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McCormack M, Paczkowski R, Gronroos NN, Noorduyn SG, Lee L, Veeranki P, Johnson MG, Igboekwe E, Kahle-Wrobleski K, Panettieri R. Outcomes of Patients with COPD Treated with ICS/LABA Before and After Initiation of Single-Inhaler Triple Therapy with Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI). Adv Ther 2024; 41:1245-1261. [PMID: 38310193 PMCID: PMC10879256 DOI: 10.1007/s12325-023-02776-8] [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: 09/28/2023] [Accepted: 12/18/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION Triple therapy (fluticasone furoate/umeclidinium/vilanterol; FF/UMEC/VI) has been shown to improve symptoms and reduce exacerbations in patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. This real-world study compared exacerbation rates and healthcare resource utilization (HCRU) before and after initiation of FF/UMEC/VI in patients with COPD previously treated with inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA). METHODS This retrospective cohort study included commercial and Medicare Advantage with Part D administrative claims data from September 01, 2016, to March 31, 2020, of patients diagnosed with COPD. The index date was the date of the first FF/UMEC/VI claim (September 2017-March 2019). The 12 months prior to index (baseline) were used to assess patient characteristics and outcomes; the 12 months following index (follow-up) were used to assess study outcomes. All patients had ≥ 30 consecutive days' supply of any ICS/LABA dual therapy during the 12 months prior to FF/UMEC/VI initiation. Subgroup analyses included patients with ≥ 30 consecutive days' supply of budesonide/formoterol (BUD/FORM) during baseline. Analyses of patients with ≥ 1 COPD exacerbation during baseline were reported as well. RESULTS The overall population included 1449 patients (mean age 70.75 years; 54.18% female), of whom 540 were patients in the BUD/FORM subgroup. Significantly fewer patients experienced any exacerbation during follow-up versus baseline (overall population 53.49% vs 62.59%; p < 0.001; BUD/FORM subgroup 55.00% vs 62.41%; p = 0.004). Effects on exacerbation reduction were more pronounced among patients with ≥ 1 exacerbation during baseline. Lower COPD-related HCRU was observed during the follow-up compared with baseline for both the overall population and the BUD/FORM subgroup. CONCLUSION Patients with COPD treated with ICS/LABA during baseline, including patients specifically treated with BUD/FORM and those with a history of ≥ 1 exacerbation, had fewer COPD exacerbations and lower COPD-related HCRU after initiating FF/UMEC/VI.
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Affiliation(s)
- Meredith McCormack
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Rosirene Paczkowski
- Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, 19426-0989, USA.
| | - Noelle N Gronroos
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Stephen G Noorduyn
- Global Value Evidence and Outcomes, GSK, Mississauga, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lydia Lee
- Value Evidence and Outcomes, R&D Global Medical, GSK, Collegeville, PA, 19426-0989, USA
- Center for Health Outcomes, Policy and Economics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Phani Veeranki
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | - Mary G Johnson
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA
| | | | | | - Reynold Panettieri
- Rutgers Institute for Translational Medicine and Science, New Brunswick, NJ, USA
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Miller RL, Rivera J, Lichtiger L, Govindarajulu US, Jung KH, Lovinsky-Desir S, Perera F, Balcer Whaley S, Newman M, Grant TL, McCormack M, Perzanowski M, Matsui EC. Associations between mitochondrial biomarkers, urban residential exposures and childhood asthma outcomes over 6 months. Environ Res 2023; 239:117342. [PMID: 37813137 PMCID: PMC10843300 DOI: 10.1016/j.envres.2023.117342] [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] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 10/11/2023]
Abstract
Determining biomarkers of responses to environmental exposures and evaluating whether they predict respiratory outcomes may help optimize environmental and medical approaches to childhood asthma. Relative mitochondrial (mt) DNA abundance and other potential mitochondrial indicators of oxidative stress may provide a sensitive metric of the child's shifting molecular responses to its changing environment. We leveraged two urban childhood cohorts (Environmental Control as Add-on Therapy in Childhood Asthma (ECATCh); Columbia Center for Children's Environmental Health (CCCEH)) to ascertain whether biomarkers in buccal mtDNA associate with airway inflammation and altered lung function over 6 months of time and capture biologic responses to multiple external stressors such as indoor allergens and fine particulate matter (PM2.5). Relative mtDNA content was amplified by qPCR and methylation of transfer RNA phenylalanine/rRNA 12S (TF/RNR1), cytochrome c oxidase (CO1), and carboxypeptidase O (CPO) was measured by pyrosequencing. Data on residential exposures and respiratory outcomes were harmonized between the two cohorts. Repeated measures and multiple regression models were utilized to assess relationships between mitochondrial biomarkers, respiratory outcomes, and residential exposures (PM2.5, allergens), adjusted for potential confounders and time-varying asthma. We found across the 6 month visits, a 0.64 fold higher level of TF/RNR1 methylation was detected among those with asthma in comparison to those without asthma ((parameter estimate (PE) 0.64, standard error 0.28, p = 0.03). In prospective analyses, CPO methylation was associated with subsequent reduced forced vital capacity (FVC; PE -0.03, standard error 0.01, p = 0.02). Bedroom dust mouse allergen, but not indoor PM2.5, was associated with higher methylation of TF/RNR1 (PE 0.015, standard error 0.006, p = 0.01). Select mtDNA measures in buccal cells may indicate children's responses to toxic environmental exposures and associate selectively with asthma and lung function.
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Affiliation(s)
- Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA; Columbia Center for Childrens Environmental Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA.
| | - Janelle Rivera
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Lydia Lichtiger
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Usha S Govindarajulu
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Kyung Hwa Jung
- Division of Pediatric Pulmonary, Columbia University Irving Medical Center, 630 W. 168th St, New York, NY, 10032, USA
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Columbia University Irving Medical Center, 630 W. 168th St, New York, NY, 10032, USA
| | - Frederica Perera
- Columbia Center for Childrens Environmental Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Susan Balcer Whaley
- Department of Population Health, Dell Medical School University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0500, Austin, TX, 78712, USA
| | - Michelle Newman
- Department of Epidemiology and Public Health, University of Maryland, 10 S. Pine St, MSTF 3-34, Baltimore, MD, 21201, USA
| | - Torie L Grant
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith McCormack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Perzanowski
- Columbia Center for Childrens Environmental Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0500, Austin, TX, 78712, USA
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3
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Bhakta NR, McGowan A, Ramsey KA, Borg B, Kivastik J, Knight SL, Sylvester K, Burgos F, Swenson ER, McCarthy K, Cooper BG, García-Río F, Skloot G, McCormack M, Mottram C, Irvin CG, Steenbruggen I, Coates AL, Kaminsky DA. European Respiratory Society/American Thoracic Society technical statement: standardisation of the measurement of lung volumes, 2023 update. Eur Respir J 2023; 62:2201519. [PMID: 37500112 DOI: 10.1183/13993003.01519-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 05/16/2023] [Indexed: 07/29/2023]
Abstract
This document updates the 2005 European Respiratory Society (ERS) and American Thoracic Society (ATS) technical standard for the measurement of lung volumes. The 2005 document integrated the recommendations of an ATS/ERS task force with those from an earlier National Heart, Lung, and Blood Institute workshop that led to the publication of background papers between 1995 and 1999 and a consensus workshop report with more in-depth descriptions and discussion. Advancements in hardware and software, new research and emerging approaches have necessitated an update to the 2005 technical standard to guide laboratory directors, physiologists, operators, pulmonologists and manufacturers. Key updates include standardisation of linked spirometry, new equipment quality control and validation recommendations, generalisation of the multiple breath washout concept beyond nitrogen, a new acceptability and grading system with addition of example tracings, and a brief review of imaging and other new techniques to measure lung volumes. Future directions and key research questions are also noted.
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Affiliation(s)
- Nirav R Bhakta
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aisling McGowan
- Department of Respiratory and Sleep Diagnostics, Connolly Hospital, Dublin, Ireland
| | - Kathryn A Ramsey
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Brigitte Borg
- Respiratory Medicine, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jana Kivastik
- Department of Physiology, University of Tartu, Tartu, Estonia
| | - Shandra Lee Knight
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Karl Sylvester
- Cambridge Respiratory Physiology, Cambridge University Hospital, Cambridge, UK
- Respiratory Physiology, Royal Papworth Hospital, Cambridge, UK
| | - Felip Burgos
- Department of Pulmonary Medicine, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, CIBERES, Barcelona, Spain
| | - Erik R Swenson
- VA Puget Sound Health Care System, Seattle, WA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Kevin McCarthy
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Gwen Skloot
- Department of Respiratory Diseases, La Paz University Hospital IdiPAZ, Autonomous University of Madrid, CIBERES, Madrid, Spain
| | | | - Carl Mottram
- Pulmonary Function Laboratory, Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Irene Steenbruggen
- Department of Physiology and Biophysics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Allan L Coates
- Pulmonary Function Department, Isala Hospital, Zwolle, The Netherlands
| | - David A Kaminsky
- Division of Respiratory Medicine, Dept of Pediatrics, Translational Research Institute, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Koehler K, Wilks M, Green T, Rule AM, Zamora ML, Buehler C, Datta A, Gentner DR, Putcha N, Hansel NN, Kirk GD, Raju S, McCormack M. Evaluation of Calibration Approaches for Indoor Deployments of PurpleAir Monitors. Atmos Environ (1994) 2023; 310:119944. [PMID: 37901719 PMCID: PMC10609655 DOI: 10.1016/j.atmosenv.2023.119944] [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: 10/31/2023]
Abstract
Low-cost air quality monitors are growing in popularity among both researchers and community members to understand variability in pollutant concentrations. Several studies have produced calibration approaches for these sensors for ambient air. These calibrations have been shown to depend primarily on relative humidity, particle size distribution, and particle composition, which may be different in indoor environments. However, despite the fact that most people spend the majority of their time indoors, little is known about the accuracy of commonly used devices indoors. This stems from the fact that calibration data for sensors operating in indoor environments are rare. In this study, we sought to evaluate the accuracy of the raw data from PurpleAir fine particulate matter monitors and for published calibration approaches that vary in complexity, ranging from simply applying linear corrections to those requiring co-locating a filter sample for correction with a gravimetric concentration during a baseline visit. Our data includes PurpleAir devices that were co-located in each home with a gravimetric sample for 1-week periods (265 samples from 151 homes). Weekly-averaged gravimetric concentrations ranged between the limit of detection (3 μg/m3) and 330 μg/m3. We found a strong correlation between the PurpleAir monitor and the gravimetric concentration (R>0.91) using internal calibrations provided by the manufacturer. However, the PurpleAir data substantially overestimated indoor concentrations compared to the gravimetric concentration (mean bias error ≥ 23.6 μg/m3 using internal calibrations provided by the manufacturer). Calibrations based on ambient air data maintained high correlations (R ≥ 0.92) and substantially reduced bias (e.g. mean bias error = 10.1 μg/m3 using a US-wide calibration approach). Using a gravimetric sample from a baseline visit to calibrate data for later visits led to an improvement over the internal calibrations, but performed worse than the simpler calibration approaches based on ambient air pollution data. Furthermore, calibrations based on ambient air pollution data performed best when weekly-averaged concentrations did not exceed 30 μg/m3, likely because the majority of the data used to train these models were below this concentration.
