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Adam S, Althoff A, Dampier W, Devlin K, Malone K, Nonnemacher M, Pirrone V, Schultheis M, Szep Z, Tillman S, Wigdahl B. B - 85 Medication Adherence in People Living with HIV: Analyzing Performance-Based Medication Management in Relation to Cognition and Real-World Adherence. Arch Clin Neuropsychol 2023; 38:1452. [PMID: 37807471 DOI: 10.1093/arclin/acad067.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE This study investigates relationships among neuropsychological functioning, medication management performance, and viral load in people living with HIV. We hypothesize that cognitive impairment, particularly in attention/working memory, executive function, and episodic memory, will negatively influence medication management and virologic control. METHODS Participants in this cross-sectional study were 29 HIV+ adults (ages 44-71, 90% Black) receiving cART and enrolled in the Temple/Drexel Comprehensive NeuroHIV Center (CNHC) cohort. Participants completed neuropsychological assessments, Medication Management Test-Revised (MMT-R), and blood sample collection. Linear regression examined cognitive domains as predictors of MMT-R performance. Logistic and linear regression examined cognition and MMT-R as predictors of viral load. RESULTS 64% of participants had undetectable HIV RNA. The remainder had low-level viral replication. 89% were prescribed one-pill-a-day regimens. Verbal memory was positively associated with MMT-R (b = 0.60, p = 0.023). Neither cognition nor MMT-R were significant predictors of detectable vs. undetectable RNA. Among participants with detectable viral load, higher RNA was associated significantly with poorer visuospatial memory (b = 0.69, p = 0.028) and marginally with poorer performance on the MMT-R daily regimen subscale (b = 0.56, p = 0.094). CONCLUSION Verbal memory was related to better MMT-R performance, but neither cognition nor MMT-R were good predictors of detectable vs. undetectable viral load. However, among those with low-level viral replication, poorer visuospatial memory and difficulty with simple MMT-R items were preliminarily related to higher viral load. Given the small sample, results are limited by low statistical power. Future research will further explore relationships among cognition, MMT-R, RNA, and regimen complexity in larger samples to inform development of tools to monitor adherence difficulties.
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Fleischer M, Coskun B, Stolte B, Della-Marina A, Kölbel H, Lax H, Nonnemacher M, Kleinschnitz C, Schara-Schmidt U, Hagenacker T. [Essen transition model for neuromuscular diseases]. Nervenarzt 2023; 94:129-135. [PMID: 35254466 PMCID: PMC9898325 DOI: 10.1007/s00115-022-01274-6] [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] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Advances in healthcare systems with new therapeutic options improve the life expectancy of patients with neuromuscular diseases. With this, a shift in the phenotype of the diseases from the neuromuscular system towards other organs is more frequently observed, requiring closer interdisciplinary cooperation in caring for these young adults. Therefore, the transition to the adult caring system is nowadays a multilayered transfer with the need for complex care of these patients. OBJECTIVE How can the transitional process be efficiently structured to combine the therapeutic effort of each specialist discipline involved and improve the healthcare process and quality of life in young adults with neuromuscular diseases? MATERIAL AND METHOD The Departments of Neuropediatrics and Neurology of the University Medicine Essen established the Essen transition model for a structured transitional process. A concept of care was developed for the late onset Pompe's disease, Duchenne muscular dystrophy and juvenile myasthenia gravis representatively for neuromuscular diseases. It consists of four components: 1) In a standardized operational procedure (SOP), general processes, clinical diagnostic steps and guidance of treatment between the two departments are harmonized and specified. 2) The young adults and their relatives are seen in a joint consultation of both disciplines allowing a comprehensive handover for healthcare professionals. 3) In a quarterly meeting, transition conference representatives from the different specialized disciplines from pediatric and adult medicine get together for a case-related interdisciplinary exchange. 4) An interdepartmental transitional database was created to integrate all diagnostic results and parameters as a common information platform and data basis. CONCLUSION The Essen transition model aims to close a gap in the transition of patients with neuromuscular diseases and improve healthcare in these patients with their complex needs.
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Affiliation(s)
- Michael Fleischer
- grid.477805.90000 0004 7470 9004Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147 Essen, Deutschland
| | - Bayram Coskun
- grid.477805.90000 0004 7470 9004Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147 Essen, Deutschland
| | - Benjamin Stolte
- grid.477805.90000 0004 7470 9004Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147 Essen, Deutschland
| | - Adela Della-Marina
- grid.477805.90000 0004 7470 9004Klinik für Kinderheilkunde 1, Abteilung für Neuropädiatrie, Universitätsmedizin Essen, Hufelandstraße 55, 45147 Essen, Deutschland
| | - Heike Kölbel
- grid.477805.90000 0004 7470 9004Klinik für Kinderheilkunde 1, Abteilung für Neuropädiatrie, Universitätsmedizin Essen, Hufelandstraße 55, 45147 Essen, Deutschland
| | - Hildegard Lax
- grid.491891.cInstitut für Medizinische Informatik, Biometrie und Epidemiologie, Hufelandstraße 55, 45122 Essen, Deutschland
| | - Michael Nonnemacher
- grid.491891.cInstitut für Medizinische Informatik, Biometrie und Epidemiologie, Hufelandstraße 55, 45122 Essen, Deutschland
| | - Christoph Kleinschnitz
- grid.477805.90000 0004 7470 9004Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147 Essen, Deutschland
| | - Ulrike Schara-Schmidt
- grid.477805.90000 0004 7470 9004Klinik für Kinderheilkunde 1, Abteilung für Neuropädiatrie, Universitätsmedizin Essen, Hufelandstraße 55, 45147 Essen, Deutschland
| | - Tim Hagenacker
- grid.477805.90000 0004 7470 9004Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Hufelandstraße 55, 45147 Essen, Deutschland
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Berman R, Dampier W, Atkins A, Allen A, Pirrone V, Passic S, Ahmed A, Szep Z, Nonnemacher M, Wigdahl B. PP 6.5 – 00205 Utilization of high-throughput assays and deep-learning for selection of CRISPR/Cas9-gRNA pairs used in an HIV-1 cure strategy. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Fleischer M, Coskun B, Stolte B, Della-Marina A, Kölbel H, Lax H, Nonnemacher M, Kleinschnitz C, Schara-Schmidt U, Hagenacker T. Essen transition model for neuromuscular diseases. Neurol Res Pract 2022; 4:41. [PMID: 36058951 PMCID: PMC9442978 DOI: 10.1186/s42466-022-00206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
With the optimization of medical care structures and the rapid progress in the development of new therapeutic methods, an increase in life expectancy is observed in patients with neuromuscular diseases. This leads to an expansion of the phenotypic spectrum, whereby new or previously less relevant disease manifestations in different organ systems gain more importance. The care of adolescents and young adults with neuromuscular diseases, therefore, requires increasingly close interdisciplinary collaboration within neuromuscular centers.
Research question
How can the transition process from pediatric to adult care be structured so that the individual disciplines are efficiently integrated into the complex treatment and care process, and the patients' quality of life is improved?
