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Loke J, McCarthy N, Jackson A, Siddique S, Hodgkinson A, Mason J, Crawley C, Gilleece M, Peniket A, Protheroe R, Salim R, Tholouli E, Wilson K, Andrew G, Dillon R, Khan N, Potter V, Krishnamurthy P, Craddock C, Freeman S. Posttransplant MRD and T-cell chimerism status predict outcomes in patients who received allografts for AML/MDS. Blood Adv 2023; 7:3666-3676. [PMID: 37058448 PMCID: PMC10365943 DOI: 10.1182/bloodadvances.2022009493] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/06/2022] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
Allogeneic stem-cell transplant allows for the delivery of curative graft-versus-leukemia (GVL) in patients with acute myeloid leukemia/myelodysplasia (AML/MDS). Surveillance of T-cell chimerism, measurable residual disease (MRD) and blast HLA-DR expression may inform whether GVL effectiveness is reduced. We report here the prognostic impact of these biomarkers in patients allografted for AML/MDS. One hundred eighty-seven patients from FIGARO, a randomized trial of reduced-intensity conditioning regimens in AML/MDS, were alive and relapse-free at the first MRD time-point and provided monitoring samples for flow cytometric MRD and T-cell chimerism, requested to month+12. Twenty-nine (15.5%) patients had at least 1 MRD-positive result posttransplant. MRD-positivity was associated with reduced overall survival (OS) (hazard ratio [HR], 2.18; P = .0028) as a time-varying Cox variable and remained significant irrespective of pretransplant MRD status in multivariate analyses (P < .001). Ninety-four patients had sequential MRD with T-cell chimerism results at months+3/+6. Patients with full donor T-cell chimerism (FDTC) had an improved OS as compared with patients with mixed donor T-cell chimerism (MDTC) (adjusted HR=0.4; P = .0019). In patients with MDTC (month+3 or +6), MRD-positivity was associated with a decreased 2-year OS (34.3%) vs MRD-negativity (71.4%) (P = .001). In contrast, in the group with FDTC, MRD was infrequent and did not affect the outcome. Among patients with posttransplant MRD-positivity, decreased HLA-DR expression on blasts significantly reduced OS, supporting this as a mechanism for GVL escape. In conclusion, posttransplant MRD is an important predictor of the outcome in patients allografted for AML/MDS and is most informative when combined with T-cell chimerism results, underlining the importance of a GVL effect in AML/MDS.
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Affiliation(s)
- Justin Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Nicholas McCarthy
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Shamyla Siddique
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Andrea Hodgkinson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - John Mason
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Rachel Protheroe
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - Rahuman Salim
- Royal Liverpool University Hospital, Liverpool, United Kingdom
| | | | | | - Georgia Andrew
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King’s College, London, United Kingdom
| | - Naeem Khan
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | | | | | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sylvie Freeman
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
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2
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McCarthy N, Daly J, Wall O, Wills T, Buckley C. 45 INTERPROFESSIONAL EDUCATION AND COLLABORATIVE PRACTICE IN FRAIL OLDER PERSONS’ CARE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Frail older adults present with complex care needs. Inter-Professional Education (IPE) is a means of creating a practice-ready workforce to improve patient safety and healthcare outcomes. A Steering Group was established comprised of acute and community clinicians, members of the Health Service Executive, service user, students and members of all Schools in the College of Medicine and Health in an Irish University (Medicine, Nursing and Midwifery, Pharmacy, Public Health, Clinical Therapies and Dentistry) to evaluate the effectiveness of IPE. A workshop dedicated to the management of frail older adults occurred for multidisciplinary healthcare students as part of a suite of three IPE workshops.
Methods
The validated ‘Interprofessional Collaborative Competencies Attainment Survey’ (ICCAS) evaluated student views of IPE pre- & post-workshop. This workshop involved a case-based study and facilitated discussion with involvement of frail older adult service users. One service user was in a rehabilitation unit post hospital admission, the other was living well at home. Their participation occurred using an online platform, supported by a consultant geriatrician in the rehabilitation unit and a relative for the home-based service user.