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Affiliation(s)
- Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Megan Wilks
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tim Green
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Misti L Zamora
- Department of Public Health Sciences UConn School of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Colby Buehler
- Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Abhirup Datta
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Drew R Gentner
- Chemical and Environmental Engineering, Yale University, New Haven, CT, USA
| | - Nirupama Putcha
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nadia N Hansel
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sarath Raju
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Meredith McCormack
- Department of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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5
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Woo H, Koehler K, Putcha N, Lorizio W, McCormack M, Peng R, Hansel NN. Principal stratification analysis to determine health benefit of indoor air pollution reduction in a randomized environmental intervention in COPD: Results from the CLEAN AIR study. Sci Total Environ 2023; 868:161573. [PMID: 36669663 PMCID: PMC9975085 DOI: 10.1016/j.scitotenv.2023.161573] [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] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Indoor air quality represents a modifiable exposure to Chronic Obstructive Pulmonary Disease (COPD) health. In a randomized controlled trial (CLEAN AIR study), air cleaner assignment had causal effect in improving COPD outcomes. It is unclear, however, what is the treatment effect among those for whom intervention reduced air pollution and whether it was reduction in fine particulate matter (PM2.5) or nitrogen dioxide (NO2) that contributed to such improvement. Because pollution is a posttreatment variable, treatment effect cannot be assessed while controlling for pollution using intention-to-treat (ITT) analysis. OBJECTIVE Using principal stratification method, we assess indoor pollutants as the intermediate variable, and determine the causal effect of reducing indoor air pollution on COPD health. METHOD In randomized controlled trial, former smokers with COPD received either active or placebo HEPA air cleaners and were followed for 6 months. Saint George's Respiratory Questionnaire (SGRQ) was the primary outcome and secondary measures included SGRQ subscales, COPD assessment test (CAT), dyspnea (mMRC), and breathlessness, cough, and sputum scale (BCSS). Indoor PM2.5 and NO2 were measured. Principal stratification analysis was performed to assess the treatment effect while controlling for pollution reduction. RESULTS Among those showing at least 40 % PM2.5 reduction through air cleaners, the intervention showed improvement in respiratory symptoms for the active (vs. placebo), and the size of treatment effect shown for this subgroup was larger than that for the overall sample. In this subgroup, those with active air cleaners (vs. placebo) showed 7.7 points better SGRQ (95%CI: -14.3, -1.1), better CAT (β = -5.5; 95%CI: -9.8, -1.2), mMRC (β = -0.6; 95%CI: -1.1, -0.1), and BCSS (β = -1.8; 95%CI: -3.0, -0.5). Among those showing at least 40 % NO2 reduction through air cleaners, there was no intervention difference in outcomes. CONCLUSION Air cleaners caused clinically significant improvement in respiratory health for individuals with COPD through reduction in indoor PM2.5. TRIAL REGISTRATION ClinicalTrials.gov: NCT02236858.
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Affiliation(s)
- Han Woo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nirupama Putcha
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy Lorizio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith McCormack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nadia N Hansel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Konstantinidis I, Qin S, Fitzpatrick M, Kessinger C, Gentry H, McMahon D, Weinman RD, Tien P, Huang L, McCormack M, Barjaktarevic I, Reddy D, Foronjy R, Lazarous D, Cohen MH, McKay H, Adimora AA, Moran C, Fischl MA, Dionne-Odom J, Stosor V, Drummond MB, Cribbs SK, Kunisaki K, Rinaldo C, Morris A, Nouraie SM. Pulmonary Function Trajectories in People with HIV: Analysis of the Pittsburgh HIV Lung Cohort. Ann Am Thorac Soc 2022; 19:2013-2020. [PMID: 35939796 PMCID: PMC9743474 DOI: 10.1513/annalsats.202204-332oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/08/2022] [Indexed: 02/02/2023] Open
Abstract
Rationale: Human immunodeficiency virus (HIV) infection is associated with chronic lung disease and impaired pulmonary function; however, longitudinal pulmonary function phenotypes in HIV are undefined. Objectives: To identify pulmonary function trajectories, their determinants, and outcomes. Methods: We used data from participants with HIV in the Pittsburgh HIV Lung Cohort with three or more pulmonary function tests between 2007 and 2020. We analyzed post-bronchodilator forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC, and diffusing capacity of the lung for carbon monoxide (DlCO) using group-based trajectory modeling to identify subgroups of individuals whose measurements followed a similar pattern over time. We examined the association between participant characteristics and trajectories using multivariable logistic regression. In exploratory adjusted analyses restricted to individuals with available plasma cytokine data, we investigated the association between 18 individual standardized cytokine concentrations and trajectories. We compared mortality, dyspnea prevalence, respiratory health status, and 6-minute-walk distance between phenotypes. Results: A total of 265 participants contributed 1,606 pulmonary function measurements over a median follow-up of 8.1 years. We identified two trajectories each for FEV1 and FVC: "low baseline, slow decline" and "high baseline, rapid decline." There were three trajectory groups for FEV1/FVC: "rapid decline," "moderate decline," and "slow decline." Finally, we identified two trajectories for DlCO: "baseline low" and "baseline high." The low baseline, slow decline FEV1 and FVC, rapid decline, and moderate decline FEV1/FVC, and baseline low DlCO phenotypes were associated with increased dyspnea prevalence, worse respiratory health status, and decreased 6-minute-walk distance. The baseline low DlCO phenotype was also associated with worse mortality. Current smoking and pack-years of smoking were associated with the adverse FEV1, FEV1/FVC, and DlCO phenotypes. Detectable viremia was the only HIV marker associated with the adverse DlCO phenotype. C-reactive protein and endothelin-1 were associated with the adverse FEV1 and FVC phenotypes, and endothelin-1 trended toward an association with the adverse DlCO phenotype. Conclusions: We identified novel, distinct longitudinal pulmonary function phenotypes with significant differences in characteristics and outcomes. These findings highlight the importance of lung dysfunction over time in people with HIV and should be validated in additional cohorts.
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Affiliation(s)
| | | | | | | | | | | | | | - Phyllis Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Laurence Huang
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Igor Barjaktarevic
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Divya Reddy
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Robert Foronjy
- Department of Medicine, SUNY Downstate Health Sciences University, New York, New York
| | - Deepa Lazarous
- Department of Medicine, Georgetown University, Washington, District of Columbia
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois
| | - Heather McKay
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Caitlin Moran
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Jodie Dionne-Odom
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Valentina Stosor
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - M. Bradley Drummond
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sushma K. Cribbs
- Department of Medicine, Emory University, Atlanta, Georgia
- Department of Medicine, Department of Veterans Affairs Medical Center, Atlanta, Georgia
| | - Ken Kunisaki
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota; and
- Department of Medicine, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Charles Rinaldo
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
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7
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Qiu AY, Leng S, McCormack M, Peden DB, Sood A. Lung Effects of Household Air Pollution. J Allergy Clin Immunol Pract 2022; 10:2807-2819. [PMID: 36064186 DOI: 10.1016/j.jaip.2022.08.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Biomass fuel smoke, secondhand smoke, and oxides of nitrogen are common causes of household air pollution (HAP). Almost 2.4 billion people worldwide use solid fuels for cooking and heating, mostly in low- and middle-income countries. Wood combustion for household heating is also common in many areas of high-income countries, and minorities are particularly vulnerable. HAP in low- and middle-income countries is associated with asthma, acute respiratory tract infections in adults and children, chronic obstructive pulmonary disease, lung cancer, tuberculosis, and respiratory mortality. Although wood smoke exposure levels in high-income countries are typically lower than in lower-income countries, it is similarly associated with accelerated lung function decline, higher prevalence of airflow obstruction and chronic bronchitis, and higher all-cause and respiratory cause-specific mortality. Household air cleaners with high-efficiency particle filters have mixed effects on asthma and chronic obstructive pulmonary disease outcomes. Biomass fuel interventions in low-income countries include adding chimneys to cookstoves, improving biomass fuel combustion stoves, and switching fuel to liquid petroleum gas. Still, the impact on health outcomes is inconsistent. In high-income countries, strategies for reducing biomass fuel-related HAP are centered on community-level woodstove changeout programs, although the results are again inconsistent. In addition, initiatives to encourage home smoking bans have mixed success in households with children. Environmental solutions to reduce HAP have varying success in reducing pollutants and health problems. Improved understanding of indoor air quality factors and actions that prevent degradation or improve polluted indoor air may lead to enhanced environmental health policies, but health outcomes must be rigorously examined.
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Affiliation(s)
- Anna Y Qiu
- Johns Hopkins University, School of Medicine, Baltimore, Md
| | - Shuguang Leng
- University of New Mexico School of Medicine, Albuquerque, NM; University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | - David B Peden
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Akshay Sood
- University of New Mexico School of Medicine, Albuquerque, NM; Miners Colfax Medical Center, Raton, NM.
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8
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McCormack M, Balasubramanian A, Wise RA, Keet CA, Matsui EC, Peng RD. Reply by McCormack et al. to Townsend and Cowl, and to Miller et al.. Am J Respir Crit Care Med 2022; 206:795-796. [PMID: 35503239 PMCID: PMC9799112 DOI: 10.1164/rccm.202202-0378le] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Meredith McCormack
- Johns Hopkins UniversityBaltimore, Maryland,Corresponding author (e-mail: )
| | | | | | | | | | - Roger D. Peng
- Johns Hopkins Bloomberg School of Public HealthBaltimore, Maryland
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9
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Palmer K, El-Shakankery K, Kefas J, Gao K, Crusz S, Flynn M, Jonathan L, Lockley M, McCormack M, Macdonald N, Nicum S, Devlin MJ, Miller R. 600P Ethnic and socio-economic status in ovarian cancer patients recruited to clinical trials. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.728] [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: 11/01/2022] Open
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10
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Sillé FCM, McCormack M, Hartung T. The Exposome Applied: A Step Toward Defining the Totality of Environmental Exposures in Asthma. Am J Respir Crit Care Med 2022; 206:1187-1188. [PMID: 35925019 DOI: 10.1164/rccm.202207-1430ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Fenna C M Sillé
- Johns Hopkins University Bloomberg School of Public Health, Environmental Health and Engineering, Baltimore, Maryland, United States;
| | - Meredith McCormack
- Johns Hopkins University, Pulmonary and Critical Care, Baltimore, Maryland, United States
| | - Thomas Hartung
- Johns Hopkins University Bloomberg School of Public Health, Environmental Health and Engineering, Baltimore, Maryland, United States.,University of Konstanz, Department of Biology, Konstanz, Germany
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11
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Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I, Cooper BG, Culver B, Derom E, Hall GL, Hallstrand TS, Leuppi JD, MacIntyre N, McCormack M, Rosenfeld M, Swenson ER. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J 2022; 60:2101499. [PMID: 34949706 DOI: 10.1183/13993003.01499-2021] [Citation(s) in RCA: 274] [Impact Index Per Article: 137.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/18/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Appropriate interpretation of pulmonary function tests (PFTs) involves the classification of observed values as within/outside the normal range based on a reference population of healthy individuals, integrating knowledge of physiological determinants of test results into functional classifications and integrating patterns with other clinical data to estimate prognosis. In 2005, the American Thoracic Society (ATS) and European Respiratory Society (ERS) jointly adopted technical standards for the interpretation of PFTs. We aimed to update the 2005 recommendations and incorporate evidence from recent literature to establish new standards for PFT interpretation. METHODS This technical standards document was developed by an international joint Task Force, appointed by the ERS/ATS with multidisciplinary expertise in conducting and interpreting PFTs and developing international standards. A comprehensive literature review was conducted and published evidence was reviewed. RESULTS Recommendations for the choice of reference equations and limits of normal of the healthy population to identify individuals with unusually low or high results are discussed. Interpretation strategies for bronchodilator responsiveness testing, limits of natural changes over time and severity are also updated. Interpretation of measurements made by spirometry, lung volumes and gas transfer are described as they relate to underlying pathophysiology with updated classification protocols of common impairments. CONCLUSIONS Interpretation of PFTs must be complemented with clinical expertise and consideration of the inherent biological variability of the test and the uncertainty of the test result to ensure appropriate interpretation of an individual's lung function measurements.
