.0%S to C/T.
Conclusion
Cefepime-taniborbactam demonstrated potent in vitro activity against EB and PA from ICU and non-ICU wards, including resistant subsets of isolates. This supports the continued development of FTB as a potential new treatment option for infections due to resistant Gram-negative pathogens.
Disclosures
All Authors: No reported disclosures.
Collapse
|
7
|
Wise M, Stone G, Hackel M, Sahm D. 12: IN VITRO ACTIVITIES OF CEFTAZIDIME-AVIBACTAM AND COMPARATOR AGENTS AGAINST PSEUDOMONAS AERUGINOSA COLLECTED IN ASIA/PACIFIC FOR THE ATLAS GLOBAL SURVEILLANCE PROGRAM 2019–2020. J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00291-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
8
|
Wise M, Arhin F, Stone G, Hackel M, Sahm D. 13: IN VITRO ACTIVITY OF CEFTAZIDIME-AVIBACTAM AND AZTREONAM-AVIBACTAM AGAINST CARBAPENEM-NONSUSCEPTIBLE ENTEROBACTERALES ISOLATES COLLECTED IN ASIA/PACIFIC FROM 2017–2020 AS PART OF THE ATLAS GLOBAL SURVEILLANCE PROGRAm. J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
9
|
Wise M, Stone G, Hackel M, Sahm D. 9: IN VITRO ACTIVITIES OF CEFTAZIDIME-AVIBACTAM AND COMPARATOR AGENTS AGAINST ENTEROBACTERALES COLLECTED IN ASIA/PACIFIC ATLAS GLOBAL SURVEILLANCE PROGRAM 2019–2020. J Glob Antimicrob Resist 2022. [DOI: 10.1016/s2213-7165(22)00288-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
10
|
Wise M. Oh what a tangled web we weave when first we practice to deceive…. Eur Psychiatry 2021. [PMCID: PMC9471917 DOI: 10.1192/j.eurpsy.2021.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
‘Oh what a tangled web we weave when first we practice to deceive’. Marmion, Sir Walter Scott 1808. Conflict is unpleasant, it is aversive, we tend to avoid it. Yet inevitably tension between individuals or between individuals and society is inevitable as the wants of one collide with the purpose of the other. Most of these tensions resolved peacefully but a societal level aggression can sometimes spill out. In the hinterlands between individuals and larger groups these can play out more safely through the courts or sometimes the avoidance of conflict can be the only tactic that the individual can use. As doctors we are used to sing medical problems with patients have true disease believe they have two disease and want to get well-the standard social model of medicine. But sometimes this plays out differently there are those who may fabricate symptoms to avoid punishment or for reward: malingering. There are those who believe they have a disease but the distress is disproportionate to any possible recognised component; somatic symptom disorder. There are those whose anxiety about whether they have a disease or not is paralysing and perhaps most distressing for all of the groups who self-harm or malinger with authentic illness or disease. In this talk Dr Wise will, using case examples, look at a couple of the tools that exist to assist psychiatrists in piloting a pathway through the stormy waters of abnormal illness in litigation.
Collapse
|
11
|
Wise M. Diagnostic dilemma’s in the new world of ICD-11 personality disorders. Eur Psychiatry 2021. [PMCID: PMC9471790 DOI: 10.1192/j.eurpsy.2021.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Personality disorders have ever been a troublesome group. From the early 90’s ICD 10 tidied up the group. DSM-IV, IV-TR, aand then DSM 5, changed the style but not substance, leaving clinicians to grapple with thorny questions of multiple diagnoses, treatment and prognosis. International views on the utility of the diagnosis often depended upon the institution or the funding mechanism. Were fears of exclusion and stigma dominated or where there was no treatment, there was under-diagnosis, such as in the United Kingdom and the Republic of Ireland. Where a label was a ticket of entry to treatment and funding, diagnostic generosity prevailed, such as in Australia, New Zealand and the United States. Gender discrepancies disappeared with structured interviews, and interest grew in the category which seem to only include the most severe forms. For many years the DSM taskforce tried to shift the construct but shied away from the cliff edge; a bold new initiative did not materialise. It was left to the ICD-11 to generate a much more adventurous and positive view of how characterological traits shift under pressure, moving from something that may at first have helped patients to ‘survive’ to something that became maladaptive and harmful. With a court tested case Dr Wise will demonstrate the differences between ICD-10 and ICD-11 highlighting the more important differences: onset, course and severity descriptors. PD’s are no longer lifelong impairments. Prepare for ‘The shock of the new’!