Results
Student scores on the six subscales of the ICCAS (communication, collaboration, roles and responsibilities, collaborative patient-centred approach, conflict management and team functioning) were compared. Scores in all categories achieved statistically significant increases after completion of the IPE workshop. The greatest positive change was observed in collaborative patient-centred approach with pre-workshop scores increasing from a mean of 2.61 to 4.25 (p<0.05).
Conclusion
This initiative explored the inclusion of a frail older adult workshop in the higher education setting. Older adults had an opportunity to share their lived experiences. Evaluation of this IPE initiative will inform future IPE activities to be incorporated into undergraduate education programmes. Similar IPE models can be replicated nationally to enable and enhance team-based working and integrated care.
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Affiliation(s)
- N McCarthy
- University College Cork Medical Education Unit, School of Medicine, , Cork, Ireland
| | - J Daly
- Health Service Executive Patient Safety, South Southwest Hospital Group, , Cork, Ireland
- Mercy University Hospital Department of Physiotherapy, , Cork, Ireland
| | - O Wall
- Primary Care Health Service Executive , Cork, Ireland
- University College Cork Occupational Therapy, , Cork, Ireland
| | - T Wills
- University College Cork School of Nursing and Midwifery, , Cork, Ireland
| | - C Buckley
- Office of the Nursing and Midwifery Services Director, Health Service Executive , Cork, Ireland
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3
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Hamilton E, Meisel J, Alemany C, Virginia B, Lin N, Wesolowski R, Mathauda-Sahota G, Makower D, Lawrence J, Faltaos D, Mitri Z, Sabanathan D, Clark D, Pluard T, Hui R, McCarthy N, Patel M. Phase 1b results from OP-1250-001, a dose escalation and dose expansion study of OP-1250, an oral CERAN, in subjects with advanced and/or metastatic estrogen receptor (ER)-positive, HER2-negative breast cancer (NCT04505826). Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00896-6] [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: 11/28/2022]
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4
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Röhnert MA, Kramer M, Schadt J, Ensel P, Thiede C, Krause SW, Bücklein V, Hoffmann J, Jaramillo S, Schlenk RF, Röllig C, Bornhäuser M, McCarthy N, Freeman S, Oelschlägel U, von Bonin M. Reproducible measurable residual disease detection by multiparametric flow cytometry in acute myeloid leukemia. Leukemia 2022; 36:2208-2217. [PMID: 35851154 PMCID: PMC9417981 DOI: 10.1038/s41375-022-01647-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/05/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/08/2022]
Abstract
Measurable residual disease (MRD) detected by multiparametric flow cytometry (MFC) is associated with unfavorable outcome in patients with AML. A simple, broadly applicable eight-color panel was implemented and analyzed utilizing a hierarchical gating strategy with fixed gates to develop a clear-cut LAIP-based DfN approach. In total, 32 subpopulations with aberrant phenotypes with/without expression of markers of immaturity were monitored in 246 AML patients after completion of induction chemotherapy. Reference values were established utilizing 90 leukemia-free controls. Overall, 73% of patients achieved a response by cytomorphology. In responders, the overall survival was shorter for MRDpos patients (HR 3.8, p = 0.006). Overall survival of MRDneg non-responders was comparable to MRDneg responders. The inter-rater-reliability for MRD detection was high with a Krippendorffs α of 0.860. The mean time requirement for MRD analyses at follow-up was very short with 04:31 minutes. The proposed one-tube MFC approach for detection of MRD allows a high level of standardization leading to a promising inter-observer-reliability with a fast turnover. MRD defined by this strategy provides relevant prognostic information and establishes aberrancies outside of cell populations with markers of immaturity as an independent risk feature. Our results imply that this strategy may provide the base for multicentric immunophenotypic MRD assessment.