Material and methods
A structured transition process was established at the University Hospital in Essen, Germany. Exemplarily, a comparable care concept was developed based on Pompe disease, Duchenne muscular dystrophy, and juvenile myasthenia gravis comprising four elements: (1) With the introduction of cross-department standard operating procedures, the logistical processes, as well as the diagnostic and therapeutic measures, are uniformly coordinated, and the transition process is bindingly defined. (2) To ensure a seamless transition, young patients are seen with their parents during joint consultations before they reach their 17th birthday. This creates an opportunity for patients to get to know the subsequent department structure and build a lasting relationship of trust. (3) A quarterly “transition board” regularly brings together the participating disciplines from pediatric and adult care systems for a case-related interdisciplinary exchange and continuous optimization of the transition process. (4) A cross-department “Transition Database”, in which medical findings and parameters are recorded, was implemented as a common information platform and database.
Conclusion
The Essen Transition Model aims to close the gap in care for young patients with neuromuscular diseases during the critical transition from pediatric to adult medicine and to create a successful continuation of treatment in adulthood.
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Stang A, Schuldt K, Trocchi P, Neusser S, Speckemeier C, Pahmeier K, Wasem J, Lax H, Nonnemacher M. The impossibility of mortality evaluation of skin cancer screening in Germany based on health insurance data: a case-control study. Eur J Cancer 2022; 173:52-58. [PMID: 35863106 DOI: 10.1016/j.ejca.2022.06.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/30/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this paper was to perform a mortality evaluation of skin cancer screening (SCS) in Germany using General Local Health Insurance Fund (AOK) data. METHODS AOK-insured men and women aged 35-99 years who died of cutaneous malignant melanoma in 2015-2016 were identified. Controls were AOK-insured people who survived to the end of each case's year of death. For each case, 10 controls were matched. The SCS history of each individual was reconstructed using the billing codes 01745 and 01746. RESULTS In total, 1037 melanoma deaths and 10,370 controls were included. Cumulative SCS prevalence increased among controls over calendar years, as expected (males and females, 2009: 13.5% and 12.5%; 2015: 52.1% and 55.1%). In contrast, among cases, cumulative SCS prevalence was already high in 2009 and did not show a monotonic increase over the years of diagnosis. Of the 1037 melanoma deaths, 224 (21.6%) had at least one SCS settled in the 12 months after diagnosis. DISCUSSION A mortality evaluation with health insurance data alone is not possible because SCS billing codes are not only used for real SCS but also for occasion-related diagnostic work-up of abnormal skin findings. A mortality evaluation with health insurance data requires an individual linking with data of the screening physician and the cancer registries.
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Affiliation(s)
- Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology; University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany; Landeskrebsregister Nordrhein-Westfalen GGmbH, Gesundheitscampus 10, 44801 Bochum, Germany; Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA 02118, USA.
| | - Katrin Schuldt
- Institute of Medical Informatics, Biometry and Epidemiology; University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Pietro Trocchi
- Institute of Medical Informatics, Biometry and Epidemiology; University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Silke Neusser
- Alfried Krupp von Bohlen und Halbach Stiftungslehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Christian Speckemeier
- Alfried Krupp von Bohlen und Halbach Stiftungslehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Kathrin Pahmeier
- Alfried Krupp von Bohlen und Halbach Stiftungslehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Jürgen Wasem
- Alfried Krupp von Bohlen und Halbach Stiftungslehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany
| | - Hildegard Lax
- Institute of Medical Informatics, Biometry and Epidemiology; University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Michael Nonnemacher
- Institute of Medical Informatics, Biometry and Epidemiology; University Hospital of Essen, Hufelandstr. 55, 45147 Essen, Germany
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Speckemeier C, Pahmeier K, Trocchi P, Schuldt K, Lax H, Nonnemacher M, Dröge P, Stang A, Wasem J, Neusser S. One-year follow-up healthcare costs of patients diagnosed with skin cancer in Germany: a claims data analysis. BMC Health Serv Res 2022; 22:771. [PMID: 35690746 PMCID: PMC9188701 DOI: 10.1186/s12913-022-08141-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Routine skin cancer screening (SCS) is covered by the German statutory health insurance (SHI) since 2008. The objective of this study was to compare direct healthcare costs between patients in whom skin cancer was detected by routine SCS and patients in whom skin cancer was not detected by routine SCS. METHODS A retrospective observational study of administrative claims data from a large German SHI was performed. Patients with a diagnosis of malignant melanoma (MM) or non-melanoma skin cancer (NMSC) diagnosed in 2014 or 2015 were included. Costs were obtained for one year before and one year after diagnosis and analyzed in a difference-in-differences approach using regression models. Frequency matching was applied and risk adjustment was performed. Additional analyses were conducted, separately for specific age groups, excluding persons who died during the observation period and without taking costs for screening into consideration. RESULTS A total of 131,801 patients were included, of whom 13,633 (10.3%) had a diagnosis of MM and 118,168 (89.7%) had a diagnosis of NMSC. The description of total costs (without risk adjustment) shows lower mean total costs among patients whose skin cancer was detected via routine SCS compared to patients in whom skin cancer was not detected by routine SCS (MM: €5,326 (95% confidence interval (CI) €5,073; €5,579) vs. €9,038 (95% CI €8,629; €9,448); NMSC: €4,660 (95% CI €4,573; €4,745) vs. €5,890 (95% CI €5,813; €5,967)). Results of the regression analysis show cost savings of 18.8% (95% CI -23.1; -8.4) through routine SCS for patients with a diagnosis of MM. These cost savings in MM patients were more pronounced in patients younger than 65 years of age. For patients with a diagnosis of NMSC, the analysis yields a non-substantial increase in costs (2.5% (95% CI -0.1; 5.2)). CONCLUSION Cost savings were detected for persons with an MM diagnosed by routine SCS. However, the study could not detect lower costs due to routine SCS in the large fraction of persons with a diagnosis of NMSC. These results offer important insights into the cost structure of the routine SCS and provide opportunities for refinements.
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Affiliation(s)
- Christian Speckemeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany.
| | - Kathrin Pahmeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Pietro Trocchi
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Katrin Schuldt
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Hildegard Lax
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Michael Nonnemacher
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Patrik Dröge
- AOK Research Institute (WIdO), Rosenthaler Str. 31, 10178, Berlin, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127, Essen, Germany
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Stolte B, Nonnemacher M, Kizina K, Bolz S, Totzeck A, Thimm A, Wagner B, Deuschl C, Kleinschnitz C, Hagenacker T. Nusinersen treatment in adult patients with spinal muscular atrophy: a safety analysis of laboratory parameters. J Neurol 2021; 268:4667-4679. [PMID: 33899154 PMCID: PMC8563549 DOI: 10.1007/s00415-021-10569-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
Background Nusinersen is an intrathecally administered antisense oligonucleotide (ASO) that improves motor function in patients with spinal muscular atrophy (SMA). In addition to efficacy, the safety of a therapy is the decisive factor for the success of the treatment. For some ASOs, various organ toxicities have been described, such as thrombocytopenia, renal and liver impairment, or coagulation abnormalities. However, systematic data on laboratory parameters under treatment with nusinersen are mainly available from studies in infants and children. Therefore, our aim was to assess the safety of nusinersen therapy in adult SMA patients. Methods Laboratory data from 404 nusinersen injections performed in 50 adult patients with SMA type 2 and type 3 were retrospectively analyzed. Results The total observation period was 76.9 patient-years, and patients received up to 12 injections. Our data provides no new safety concerns. In cerebrospinal fluid (CSF), the mean white blood cell count and lactate remained stable over time. Total CSF protein increased by 2.9 mg/dL. No change in mean platelet count was observed under therapy. Only one patient showed sporadic mild thrombocytopenia. Coagulation parameters and inflammatory markers were stable. The mean creatinine level decreased by 0.09 mg/dL. Analysis of mean liver enzyme levels revealed no relevant changes during treatment. Conclusion Our data demonstrate a favorable safety profile of nusinersen therapy in adult SMA patients under longer-term “real-world” conditions. In particular, we found no evidence of clinically relevant platelet declines, coagulopathies, or renal or hepatic organ toxicities, which are common concerns with the use of ASOs. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10569-8.