Collapse
|
12
|
Estabrook M, Kazmierczak KM, Wise M, Arhin FF, Stone GG, Sahm DF. Molecular characterization of clinical isolates of Enterobacterales with elevated MIC values for aztreonam-avibactam from the INFORM global surveillance study, 2012-2017. J Glob Antimicrob Resist 2021; 24:316-320. [PMID: 33524556 DOI: 10.1016/j.jgar.2021.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/23/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES While aztreonam-avibactam is a potent β-lactam-β-lactamase-inhibitor combination, reduced in vitro activity against some Enterobacterales isolates has been reported. In this study, globally collected clinical isolates of Enterobacterales with elevated minimum inhibitory concentrations (MICs) for aztreonam-avibactam were examined for potential resistance mechanisms. METHODS Isolates with aztreonam-avibactam MICs ≥8 μg/mL (n = 55: Escherichia coli, n = 38; Enterobacter cloacae, n = 10; Klebsiella pneumoniae, n = 3; others, n = 4) and <8 μg/mL (n = 18) collected for the INFORM global surveillance programme were characterized by short read whole-genome sequencing. Sequences were inspected for the presence of β-lactamase genes, penicillin-binding protein (PBP) mutations, and disruptions in the coding sequences of porin genes. RESULTS All isolates of E. coli testing with aztreonam-avibactam MIC values ≥8 μg/mL carried a previously documented four-amino-acid insertion in PBP3 at position 333 of YRI(K/N/P). Such mutations were absent in isolates with MICs <2 μg/mL (n = 6). Among other species, carriage of PER- or VEB-type β-lactamases was identified in 10/17 (58.8%) of isolates testing with aztreonam-avibactam MICs ≥8 μg/mL, but no isolates with lower MIC values (n = 11). CONCLUSIONS PBP3 mutations are known to confer resistance to aztreonam in E. coli, providing a rationale for the elevated MIC values for aztreonam-avibactam in these isolates. Elevated MICs in other isolates were associated with the carriage of PER-type β-lactamases, which have been previously shown to be inhibited less effectively by avibactam than other Class A β-lactamases and may contribute to this phenotype. Other resistance mechanisms contributing to poor in vitro activity for aztreonam-avibactam in some of these isolates are not yet elucidated.
Collapse
Affiliation(s)
- Mark Estabrook
- International Health Management Associates, Inc., Schaumburg, IL, USA.
| | | | - Mark Wise
- International Health Management Associates, Inc., Schaumburg, IL, USA
| | | | | | - Daniel F Sahm
- International Health Management Associates, Inc., Schaumburg, IL, USA
| |
Collapse
|
13
|
Nichols M, Stevenson L, Koski L, Basler C, Wise M, Whitlock L, Francois Watkins L, Friedman CR, Chen J, Tagg K, Joseph L, Caidi H, Patel K, Tolar B, Hise K, Classon A, Ceric O, Reimschuessel R, Williams IT. Detecting national human enteric disease outbreaks linked to animal contact in the United States of America. REV SCI TECH OIE 2020; 39:471-480. [PMID: 33046928 DOI: 10.20506/rst.39.2.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Enteric pathogens, such as non-typhoidal Salmonella, Campylobacter and Escherichia coli, can reside in the intestinal tract of many animals, including livestock, companion animals, small mammals and reptiles. Often, these animals can appear healthy; nonetheless, humans can become infected after direct or indirect contact, resulting in a substantial illness burden. An estimated 14% of the 3.2 million illnesses that occur in the United States of America (USA) each year from such enteric pathogens are attributable to animal contact. Surveillance for enteric pathogens in the USA includes the compilation and interpretation of both laboratory and epidemiologic data. However, the authors feel that a collaborative, multisectoral and transdisciplinary - or One Health - approach is needed for data collection and analysis, at every level. In addition, they suggest that the future of enteric illness surveillance lies in the development of improved technologies for pathogen detection and characterisation, such as genomic sequencing and metagenomics. In particular, using whole-genome sequencing to compare genetic sequences of enteric pathogens from humans, food, animals and the environment, can help to predict antimicrobial resistance among these pathogens, determine their genetic relatedness and identify outbreaks linked to a common source. In this paper, the authors describe three recent, multi-state human enteric illness outbreaks linked to animal contact in the USA and discuss how integrated disease surveillance was essential to outbreak detection and response. Additional datasharing between public health and animal health laboratories and epidemiologists at the local, national, regional and international level may help to improve surveillance for emerging animal and human health threats and lead to new opportunities for prevention.
Collapse
|
14
|
Robbins R, Hale L, Beebe D, Wolfson AR, Grandner MA, Mindell JA, Owens J, Tapia I, Byars KC, Gruber R, Montgomery-Downs H, Wise M, Carskadon MA. 0408 Myths About Infant, Child, and Adolescent Sleep: Addressing False Beliefs That Hinder Sleep Health During These Crucial Developmental Stages. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.405] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep is vital for healthy development from infancy through adolescence. Despite its importance, false beliefs that conflict with scientific evidence (myths) may be common among caregivers and impair sleep health during these crucial stages.
Methods
Researchers compiled a list of potential myth statements using internet searches of popular press and scientific literature. We utilized a Delphi process with experts (n=12) from the fields of pediatric, sleep, and circadian research and clinical practice. Selection and refinement of myths by sleep experts proceeded in three phases, including: focus groups (Phase 1); email-based feedback to edit, add, or remove myths (Phase 2); and closed-ended questionnaires (Phase 3) where experts rated myths on two dimensions: (1) falseness and (2) public health significance using 5-point Likert scale: 1 (“not at all”) to 5 (“extremely false/important”).