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Affiliation(s)
- Sanja Stanojevic
- Dept of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - David A Kaminsky
- Pulmonary Disease and Critical Care Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Martin R Miller
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Bruce Thompson
- Physiology Service, Dept of Respiratory Medicine, The Alfred Hospital and School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Andrea Aliverti
- Dept of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Igor Barjaktarevic
- Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, CA, USA
| | - Brendan G Cooper
- Lung Function and Sleep, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bruce Culver
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Eric Derom
- Dept of Respiratory Medicine, Ghent University, Ghent, Belgium
| | - Graham L Hall
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute and School of Allied Health, Faculty of Health Science, Curtin University, Bentley, Australia
| | - Teal S Hallstrand
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Basel, Liestal, Switzerland
- University Clinic of Medicine, University of Basel, Basel, Switzerland
| | - Neil MacIntyre
- Division of Pulmonary, Allergy, and Critical Care Medicine, Dept of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Meredith McCormack
- Pulmonary Function Laboratory, Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Erik R Swenson
- Dept of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
- VA Puget Sound Health Care System, Seattle, WA, USA
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12
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Johnson O, Gerald LB, Harvey J, Roy G, Hazucha H, Large C, Burke A, McCormack M, Wise RA, Holbrook JT, Dixon AE. An Online Weight Loss Intervention for People With Obesity and Poorly Controlled Asthma. J Allergy Clin Immunol Pract 2022; 10:1577-1586.e3. [PMID: 35304842 PMCID: PMC9188993 DOI: 10.1016/j.jaip.2022.02.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 04/08/2023]
Abstract
BACKGROUND Weight loss might improve asthma control in people with obesity. However, people with asthma might have particular challenges losing weight and the amount of weight loss needed to improve asthma control is not clear. OBJECTIVES To pilot-test an online weight loss intervention and to estimate the impact of weight loss on asthma control. METHODS We performed a 6-month, single-arm, futility trial of an online weight loss intervention at 2 centers. To reject the assumption of futility, 9 or more participants had to lose at least 5% of their body weight. We also assessed the association between weight loss (≥5%) and asthma outcomes. RESULTS Forty-three participants (85% women) started the weight loss intervention. The median and interquartile range for the body mass index was 40.3 kg/m2 (range 34.7-46.8 kg/m2), and 14 (range 12-17 kg/m2) for the Asthma Control Test score. At 6 months, 10 participants (23%; 95% CI 12%-39%) lost at least 5% of their initial weight. Weight loss of at least 5% was associated with a clinically and statistically significant improvements in their Asthma Control Test (median [interquartile range] increase of 3 [1 to 7]; P < .05), Marks Asthma Quality of Life Score (-9.5 [-18 to -3]; P = .008), and their general health-related quality of life score (RAND-36; improved by 9.4 [2.8 to 22.5]; P =.014). CONCLUSIONS An online weight loss intervention has the potential to meet U.S. Food and Drug Administration guidance for product evaluation (at least a 5% weight loss in 35% of people) for treating obesity, and is associated with a clinically significant improvement in asthma control, quality of life, and overall health-related quality of life.
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Affiliation(s)
- Olivia Johnson
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vt
| | - Lynn B Gerald
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, Tucson, Ariz; Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Jean Harvey
- Department of Nutrition and Food Science, College of Agriculture and Life Sciences, University of Vermont, Burlington, Vt
| | - Gem Roy
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Heather Hazucha
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Chelsey Large
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| | - Alyce Burke
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Meredith McCormack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Robert A Wise
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Janet T Holbrook
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - Anne E Dixon
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vt.
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13
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Lorusso D, Colombo N, Casado Herraez A, Santin A, Colomba E, Miller D, Fujiwara K, Pignata S, Baron-Hay S, Ray-Coquard I, Shapira-Frommer R, Kim Y, McCormack M, Massaad R, Martin Nguyen A, Zhao Q, McKenzie J, Prabhu V, Makker V. 20MO Time to deterioration in quality of life in patients (pts) with advanced endometrial cancer (aEC) treated with lenvatinib plus pembrolizumab (L+P) or treatment of physician’s choice (TPC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Coffman VR, Hall DJ, Pisanic N, Wiesner-Friedman C, Rogers S, Rule A, McCormack M, Diener-West M, Davis MF, Heaney CD. Assessing Residential Exposure to Microbes from Industrial Hog Operations in Rural North Carolina: Methods and Lessons Learned. Prog Community Health Partnersh 2022; 16:61-72. [PMID: 35342111 DOI: 10.1353/cpr.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Recent advances in molecular source tracking make answering questions from residents regarding their exposure to microbial contaminants from industrial hog operations (IHOs) possible. Associations between residential distance to IHOs and exposure can be addressed by measuring livestock-associated (Staphylococcus aureus) and pig-specific bacteria in the air, on household surfaces, and in participants' nasal and saliva swabs. OBJECTIVES Here we assess the mechanics, feasibility, capacity-building, and lessons learned during a pilot study employing this novel technology in community-based participatory research of bacterial exposure and human health. METHODS Together, our team of academics and community members designed a field- and laboratory-based pilot study. Air samples, surface and human swabs, and questionnaires from households at varying distances from IHOs were collected. Data were assessed for completeness and quality by two independent reviewers. These metrics were defined as: missingness (completeness), incorrect data type (validity), out of range (validity), and outliers (accuracy). LESSONS LEARNED While critical field equipment was obtained, and knowledge exchange occurred, leading to an increased capacity for future work, after review, 38 of 49 households were deemed eligible for inclusion in the study. Of eligible participants, 98% of required electronic survey questions were complete and 100% were valid; an improvement over prior work which employed paper surveys. While all human microbial and air samples were collected from eligible households (n = 231), (5%) of environmental swabs were reported missing. CONCLUSIONS Using community-appropriate sampling protocols, a pilot study of residential exposure to bacteria from IHOs was completed. While high-quality data was collected from those eligible, we learned the necessity of early and continual data review.
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15
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McCormack M, McDonagh C, Ali M. A progressive and severe rash. Acute Med 2022; 20:280-281. [PMID: 35072385 DOI: 10.52964/amja.0878] [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]
Abstract
A 73-year-old female attended the Emergency Department with a twenty four hour history of a progressive, diffuse macular rash, predominantly affecting limbs and trunk, with associated oral and ocular discharge.
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Affiliation(s)
| | | | - M Ali
- Walsall Healthcare NHS Trust
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16
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Kaviany P, Senter JP, Collaco JM, Corrigan AE, Brigham E, Wood M, Woo H, Liu C, Koehl R, Galiatsatos P, Koehler K, Hansel N, McCormack M. Spatial analysis of tobacco outlet density on secondhand smoke exposure and asthma health among children in Baltimore City. Tob Control 2022; 32:tobaccocontrol-2021-056878. [PMID: 35046128 PMCID: PMC9294062 DOI: 10.1136/tobaccocontrol-2021-056878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/27/2021] [Indexed: 11/03/2022]
Abstract
RATIONALE Tobacco outlets are concentrated in low-income neighbourhoods; higher tobacco outlet density is associated with increased smoking prevalence. Secondhand smoke (SHS) exposure has significant detrimental effects on childhood asthma. We hypothesised there was an association between higher tobacco outlet density, indoor air pollution and worse childhood asthma. METHODS Baseline data from a home intervention study of 139 children (8-17 years) with asthma in Baltimore City included residential air nicotine monitoring, paired with serum cotinine and asthma control assessment. Participant addresses and tobacco outlets were geocoded and mapped. Multivariable regression modelling was used to describe the relationships between tobacco outlet density, SHS exposure and asthma control. RESULTS Within a 500 m radius of each participant home, there were on average six tobacco outlets. Each additional tobacco outlet in a 500 m radius was associated with a 12% increase in air nicotine (p<0.01) and an 8% increase in serum cotinine (p=0.01). For every 10-fold increase in air nicotine levels, there was a 0.25-point increase in Asthma Therapy Assessment Questionnaire (ATAQ) score (p=0.01), and for every 10-fold increase in serum cotinine levels, there was a 0.54-point increase in ATAQ score (p<0.05). CONCLUSIONS Increased tobacco outlet density is associated with higher levels of bedroom air nicotine and serum cotinine. Increasing levels of SHS exposure (air nicotine and serum cotinine) are associated with less controlled childhood asthma. In Baltimore City, the health of children with asthma is adversely impacted in neighbourhoods where tobacco outlets are concentrated. The implications of our findings can inform community-level interventions to address these health disparities.
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Affiliation(s)
- Parisa Kaviany
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James Paul Senter
- Pediatrics Residency Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph Michael Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anne E Corrigan
- Spatial Science for Public Health Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily Brigham
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Megan Wood
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Han Woo
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chen Liu
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachelle Koehl
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Panagis Galiatsatos
- Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia Hansel
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meredith McCormack
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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17
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Polverino F, Wu TD, Rojas-Quintero J, Wang X, Mayo J, Tomchaney M, Tram J, Packard S, Zhang D, Cleveland KH, Cordoba-Lanus E, Owen CA, Fawzy A, Kinney GL, Hersh CP, Hansel NN, Doubleday K, Sauler M, Tesfaigzi Y, Ledford JG, Casanova C, Zmijewski J, Konhilas J, Langlais PR, Schnellmann R, Rahman I, McCormack M, Celli B. Metformin: Experimental and Clinical Evidence for a Potential Role in Emphysema Treatment. Am J Respir Crit Care Med 2021; 204:651-666. [PMID: 34033525 PMCID: PMC8521702 DOI: 10.1164/rccm.202012-4510oc] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Cigarette smoke (CS) inhalation triggers oxidative stress and inflammation, leading to accelerated lung aging, apoptosis, and emphysema, as well as systemic pathologies. Metformin is beneficial for protecting against aging-related diseases. Objectives: We sought to investigate whether metformin may ameliorate CS-induced pathologies of emphysematous chronic obstructive pulmonary disease (COPD). Methods: Mice were exposed chronically to CS and fed metformin-enriched chow for the second half of exposure. Lung, kidney, and muscle pathologies, lung proteostasis, endoplasmic reticulum (ER) stress, mitochondrial function, and mediators of metformin effects in vivo and/or in vitro were studied. We evaluated the association of metformin use with indices of emphysema progression over 5 years of follow-up among the COPDGene (Genetic Epidemiology of COPD) study participants. The association of metformin use with the percentage of emphysema and adjusted lung density was estimated by using a linear mixed model. Measurements and Main Results: Metformin protected against CS-induced pulmonary inflammation and airspace enlargement; small airway remodeling, glomerular shrinkage, oxidative stress, apoptosis, telomere damage, aging, dysmetabolism in vivo and in vitro; and ER stress. The AMPK (AMP-activated protein kinase) pathway was central to metformin's protective action. Within COPDGene, participants receiving metformin compared with those not receiving it had a slower progression of emphysema (-0.92%; 95% confidence interval [CI], -1.7% to -0.14%; P = 0.02) and a slower adjusted lung density decrease (2.2 g/L; 95% CI, 0.43 to 4.0 g/L; P = 0.01). Conclusions: Metformin protected against CS-induced lung, renal, and muscle injury; mitochondrial dysfunction; and unfolded protein responses and ER stress in mice. In humans, metformin use was associated with lesser emphysema progression over time. Our results provide a rationale for clinical trials testing the efficacy of metformin in limiting emphysema progression and its systemic consequences.