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Affiliation(s)
- Benjamin Stolte
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
| | - Michael Nonnemacher
- Institute for Medical Informatics, Biometrics and Epidemiology, University Hospital Essen, Essen, Germany
| | - Kathrin Kizina
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
| | - Saskia Bolz
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
| | - Andreas Totzeck
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
| | - Andreas Thimm
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
| | - Bernd Wagner
- Department of Clinical Chemistry, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.,Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.,Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany. .,Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany.
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Schweim JK, Nonnemacher M, Jöckel KH. Heterogeneity of national legislation and practice on clinical trials with vulnerable patients based on the EU Clinical Trials Directive by the example of adults permanently incapable of giving informed consent. Ger Med Sci 2021; 19:Doc03. [PMID: 33796001 PMCID: PMC7983012 DOI: 10.3205/000290] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/05/2021] [Indexed: 12/03/2022]
Abstract
In principle, persons wishing to participate in a clinical trial must give informed consent in advance after comprehensive information has been provided. Under certain conditions, it is possible to deviate from this requirement in the European Union (EU) in order to enable the participation of so-called vulnerable persons who are incapable of giving their informed consent. Kuthning et al. [1] have already dealt with general and specific aspects of vulnerable patients and the principle of informed consent in clinical trials. One group of vulnerable persons, for example, are adults temporarily or permanently incapable of giving consent due to their state of health. For a long period of time, no systematic and uniform legal basis for clinical trials existed in the EU as a whole. The Clinical Trials Directive (CTD) [2], adopted in 2001, aimed to change this by harmonizing all legal regulations on clinical trials applicable in the EU, but nevertheless allowing national deviations in implementation into national laws through opening clauses and aspects that were left unregulated. In view of the Clinical Trials Regulation (CTR) [3] which, according to the current status, will with high probability be applied from 2022 on, and which in future will be the legal basis for clinical trials with medicinal products in humans, applied directly in all EU member states, the necessity to take stock of the effects of the CTD was evident. The national deviations with regard to the participation of patients incapable of giving informed consent were investigated qualitatively and quantitatively by means of a systematic analysis of legislation in 16 EU countries and a retrospective database analysis of a European clinical trial registry over a ten-year observation period. Although the analysis initially showed a predominantly homogeneous picture, the differences between the EU member states became apparent in a detailed examination. The database analysis yielded a clear result, since in some countries the majority of clinical trials are carried out. The clearest difference was found between the legal analysis and the results of the evaluated clinical trials concerning adults who are permanently incapable of giving informed consent. A presumed association between the “degree of liberality” of the national law and the frequency of clinical trials conducted in the respective country could not be confirmed. In the past, the selection of countries for conducting a clinical trial was based less on legal requirements and more on experience and financial considerations.
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Affiliation(s)
- Janna K Schweim
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University Medicine Essen, Germany
| | - Michael Nonnemacher
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University Medicine Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University Medicine Essen, Germany
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Kowall B, Nonnemacher M, Brune B, Brinkmann M, Dudda M, Böttcher J, Schmidt B, Standl F, Stolpe S, Dittmer U, Jöckel KH, Stang A. A model to identify individuals with a high probability of a SARS-CoV-2 infection. J Infect 2020; 82:e32-e34. [PMID: 33245942 PMCID: PMC7686708 DOI: 10.1016/j.jinf.2020.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 01/22/2023]
Affiliation(s)
- B Kowall
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.
| | - M Nonnemacher
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - B Brune
- Medical Emergency Service of the City of Essen, Germany; Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Essen, Germany
| | - M Brinkmann
- Center for Clinical Trials, University Hospital Essen, Germany
| | - M Dudda
- Medical Emergency Service of the City of Essen, Germany; Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Essen, Germany
| | - J Böttcher
- Public Health Office of the City of Essen, Germany
| | - B Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - F Standl
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - S Stolpe
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - U Dittmer
- Institute for Virology, University Hospital Essen, Germany
| | - K H Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - A Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, Boston, United States
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Bearoff F, Johnson M, Dhavale D, Nonnemacher M, Kotzbauer P, Kortagere S. Peripheral Inflammation Drives TLR2 and IL‐1R1 Mediated Neurodegeneration in Parkinson’s Disease. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.05585] [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: 11/11/2022]
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Wigdahl B, Allen A, Worell S, Nwaozo G, Madrid R, Dampier W, Nonnemacher M. Broad-spectrum gRNAs abolish HIV-1 LTR-mediated transcription in cells that receive CRISPR/Cas9 therapy. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30217-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Schmidt CO, Krabbe CEM, Schössow J, Berger K, Enzenbach C, Kamtsiuris P, Schöne G, Houben R, Meisinger C, Bamberg F, Hendel T, Selder S, Nonnemacher M, Moebus S, Stausberg J. [Quality standards for epidemiologic cohort studies : An evaluated catalogue of requirements for the conduct and preparation of cohort studies]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:65-77. [PMID: 29147857 DOI: 10.1007/s00103-017-2658-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/18/2022]
Abstract
BACKGROUND Cohort studies are a longitudinal observational study type. They are firmly established within epidemiology to assess the course of diseases and risk factors. Yet, standards to describe and evaluate quality characteristics of cohort studies need further development. OBJECTIVE Within the TMF ("Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V.") project "Quality management standards in cohort studies", a catalogue of requirements was compiled and evaluated, focusing on the preparation and conduct of epidemiologic cohort studies. MATERIALS AND METHODS The catalogue of requirements was established based on a consensus process between representatives of seven German epidemiologic cohort studies. For this purpose, a set of expert meetings (telephone, face-to-face, web-based) was conducted and the importance of each element of the catalogue was assessed as well as its implementation. RESULTS A catalogue of requirements with 138 requirements was consented. It is structured into ten sections: 1. Study documentation; 2. Selection of instruments; 3. Study implementation, 4. Organizational structure; 5. Qualification and certification; 6. Participant recruitment; 7. Preparation, conduct and follow-up processing of examinations; 8. Study logistics and maintenance, 9. Data capture and data management; 10. Reporting and monitoring. In total, 41 elements were categorized as being essential, 91 as important, and 6 as less important. CONCLUSION The catalogue of requirements provides a guideline to improve the preparation and operation of cohort studies. The evaluation of the importance and degree of implementation of requirements depended on the study design. With adaptations, the catalogue might be transferable to other study types.