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Affiliation(s)
- Maximilian A Röhnert
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany.
| | - Michael Kramer
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Jonas Schadt
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Philipp Ensel
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
- AgenDix GmbH, Dresden, Germany
| | - Stefan W Krause
- Department of Medicine 5, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Veit Bücklein
- Department of Medicine III, University Hospital LMU Munich, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center, LMU Munich, Munich, Germany
| | - Jörg Hoffmann
- Department of Internal Medicine and Hematology, Oncology and Immunology, Philipps University Marburg and University Hospital Giessen and Marburg, Marburg, Germany
| | - Sonia Jaramillo
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard F Schlenk
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
- National Center of Tumor Diseases, Dresden, Germany
| | - Nicholas McCarthy
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sylvie Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Uta Oelschlägel
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
| | - Malte von Bonin
- Department of Medicine I, University Hospital Carl Gustav Carus TU Dresden, Dresden, Germany
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5
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Franciosi AN, McCarthy N, Gaffney B, Duignan J, Sweeney E, O'Connell N, Murphy K, Áinle FN, Butler MW, Dodd JD, Keane MP, Murphy DJ, Curran KM, McCarthy C. Extended D-dimer Cut-offs and Machine Learning for Ruling Out Pulmonary Embolism in individuals undergoing CTPA. Eur Respir J 2022; 59:13993003.00075-2022. [PMID: 35236722 DOI: 10.1183/13993003.00075-2022] [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] [Received: 11/22/2021] [Accepted: 02/07/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Alessandro N Franciosi
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Denotes joint first authorship
| | - Nicholas McCarthy
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Denotes joint first authorship
| | - Brian Gaffney
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - John Duignan
- Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Eamon Sweeney
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Niall O'Connell
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Karen Murphy
- Department of Haematology, St Vincent's University Hospital, Dublin, Ireland
| | - Fionnuala Ní Áinle
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Haematology, Mater Misericordiae Hospital, Dublin, Ireland
| | - Marcus W Butler
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jonathan D Dodd
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - David J Murphy
- School of Medicine, University College Dublin, Dublin 4, Ireland.,Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | - Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland .,School of Medicine, University College Dublin, Dublin 4, Ireland
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6
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Ting Loke JC, McCarthy N, Jackson A, Siddique S, Hodgkinson A, Crawley C, Gilleece MH, Protheroe R, Peniket A, Salim R, Tholouli E, Wilson KM, Andrew G, Dillon R, Khan N, Potter V, Krishnamurthy P, Craddock C, Freeman S. Post-Transplant MRD Status and T Cell Chimerism Predict Outcomes in Patients Allografted for AML/MDS-a Prospective Analysis from the UK NCRI Figaro Trial. Transplant Cell Ther 2022. [DOI: 10.1016/s2666-6367(22)00716-3] [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: 10/18/2022]
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7
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Guerandel A, McCarthy N, McCarthy J, Mulligan D. An approach to teaching psychiatry to medical students in the time of Covid-19. Ir J Psychol Med 2021; 38:293-299. [PMID: 32611461 PMCID: PMC7463153 DOI: 10.1017/ipm.2020.87] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/24/2020] [Indexed: 12/31/2022]
Abstract
In this time of Covid-19, life in healthcare has changed immeasurably. It has rapidly been injected with an 'all hands-on deck' approach, to facilitate the necessary adaptations required to reduce the spread of the virus and deliver frontline clinical care. Inevitably aspects of these changes have disrupted the delivery of medical education, notably clinical placements have been cancelled and social distancing guidelines prohibit face-to-face teaching. The training of future doctors is an essential part of this effort. Indeed, the emergence of a global health threat has underlined its continued importance. For medical educators and students alike, we have been presented with a challenge. Concurrently, this presents us with an impetus and opportunity for innovation. For some time now, a transformation in medical education has been called for, with an increasing recognition of the need to prepare students for the changing landscape of healthcare systems. This has included a focus on the use of technology-enhanced and self-directed learning. As a team of educators and clinicians in psychiatry, working in the School of Medicine and Medical Sciences (SMMS) in University College Dublin (UCD), we will share how we have responded. We outline the adaptations made to our 'Psychiatry' module and consider the influence this may have on its future delivery. These changes were informed by direct student input.