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Affiliation(s)
| | - Tianshi David Wu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas;,Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | | | - Xiaoyun Wang
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia and Charlie Norwood VA Medical Center, Augusta, Georgia
| | | | | | - Judy Tram
- Asthma and Airway Disease Research Center and
| | | | | | | | - Elizabeth Cordoba-Lanus
- Servicio de Neumología, Unidad de Investigación, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | | | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Greg L. Kinney
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Craig P. Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Maor Sauler
- Pulmonary Division, School of Medicine, Yale University, New Haven, Connecticut
| | | | | | - Ciro Casanova
- Servicio de Neumología, Unidad de Investigación, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Jaroslaw Zmijewski
- Pulmonary and Critical Care Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama; and
| | - John Konhilas
- Department of Physiology, University of Arizona, Tucson, Arizona
| | | | | | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York
| | - Meredith McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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18
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Coffman VR, Hall DJ, Pisanic N, Nadimpalli M, McCormack M, Diener‐West M, Davis MF, Heaney CD. Personal protective equipment use during industrial hog operation work activities and acute lung function changes in a prospective worker cohort, North Carolina 2014-2015. Am J Ind Med 2021; 64:688-698. [PMID: 34091939 DOI: 10.1002/ajim.23260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Occupational activities related to industrial hog operation (IHO) worker lung function are not well defined. Therefore, we aimed to identify IHO work activities associated with diminished respiratory function and the effectiveness, if any, of personal protective equipment (PPE) use on IHOs. METHODS From 2014 to 2015, 103 IHO workers were enrolled and followed for 16 weeks. At each biweekly visit, work activities and PPE use were self-reported via questionnaire and lung function measurements were collected via spirometry. Generalized linear and linear fixed-effects models were fitted to cross-sectional and longitudinal data. RESULTS Increasing years worked on an IHO were associated with diminished lung function, but baseline and longitudinal work activities were largely inconsistent in direction and magnitude. Unexpectedly, a -0.3 L (95% confidence interval: -0.6, -0.04) difference in forced expiratory volume in the first second (FEV1 ) was estimated when workers wore PPE consistently (≥80% of the time at work) versus those weeks they did not. In post-hoc analyses, we found that coveralls and facemasks were worn less consistently when workers experienced worse barn conditions and had more contact with pigs, but coveralls were worn more consistently as cleaning activities increased. CONCLUSIONS Similar to past studies, baseline estimates were likely obscured by healthy worker effect bias, but showed decrements in worker lung function as years of work increased. A challenge to disentangling the effect of work activities on lung function was the discovery that IHO workers used PPE differently according to the work task. These data suggest that interventions may be targeted toward improving barn conditions so that workers can consistently utilize IHO-provided PPE.
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Affiliation(s)
- Vanessa R. Coffman
- Division of Epidemiology and Biostatistics, School of Public Health University of Illinois at Chicago Chicago Illinois USA
| | - Devon J. Hall
- Rural Empowerment Association for Community Help (REACH) Warsaw North Carolina USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Maya Nadimpalli
- Department of Civil and Environmental Engineering Tufts University Medford Massachusetts USA
- Center for Integrated Management of Antimicrobial Resistance (CIMAR) Tufts University Boston Massachusetts USA
| | - Meredith McCormack
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- School of Medicine Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
| | - Marie Diener‐West
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- School of Nursing Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Meghan F. Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- School of Medicine Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Christopher D. Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
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19
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Wortman B, Post C, Powell M, Khaw P, Fyles A, D’Amico R, Haie-Meder C, Jurgenliemk-Schulz I, McCormack M, Do V, Katsaros D, Bessette P, Baron M, Nout R, Whitmarsh K, Mileshkin L, Lutgens L, Kitchener H, Brooks S, Nijman H, Astreinidou E, Putter H, Creutzberg C, de Boer S. OC-0298 Toxicity and patient-reported symptoms after 3D-conformal or intensity-modulated pelvic radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Jabre NA, Keet CA, McCormack M, Peng R, Balcer-Whaley S, Matsui EC. Material Hardship and Indoor Allergen Exposure among Low-Income, Urban, Minority Children with Persistent Asthma. J Community Health 2021; 45:1017-1026. [PMID: 32377967 DOI: 10.1007/s10900-020-00822-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Traditional measures of socioeconomic status (SES) are associated with asthma morbidity, but their specific contributions are unclear. Increased exposure to indoor allergens among low SES children is an important consideration. Material hardship, a concept describing poor access to basic goods and services, may explain the relationship between low SES and indoor allergen exposure, and thereby, the increased risk of asthma morbidity. We sought to (i) describe the specific hardships experienced by low-Income, urban, minority children with asthma and indoor allergen sensitization and (ii) determine if material hardship is associated with indoor allergen exposure in this population. We conducted a cross-sectional analysis of children undergoing the baseline assessment for a clinical trial of home environmental modification. Participants were scored in five domains of material hardship. Domain scores were assigned based on caregiver responses to a questionnaire and were summed to generate a total material hardship score. Linear regression was used to examine the relationship between material hardship scores and bedroom floor concentrations of five common indoor allergens. Participants experienced high levels of material hardship in each of the five domains, with 33% not having access to a car, 35% not being able to pay utility bills, and 28% not being able to pay rent in the past year. Each one-point increase in material hardship was associated with an increase in cockroach allergen of 16.2% (95% CI 9.4%, 24.6%) and an increase in mouse allergen of 9.4% (95% CI 1.0%, 18.5%). After adjusting for traditional measures of SES, including household income, health insurance type, caregiver education, and caregiver employment status, the association between material hardship and cockroach allergen, but not mouse allergen, remained. These data suggest that a significant proportion of families of low-income, minority children with asthma may experience material hardship, and that they may be at greater risk of cockroach allergen exposure than their peers with similar income, but without material hardship.
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Affiliation(s)
- Nicholas A Jabre
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corinne A Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roger Peng
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan Balcer-Whaley
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth C Matsui
- Department of Population Health and Pediatrics, Dell Medical School, The University of Texas at Austin, 1701 Trinity St, Austin, TX, 78704, USA.
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21
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Coffman VR, Hall DJ, Pisanic N, Love DC, Nadimpalli M, McCormack M, Diener‐West M, Davis MF, Heaney CD. Self-reported work activities, eye, nose, and throat symptoms, and respiratory health outcomes among an industrial hog operation worker cohort, North Carolina, USA. Am J Ind Med 2021; 64:403-413. [PMID: 33616247 DOI: 10.1002/ajim.23236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/30/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Respiratory disease among industrial hog operation (IHO) workers is well documented; however, it remains unclear whether specific work activities are more harmful and if personal protective equipment (PPE), as used by workers, can reduce adverse health outcomes. METHODS IHO workers (n = 103) completed baseline and up to eight bi-weekly study visits. Workers reported typical (baseline) and transient (bi-weekly) work activities, PPE use, and physical health symptoms. Baseline and longitudinal associations were assessed using generalized logistic and fixed-effects logistic regression models, respectively. RESULTS At baseline, reports of ever versus never drawing pig blood, applying pesticides, and increasing years worked at any IHO were positively associated with reports of eye, nose, and/or throat irritation. Over time, transient exposures, associated with dustiness in barns, cleaning of barns, and pig contact were associated with increased odds of sneezing, headache, and eye or nose irritation, particularly in the highest categories of exposure. When PPE was used, workers had lower odds of symptoms interfering with sleep (odds ratio [OR]: 0.1; 95% confidence interval [CI]: 0.01-0.8), and eye or nose irritation (OR: 0.1; 95% CI: 0.02-0.9). Similarly, when they washed their hands eight times or more per shift (median frequency) versus less frequently, the odds of any respiratory symptom were reduced (OR: 0.3; 95% CI: 0.1-0.8). CONCLUSIONS In this healthy volunteer worker population, increasingly unfavorable IHO activities were associated with self-reported eye, nose, throat, and respiratory health symptoms. Strong protective associations were seen between PPE use and handwashing and the odds of symptoms, warranting further investigation.
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Affiliation(s)
- Vanessa R. Coffman
- Division of Epidemiology and Biostatistics University of Illinois at Chicago Chicago Illinois USA
| | - Devon J. Hall
- Rural Empowerment Association for Community Help (REACH) Warsaw North Carolina USA
| | - Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - David C. Love
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Maya Nadimpalli
- Department of Civil and Environmental Engineering Tufts University Medford Massachusetts USA
- Stuart B. Levy Center for Integrated Management of Antimicrobial Resistance (Levy CIMAR) Tufts University Boston Massachusetts USA
| | - Meredith McCormack
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- School of Medicine Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
| | - Marie Diener‐West
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins School of Nursing Baltimore Maryland USA
- Johns Hopkins Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Meghan F. Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- School of Medicine Johns Hopkins University Baltimore Maryland USA
| | - Christopher D. Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Johns Hopkins Center for Global Health Johns Hopkins University Baltimore Maryland USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
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McCormack M, McDonagh C, Ali M. A progressive and severe rash - Answers. Acute Med 2021; 20:298-301. [PMID: 35072390] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 73-year-old female patient with epilepsy presented to hospital with a progressive, diffuse macular rash over the trunk and limbs with associated mucosal blistering and discharge. Ocular symptoms initially predominated and she was treated for presumed bacterial conjunctivitis by her General Practitioner the previous day. On the acute medical unit supportive management was initiated for suspected adverse drug reaction (ADR) to a recent lamotrigine dose increase. Skin biopsy confirmed a diagnosis of toxic epidermal necrolysis. We present this case to highlight the importance of medication history taking and raise awareness of indolent presentations of life-threatening ADRs. Caution should be applied following dose changes to anti-epileptics, even if previously stable.