Results
Thirty-two sleep myths were identified across three developmental categories: infant (14 myths), child (6 myths), and adolescent (12 myths). Mean expert ratings illuminated the most pressing myths in each developmental category: infant sleep (“Sleep training causes psychological harm, including reduced parent-child attachment:” falseness =4.7, s.d.=0.7; public health significance=4.0, s.d.=1.1); child sleep (“Heavy, loud snoring for my child means he’s sleeping deeply:” falseness=4.8, s.d.=0.6; public health significance=4.7, s.d.=0.7), and teenager sleep (“Falling asleep in class means your teenager is lazy and not motivated:” falseness=4.8, s.d.=0.5; public health significance=4.3, s.d.=0.8).
Conclusion
The current study identified commonly-held myths about infant, child, and adolescent sleep that are not supported by (or worse, counter to) scientific evidence. If unchecked, these myths may hinder sleep at a critical developmental stage. Future research may include public health education to correct myths and promote healthy sleep among infants, children, and teenagers.
Support
5T32HL007901
Collapse
Affiliation(s)
- R Robbins
- Brigham and Women’s Hospital, Boston, MA
| | - L Hale
- Population and Preventive Medicine, Stony Brook, NY
| | - D Beebe
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - M A Grandner
- University of Arizona College of Medicine, Tucson, AZ
| | - J A Mindell
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - J Owens
- Center for Pediatric Sleep Disorders, Boston, MA
| | - I Tapia
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - K C Byars
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - R Gruber
- Douglas Mental Health University Institute, Montreal, QC, CANADA
| | | | - M Wise
- Methodist Le Bonheur Healthcare, Memphis, TN
| | - M A Carskadon
- Warren Alpert Medical School of Brown University, Providence, RI
| |
Collapse
|
15
|
Affiliation(s)
- M. Wise
- Manchester Royal Infirmary Manchester, England
| | - J. Manos
- Manchester Royal Infirmary Manchester, England
| | - R. Gokal
- Manchester Royal Infirmary Manchester, England
| |
Collapse
|
16
|
Govoni F, Orrù E, Bonafede A, Iacobelli M, Paladino R, Vazza F, Murgia M, Vacca V, Giovannini G, Feretti L, Loi F, Bernardi G, Ferrari C, Pizzo RF, Gheller C, Manti S, Brüggen M, Brunetti G, Cassano R, de Gasperin F, Enßlin TA, Hoeft M, Horellou C, Junklewitz H, Röttgering HJA, Scaife AMM, Shimwell TW, van Weeren RJ, Wise M. A radio ridge connecting two galaxy clusters in a filament of the cosmic web. Science 2019; 364:981-984. [DOI: 10.1126/science.aat7500] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/13/2019] [Indexed: 11/02/2022]
Abstract
Galaxy clusters are the most massive gravitationally bound structures in the Universe. They grow by accreting smaller structures in a merging process that produces shocks and turbulence in the intracluster gas. We observed a ridge of radio emission connecting the merging galaxy clusters Abell 0399 and Abell 0401 with the Low-Frequency Array (LOFAR) telescope network at 140 megahertz. This emission requires a population of relativistic electrons and a magnetic field located in a filament between the two galaxy clusters. We performed simulations to show that a volume-filling distribution of weak shocks may reaccelerate a preexisting population of relativistic particles, producing emission at radio wavelengths that illuminates the magnetic ridge.
Collapse
|
17
|
Wise M, Kazmierczak K, Stone GG, Sahm D. 1358. In vitro Activity of Ceftazidime–Avibactam and Comparator Agents Against Pseudomonas aeruginosa Causing Intra-Abdominal, Lower Respiratory, and Urinary Tract Infections Collected in Latin America as Part of the INFORM Global Surveillance Program, 2012–2016. Open Forum Infect Dis 2018. [PMCID: PMC6252817 DOI: 10.1093/ofid/ofy210.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
Collapse
Affiliation(s)
| | | | | | - Dan Sahm
- International Health Management Associates, Inc., Schaumburg, Illinois
| |
Collapse
|
18
|
Düring J, Dankiewicz J, Cronberg T, Hassager C, Hovdenes J, Kjaergaard J, Kuiper M, Nielsen N, Pellis T, Stammet P, Vulto J, Wanscher M, Wise M, Åneman A, Friberg H. Lactate, lactate clearance and outcome after cardiac arrest: A post-hoc analysis of the TTM-Trial. Acta Anaesthesiol Scand 2018; 62:1436-1442. [PMID: 29926901 DOI: 10.1111/aas.13172] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Admission lactate and lactate clearance are implemented for risk stratification in sepsis and trauma. In out-of-hospital cardiac arrest, results regarding outcome and lactate are conflicting. METHODS This is a post-hoc analysis of the Target Temperature Management trial in which 950 unconscious patents after out-of-hospital cardiac arrest were randomized to a temperature intervention of 33°C or 36°C. Serial lactate samples during the first 36 hours were collected. Admission lactate, 12-hour lactate, and the clearance of lactate within 12 hours after admission were analyzed and the association with 30-day mortality assessed. RESULTS Samples from 877 patients were analyzed. In univariate logistic regression analysis, the odds ratio for death by day 30 for each mmol/L was 1.12 (1.08-1.16) for admission lactate, P < .01, 1.21 (1.12-1.31) for 12-hour lactate, P < .01, and 1.003 (1.00-1.01) for each percentage point increase in 12-hour lactate clearance, P = .03. Only admission lactate and 12-hour lactate levels remained significant after adjusting for known predictors of outcome. The area under the receiver operating characteristic curve was 0.65 (0.61-0.69), P < .001, 0.61 (0.57-0.65), P < .001, and 0.53 (0.49-0.57), P = .15 for admission lactate, 12-hour lactate, and 12-hour lactate clearance, respectively. CONCLUSIONS Admission lactate and 12-hour lactate values were independently associated with 30-day mortality after out-of-hospital cardiac arrest while 12-hour lactate clearance was not. The clinical value of lactate as the sole predictor of outcome after out-of-hospital cardiac arrest is, however, limited.