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Affiliation(s)
- Carsten Oliver Schmidt
- Institut für Community Medicine - Abteilung SHIP-KEF, SHIP, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Deutschland.
| | - Christine E M Krabbe
- Institut für Community Medicine - Abteilung SHIP-KEF, SHIP, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Deutschland
| | - Janka Schössow
- Institut für Community Medicine - Abteilung SHIP-KEF, SHIP, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Deutschland
| | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin, BiDirect, Universität Münster, Münster, Deutschland
| | - Cornelia Enzenbach
- Institut für Medizinische Informatik, Statistik und Epidemiologie, LIFE-ADULT, Universität Leipzig, Leipzig, Deutschland
| | | | - Gina Schöne
- KiGGS und DEGS, Robert Koch-Institut, Berlin, Deutschland
| | - Robin Houben
- KiGGS und DEGS, Robert Koch-Institut, Berlin, Deutschland
| | - Christa Meisinger
- Institut für Epidemiologie II, KORA, Helmholtz Zentrum München, München, Deutschland
| | - Fabian Bamberg
- Universitätsklinikum Tübingen, NAKO - MRT, Klinikum der Universität München, München, Deutschland
| | - Thomas Hendel
- Klinik und Poliklinik für Radiologie - NAKO MRT, Universität München , München, Deutschland
| | - Sonja Selder
- Klinik und Poliklinik für Radiologie - NAKO MRT, Universität München , München, Deutschland
| | - Michael Nonnemacher
- Institut für Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Heinz-Nixdorf Recall Studie, Universitätsklinikum Essen, Essen, Deutschland
| | - Susanne Moebus
- Institut für Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Heinz-Nixdorf Recall Studie, Universitätsklinikum Essen, Essen, Deutschland
| | - Jürgen Stausberg
- Institut für Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Heinz-Nixdorf Recall Studie, Universitätsklinikum Essen, Essen, Deutschland
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Azar A, Devlin K, Mell J, Giovannetti T, Pirrone V, Nonnemacher M, Jacobson J, Wigdhal B, Dampier W, Lee E, Libon DJ, Sell C. Mitochondrial haplogroup influences motor function in long-term HIV-1 infected individuals. Exp Gerontol 2017. [DOI: 10.1016/j.exger.2017.02.027] [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: 11/28/2022]
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Weinmayr G, Hennig F, Fuks K, Nonnemacher M, Jakobs H, Möhlenkamp S, Erbel R, Jöckel KH, Hoffmann B, Moebus S. Erratum to: Long-term exposure to fine particulate matter and incidence of type 2 diabetes mellitus in a cohort study: effects of total and traffic-specific air pollution. Environ Health 2016; 15:45. [PMID: 27009678 PMCID: PMC4806469 DOI: 10.1186/s12940-016-0128-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Gudrun Weinmayr
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
- Medical School, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.
| | - Frauke Hennig
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Kateryna Fuks
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Michael Nonnemacher
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Hermann Jakobs
- Rhenish Institute for Environmental Research at the University of Cologne, Cologne, Germany
| | - Stefan Möhlenkamp
- Department of Cardiology, West German Heart Centre of Essen, University of Duisburg-Essen, Essen, Germany
| | - Raimund Erbel
- Department of Cardiology, West German Heart Centre of Essen, University of Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Barbara Hoffmann
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
- Medical School, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Viehmann A, Hertel S, Fuks K, Eisele L, Moebus S, Möhlenkamp S, Nonnemacher M, Jakobs H, Erbel R, Jöckel KH, Hoffmann B. Long-term residential exposure to urban air pollution, and repeated measures of systemic blood markers of inflammation and coagulation. Occup Environ Med 2015; 72:656-63. [PMID: 26163546 DOI: 10.1136/oemed-2014-102800] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [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: 12/31/2014] [Accepted: 06/22/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND In several studies, exposure to fine particulate matter (PM) has been associated with inflammation, with inconsistent results. We used repeated measurements to examine the association of long-term fine and ultrafine particle exposure with several blood markers of inflammation and coagulation. METHODS We used baseline (2000-2003) and follow-up (2006-2008) data from the Heinz Nixdorf Recall Study, a German population-based prospective cohort of 4814 participants. A chemistry transport model was applied to model daily surface concentrations of PM air pollutants (PM10, PM2.5) and particle number on a grid of 1 km(2). Applying mixed regression models, we analysed associations of long-term (mean of 365 days prior to blood draw) particle exposure at each participant's residence with the level of high-sensitivity C reactive protein (hs-CRP), fibrinogen, platelet and white cell count (WCC), adjusting for short-term PM exposure (moving averages of 1-7 days), personal characteristics, season, ambient temperature (1-5 days), ozone and time trend. RESULTS We analysed 6488 observations: 3275 participants with baseline data and 3213 with follow-up data. An increase of 2.4 µg/m(3) in long-term PM2.5 was associated with an adjusted increase of 5.4% (95% CI 0.6% to 10.5%) in hs-CRP and of 2.3% (95% CI 1.4% to 3.3%) in the platelet count. Fibrinogen and WCC were not associated with long-term particle exposure. CONCLUSIONS In this population-based cohort, we found associations of long-term exposure to PM with markers of inflammation (hs-CRP) and coagulation (platelets). This finding supports the hypothesis that inflammatory processes might contribute to chronic effects of air pollution on cardiovascular disease.
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Affiliation(s)
- Anja Viehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Sabine Hertel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Kateryna Fuks
- IUF-Leibniz Institute of Environmental Medicine Research and Medical Faculty, Deanery of Medicine, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Lewin Eisele
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | | | - Michael Nonnemacher
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Hermann Jakobs
- Rhenish Institute for Environmental Research at the University of Cologne, Cologne, Germany
| | - Raimund Erbel
- Department of Cardiology, West German Heart Centre of Essen, University Hospital of Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Barbara Hoffmann
- IUF-Leibniz Institute of Environmental Medicine Research and Medical Faculty, Deanery of Medicine, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
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Weinmayr G, Hennig F, Fuks K, Nonnemacher M, Jakobs H, Möhlenkamp S, Erbel R, Jöckel KH, Hoffmann B, Moebus S. Long-term exposure to fine particulate matter and incidence of type 2 diabetes mellitus in a cohort study: effects of total and traffic-specific air pollution. Environ Health 2015; 14:53. [PMID: 26087770 PMCID: PMC4479324 DOI: 10.1186/s12940-015-0031-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 05/14/2015] [Indexed: 05/17/2023]
Abstract
BACKGROUND Studies investigating the link between long-term exposure to air pollution and incidence of diabetes are still scarce and results are inconsistent, possibly due to different compositions of the particle mixture. We investigate the long-term effect of traffic-specific and total particulate matter (PM) and road proximity on cumulative incidence of diabetes mellitus (mainly type 2) in a large German cohort. METHODS We followed prospectively 3607 individuals without diabetes at baseline (2000-2003) from the Heinz Nixdorf Recall Study in Germany (mean follow-up time 5.1 years). Mean annual exposures to total as well as traffic-specific PM10 and PM2.5 at residence were estimated using a chemistry transport model (EURAD, 1 km(2) resolution). Effect estimates for an increase of 1 μg/m(3) in PM were obtained with Poisson regression adjusting for sex, age, body mass index, lifestyle factors, area-level and individual-level socio-economic status, and city. RESULTS 331 incident cases developed. Adjusted RRs for total PM10 and PM2.5 were 1.05 (95%-CI: 1.00;1.10) and 1.03 (95%-CI: 0.95;1.12), respectively. Markedly higher point estimates were found for local traffic-specific PM with RRs of 1.36 (95%-CI: 0.98;1.89) for PM10 and 1.36 (95%-CI: 0.97;1.89) for PM2.5. Individuals living closer than 100 m to a busy road had a more than 30% higher risk (1.37;95%-CI: 1.04;1.81) than those living further than 200 m away. CONCLUSIONS Long-term exposure to total PM increases type two diabetes risk in the general population, as does living close to a major road. Local traffic-specific PM was related to higher risks for type two diabetes than total PM.