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Affiliation(s)
- M McCormack
- MBChB, Internal Medicine Trainee, University Hospitals Coventry & Warwickshire NHS Trust, UK
| | - C McDonagh
- MBChB, Clinical Fellow, Department of Medicine, Walsall Healthcare NHS Trust, UK
| | - M Ali
- MBBS, Consultant in Acute Medicine, Walsall Healthcare NHS Trust, UK
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Fawzy A, Woo H, Balasubramanian A, Barjaktarevic I, Barr RG, Bowler RP, Comellas AP, Cooper CB, Couper D, Criner GJ, Dransfield MT, Han MK, Hoffman EA, Kanner RE, Krishnan JA, Martinez FJ, McCormack M, Paine Iii R, Peters S, Wise R, Woodruff PG, Hansel NN, Putcha N. Polycythemia is Associated with Lower Incidence of Severe COPD Exacerbations in the SPIROMICS Study. Chronic Obstr Pulm Dis 2021; 8:326-335. [PMID: 34197703 DOI: 10.15326/jcopdf.2021.0216] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Secondary polycythemia has long been recognized as a consequence of chronic pulmonary disease and hypoxemia and is associated with lower mortality and fewer hospitalizations among individuals with chronic obstructive pulmonary disease (COPD)-prescribed long-term oxygen therapy. This study investigates the association of polycythemia with COPD severity, phenotypic features, and respiratory exacerbations in a contemporary and representative sample of individuals with COPD. Current and former smokers with COPD (forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ratio <70%) without a history of hematologic/oncologic disorders were selected from the SubPopulations and InteRmediate Outcomes Measures In COPD Study (SPIROMICS), a multi-center observational cohort. Participants with polycythemia (hemoglobin ≥15g/dL [females] or ≥17g/dL [males]), were compared to individuals without anemia (hemoglobin ≥12g/dL [females] or ≥13g/dL [males]). Cross-sectional outcomes including percent predicted FEV1, respiratory symptoms, quality of life, exercise tolerance, and percentage and distribution of emphysema (voxels<-950 Hounsfield units [HU] at total lung capacity) were evaluated using linear or logistic regression. Longitudinal acute exacerbation of COPD (AECOPD) and severe AECOPD (requiring an emergency department visit or hospitalization) were assessed using zero-inflated negative binomial models. Among 1261 participants, 148 (11.7%) had polycythemia. Average follow-up was 4.2±1.7 years and did not differ by presence of polycythemia. In multivariate analysis, compared to participants with normal hemoglobin, polycythemia was associated with a reduced rate of severe AECOPD (adjusted incidence rate ratio 0.57, 95% CI: 0.33-0.98), lower percent predicted FEV1, lower resting oxygen saturation, increased upper to lower lobe ratio of emphysema, and a greater degree of emphysema, though the latter was attenuated after adjusting for lung function. There were no significant differences in total AECOPD, patient-reported outcomes, or exercise tolerance. These findings suggest that polycythemia, while associated with less favorable physiologic parameters, is not independently associated with symptoms, and is associated with fewer severe exacerbations. Future studies should explore the potentially protective role of increased hemoglobin beyond the correction of anemia.
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Affiliation(s)
- Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Igor Barjaktarevic
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - R Graham Barr
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Russell P Bowler
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado, United States
| | - Alejandro P Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Christopher B Cooper
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Gerard J Criner
- Department of Thoracic Surgery and Medicine, Temple University, Philadelphia, Pennsylvania, United States
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Eric A Hoffman
- Department of Radiology, Medicine and Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Richard E Kanner
- Division of Respiratory, Critical Care and Occupational Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Fernando J Martinez
- Division of Pulmonology and Critical Care Medicine, Weill-Cornell Medical Center, Cornell University, New York, New York, United States
| | - Meredith McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Robert Paine Iii
- Division of Respiratory, Critical Care and Occupational Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Stephen Peters
- Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina, United States
| | - Robert Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
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Galiatsatos P, Judge E, Koehl R, Hill M, Veira O, Hansel N, Eakin M, McCormack M. The Lung Health Ambassador Program: A Community-Engagement Initiative Focusing on Pulmonary-Related Health Issues and Disparities Regarding Tobacco Use. Int J Environ Res Public Health 2020; 18:E5. [PMID: 33374951 PMCID: PMC7792622 DOI: 10.3390/ijerph18010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
Introduction: Educational campaigns have the potential to inform at risk populations about key issues relevant to lung health and to facilitate active engagement promoting healthy behaviors and risk prevention. We developed a community-based educational campaign called the Lung Health Ambassador Program (LHAP) with a goal of engaging youth and empowering them to be advocates for pulmonary health in their community. Objective: To evaluate the process outcomes and feasibility of the inaugural LHAP (2018-2019 academic year), with a specific aim to impact tobacco policy in the state of Maryland. Methods: Outcomes regarding feasibility included assessment of number of schools reached, number of students and healthcare professionals participating, and types of projects developed by participating students to impact modifiable risk factors for lung health. The courses for the LHAP were five 1 h sessions implemented at days and times identified by the community. The topics of the LHAP focused on lung anatomy, pulmonary diseases affecting school aged youth, tobacco use and prevalence, and air pollution (both indoor and outdoor). The fifth class discussed ways in which the students could impact lung health (e.g., policy and advocacy) and mitigate pulmonary disparities. Main Results: The LHAP was implemented at two elementary/middle schools, one high school, and two recreation centers within an urban metropolitan region. A total of 268 youths participated in the LHAP (age ranging from 11 to 18), whereby 72 (26.9%) were Hispanic/Latino and 110 (41.0%) were African American. Of the participating students, 240 wrote letters to local politicians to advocate for policies that would raise the legal age of acquiring tobacco products to 21. As for healthcare professionals, 18 academic faculty members participated in implementing the LHAP: 8 physicians and faculty staff and 10 nurses. Conclusions: The LHAP is a community-based program that provides education and training in advocacy with a goal of teaching about and, ultimately, reducing respiratory health disparities. The results from the first year demonstrate that the program is feasible, with success demonstrated in completing educational modules and engaging students. Next steps will include strategies to ensure sustainability and scalability to increase the reach of this program.
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Affiliation(s)
- Panagis Galiatsatos
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA; (E.J.); (R.K.); (M.H.); (O.V.); (N.H.); (M.E.); (M.M.)
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25
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Coffman VR, Hall DJ, Pisanic N, Nadimpalli M, McCormack M, Diener-West M, Davis MF, Heaney CD. The use of personal protective equipment during common industrial hog operation work activities and acute lung function changes in a prospective worker cohort, North Carolina, USA. medRxiv 2020. [PMID: 33173898 DOI: 10.1101/2020.11.03.20205252] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction As occupational activities related to acute industrial hog operation (IHO) worker lung function are not well defined, we aimed to identify IHO work activities associated with diminished respiratory function and the effectiveness, if any, of personal protective equipment (PPE) on IHOs. Methods From 2014-2015, 103 IHO workers were enrolled and followed for 16 weeks. At each bi-weekly visit, lung function measurements were collected via spirometry and work activities and PPE use were self-reported via questionnaire. Generalized linear and linear fixed-effects models were fitted to cross-sectional and longitudinal data. Results At baseline, increasing years worked on an IHO were associated with diminished lung function, but other activities were less consistent in direction and magnitude. In longitudinal models, only reports of working in feeding/finisher barns, showed a consistent association. However, a -0.3 L (95% confidence interval: -0.6, -0.04) difference in FEV 1 was estimated when workers wore PPE consistently versus those weeks they did not. In post-hoc analyses, we found that coveralls and facemasks were worn less consistently when workers experienced worse barn conditions and had more contact with pigs, but coveralls were worn more consistently as cleaning activities increased. Conclusions Similar to past studies, baseline estimates were likely obscured by healthy worker bias. Also making it challenging to disentangle the effect of work activities on lung function was the discovery that IHO workers used PPE differently according to work task. These data suggest that interventions may be targeted toward improving barn conditions so that workers can consistently utilize IHO-provided PPE. KEY MESSAGES What is already known about this subject?: Working on industrial hog operations may be deleterious to long- and short-term respiratory health due to airborne bacteria, endotoxin, hazardous gases, dust, and dander in barns. In efficacy studies PPE has been shown to be protective, but studies have shown that PPE utilization among hog workers has historically been sub-optimal.What are the new findings?: As barn conditions worsened and contact with pigs increased, workers in this cohort reported wearing coveralls and face masks less often; however, they reported increased PPE use as they conducted more cleaning activities at work. During weeks when workers wore PPE their lung function declined, a possible cause being the improper use of the equipment leading to a false sense of protection or re-exposure to hazardous contaminants.How might this impact on policy or clinical practice in the foreseeable future?: Given COVID-19, the H1N1 "swine flu" pandemic, our knowledge of antimicrobial resistant pathogens, and increasing awareness about how food systems are linked to the spread of emerging infectious diseases, occupational health intervention research and workplace policies may focus on creating barn environments that are more conducive to PPE use which could help protect workers and consequently the community.
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Diez P, Bourner J, Sharp A, Hoskin P, McCormack M. OC-1037: Real world interpretation of GEC-ESTRO image-guided brachytherapy recommendations for cervix cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Lester R, Prescott L, McCormack M, Sampson M. Service users' experiences of receiving a diagnosis of borderline personality disorder: A systematic review. Personal Ment Health 2020; 14:263-283. [PMID: 32073223 DOI: 10.1002/pmh.1478] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 07/09/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 11/11/2022]
Abstract
There is ongoing controversy regarding the borderline personality disorder (BPD) diagnosis. Whilst the experiences of people living with BPD have been widely acknowledged, the process of receiving the diagnosis is poorly described. This systematic review aimed to synthesize the existing research exploring people's experiences of receiving a diagnosis of BPD, as well as examining what is considered best practice in the diagnostic delivery process. The findings from 12 qualitative studies were synthesized using thematic analysis, generating two overarching themes: negative and positive experiences of receiving a diagnosis of BPD. These themes were described using the following sub-themes: the communication of diagnosis and meaning made of it, validity around diagnosis and attitudes of others. Results indicate that there is a substantial difference between a well-delivered and poorly delivered diagnosis. The diagnostic delivery process is fundamental to how people understand and interpret the BPD diagnosis. The way in which the BPD diagnosis is shared with people can ultimately shape their views about hope for recovery and their subsequent engagement with services. © 2020 John Wiley & Sons, Ltd.
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Affiliation(s)
- R Lester
- St Helens Recovery Team, Harry Blackman House, Peasley Cross Hospital, St Helens, UK
| | - L Prescott
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - M McCormack
- St Helens Recovery Team, Harry Blackman House, Peasley Cross Hospital, St Helens, UK
| | - M Sampson
- St Helens Recovery Team, Harry Blackman House, Peasley Cross Hospital, St Helens, UK
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28
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Quirós-Alcalá L, Hansel NN, McCormack M, Calafat AM, Ye X, Peng RD, Matsui EC. Exposure to bisphenols and asthma morbidity among low-income urban children with asthma. J Allergy Clin Immunol 2020; 147:577-586.e7. [PMID: 32736870 DOI: 10.1016/j.jaci.2020.05.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/24/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Bisphenol A (BPA) has been linked with pediatric asthma development and allergic airway inflammation in animal models. Whether exposure to BPA or its structural analogs bisphenol S (BPS) and bisphenol F (BPF) is associated with asthma morbidity remains unknown. OBJECTIVE We examined associations between bisphenols and morbidity due to pediatric asthma. METHODS We quantified concentrations of BPA, BPS, and BPF in 660 urine samples from 148 predominantly low-income, African American children (aged 5-17 years) with established asthma. We used biobanked biospecimens and data on symptoms, health care utilization, and pulmonary function and inflammation that were collected every 3 months over the course of a year. We used generalized estimating equations to examine associations between concentrations or detection of urinary bisphenols and morbidity outcomes and assessed heterogeneity of associations by sex. RESULTS We observed consistent positive associations between BPA exposure and measures of asthma morbidity. For example, we observed increased odds of general symptom days (adjusted odds ratio [aOR] = 1.40 [95% C = 1.02-1.92]), maximal symptom days (aOR = 1.36 [95% CI = 1.00-1.83]), and emergency department visits (aOR = 2.12 [95% CI =1.28-3.51]) per 10-fold increase in BPA concentration. We also observed evidence of sexually dimorphic effects; BPA concentrations were associated with increased odds of symptom days and health care utilization only among boys. Findings regarding BPS and BPF did not consistently point to associations with asthma symptoms or health care utilization. CONCLUSION We found evidence to suggest that BPA exposure in a predominantly low-income, minority pediatric cohort is associated with asthma morbidity and that associations may differ by sex. Our findings support additional studies, given the high pediatric asthma burden and widespread exposure to BPA in the United States.