Collapse
Affiliation(s)
- J. Düring
- Department of Clinical Sciences, Intensive and Perioperative Care Lund University Skane University Hospital Malmö Sweden
| | - J. Dankiewicz
- Department of Clinical Sciences, Cardiology Lund University Skane University Hospital Lund Sweden
| | - T. Cronberg
- Department of Clinical Sciences, Neurology Lund University Skane University Hospital Lund Sweden
| | - C. Hassager
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - J. Hovdenes
- Division of Emergencies and Critical Care Department of Anesthesiology Oslo University Hospital Rikshospitalet Oslo Norway
| | - J. Kjaergaard
- Department of Cardiology The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - M. Kuiper
- Department of Intensive Care Medical Center Leeuwarden Leeuwarden The Netherlands
| | - N. Nielsen
- Department of Clinical Sciences, Department of Anesthesiology and Intensive Care Lund University Helsingborg Hospital Helsingborg Sweden
| | - T. Pellis
- Department of Anaesthesia and Intensive Care Azienda Ospedaliera ‘Card. G. Panico’ Tricase Italy
| | - P. Stammet
- Medical Department National Rescue Services Luxembourg City Luxembourg
| | - J. Vulto
- Department of Emergency Medicine Medical Centre Leeuwarden Leeuwarden The Netherlands
| | - M. Wanscher
- Department of Cardiothoracic Anaesthesia 4142 The Heart Center Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - M. Wise
- Department of Adult Critical Care University Hospital of Wales Cardiff UK
| | - A. Åneman
- Intensive Care Unit Liverpool Hospital South Western Sydney Local Health District Sidney NSW Australia
- South Western Clinical School University of New South Wales Sydney NSW Australia
- The Ingham Institute for Applied Medical Research Sydney NSW Australia
| | - H. Friberg
- Department of Clinical Sciences, Intensive and Perioperative Care Lund University Skane University Hospital Malmö Sweden
| |
Collapse
|
19
|
Gruber R, Somerville G, Boursier J, Wise M. 0807 Associations Between Report Card Grades And Objective And Subjective Sleep Measures In Adolescents With Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Gruber
- McGill Univesrity, Montreal, QC, CANADA
| | - G Somerville
- Riverside School Board, Saint-Hubert, QC, CANADA
| | - J Boursier
- Riverside School Board, Saint-Hubert, QC, CANADA
| | - M Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN
| |
Collapse
|
20
|
Niel K, Mandrell B, Wise M, Walker B, Indelicato D, Merchant T, McLaughlin Crabtree V. 0845 Excessive Daytime Sleepiness Impacts QOL in Pediatric Craniopharyngioma. Sleep 2018. [DOI: 10.1093/sleep/zsy061.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Niel
- St. Jude Children’s Research Hospital, Memphis, TN
| | - B Mandrell
- St. Jude Children’s Research Hospital, Memphis, TN
| | - M Wise
- Methodist Le Bonheur Healthcare, Memphis, TN
| | - B Walker
- St. Jude Children’s Research Hospital, Memphis, TN
| | - D Indelicato
- University of Florida Proton Therapy Institute, Jacksonville, FL
| | - T Merchant
- St. Jude Children’s Research Hospital, Memphis, TN
| | | |
Collapse
|
21
|
Kazmierczak K, Wise M, Stone GG, Sahm D. Activity of Ceftazidime–Avibactam Against Respiratory Isolates of Enterobacteriaceae and Pseudomonas aeruginosa Collected in Asia/Pacific as part of the INFORM Global Surveillance Program, 2014–2016. Open Forum Infect Dis 2017. [PMCID: PMC5630827 DOI: 10.1093/ofid/ofx163.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Avibactam (AVI) is a non-β-lactam β-lactamase inhibitor that restores the in vitro activity of ceftazidime (CAZ) against class A, class C, and some class D β-lactamases, including extended-spectrum β-lactamases, serine carbapenemases, and the chromosomal AmpC of Pseudomonas aeruginosa (Pae). This study evaluated the in vitro activity of CAZ-AVI and comparators against Enterobacteriaceae (Eba) and Pae collected from patients with lower respiratory tract infections (LRTI) in Asia/Pacific in 2014–2016 as part of the INFORM surveillance program. Methods Non-duplicate isolates from patients with LRTI were collected from 28 medical centers in Australia, Hong Kong, Japan, Malaysia, Philippines, South Korea, Taiwan, and Thailand. Susceptibility (S) testing was performed by broth microdilution and interpreted using FDA breakpoints for CAZ-AVI and CLSI breakpoints