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Affiliation(s)
- Gudrun Weinmayr
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
- Medical School, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.
| | - Frauke Hennig
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
| | - Kateryna Fuks
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
| | - Michael Nonnemacher
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
| | - Hermann Jakobs
- Rhenish Institute for Environmental Research at the University of Cologne, Cologne, Germany.
| | - Stefan Möhlenkamp
- Department of Cardiology, West German Heart Centre of Essen, University of Duisburg-Essen, Essen, Germany.
| | - Raimund Erbel
- Department of Cardiology, West German Heart Centre of Essen, University of Duisburg-Essen, Essen, Germany.
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
| | - Barbara Hoffmann
- IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
- Medical School, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
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Stausberg J, Nasseh D, Nonnemacher M. Measuring Data Quality: A Review of the Literature between 2005 and 2013. Stud Health Technol Inform 2015; 210:712-716. [PMID: 25991245] [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: 06/04/2023]
Abstract
A literature review was done within a revision of a guideline concerned with data quality management in registries and cohort studies. The review focused on quality indicators, feedback, and source data verification. Thirty-nine relevant articles were selected in a stepwise selection process. The majority of the papers dealt with indicators. The papers presented concepts or data analyses. The leading indicators were related to case or data completeness, correctness, and accuracy. In the future, data pools as well as research reports from quantitative studies should be obligatory supplemented by information about their data quality, ideally picking up some indicators presented in this review.
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Affiliation(s)
| | - Daniel Nasseh
- IBE, Ludwig-Maximilians-Universität München, Germany
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18
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Eeftens M, Beelen R, de Hoogh K, Bellander T, Cesaroni G, Cirach M, Declercq C, Dėdelė A, Dons E, de Nazelle A, Dimakopoulou K, Eriksen K, Falq G, Fischer P, Galassi C, Gražulevičienė R, Heinrich J, Hoffmann B, Jerrett M, Keidel D, Korek M, Lanki T, Lindley S, Madsen C, Mölter A, Nádor G, Nieuwenhuijsen M, Nonnemacher M, Pedeli X, Raaschou-Nielsen O, Patelarou E, Quass U, Ranzi A, Schindler C, Stempfelet M, Stephanou E, Sugiri D, Tsai MY, Yli-Tuomi T, Varró MJ, Vienneau D, Klot SV, Wolf K, Brunekreef B, Hoek G. Development of Land Use Regression models for PM(2.5), PM(2.5) absorbance, PM(10) and PM(coarse) in 20 European study areas; results of the ESCAPE project. Environ Sci Technol 2012; 46:11195-11205. [PMID: 22963366 DOI: 10.1016/j.atmosenv.2013.02.037] [Citation(s) in RCA: 537] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Land Use Regression (LUR) models have been used increasingly for modeling small-scale spatial variation in air pollution concentrations and estimating individual exposure for participants of cohort studies. Within the ESCAPE project, concentrations of PM(2.5), PM(2.5) absorbance, PM(10), and PM(coarse) were measured in 20 European study areas at 20 sites per area. GIS-derived predictor variables (e.g., traffic intensity, population, and land-use) were evaluated to model spatial variation of annual average concentrations for each study area. The median model explained variance (R(2)) was 71% for PM(2.5) (range across study areas 35-94%). Model R(2) was higher for PM(2.5) absorbance (median 89%, range 56-97%) and lower for PM(coarse) (median 68%, range 32- 81%). Models included between two and five predictor variables, with various traffic indicators as the most common predictors. Lower R(2) was related to small concentration variability or limited availability of predictor variables, especially traffic intensity. Cross validation R(2) results were on average 8-11% lower than model R(2). Careful selection of monitoring sites, examination of influential observations and skewed variable distributions were essential for developing stable LUR models. The final LUR models are used to estimate air pollution concentrations at the home addresses of participants in the health studies involved in ESCAPE.
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Affiliation(s)
- Marloes Eeftens
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands.
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19
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Eeftens M, Beelen R, de Hoogh K, Bellander T, Cesaroni G, Cirach M, Declercq C, Dėdelė A, Dons E, de Nazelle A, Dimakopoulou K, Eriksen K, Falq G, Fischer P, Galassi C, Gražulevičienė R, Heinrich J, Hoffmann B, Jerrett M, Keidel D, Korek M, Lanki T, Lindley S, Madsen C, Mölter A, Nádor G, Nieuwenhuijsen M, Nonnemacher M, Pedeli X, Raaschou-Nielsen O, Patelarou E, Quass U, Ranzi A, Schindler C, Stempfelet M, Stephanou E, Sugiri D, Tsai MY, Yli-Tuomi T, Varró MJ, Vienneau D, Klot SV, Wolf K, Brunekreef B, Hoek G. Development of Land Use Regression models for PM(2.5), PM(2.5) absorbance, PM(10) and PM(coarse) in 20 European study areas; results of the ESCAPE project. Environ Sci Technol 2012; 46:11195-205. [PMID: 22963366 DOI: 10.1021/es301948k] [Citation(s) in RCA: 714] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Land Use Regression (LUR) models have been used increasingly for modeling small-scale spatial variation in air pollution concentrations and estimating individual exposure for participants of cohort studies. Within the ESCAPE project, concentrations of PM(2.5), PM(2.5) absorbance, PM(10), and PM(coarse) were measured in 20 European study areas at 20 sites per area. GIS-derived predictor variables (e.g., traffic intensity, population, and land-use) were evaluated to model spatial variation of annual average concentrations for each study area. The median model explained variance (R(2)) was 71% for PM(2.5) (range across study areas 35-94%). Model R(2) was higher for PM(2.5) absorbance (median 89%, range 56-97%) and lower for PM(coarse) (median 68%, range 32- 81%). Models included between two and five predictor variables, with various traffic indicators as the most common predictors. Lower R(2) was related to small concentration variability or limited availability of predictor variables, especially traffic intensity. Cross validation R(2) results were on average 8-11% lower than model R(2). Careful selection of monitoring sites, examination of influential observations and skewed variable distributions were essential for developing stable LUR models. The final LUR models are used to estimate air pollution concentrations at the home addresses of participants in the health studies involved in ESCAPE.