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Affiliation(s)
- Lesliam Quirós-Alcalá
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md; Maryland Institute of Applied Environmental Health, School of Public Health, University of Maryland, College Park, Md.
| | - Nadia N Hansel
- School of Medicine, Johns Hopkins University, Baltimore, Md
| | | | - Antonia M Calafat
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, Ga
| | - Xiaoyun Ye
- National Center for Environmental Health, US Centers for Disease Control and Prevention, Atlanta, Ga
| | - Roger D Peng
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md
| | - Elizabeth C Matsui
- School of Medicine, Johns Hopkins University, Baltimore, Md; Dell Medical School, University of Texas, Austin, Tex
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Akenroye A, McCormack M, Keet C. Severe asthma in the US population and eligibility for mAb therapy. J Allergy Clin Immunol 2020; 145:1295-1297.e6. [PMID: 31866437 PMCID: PMC10405858 DOI: 10.1016/j.jaci.2019.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/30/2019] [Accepted: 12/04/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Ayobami Akenroye
- Department of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Meredith McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Corinne Keet
- Department of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
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McCormack A, Matsui E, McCormack M, Peng R, Davis M. Eosinophils modify the relationship between Staphylococcus aureus colonization and respiratory outcomes in the US population. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sakornsakolpat P, McCormack M, Bakke P, Gulsvik A, Make BJ, Crapo JD, Cho MH, Silverman EK. Genome-Wide Association Analysis of Single-Breath Dl CO. Am J Respir Cell Mol Biol 2019; 60:523-531. [PMID: 30694715 DOI: 10.1165/rcmb.2018-0384oc] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
DlCO is a widely used pulmonary function test in clinical practice and a particularly useful measure for assessing patients with chronic obstructive pulmonary disease (COPD). We hypothesized that elucidating genetic determinants of DlCO could lead to better understanding of the genetic architecture of COPD. We estimated the heritability of DlCO using common genetic variants and performed genome-wide association analyses in four cohorts enriched for subjects with COPD (COPDGene [Genetic Epidemiology of COPD], NETT [National Emphysema Treatment Trial], GenKOLS [Genetics of Chronic Obstructive Lung Disease study], and TESRA [Treatment of Emphysema With a Gamma-Selective Retinoid Agonist study]) using a combined European ancestry white dataset and a COPDGene African American dataset. We assessed our genome-wide significant and suggestive associations for DlCO in previously reported genome-wide association studies of COPD and related traits. We also characterized associations of known COPD-associated variants and DlCO. We estimated the SNP-based heritability of DlCO in the European ancestry white population to be 22% (P = 0.0004). We identified three genome-wide significant associations with DlCO: variants near TGFB2, CHRNA3, and PDE11A loci (P < 5 × 10-8). In addition, 12 loci were suggestively associated with DlCO in European ancestry white (P < 1 × 10-5 in the combined analysis and P < 0.05 in both COPDGene and GenKOLS), including variants near NEGR1, CADM2, PCDH7, RETREG1, DACT2, NRG1, ANKRD18A, KRT86, NTN4, ARHGAP28, INSR, and PCBP3. Some DlCO-associated variants were also associated with COPD, emphysema, and/or spirometric values. Among 25 previously reported COPD loci, TGFB2, CHRNA3/CHRNA5, FAM13A, DSP, and CYP2A6 were associated with DlCO (P < 0.001). We identified several genetic loci that were significantly associated with DlCO and characterized effects of known COPD-associated loci on DlCO. These results could lead to better understanding of the heterogeneous nature of COPD.
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Affiliation(s)
- Phuwanat Sakornsakolpat
- 1 Channing Division of Network Medicine and.,2 Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Meredith McCormack
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, and.,4 Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Per Bakke
- 5 Department of Clinical Science, University of Bergen, Bergen, Norway; and
| | - Amund Gulsvik
- 5 Department of Clinical Science, University of Bergen, Bergen, Norway; and
| | - Barry J Make
- 6 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - James D Crapo
- 6 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Michael H Cho
- 1 Channing Division of Network Medicine and.,7 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edwin K Silverman
- 1 Channing Division of Network Medicine and.,7 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Redondo A, Colombo N, Dreosti L, McCormack M, Rodrigues AN, Scambia G, Roszak A, Donica M, Ulker B, Martín AG. Primary results from CECILIA, a global single-arm phase II study evaluating bevacizumab (BEV), carboplatin (C) and paclitaxel (P) for advanced cervical cancer (aCC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz250.061] [Citation(s) in RCA: 3] [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: 11/13/2022] Open
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Brigham EP, Woo H, McCormack M, Rice J, Koehler K, Vulcain T, Wu T, Koch A, Sharma S, Kolahdooz F, Bose S, Hanson C, Romero K, Diette G, Hansel NN. Omega-3 and Omega-6 Intake Modifies Asthma Severity and Response to Indoor Air Pollution in Children. Am J Respir Crit Care Med 2019; 199:1478-1486. [PMID: 30922077 PMCID: PMC6580674 DOI: 10.1164/rccm.201808-1474oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/30/2019] [Indexed: 01/07/2023] Open
Abstract
Rationale: Higher indoor particulate matter (PM) concentrations are linked with increased asthma morbidity. Dietary intake of fatty acids, also linked with asthma outcomes, may influence this relationship. Objectives: To determine the relationship between omega-3 and omega-6 fatty acid intake and pediatric asthma morbidity, and the association between fatty acid intake and strength of indoor, PM-related asthma symptoms, albuterol use, and systemic inflammation. Methods: Analyses included 135 children with asthma enrolled in the AsthmaDIET Study. At baseline, 3 months, and 6 months, data included: week-long average home indoor concentration of PM ≤2.5 μm in aerodynamic diameter and PM ≤10 μm in aerodynamic diameter, dietary intake of omega-3 and omega-6 fatty acids, daily symptoms, and peripheral blood leukocytes. Asthma severity and lung function were assessed at baseline. Multivariable regression models, adjusted for known confounders, were used to determine associations between each fatty acid and outcomes of interest, with interaction terms (fatty acids × PM) in longitudinal analyses. Measurements and Main Results: Higher omega-6 intake associated with increased odds of increased asthma severity (P = 0.02), and lower FEV1/FVC ratio (P = 0.01). Higher omega-3 intake associated with reduced effect of indoor PM ≤2.5 μm in aerodynamic diameter on symptoms (P < 0.01), whereas higher omega-6 intake associated with amplified effect of indoor PM ≤2.5 μm in aerodynamic diameter on symptoms and circulating neutrophil percentage (P < 0.01). Conclusions: Omega-3 and omega-6 intake are associated with pediatric asthma morbidity and may modify the asthmatic response to indoor PM.
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Affiliation(s)
- Emily P. Brigham
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Han Woo
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meredith McCormack
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica Rice
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kirsten Koehler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Tianshi Wu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abigail Koch
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Sonali Bose
- Icahn School of Medicine at Mount Sinai, New York, New York; and
| | | | - Karina Romero
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory Diette
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nadia N. Hansel
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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34
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Schweitzer A, Barron B, Barron N, McCormack M, Brigham E. Developing Mediterranean and Western Diets for an Anti-Inflammatory Feeding Trial (P12-017-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz035.p12-017-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Design a research diet that can be used to evaluate the relationship between nutrition and inflammation in a randomized, cross-over study in adults.
Methods
Dietary components were established for a Mediterranean menu and a Western menu based on a literature review. Three-day menu cycles were planned using the established components. Recipes were developed and adapted to meet menu goals at the 2000 calorie level. Proportional increments of menu items at the 2000 kcal level were used to establish 2500, 3000, and 3500 daily kcal levels to allow for varying energy requirements of participants. Meal plans were analyzed using Nutrition Data System for Research 2017 (NDSR). Healthy Eating Index was calculated using NDSR data.
Results
100% of grains in the Mediterranean diet, none in the Western diet, were whole grains. Sweets and pastries were included in the Western diet daily but not the Intervention diet. Mean HEI score for the three-day menu cycle was 91.1 and 37.2 for the Mediterranean and Western diet, respectively. Preliminary results from three participants fed both diets for 6 days: All three participants consumed within 5% of the planned diet with the exception of one participant, who, during the Mediterranean diet cycle, consumed 64%. Mean HEI calculated for actual participant intake (n = 3, 6 days each) was: 89.7 Mediterranean, 36.4 Western
Conclusions
The Mediterranean diet had a 10-fold higher ratio of omega-6: omega-3 fat than Western. A three-day menu cycle was planned and met goals for an anti-inflammatory feeding study. Recruitment is ongoing to study the feasibility of providing a Mediterranean style and Western style diet to adults with asthma in Baltimore City. Mean HEI for the first three recruits was similar to that of the planned menu, indicating that lack of strict diet adherence did not alter HEI goal of the diet. Although diet design was successful, there were challenges to feeding study participants that must be considered in future feeding studies. Adequate freezer space is key in food preparation and delivery. Acceptability of foods in the Mediterranean diet may effect diet compliance in those who typically eat a Western diet. Dietary restrictions and allergies excluded potential study subjects.
Funding Sources
This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR001079 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH.
Supporting Tables, Images and/or Graphs
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Majd E, McCormack M, Davis M, Curriero F, Berman J, Connolly F, Leaf P, Rule A, Green T, Clemons-Erby D, Gummerson C, Koehler K. Indoor air quality in inner-city schools and its associations with building characteristics and environmental factors. Environ Res 2019; 170:83-91. [PMID: 30576993 PMCID: PMC6360122 DOI: 10.1016/j.envres.2018.12.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/01/2018] [Accepted: 12/06/2018] [Indexed: 06/01/2023]
Abstract
Indoor concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and carbon monoxide (CO) were measured across 16 urban public schools in three different seasons. Exceedance of the WHO guidelines for indoor air was observed, mainly for the hourly average NO2 concentrations. Seasonal variability was statistically significant for indoor NO2 and CO concentrations, with higher exposures in fall and winter. An extensive list of potential factors at the outdoor environment, school, and room level that may explain the variability in indoor exposure was examined. Factors with significant contributions to indoor exposure were mostly related to the outdoor pollution sources. This is evidenced by the strong associations between indoor concentration of CO and NO2 and factors including outdoor PM2.5 and NO2 concentrations, including length of the nearby roads and the number of nearby industrial facilities. Additionally, we found that poor conditions of the buildings (a prevalent phenomenon in the studied urban area), including physical defects and lack of proper ventilation, contributed to poor air quality in schools. The results suggest that improving building conditions and facilities as well as a consideration of the school surroundings may improve indoor air quality in schools.
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Affiliation(s)
- Ehsan Majd
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA
| | - Meredith McCormack
- Johns Hopkins School of Medicine, Pulmonary and Critical Care Medicine, 1830 East Monument Street, Baltimore, MD 21205, USA
| | - Meghan Davis
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA
| | - Frank Curriero
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA
| | - Jesse Berman
- University of Minnesota, School of Public Health, 420 Delaware St SE, Mayo Mail Code #807, Minneapolis, MN 55455, USA
| | - Faith Connolly
- Johns Hopkins University Baltimore Education Research Consortium, 2701N. Charles Street, Suite 300, Baltimore, MD 21218, USA
| | - Philip Leaf
- Johns Hopkins Bloomberg School of Public Health, Center for Adolescent Health, 624N. Broadway, Hampton House 819, Baltimore, MD 21205, USA
| | - Ana Rule
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA
| | - Timothy Green
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA
| | - Dorothy Clemons-Erby
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA
| | - Christine Gummerson
- Johns Hopkins School of Medicine, Pulmonary and Critical Care Medicine, 1830 East Monument Street, Baltimore, MD 21205, USA
| | - Kirsten Koehler
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA.