for comparators. AVI was tested at a fixed concentration of 4 µg/mL with doubling dilutions of CAZ. Multidrug resistance (MDR) phenotype was defined as resistant by CLSI breakpoints to sentinel agents from ≥3 drug classes. Results CAZ-AVI showed potent in vitro activity against the overall population of Eba (MIC90, 0.5 µg/mL; 98.0% S) and against ceftazidime-nonsusceptible (CAZ-NS), colistin-resistant (CST-R), and MDR isolates, with >91% of these resistant subsets testing as susceptible (MIC ≤8 µg/mL). Reduced activity against meropenem-nonsusceptible (MEM-NS) Eba was attributable to the presence of class B metallo-β-lactamases (MBL); 95.7% of MEM-NS, MBL-negative isolates were susceptible to CAZ-AVI. CAZ-AVI also showed good activity against most Pae isolates (MIC90, 8 µg/mL; 92.5% S), as well as CST-R isolates (MIC90, 8 µg/mL; 100% S). Activity of CAZ-AVI was reduced against CAZ-NS, MEM-NS, MEM-NS MBL-negative, and MDR Pae subsets (46.9–82.3% S) but exceeded the activity of CAZ and MEM. Conclusion CAZ-AVI is a potential therapeutic option for treating respiratory infections in the Asia/Pacific region caused by Eba and Pae isolates resistant to commonly used and last-in-line agents. Disclosures G. G. Stone, Pfizer: Employee, Salary AstraZeneca: Shareholder, Capital Gains
Collapse
Affiliation(s)
| | | | | | - Dan Sahm
- International Health Management Associates, Inc., Schaumburg, Illinois
| |
Collapse
|
22
|
Niel K, Mandrell B, Wise M, Walker B, Indelicato D, Merchant T, Crabtree V. 0955 EXCESSIVE DAYTIME SLEEPINESS PERSISTS OVER TIME IN PEDIATRIC CRANIOPHARYNGIOMA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
23
|
Dattalo M, Wise M, Ford II JH, Abramson B, Mahoney J. Essential Resources for Implementation and Sustainability of Evidence-Based Health Promotion Programs: A Mixed Methods Multi-Site Case Study. J Community Health 2016; 42:358-368. [DOI: 10.1007/s10900-016-0263-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
24
|
Kapacee ZA, Susnerwala S, Wise M, Biswas A, Danwata F, Scott N. Chemoradiotherapy for squamous cell anal carcinoma: a review of prognostic factors. Colorectal Dis 2016; 18:1080-1086. [PMID: 27028038 DOI: 10.1111/codi.13342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/03/2016] [Indexed: 12/24/2022]
Abstract
AIM Previous literature has sought prognostic factors for the survival of anal cancer patients. The present study aimed to determine prognostic factors for local disease recurrence, distant metastasis and survival for patients treated with radical chemoradiotherapy (CRT) at the Rosemere Cancer Centre, Preston, UK. METHOD Patients treated with CRT for nonmetastatic squamous cell anal cancer between September 2000 and January 2013 were studied. Kaplan-Meier and Cox regression analysis assessed the prognostic value of age, sex, tumour size, the proportion of the anal canal circumference involved (ACCI), nodal disease, tumour location and pretreatment haemoglobin. RESULTS One hundred and 48 patients with a mean age of 63 years were studied, of whom 15% suffered local disease recurrence and 10% developed distant metastasis. The 5-year overall and cancer-specific survival rates were 84% and 86%, respectively. Predictors of local recurrence were tumour size >5 cm and over two-thirds ACCI (P < 0.01). Predictors of distant metastasis and poor survival were tumour size >5 cm (P < 0.01), node positive disease on imaging (P < 0.05), over two-thirds ACCI (P < 0.01) and a pretreatment haemoglobin level below 130 g/l (P < 0.05). Multivariate analysis found large tumour size to be the most significant factor for local recurrence (P = 0.002) and survival (P = 0.02) whilst over two-thirds ACCI was most predictive of distant metastasis (P < 0.001). Age, gender, palpable lymph nodes and tumour location were not of prognostic value for local disease recurrence, distant metastasis or survival. CONCLUSION Tumour size, nodal disease, over two-thirds ACCI and low pretreatment haemoglobin confer poorer prognostic and survival outcomes. Use of intensity-modulated radiation therapy may allow greater radiation doses to be given for locally advanced tumours, thus improving local control and survival and reducing morbidity.
Collapse
Affiliation(s)
- Z A Kapacee
- Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Preston, UK.