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Affiliation(s)
- Marloes Eeftens
- Institute for Risk Assessment Sciences, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands.
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Stausberg J, Pritzkuleit R, Schmidt CO, Schrader T, Nonnemacher M. Indicators of data quality: revision of a guideline for networked medical research. Stud Health Technol Inform 2012; 180:711-715. [PMID: 22874284] [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: 06/01/2023]
Abstract
Data quality significantly impacts the reliability and validity of empirical medical research. Specific measures can be used to check the quality of data during operation of a research project like a register. Furthermore these indicators allow an assessment of data quality independently from the institution responsible for data recording. A previously developed set of 24 data quality indicators was compared with measures of three research projects, each representing a specific view on the topic. The structure of the set was confirmed, being able to capture most of the projects' measures under the headings plausibility, organization, and correctness. Solely two indicators about metadata could not be appropriately mapped. However, several measures not considered so far were added to reach a number of 51 quality indicators in a first draft of a revised set. Most of the new indicators refine existing ones; e. g. the indicator "allowed values for missings" refines the existing indicator "allowed values for qualitative data elements". Seven projects' measures contribute supplementary aspects of data quality. The draft of the revised set of quality indicators will now be reviewed within and beyond the group.
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Affiliation(s)
- Jürgen Stausberg
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Universität München, Germany.
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Fuks K, Moebus S, Hertel S, Viehmann A, Nonnemacher M, Dragano N, Möhlenkamp S, Jakobs H, Kessler C, Erbel R, Hoffmann B. Long-term urban particulate air pollution, traffic noise, and arterial blood pressure. Environ Health Perspect 2011; 119:1706-11. [PMID: 21827977 PMCID: PMC3261981 DOI: 10.1289/ehp.1103564] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 08/09/2011] [Indexed: 05/03/2023]
Abstract
BACKGROUND Recent studies have shown an association of short-term exposure to fine particulate matter (PM) with transient increases in blood pressure (BP), but it is unclear whether long-term exposure has an effect on arterial BP and hypertension. OBJECTIVES We investigated the cross-sectional association of residential long-term PM exposure with arterial BP and hypertension, taking short-term variations of PM and long-term road traffic noise exposure into account. METHODS We used baseline data (2000-2003) on 4,291 participants, 45-75 years of age, from the Heinz Nixdorf Recall Study, a population-based prospective cohort in Germany. Urban background exposure to PM with aerodynamic diameter ≤ 2.5 μm (PM(2.5)) and ≤ 10 μm (PM(10)) was assessed with a dispersion and chemistry transport model. We used generalized additive models, adjusting for short-term PM, meteorology, traffic proximity, and individual risk factors. RESULTS An interquartile increase in PM2.5 (2.4 μg/m(3)) was associated with estimated increases in mean systolic and diastolic BP of 1.4 mmHg [95% confidence interval (CI): 0.5, 2.3] and 0.9 mmHg (95% CI: 0.4, 1.4), respectively. The observed relationship was independent of long-term exposure to road traffic noise and robust to the inclusion of many potential confounders. Residential proximity to high traffic and traffic noise exposure showed a tendency toward higher BP and an elevated prevalence of hypertension. CONCLUSIONS We found an association of long-term exposure to PM with increased arterial BP in a population-based sample. This finding supports our hypothesis that long-term PM exposure may promote atherosclerosis, with air-pollution-induced increases in BP being one possible biological pathway.
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Affiliation(s)
- Kateryna Fuks
- Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.
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Moysidis T, Niebel W, Bartsch K, Maier I, Lehmann N, Nonnemacher M, Kroeger K. Prevention of pressure ulcer: interaction of body characteristics and different mattresses. Int Wound J 2011; 8:578-84. [PMID: 21999615 DOI: 10.1111/j.1742-481x.2011.00814.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
We analysed the effect of different body features on contact area, interface pressure and pressure distribution of three different mattresses. Thirty-eight volunteers (age ranged from 17 to 73 years, 23 females) were asked to lie on three different mattresses in a random order: I, standard hospital foam mattresses; II, higher specification foam mattresses (Viscorelax Sure® ); III, constant low pressure devices (CareMedx® , AirSystems). Measurements were performed in supine position and in a 90° left- and right-sided position, respectively, using a full-body mat (pressure mapping device Xsensor X2-Modell). Outcome variables were contact area (CA) in cm(2) , mean interface pressure (IP) in mmHg and pressure distribution (PD) estimated as rate of low pressures between 5 and 33 mmHg on each mattress in percent. Mean CA was lowest in the standard hospital foam mattresses and increased in the higher specification foam mattresses and was highest in the constant low pressure device (supine position: 491 ± 86 cm(2) , 615 ± 95 cm(2) , 685 ± 116 cm(2) ). Mean IP was highest in the standard hospital foam mattresses and lower but similar in the higher specification foam mattresses and the constant low pressure devices (supine position: 22·3 ± 1·5 mmHg, 17·6 ± 1·7 mmHg, 17·6 ± 2·2 mmHg). Models were estimated for CA, IP and PD including the independent variables height, weight and waist-to-hip-ratio (WHR). They show that body morphology seems to play a minor role for CA, IP and PD, but very thin and tall patients and very small and obese people might benefit from different mattresses. Our data show that CA increases with increasing specification of mattresses. Higher specification foam mattresses and constant low pressure devices show similar IP, but constant low pressure devices show a wider pressure distribution. Body morphology should be considered to optimise prevention for single patients.
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Affiliation(s)
- Theodoros Moysidis
- Department of Angiology, HELIOS Klinik Krefeld, Lutherplatz 40, Krefeld, Germany
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Bauer M, Moebus S, Möhlenkamp S, Dragano N, Nonnemacher M, Fuchsluger M, Kessler C, Jakobs H, Memmesheimer M, Erbel R, Jöckel KH, Hoffmann B. Urban particulate matter air pollution is associated with subclinical atherosclerosis: results from the HNR (Heinz Nixdorf Recall) study. J Am Coll Cardiol 2011; 56:1803-8. [PMID: 21087707 DOI: 10.1016/j.jacc.2010.04.065] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [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: 01/28/2010] [Revised: 04/07/2010] [Accepted: 04/12/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association of long-term residential exposure to fine particles with carotid intima-media thickness (CIMT). BACKGROUND Experimental and epidemiological evidence suggest that long-term exposure to air pollution might have a causal role in atherogenesis, but epidemiological findings are still inconsistent. We investigate whether urban particulate matter (PM) air pollution is associated with CIMT, a marker of subclinical atherosclerosis. METHODS We used baseline data (2000 to 2003) from the HNR (Heinz Nixdorf Recall) study, a population-based cohort of 4,814 participants, 45 to 75 years of age. We assessed residential long-term exposure to PM with a chemistry transport model and measured distance to high traffic. Multiple linear regression was used to estimate associations of air pollutants and traffic with CIMT, adjusting for each other, city of residence, age, sex, diabetes, and lifestyle variables. RESULTS Median CIMT of the 3,380 analyzed participants was 0.66 mm (interquartile range 0.16 mm). An interdecile range increase in PM(2.5) (4.2 μg/m(3)), PM(10) (6.7 μg/m(3)), and distance to high traffic (1,939 m) was associated with a 4.3% (95% confidence interval [CI]: 1.9% to 6.7%), 1.7% (95% CI: -0.7% to 4.1%), and 1.2% (95% CI: -0.2% to 2.6%) increase in CIMT, respectively. CONCLUSIONS Our study shows a clear association of long-term exposure to PM(2.5) with atherosclerosis. This finding strengthens the hypothesized role of PM(2.5) as a risk factor for atherogenesis.