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36
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Coles CE, Griffin CL, Kirby AM, Haviland JS, Titley JC, Benstead K, Brunt AM, Chan C, Ciurlionis L, Din OS, Donovan EM, Eaton DJ, Harnett AN, Hopwood P, Jefford ML, Jenkins PJ, Lee CE, McCormack M, Sherwin L, Syndikus I, Tsang Y, Twyman NI, Ventikaraman R, Wickers S, Wilcox MH, Bliss JM, Yarnold JR. Abstract GS4-05: Dose escalated simultaneous integrated boost radiotherapy for women treated by breast conservation surgery for early breast cancer: 3-year adverse effects in the IMPORT HIGH trial (CRUK/06/003). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs4-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
IMPORT HIGH is a randomised, multi-centre phase III trial testing dose escalated simultaneous integrated boost (SIB) against sequential boost each delivered by intensity modulated radiotherapy (IMRT) for early stage breast cancer with higher risk of local relapse. The primary endpoint was initially breast induration at 3 years, requiring 840 patients; accrual was extended (target 2568) with the new primary endpoint of local relapse. We report adverse effects (AE) at 3 years.
Methods
Women age ≥18 after breast conservation surgery for pT1-3 pN0-pN3a M0 invasive carcinoma were eligible. Randomisation was 1:1:1 between 40Gy/15F to whole breast (WB) + 16Gy/8F sequential photon boost to tumour bed (40+16Gy), 36Gy/15F to WB, 40Gy to partial breast + 48Gy (48Gy) or + 53Gy (53Gy) in 15F SIB to tumour bed. AEs were assessed annually by clinicians in all patients and in a planned sub-set (840) of patients by photographs at 3 years and by patients at 6 months, 1 and 3 years. AE scores were dichotomised as none/mild vs marked for photographs and none/mild vs moderate/marked for patients and clinicians. Fisher's exact tests compared groups; principal comparison (protocol-specified) between 53Gy and 48Gy (p<0.01 defined as statistical significance).
Results
2617 women consented between 03/2009 and 09/2015 from 39 UK radiotherapy centres. Median follow-up was 49.1 (IQR 36.8-63.2) months. Median age was 49 (IQR 44-56); 9%, 38% & 53% were tumour grade 1, 2 & 3 respectively; 30% were node positive. 66% received chemotherapy and 73% endocrine therapy. 3-year AE data were available for 2017 clinician assessments, 641 photographs and 842 patient assessments. Proportions of patients with marked AEs were low overall. Rates of moderate/marked AEs at 3 years were broadly similar between the randomised groups; with a suggestion of a slightly increased risk for breast induration in 53Gy compared with control (borderline significance).
AE at 3 years 40+16Gy n(%)48Gy n(%)53Gy n(%)ClinicianBreast induration;N656668654None451 (69)483 (72)445 (68)Mild167 (25)141 (21)146 (22)Moderate32 (5)42 (6)56 (9)Marked6 (1)2 (1)7 (1)P-value 0.57010.0102 0.0443Breast shrinkage;N655669654None442 (68)472 (71)448 (69)Mild167 (26)161 (24)166 (25)Moderate40 (6)33 (5)35 (5)Marked6 (1)3 (1)5 (1)P-value 0.25410.5772 0.6373Breast distortion;N656669654None451 (69)464 (69)442 (68)Mild169 (26)170 (25)170 (26)Moderate33 (5)32 (5)38 (6)Marked3 (1)3 (1)4 (1)P-value 0.90310.4862 0.4113PatientChange in breast appearance;N287264285None38 (13)50 (19)58 (20)Mild164 (57)151 (57)142 (50)Moderate57 (20)45 (17)54 (19)Marked28 (10)18 (7)31 (11)P-value 0.14910.9992 0.1243PhotographChange in breast appearance;N218210213None183 (84)185 (88)177 (83)Mild25 (11)23 (11)32 (15)Marked10 (5)2 (1)4 (2)P-value 0.03610.1732 0.6853148Gy v 40+16Gy; 253Gy v 40+16Gy; 353Gy v 48Gy
Conclusions
These results represent the largest and most mature reported AE outcomes of breast SIB within a clinical trial. At 3 years, rates of moderate/marked AEs were similar between SIB IMRT and WB + sequential boost IMRT delivered over 3 and 4.5 weeks respectively.
Citation Format: Coles CE, Griffin CL, Kirby AM, Haviland JS, Titley JC, Benstead K, Brunt AM, Chan C, Ciurlionis L, Din OS, Donovan EM, Eaton DJ, Harnett AN, Hopwood P, Jefford ML, Jenkins PJ, Lee CE, McCormack M, Sherwin L, Syndikus I, Tsang Y, Twyman NI, Ventikaraman R, Wickers S, Wilcox MH, Bliss JM, Yarnold JR. Dose escalated simultaneous integrated boost radiotherapy for women treated by breast conservation surgery for early breast cancer: 3-year adverse effects in the IMPORT HIGH trial (CRUK/06/003) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS4-05.
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Affiliation(s)
- CE Coles
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - CL Griffin
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - AM Kirby
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - JS Haviland
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - JC Titley
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - K Benstead
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - AM Brunt
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - C Chan
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - L Ciurlionis
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - OS Din
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - EM Donovan
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - DJ Eaton
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - AN Harnett
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - P Hopwood
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - ML Jefford
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - PJ Jenkins
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - CE Lee
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - M McCormack
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - L Sherwin
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - I Syndikus
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - Y Tsang
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - NI Twyman
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - R Ventikaraman
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - S Wickers
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - MH Wilcox
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - JM Bliss
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
| | - JR Yarnold
- Oncology Centre, University of Cambridge, Cambridge, United Kingdom; The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom; University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom; Nuffield Health Cheltenham Hospital, Cheltenham, United Kingdom; Aukland City Hospital, Aukland, New Zealand; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; The University of Surrey, Guildford, United Kingdom; RTTQA Mount Vernon Hospital, Northwood, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; University College London Hospitals NHS Foundation Trust, London, United Kingdom; Ipswich Hospital NHS Trust, Ipswich, United Kingdom; The Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United K
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Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N. Corrections to “Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up”. Ann Oncol 2018; 29:iv262. [DOI: 10.1093/annonc/mdy160] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Keet CA, McCormack M. Cardiac Asthma: An Old Term That May Have New Meaning? J Allergy Clin Immunol Pract 2018; 4:924-5. [PMID: 27587322 DOI: 10.1016/j.jaip.2016.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Corinne A Keet
- Division of Pediatric Allergy and Immunology, Johns Hopkins School of Medicine, Baltimore, Md.
| | - Meredith McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Md
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Chuang L, Berek J, Randall T, McCormack M, Schmeler K, Manchanda R, Rebbeck T, Jeng C, Pyle D, Quinn M, Trimble E, Naik R, Lai C, Ochiai K, Denny L, Bhatla N. Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities. Gynecol Oncol Rep 2018; 25:65-69. [PMID: 29928684 PMCID: PMC6008286 DOI: 10.1016/j.gore.2018.05.005] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 11/28/2022] Open
Abstract
Eighty-five percent of the incidents and deaths from cervical cancer occur in low and middle income countries. In many of these countries, this is the most common cancer in women. The survivals of the women with gynecologic cancers are hampered by the paucity of prevention, screening, treatment facilities and gynecologic oncology providers. Increasing efforts dedicated to improving education and research in these countries have been provided by international organizations. We describe here the existing educational and research programs that are offered by major international organizations, the barriers and opportunities provided by these collaborations and hope to improve the outcomes of cervical cancer through these efforts.
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Affiliation(s)
- L. Chuang
- Western Connecticut Health Network, Larner College of Medicine at the University of Vermont, Danbury, CT, USA
| | - J. Berek
- Stanford University School of Medicine, Stanford, CA, USA
| | - T. Randall
- The Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - K. Schmeler
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R. Manchanda
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - T. Rebbeck
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - C.J. Jeng
- Kaohsiung Medical University Hospital, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - D. Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - M. Quinn
- University of Melbourne, Melbourne, VIC, Australia
| | - E. Trimble
- Center for Global Health, National Cancer Institute, Bethesda, MS, USA
| | - R. Naik
- Northern Gynecological Oncology Centre, Gateshead, UK
| | - C.H. Lai
- Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - K. Ochiai
- Jikei University School of Medicine, Tokyo, Japan
| | - L. Denny
- University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa
| | - N. Bhatla
- All India Institute of Medical Sciences, New Delhi, India
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McCormack M. Radiation Therapy in Ovarian Cancer: An Overview and Future Directions. Clin Oncol (R Coll Radiol) 2018; 30:504-506. [PMID: 29981691 DOI: 10.1016/j.clon.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
Clear cell cancer of the ovary is a rare and aggressive subtype. There is a general paucity of data from randomised trials to inform the most appropriate approach to adjuvant therapy. Retrospective data has highlighted an improvement in disease free survival with the addition of whole abdominal radiotherapy. This approach merits further exploration in a randomised clinical trial.
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Affiliation(s)
- M McCormack
- Department of Oncology, University College London Hospital, London, UK.
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Culver BH, Graham BL, MacIntyre NR, McCormack M, Kaminsky DA, Coates AL, Weiner DJ, Rosenfeld M, Wanger J. Reply to Johnson: Improve Pulmonary Function Test Reporting. Am J Respir Crit Care Med 2018. [DOI: 10.1164/rccm.201802-0280le] [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: 11/16/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Jack Wanger
- Pulmonary Function Testing and Clinical Trials Consultant
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Galiatsatos P, Kineza C, Hwang S, Pietri J, Brigham E, Putcha N, Rand CS, McCormack M, Hansel NN. Neighbourhood characteristics and health outcomes: evaluating the association between socioeconomic status, tobacco store density and health outcomes in Baltimore City. Tob Control 2018; 27:e19-e24. [PMID: 29170167 PMCID: PMC5966324 DOI: 10.1136/tobaccocontrol-2017-053945] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Several studies suggest that the health of an individual is influenced by the socioeconomic status (SES) of the community in which he or she lives. This analysis seeks to understand the relationship between SES, tobacco store density and health outcomes at the neighbourhood level in a large urban community. METHODS Data from the 55 neighbourhoods of Baltimore City were reviewed and parametric tests compared demographics and health outcomes for low-income and high-income neighbourhoods, defined by the 50th percentile in median household income. Summary statistics are expressed as median. Tobacco store density was evaluated as both an outcome and a predictor. Association between tobacco store densities and health outcomes was determined using Moran's I and spatial regression analyses to account for autocorrelation. RESULTS Compared with higher-income neighbourhoods, lower-income neighbourhoods had higher tobacco store densities (30.5 vs 16.5 stores per 10 000 persons, P=0.01), lower life expectancy (68.5 vs 74.9 years, P<0.001) and higher age-adjusted mortality (130.8 vs 102.1 deaths per 10 000 persons, P<0.001), even when controlling for other store densities, median household income, race, education status and age of residents. CONCLUSION In Baltimore City, median household income is inversely associated with tobacco store density, indicating poorer neighbourhoods in Baltimore City have greater accessibility to tobacco. Additionally, tobacco store density was linked to lower life expectancy, which underscores the necessity for interventions to reduce tobacco store densities.