| | - S Susnerwala
- Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Preston, UK
| | - M Wise
- Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Preston, UK
| | - A Biswas
- Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Preston, UK
| | - F Danwata
- Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Preston, UK
| | - N Scott
- Royal Preston Hospital, Lancashire Teaching Hospitals Trust, Preston, UK
| |
Collapse
|
25
|
|
26
|
Carbone D, van der Horst AJ, Wijers RAMJ, Swinbank JD, Rowlinson A, Broderick JW, Cendes YN, Stewart AJ, Bell ME, Breton RP, Corbel S, Eislöffel J, Fender RP, Grießmeier JM, Hessels JWT, Jonker P, Kramer M, Law CJ, Miller-Jones JCA, Pietka M, Scheers LHA, Stappers BW, van Leeuwen J, Wijnands R, Wise M, Zarka P. New methods to constrain the radio transient rate: results from a survey of four fields with LOFAR. Mon Not R Astron Soc 2016; 459:3161-3174. [PMID: 27279785 DOI: 10.1093/mnras/stw539] [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] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 06/06/2023]
Abstract
We report on the results of a search for radio transients between 115 and 190 MHz with the LOw-Frequency ARray (LOFAR). Four fields have been monitored with cadences between 15 min and several months. A total of 151 images were obtained, giving a total survey area of 2275 deg2. We analysed our data using standard LOFAR tools and searched for radio transients using the LOFAR Transients Pipeline. No credible radio transient candidate has been detected; however, we are able to set upper limits on the surface density of radio transient sources at low radio frequencies. We also show that low-frequency radio surveys are more sensitive to steep-spectrum coherent transient sources than GHz radio surveys. We used two new statistical methods to determine the upper limits on the transient surface density. One is free of assumptions on the flux distribution of the sources, while the other assumes a power-law distribution in flux and sets more stringent constraints on the transient surface density. Both of these methods provide better constraints than the approach used in previous works. The best value for the upper limit we can set for the transient surface density, using the method assuming a power-law flux distribution, is 1.3 × 10-3 deg-2 for transients brighter than 0.3 Jy with a time-scale of 15 min, at a frequency of 150 MHz. We also calculated for the first time upper limits for the transient surface density for transients of different time-scales. We find that the results can differ by orders of magnitude from previously reported, simplified estimates.
Collapse
Affiliation(s)
- D Carbone
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands
| | - A J van der Horst
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands; Department of Physics, The George Washington University, 725 21 Street NW, Washington, DC 20052, USA
| | - R A M J Wijers
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands
| | - J D Swinbank
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands; Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544, USA
| | - A Rowlinson
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands; CSIRO Australia Telescope National Facility, PO Box 76, Epping NSW 1710, Australia; ASTRON, The Netherlands Institute for Radio Astronomy, Postbus 2, NL-7990 AA Dwingeloo, the Netherlands
| | - J W Broderick
- ASTRON, The Netherlands Institute for Radio Astronomy, Postbus 2, NL-7990 AA Dwingeloo, the Netherlands; Oxford Astrophysics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK; Physics and Astronomy, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Y N Cendes
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands
| | - A J Stewart
- Oxford Astrophysics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - M E Bell
- CSIRO Australia Telescope National Facility, PO Box 76, Epping NSW 1710, Australia; ARC Centre of Excellence for All-sky Astrophysics (CAASTRO), The University of Sydney, NSW 2006, Australia
| | - R P Breton
- Jodrell Bank Centre for Astrophysics, School of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, UK
| | - S Corbel
- Laboratoire AIM (CEA/IRFU - CNRS/INSU - Université Paris Diderot), CEA DSM/IRFU/SAp, F-91191 Gif-sur-Yvette, France; Station de Radioastronomie de Nançay, Observatoire de Paris, CNRS/INSU, USR 704 - Univ. Orléans, OSUC, F-18330 Nançay, France
| | - J Eislöffel
- Thüringer Landessternwarte Tautenburg, Sternwarte 5, D-07778 Tautenburg, Germany
| | - R P Fender
- Oxford Astrophysics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - J-M Grießmeier
- Station de Radioastronomie de Nançay, Observatoire de Paris, CNRS/INSU, USR 704 - Univ. Orléans, OSUC, F-18330 Nançay, France; Laboratoire de Physique et Chimie de l'Environnement et de l'Espace, LPC2E UMR 7328 CNRS, F-45071 Orléans, France
| | - J W T Hessels
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands; ASTRON, The Netherlands Institute for Radio Astronomy, Postbus 2, NL-7990 AA Dwingeloo, the Netherlands
| | - P Jonker
- SRON, Netherlands Institute for Space Research, Sorbonnelaan 2, NL-3584-CA Utrecht, the Netherlands; Department of Astrophysics/IMAPP, Radboud University Nijmegen, PO Box 9010, NL-6500 GL Nijmegen, the Netherlands
| | - M Kramer
- Jodrell Bank Centre for Astrophysics, School of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, UK; Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn, Germany
| | - C J Law
- Department of Astronomy and Radio Astronomy Lab, University of California, Berkeley, CA, USA
| | - J C A Miller-Jones
- International Centre for Radio Astronomy Research, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - M Pietka
- Oxford Astrophysics, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, UK
| | - L H A Scheers
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands; Centrum Wiskunde & Informatica, PO Box 94079, NL-1090 GB Amsterdam, the Netherlands
| | - B W Stappers
- Jodrell Bank Centre for Astrophysics, School of Physics and Astronomy, The University of Manchester, Manchester M13 9PL, UK
| | - J van Leeuwen
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands; ASTRON, The Netherlands Institute for Radio Astronomy, Postbus 2, NL-7990 AA Dwingeloo, the Netherlands