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Affiliation(s)
- Marcus Bauer
- Department of Cardiology, West German Heart Center Essen, University Hospital, University of Duisburg-Essen, Essen, Germany
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Hertel S, Viehmann A, Moebus S, Mann K, Bröcker-Preuss M, Möhlenkamp S, Nonnemacher M, Erbel R, Jakobs H, Memmesheimer M, Jöckel KH, Hoffmann B. Erratum to: Influence of short-term exposure to ultrafine and fine particles on systemic inflammation. Eur J Epidemiol 2011. [DOI: 10.1007/s10654-011-9550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Viehmann A, Moebus S, Möhlenkamp S, Nonnemacher M, Dragano N, Jakobs H, Kessler C, Erbel R, Jöckel K, Hoffmann B. Does traffic noise explain the association of residential proximity to traffic with coronary artery calcification? Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Fuks K, Nonnemacher M, Moebus S, Jakobs H, Kessler C, Erbel R, Jöckel K, Hoffmann B. Do proximity to high traffic and traffic noise influence blood pressure and hypertension in the general population? Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nonnemacher M, Stausberg J, Bartoszek G, Lottko B, Neuhaeuser M, Maier I. Predicting pressure ulcer risk: a multifactorial approach to assess risk factors in a large university hospital population. J Clin Nurs 2009; 18:99-107. [DOI: 10.1111/j.1365-2702.2008.02425.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [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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Neuhäuser M, Lehmann N, Nonnemacher M, Stausberg J. An attempt at data verification in the EACTS Congenital Database: data before and after verification differ significantly☆. Eur J Cardiothorac Surg 2006; 30:691. [PMID: 16895754 DOI: 10.1016/j.ejcts.2006.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 12/23/2005] [Accepted: 06/27/2006] [Indexed: 11/19/2022] Open
Affiliation(s)
- Markus Neuhäuser
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany
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Grant C, Jain P, Nonnemacher M, Flaig KE, Irish B, Ahuja J, Alexaki A, Alefantis T, Wigdahl B. AP-1-directed human T cell leukemia virus type 1 viral gene expression during monocytic differentiation. J Leukoc Biol 2006; 80:640-50. [PMID: 16829632 DOI: 10.1189/jlb.1205723] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/24/2022] Open
Abstract
Human T cell leukemia virus type 1 (HTLV-1) has previously been shown to infect antigen-presenting cells and their precursors in vivo. However, the role these important cell populations play in the pathogenesis of HTLV-1-associated myelopathy/tropical spastic paraparesis or adult T cell leukemia remains unresolved. To better understand how HTLV-1 infection of these important cell populations may potentially impact disease progression, the regulation of HTLV-1 viral gene expression in established monocytic cell lines was examined. U-937 promonocytic cells transiently transfected with a HTLV-1 long-terminal repeat (LTR) luciferase construct were treated with phorbol 12-myristate 13-acetate (PMA) to induce cellular differentiation. PMA-induced cellular differentiation resulted in activation of basal and Tax-mediated transactivation of the HTLV-1 LTR. In addition, electrophoretic mobility shift analyses demonstrated that PMA-induced cellular differentiation induced DNA-binding activity of cellular transcription factors to Tax-responsive element 1 (TRE-1) repeat II. Supershift analyses revealed that factors belonging to the activator protein 1 (AP-1) family of basic region/leucine zipper proteins (Fra-1, Fra-2, JunB, and JunD) were induced to bind to TRE-1 repeat II during cellular differentiation. Inhibition of AP-1 DNA-binding activity by overexpression of a dominant-negative c-Fos mutant (A-Fos) in transient expression analyses resulted in severely decreased levels of HTLV-1 LTR activation in PMA-induced U-937 cells. These results have suggested that following infection of peripheral blood monocytes, HTLV-1 viral gene expression may become up-regulated by AP-1 during differentiation into macrophages or dendritic cells.
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Affiliation(s)
- Christian Grant
- Viral Immunology Section, Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Yao J, Grant C, Harhaj E, Nonnemacher M, Alefantis T, Martin J, Jain P, Wigdahl B. Regulation of human T-cell leukemia virus type 1 gene expression by Sp1 and Sp3 interaction with TRE-1 repeat III. DNA Cell Biol 2006; 25:262-76. [PMID: 16716116 DOI: 10.1089/dna.2006.25.262] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/13/2022] Open
Abstract
Transcription factors of the Sp family are known to play key roles in the regulation of both constitutive as well as cell type- and differentiation stage-specific gene expression. Binding sites for factors of the Sp family (Sp1 and Sp3) have previously been identified within the U3 region of the human T-cell leukemia virus type 1 (HTLV-1) long terminal repeat (LTR). Although previous studies have demonstrated that Sp1 and Sp3 can interact with the Tax-responsive element 1 (TRE-1) repeat III, the sequences required for Sp1/Sp3 binding have not been mapped in detail. Herein, we demonstrate that the GC-rich regions flanking the viral cAMP-responsive element (CRE) within TRE-1 repeat III exhibit substantial affinity for both Sp1 and Sp3. We demonstrate that purified Sp1 competes with purified CREB for binding to TRE-1 repeat III due to the physical proximity of the Sp1/Sp3 and ATF/CREB binding sites, while purified Sp1 forms a multiprotein complex with purified CREB in the presence of Tax as demonstrated by electrophoretic mobility shift (EMS) analyses. Sp1 and Sp3 binding to the U3 region of the HTLV-1 LTR in the presence of Tax in vivo was confirmed by chromatin immunoprecipitation using HTLV-1-infected T cells (SLB-1 and C8166). Overexpression of Sp1 was modestly enhanced, while overexpression of Sp3 inhibited basal and Tax-mediated transactivation of the HTLV-1 LTR in U-937 cells (which express relatively low levels of endogenous Sp1 and Sp3). Furthermore, the modest upregulation of LTR activation caused by overexpression of Sp1 could be blocked by site-directed mutagenesis of the GC-rich Sp1/Sp3 binding sites within TRE-1 repeat III. These results suggest that both Sp1 and Sp3 transcription factor binding to TRE-1 repeat III participate in regulation of HTLV-1 viral gene expression.