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Affiliation(s)
- Panagis Galiatsatos
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Medicine for the Greater Good, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Cynthia Kineza
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Seungyoun Hwang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Juliana Pietri
- Medicine for the Greater Good, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Emily Brigham
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Cynthia S Rand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meredith McCormack
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Rice JL, Brigham E, Dineen R, Muqueeth S, O'Keefe G, Regenold S, Koehler K, Rule A, McCormack M, Hansel NN, Diette GB. The feasibility of an air purifier and secondhand smoke education intervention in homes of inner city pregnant women and infants living with a smoker. Environ Res 2018; 160:524-530. [PMID: 29089103 PMCID: PMC5929467 DOI: 10.1016/j.envres.2017.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/19/2017] [Accepted: 10/12/2017] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Secondhand smoke (SHS) and other air pollutants adversely affect the health of pregnant women and infants. A feasibility study aimed at reducing air pollution in homes of pregnant women or infants living with a smoker was completed. METHODS In collaboration with the Baltimore City Health Department, women ≥ 18 years of age and either pregnant nonsmokers, or post-partum (any smoking status) with an infant age 0-12 months were recruited. Homes had at least one smoker. Intervention included two air purifiers and secondhand smoke education. Outcomes included feasibility, change in fine particulate matter (PM2.5), air nicotine, and salivary cotinine pre- and post-intervention. RESULTS Fifty women were enrolled (mean age 27 years, 92% African American, 71% single, 94% Medicaid eligible, 34% reported smoking) and 86% completed the study. Of the 50 women, 32 had infants and 18 were pregnant at time of enrollment. Post- intervention, 70% of participants reported smokers were less likely to smoke indoors, and 77% had at least one air purifier turned on at the final visit. Participant satisfaction was high (91%) and 98% would recommend air purifiers. Indoor PM2.5 was significantly decreased (P < 0.001). Salivary cotinine was significantly decreased for non-smoking women (P < 0.01) but not infants, and no significant change in air nicotine occurred (P = 0.6). CONCLUSIONS Air purifiers with SHS education is a feasible intervention in homes of women and infants. These data demonstrate reduction in indoor PM2.5 and salivary cotinine in non-smoking adults. Air purifiers are not an alternative for smoking cessation and a home/ car smoking ban. Smoking cessation should be strongly encouraged for all pregnant women, and nonsmoking mothers with infants should be counseled to completely avoid SHS exposure. This study provides support for a future intervention evaluating clinical endpoints.
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Affiliation(s)
- Jessica L Rice
- Johns Hopkins University School of Medicine, Division of Pediatric Pulmonology, Baltimore, MD, USA
| | - Emily Brigham
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Rebecca Dineen
- Baltimore City Department of Health, Bureau of Maternal and Child Health, Baltimore, MD, USA
| | - Sadiya Muqueeth
- Baltimore City Department of Health, Bureau of Maternal and Child Health, Baltimore, MD, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gena O'Keefe
- Baltimore City Department of Health, Bureau of Maternal and Child Health, Baltimore, MD, USA; The Annie E. Casey Foundation, Baltimore, MD, USA
| | - Stephanie Regenold
- Baltimore City Department of Health, Bureau of Maternal and Child Health, Baltimore, MD, USA; Loyola University, Student Health and Education Services, Baltimore, MD, USA
| | - Kirsten Koehler
- Johns Hopkins Bloomberg School of Public Health, Environmental Health and Engineering, Baltimore, MD, USA
| | - Ana Rule
- Johns Hopkins Bloomberg School of Public Health, Environmental Health and Engineering, Baltimore, MD, USA
| | - Meredith McCormack
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA
| | - Nadia N Hansel
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Environmental Health and Engineering, Baltimore, MD, USA
| | - Gregory B Diette
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Environmental Health and Engineering, Baltimore, MD, USA.
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Marth C, Landoni F, Mahner S, McCormack M, Gonzalez-Martin A, Colombo N. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2017; 28:iv72-iv83. [PMID: 28881916 DOI: 10.1093/annonc/mdx220] [Citation(s) in RCA: 411] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Affiliation(s)
- C Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - F Landoni
- Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
| | - S Mahner
- Department of Gynecology and Obstetrics, University of Munich, Munich, Germany
| | - M McCormack
- Department of Oncology, University College Hospital, London, UK
| | - A Gonzalez-Martin
- Medical Oncology Department, MD Anderson Cancer Center, Madrid, Spain
| | - N Colombo
- Department of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
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Tuszynski MH, Weidner N, McCormack M, Miller I, Powell H, Conner J. Grafts of Genetically Modified Schwann Cells to the Spinal Cord: Survival, Axon Growth, and Myelination. Cell Transplant 2017; 7:187-96. [PMID: 9588600 DOI: 10.1177/096368979800700213] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Schwann cells naturally support axonal regeneration after injury in the peripheral nervous system, and have also shown a significant, albeit limited, ability to support axonal growth and remyelination after grafting to the central nervous system (CNS). It is possible that Schwann cell-induced axonal growth in the CNS could be substantially increased by genetic manipulation to secrete augmented amounts of neurotrophic factors. To test this hypothesis, cultured primary adult rat Schwann cells were genetically modified using retroviral vectors to produce and secrete high levels of human nerve growth factor (NGF). These cells were then grafted to the midthoracic spinal cords of adult rats. Findings were compared to animals that received grafts of nontransduced Schwann cells. Spinal cord lesions were not placed prior to grafting because the primary aim of this study was to examine features of grafted Schwann cell survival, growth, and effects on host axons. In vitro prior to grafting, Schwann cells secreted 1.5 + 0.1 ng human NGF/ml/106 cells/day. Schwann cell transplants readily survived for 2 wk to 1 yr after in vivo placement. Some NGF-transduced grafts slowly increased in size over time compared to nontransduced grafts; the latter remained stable in size. NGF-transduced transplants were densely penetrated by primary sensory nociceptive axons originating from the dorsolateral fasciculus of the spinal cord, whereas control grafts showed significantly fewer penetrating sensory axons. Over time, Schwann cell grafts also became penetrated by TH- and DBH-labeled axons of putative coerulospinal origin, unlike control cell grafts. Ultrastructurally, axons in both graft types were extensively myelinated by Schwann cells. Grafted animals showed no changes in gross locomotor function. In vivo expression of the human NGF transgene was demonstrated for periods of at least 6 m. These findings demonstrate that primary adult Schwann cells 1) can be transduced to secrete augmented levels of neurotrophic factors, 2) survive grafting to the CNS for prolonged time periods, 3) elicit robust growth of host neurotrophin-responsive axons, 4) myelinate CNS axons, and 5) express the transgene for prolonged time periods in vivo. Some grafts slowly enlarge over time, a feature that may be attributable to the propensity of Schwann cells to immortalize after multiple passages. Transduced Schwann cells merit further study as tools for promoting CNS regeneration.
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Affiliation(s)
- M H Tuszynski
- Department of Neurosciences, University of California-San Diego, La Jolla 92093-0608, USA
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Baran P, Pacile S, Nesterets YI, Mayo SC, Dullin C, Dreossi D, Arfelli F, Thompson D, Lockie D, McCormack M, Taba ST, Brun F, Pinamonti M, Nickson C, Hall C, Dimmock M, Zanconati F, Cholewa M, Quiney H, Brennan PC, Tromba G, Gureyev TE. Optimization of propagation-based x-ray phase-contrast tomography for breast cancer imaging. Phys Med Biol 2017; 62:2315-2332. [DOI: 10.1088/1361-6560/aa5d3d] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Perna C, Eminowicz G, Asghar U, Imseeh G, Kirkwood A, Mitra A, Arora R, Kristeleit R, McCormack M. Uterine carcinosarcoma: a retrospective clinical cohort analysis. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw374.45] [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
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Eminowicz G, Motlib J, Khan S, Perna C, McCormack M. Pelvic Organ Motion during Radiotherapy for Cervical Cancer: Understanding Patterns and Recommended Patient Preparation. Clin Oncol (R Coll Radiol) 2016; 28:e85-91. [DOI: 10.1016/j.clon.2016.04.044] [Citation(s) in RCA: 17] [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] [Received: 01/27/2016] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
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Rasmussen SG, Ogburn EL, McCormack M, Casey JA, Bandeen-Roche K, Mercer DG, Schwartz BS. Association Between Unconventional Natural Gas Development in the Marcellus Shale and Asthma Exacerbations. JAMA Intern Med 2016; 176:1334-43. [PMID: 27428612 PMCID: PMC5424822 DOI: 10.1001/jamainternmed.2016.2436] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Asthma is common and can be exacerbated by air pollution and stress. Unconventional natural gas development (UNGD) has community and environmental impacts. In Pennsylvania, UNGD began in 2005, and by 2012, 6253 wells had been drilled. There are no prior studies of UNGD and objective respiratory outcomes. OBJECTIVE To evaluate associations between UNGD and asthma exacerbations. DESIGN A nested case-control study comparing patients with asthma with and without exacerbations from 2005 through 2012 treated at the Geisinger Clinic, which provides primary care services to over 400 000 patients in Pennsylvania. Patients with asthma aged 5 to 90 years (n = 35 508) were identified in electronic health records; those with exacerbations were frequency matched on age, sex, and year of event to those without. EXPOSURES On the day before each patient's index date (cases, date of event or medication order; controls, contact date), we estimated activity metrics for 4 UNGD phases (pad preparation, drilling, stimulation [hydraulic fracturing, or "fracking"], and production) using distance from the patient's home to the well, well characteristics, and the dates and durations of phases. MAIN OUTCOMES AND MEASURES We identified and defined asthma exacerbations as mild (new oral corticosteroid medication order), moderate (emergency department encounter), or severe (hospitalization). RESULTS We identified 20 749 mild, 1870 moderate, and 4782 severe asthma exacerbations, and frequency matched these to 18 693, 9350, and 14 104 control index dates, respectively. In 3-level adjusted models, there was an association between the highest group of the activity metric for each UNGD phase compared with the lowest group for 11 of 12 UNGD-outcome pairs: odds ratios (ORs) ranged from 1.5 (95% CI, 1.2-1.7) for the association of the pad metric with severe exacerbations to 4.4 (95% CI, 3.8-5.2) for the association of the production metric with mild exacerbations. Six of the 12 UNGD-outcome associations had increasing ORs across quartiles. Our findings were robust to increasing levels of covariate control and in sensitivity analyses that included evaluation of some possible sources of unmeasured confounding. CONCLUSIONS AND RELEVANCE Residential UNGD activity metrics were statistically associated with increased risk of mild, moderate, and severe asthma exacerbations. Whether these associations are causal awaits further investigation, including more detailed exposure assessment.
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Affiliation(s)
- Sara G. Rasmussen
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth L. Ogburn
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meredith McCormack
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Joan A. Casey
- Robert Wood Johnson Foundation Health and Society Scholars Program, UC San Francisco and UC Berkeley, California, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dione G. Mercer
- Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
| | - Brian S. Schwartz
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Center for Health Research, Geisinger Health System, Danville, Pennsylvania, USA
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Eminowicz G, Motlib J, Khan S, Perna C, McCormack M. PO-0725: Pelvic organ motion during radiotherapy for cervical cancer and impact on target coverage. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31975-2] [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: 11/29/2022]
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