| | - R Wijnands
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands
| | - M Wise
- Anton Pannekoek Institute for Astronomy, University of Amsterdam, Postbus 94249, NL-1090 GE Amsterdam, the Netherlands; ASTRON, The Netherlands Institute for Radio Astronomy, Postbus 2, NL-7990 AA Dwingeloo, the Netherlands
| | - P Zarka
- LESIA, Observatoire de Paris, CNRS, UPMC, Université Paris-Diderot, 5 place Jules Janssen, F-92195 Meudon, France
| |
Collapse
|
27
|
Shao J, Tong M, Wei J, Wise M, Stone P, Chamley L, Chen Q. Increased levels of High Mobility Group Box 1 (HMGB1) in trophoblastic debris may contribute to endothelial cell activation: A potential player in the pathogenesis of preeclampsia. J Reprod Immunol 2016. [DOI: 10.1016/j.jri.2016.04.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
28
|
Wise M, Akers K, Bowdridge E, Holaskova I, Dailey RA. 042 Changes in Body Condition from Prepartum to Postpartum on Reproduction in Dairy Cattle. J Anim Sci 2016. [DOI: 10.2527/ssasas2015-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
29
|
Mariyaselvam M, Marsh L, Wise M, Williams D. An in vitro microbiological study comparing eight endotracheal tubes and their ability to prevent microaspiration. Intensive Care Med Exp 2015. [PMCID: PMC4797778 DOI: 10.1186/2197-425x-3-s1-a382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
30
|
Walshaw R, Prasad K, Susnerwala S, Kumar R, Parikh O, Danwata F, Wise M, Charnley N, Birtle A. Small Cell Carcinoma of the Bladder: A Multi-centre Retrospective Review of Treatment and Outcome. Clin Oncol (R Coll Radiol) 2015. [DOI: 10.1016/j.clon.2014.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
31
|
Wise M. A LETTER FROM THE DMU WHITE COAT CEREMONY. Iowa Med 2015; 105:8. [PMID: 26897875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
32
|
Kapacee Z, Susnerwala S, Scott N, Danwata F, Wise M, Biswas A. Prognostic Factors for Local Recurrence, Distant Metastases and Survival in Anal Carcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Gollins S, Sherman T, Byers H, Bowes J, Myint A, Susnerwala S, Haylock B, Wise M, Saunders M, Essapen S, Samuel L, Latif M, Azam F, Ryder D, Newman W. Relationship of Ugt1A and Abc Genetic Variants to Toxicity and Response in Preoperative Chemoradiation (Crt) with Concurrent Irinotecan for Locally Advanced Rectal Cancer (Larc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
34
|
Greenbaum AH, Wong K, Nguyen D, Smith E, Torso L, Chen G, Wise M, Casey M, Ostroff S, Nambiar A, Nalluswami K, Miller J, Lute J, Klimov A, Emery S, Green M, Giampa P, Moll M, Finelli L, Jhung M. Assessment for possible healthcare-associated transmission of a new variant influenza virus--Pennsylvania, August 2011. Infect Control Hosp Epidemiol 2013; 34:1306-9. [PMID: 24225616 DOI: 10.1086/673980] [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: 11/03/2022]
Abstract
In August 2011, one of the earliest cases of influenza A(H3N2) variant [A(H3N2)v] virus infection was hospitalized with severe illness. To investigate the potential for healthcare-associated transmission of influenza A(H3N2)v, we evaluated both healthcare providers and patient contacts of the case. We found that healthcare-associated transmission was unlikely.
Collapse
Affiliation(s)
- Adena H Greenbaum
- Epidemic Intelligence Service Assigned to Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Dabbas N, Cutress R, Wise M, Yiangou C, Agrawal A. Repeat surgery following breast conservation and intra-operative sentinel lymph node analysis for breast cancer. Surgeon 2013; 11:235-40. [DOI: 10.1016/j.surge.2012.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/18/2012] [Accepted: 12/20/2012] [Indexed: 12/16/2022]
|
36
|
Giannotti M, Wise M, Mohammed A. MESAFace, a graphical interface to analyze the MESA output. Comput Phys Commun 2013; 184:1333-1338. [PMID: 24563547 PMCID: PMC3928983 DOI: 10.1016/j.cpc.2012.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED MESA (Modules for Experiments in Stellar Astrophysics) has become very popular among astrophysicists as a powerful and reliable code to simulate stellar evolution. Analyzing the output data thoroughly may, however, present some challenges and be rather time-consuming. Here we describe MESAFace, a graphical and dynamical interface which provides an intuitive, efficient and quick way to analyze the MESA output. NATURE OF PROBLEM Find a way to quickly and thoroughly analyze the output of a MESA run, including all the profiles, and have an efficient method to produce graphical representations of the data. SOLUTION METHOD We created two scripts (to be run consecutively). The first one downloads all the data from a MESA run and organizes the profiles in order of age. All the files are saved as tables or arrays of tables which can then be accessed very quickly by Mathematica. The second script uses the Manipulate function to create a graphical interface which allows the user to choose what to plot from a set of menus and buttons. The information shown is updated in real time. The user can access very quickly all the data from the run under examination and visualize it with plots and tables. UNUSUAL FEATURES Moving the slides in certain regions may cause an error message. This happens when Mathematica is asked to read nonexistent data. The error message, however, disappears when the slides are moved back. This issue does not preclude the good functioning of the interface. ADDITIONAL COMMENTS The program uses the dynamical capabilities of Mathematica. When the program is opened, Mathematica prompts the user to "Enable Dynamics". It is necessary to accept before proceeding. RUNNING TIME Depends on the size of the data downloaded, on where the data are stored (hard-drive or web), and on the speed of the computer or network connection. In general, downloading the data may take from a minute to several minutes. Loading directly from the web is slower. For example, downloading a 200MB data folder (a total of 102 files) with a dual-core Intel laptop, P8700, 2 GB of RAM, at 2.53 GHz took about a minute from the hard-drive and about 23 minutes from the web (with a basic home wireless connection).