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Affiliation(s)
- Jing Yao
- Department of Microbiology and Immunology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Grant C, Nonnemacher M, Jain P, Pandya D, Irish B, Williams SC, Wigdahl B. CCAAT/enhancer-binding proteins modulate human T cell leukemia virus type 1 long terminal repeat activation. Virology 2006; 348:354-69. [PMID: 16458341 DOI: 10.1016/j.virol.2005.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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] [Received: 08/15/2005] [Revised: 09/06/2005] [Accepted: 12/09/2005] [Indexed: 10/25/2022]
Abstract
CCAAT/enhancer-binding protein (C/EBP) basic region/leucine zipper (bZIP) transcription factors have been shown to form heterodimers with cAMP-responsive element binding protein 2 (CREB-2), a transcription factor involved in regulating basal and Tax-mediated transactivation of the human T cell leukemia virus type 1 (HTLV-1) long terminal repeat (LTR). In cells of the monocyte-macrophage lineage (proposed to play a role in HTLV-1 pathogenesis as an accessory target cell), several members of the C/EBP family are expressed at high levels and may have functional impact on both basal and Tax-mediated transactivation of the HTLV-1 LTR. Basal activation of the HTLV-1 LTR was enhanced by overexpression of C/EBPbeta, C/EBPdelta, or C/EBPepsilon, whereas transactivation of the LTR by Tax was inhibited by overexpression of C/EBPalpha and C/EBPbeta. Inhibition of Tax-mediated transactivation of the HTLV-1 LTR was co-activator-independent, did not require C/EBP binding to the Tax-responsive elements, and may involve heterodimerization with CREB factors.
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Affiliation(s)
- Christian Grant
- Department of Microbiology and Immunology, The Pennsylvania State University, College of Medicine, Hershey, 17033, USA
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Stausberg J, Nonnemacher M, Weiland D, Antony G, Neuhäuser M. Management of data quality--development of a computer-mediated guideline. Stud Health Technol Inform 2006; 124:477-82. [PMID: 17108564] [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: 05/12/2023]
Abstract
Appropriate data quality is a crucial issue in the use of electronically available health data. As source data verification (SDV) and feedback are two standard procedures for measuring and improving data quality it would be worthwhile to adapt these procedures to a current level of quality in order to reduce costs in data management. This project aims to develop a guideline for the management of data quality with special emphasis on this adaptation against the backdrop of research networks in Germany, which operate registers and conduct epidemiological studies. The first step in guideline development was a thorough literature review. The literature offers many measurements as candidates for quality indicators, however, systematic assessments and concepts of SDV and feedback are missing. We assigned possible quality indicators to the levels plausibility, organization, and trueness. Each indicator must be operationally defined to allow automatical calculation. The SDV sample size calculation leads to lower numbers for sites providing data of good quality and larger numbers for sites with poor data quality. The guideline's implementation in a software tool combines two cycles, one for the adaptation of recommendations to a given study/register, the other for the improvement of data quality in a PDCA-like approach. The recommendations will address needs common to medical documentation in daily health care, clinical, epidemiological, and observational studies as well as in surveillance data bases and registers. Further work will have to supplement other aspects of data management.
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Affiliation(s)
- Jürgen Stausberg
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Duisburg-Essen, Germany.
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Alexaki A, Nonnemacher M, Wigdahl B. Development of a Human Bone Marrow Progenitor Cell Line to Examine HIV-1 Susceptibility and LTR Activity. Retrovirology 2005. [DOI: 10.1186/1742-4690-2-s1-p8] [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: 11/10/2022] Open
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34
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Asante A, Nonnemacher M, Alexaki A, Papazoglou E, Lelkes P, Wigdahl B. Development of a Quantum Dot-based Assay System for Detection of Specific HIV-1 LTR Sequence Variants. Retrovirology 2005. [DOI: 10.1186/1742-4690-2-s1-p9] [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: 11/10/2022] Open
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35
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Liu Y, Nonnemacher M, Alexaki A, Wigdahl B. Characterization of C/EBP Binding Sites Downstream of the Transcriptional Start Site in the HIV-1 LTR. Retrovirology 2005. [DOI: 10.1186/1742-4690-2-s1-s155] [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: 11/10/2022] Open
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36
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Banjeree A, Nonnemacher M, Irish B, Wigdahl B. HIV-1 LTR Activity is Altered by Recruitment of Sp Transcription Factors During Monocytic Differentiation. Retrovirology 2005. [DOI: 10.1186/1742-4690-2-s1-s157] [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: 11/10/2022] Open
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37
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Li L, Liu Y, Nonnemacher M, Wigdahl B. Identification of C/EBP Binding Sites Within the Clade C LTR. Retrovirology 2005. [DOI: 10.1186/1742-4690-2-s1-p56] [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: 11/10/2022] Open
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38
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Springhetti E, Liu Y, Nonnemacher M, Wigdahl B. Sequence-Specific Vpr Binding to HIV-1 LTR C/EBP Binding Sites and Adjacent Regions. Retrovirology 2005. [DOI: 10.1186/1742-4690-2-s1-s156] [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: 11/10/2022] Open
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39
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Burdo TH, Nonnemacher M, Irish BP, Choi CH, Krebs FC, Gartner S, Wigdahl B. High-affinity interaction between HIV-1 Vpr and specific sequences that span the C/EBP and adjacent NF-kappaB sites within the HIV-1 LTR correlate with HIV-1-associated dementia. DNA Cell Biol 2004; 23:261-9. [PMID: 15142383 DOI: 10.1089/104454904773819842] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [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: 11/12/2022] Open
Abstract
Numerous host and viral factors likely participate in the onset and progression of HIV-1-associated dementia (HIVD). Previous studies have suggested that viral gene expression in resident central nervous system (CNS) cells of monocyte/macrophage lineage play a central role in the production of neurotoxic viral proteins and infectious virus, deregulation of cellular gene expression, and/or dysfunction of glial and neuronal cell populations. HIV-1 replication is regulated, in part, by interactions between cellular transcription factors and the viral trans-activators, Tat and viral protein R (Vpr), with cis-acting promoter elements within the LTR. We have previously demonstrated that Vpr binds with high affinity to selected sequence configurations within CCAAT/enhancer binding protein (C/EBP) site I and downstream sequences immediately adjacent to this site. Studies reported herein establish a correlation between the diagnosis of HIVD and the increased prevalence of HIV-1 LTRs containing a C/EBP binding site I that exhibits high affinity for Vpr. To this end, the interaction of Vpr with C/EBP site I variants in 47 LTRs from three nondemented patients and 96 LTRs from seven demented patients was examined. Competition electrophoretic mobility shift (EMS) analyses were utilized to examine Vpr binding to oligonucleotide probes containing C/EBP site I variants. We demonstrated that 89% of LTRs derived from patients exhibiting clinical dementia contained C/EBP site I configurations that displayed a high relative affinity for Vpr, while only 11% of LTRs contained C/EBP site I configurations that exhibited a low relative affinity Vpr binding phenotype. In contrast, examination of LTRs derived from patients lacking clinically evident dementia revealed that only 53% of brain-derived LTRs contained C/EBP site I configurations that displayed a high relative affinity for Vpr, while 47% of LTRs contained C/EBP site I configurations that exhibited a low relative affinity Vpr binding phenotype. We propose that sequence-specific interactions between cis-acting elements in the LTR, members of the C/EBP family of transcription factors, and the virion-associated trans-activator protein Vpr play important roles in the pathogenesis of HIVD.
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Affiliation(s)
- Tricia H Burdo
- Department of Microbiology and Immunology, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
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