Collapse
|
37
|
Brandstetter S, McCool M, Wise M, Loss J. Australian health promotion practitioners' perceptions on evaluation of empowerment and participation. Health Promot Int 2012; 29:70-80. [DOI: 10.1093/heapro/das046] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
38
|
Layfield D, May D, Cutress R, Richardson C, Agrawal A, Wise M, Yiangou C. The effect of introducing an in-theatre intra-operative specimen radiography (IOSR) system on the management of palpable breast cancer within a single unit. Breast 2012; 21:459-63. [DOI: 10.1016/j.breast.2011.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Revised: 10/05/2011] [Accepted: 10/31/2011] [Indexed: 11/17/2022] Open
|
39
|
|
40
|
Johns R, Dabbas N, McDowell A, Gabriel G, Agrawal A, Cree I, Yiangou C, Wise M. Breast Cancer Sentinel Node Intraoperative Molecular Diagnosis: GeneSearch BLN assay vs. Metasin assay. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
41
|
Wise M, Wise I. A psychotherapy program for soldiers dependents: The effect on recall rates. “They are not going for three weeks and the fighting has already begun!”. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73039-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionDeployment to conflict areas poses problems for service families. These stressors pose a high cost from increased rates of marital/family break-up and the impact on operational effectiveness, through early recall from combat zones. Soldiers look forward to a mission whilst partners are more ambivalent. The time before deployment is hard on those who stay behind, who experience high levels of anxiety. Those about to be deployed feel guilty, and have to manage their own anxieties about what the mission will bring - hard work, excitement and danger. Most do not talk about this to their partners, who in turn have to manage their own inner turmoil and worst case ‘fantasies’.AimsThe project grew from concerns about the welfare of families of deployed army personnel.ObjectivesThe project aimed to help them develop a greater capacity to manage, contain and function with these worries. The program provided psychodynamic psychoanalytic practices to a previously neglected group that was not wholly army, but is essential to its well-being.MethodsThe program gave the families a greater understanding of the emotional difficulties faced by their partners before, during and after deployment and lessened the stress in their relationships; strengthening their own and their partners’ sense of self, resilience, and the marital bond.ResultsUsually 3–5% of a unit would be recalled from combat operations, over the duration of a tour, this was reduced to 1%.ConclusionA psychotherapy programme for the families of soldiers reduces attrition rates.
Collapse
|
42
|
Cutress R, McDowell A, Gabriel F, Brown V, Shetty A, Jeffrey M, Agrawal A, Wise M, Raftery J, Cree I, Yiangou C. Health economic analysis of the implementation of a molecular method for intra-operative breast cancer sentinel node (SLN) analysis. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
43
|
Brown V, Cutress R, Simoes T, Wise M, Yiangou C. The use of both cytokeratin19 and mammaglobin in the intraoperative analysis of sentinel lymph nodes. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
44
|
Brown V, Cutress R, Simoes T, Agrawal A, Wise M, Cree I, Yiangou C. O-59 Single centre experience of 500 patients with intra-operative RT-PCR breast sentinel node analysis. EJC Suppl 2010. [DOI: 10.1016/j.ejcsup.2010.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
45
|
Gollins SW, Myint S, Susnerwala S, Wise M, Haylock BJ, Saunders MP, Neupane R, Topham C, Samuel LM, Levine EL. Preoperative chemoradiation (CRT) with concurrent capecitabine and irinotecan in MRI-defined locally advanced rectal cancer: Relationship of histologic downstaging to long-term survival end points. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
46
|
Cutress RI, McDowell A, Gabriel FG, Gill J, Jeffrey MJ, Agrawal A, Wise M, Raftery J, Cree IA, Yiangou C. Observational and cost analysis of the implementation of breast cancer sentinel node intraoperative molecular diagnosis. J Clin Pathol 2010; 63:522-9. [DOI: 10.1136/jcp.2009.072942] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
47
|
Eyre K, Oakley T, Gill J, Cutress R, Nicol R, Agrawal A, Yiangou C, Wise M. To dilute or not to dilute? A study of the effect of dilution of patent blue dye on the identification rate of sentinel lymph nodes in breast cancer. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
48
|
Edgar I, Gill J, Agrawal A, Wise M, Yiangou C, Cutress R. Coding and revenue: impact on Portsmouth Breast Unit. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
49
|
Byrne B, Cutress R, Gill J, Wise M, Yiangou C, Agrawal A. Does sentinel node biopsy or the timing of completion axillary clearance alter the axillary nodal harvest in breast cancer surgery? Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
50
|
McDowell A, Cutress R, Gabriel F, Jeffrey M, Agrawal A, Wise M, Yiangou C, Raftery J, Cree I. PP83 Implementation and cost effectiveness of intra-operative qRT-PCR analysis of sentinel lymph nodes (SLN) in breast cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)72187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|