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Affiliation(s)
- A. Guerandel
- Department of Psychiatry and Mental Health Research, St. Vincent’s University Hospital and University College Dublin
| | - N. McCarthy
- Department of Psychiatry and Mental Health Research, St. Vincent’s University Hospital and University College Dublin
| | - J. McCarthy
- Department of Psychiatry and Mental Health Research, St. Vincent’s University Hospital and University College Dublin
| | - D. Mulligan
- Department of Psychiatry and Mental Health Research, St. Vincent’s University Hospital and University College Dublin
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8
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Galactionova K, Loibl S, Salari P, Marmé F, Martin M, Untch M, Bonnefoi H, Kim SB, Bear H, McCarthy N, Gelmon K, García-Saenz J, Kelly C, Reimer T, Toi M, Rugo H, Gnant M, Makris A, Burchardi N, Schwenkglenks M. 132P Health economic properties of palbociclib in breast cancer patients with high risk of relapse following neoadjuvant therapy: Results from the Penelope-B trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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9
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Craddock C, Jackson A, Loke J, Siddique S, Hodgkinson A, Mason J, Andrew G, Nagra S, Malladi R, Peniket A, Gilleece M, Salim R, Tholouli E, Potter V, Crawley C, Wheatley K, Protheroe R, Vyas P, Hunter A, Parker A, Wilson K, Pavlu J, Byrne J, Dillon R, Khan N, McCarthy N, Freeman SD. Augmented Reduced-Intensity Regimen Does Not Improve Postallogeneic Transplant Outcomes in Acute Myeloid Leukemia. J Clin Oncol 2021; 39:768-778. [PMID: 33373276 PMCID: PMC8078252 DOI: 10.1200/jco.20.02308] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Reduced-intensity conditioning (RIC) regimens have extended the curative potential of allogeneic stem-cell transplantation to older adults with high-risk acute myeloid leukemia (AML) and myelodysplasia (MDS) but are associated with a high risk of disease relapse. Strategies to reduce recurrence are urgently required. Registry data have demonstrated improved outcomes using a sequential transplant regimen, fludarabine/amsacrine/cytarabine-busulphan (FLAMSA-Bu), but the impact of this intensified conditioning regimen has not been studied in randomized trials. PATIENTS AND METHODS Two hundred forty-four patients (median age, 59 years) with high-risk AML (n = 164) or MDS (n = 80) were randomly assigned 1:1 to a fludarabine-based RIC regimen or FLAMSA-Bu. Pretransplant measurable residual disease (MRD) was monitored by flow cytometry (MFC-MRD) and correlated with outcome. RESULTS There was no difference in 2-year overall survival (hazard ratio 1.05 [85% CI, 0.80 to 1.38] P = .81) or cumulative incidence of relapse (CIR) (hazard ratio 0.94 [95%CI, 0.60 to 1.46] P = .81) between the control and FLAMSA-Bu arms. Detectable pretransplant MFC-MRD was associated with an increased CIR (2-year CIR 41.0% v 20.0%, P = .01) in the overall trial cohort with a comparable prognostic impact when measured by an unsupervised analysis approach. There was no evidence of interaction between MRD status and conditioning regimen intensity for relapse or survival. Acquisition of full donor T-cell chimerism at 3 months abrogated the adverse impact of pretransplant MRD on CIR and overall survival. CONCLUSION The intensified RIC conditioning regimen, FLAMSA-Bu, did not improve outcomes in adults transplanted for high-risk AML or MDS regardless of pretransplant MRD status. Our data instead support the exploration of interventions with the ability to accelerate acquisition of full donor T-cell chimerism as a tractable strategy to improve outcomes in patients allografted for AML.
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Affiliation(s)
- Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Justin Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Shamyla Siddique
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Andrea Hodgkinson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - John Mason
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Georgia Andrew
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Sandeep Nagra
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Ram Malladi
- Addenbrookes Hospital, Cambridge, United Kingdom
| | | | | | | | | | | | | | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | | | | | - Ann Hunter
- Leicester Royal Infirmary, United Kingdom
| | - Anne Parker
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Jiri Pavlu
- Imperial College Hospital, London, Unite Kingdom
| | - Jenny Byrne
- Centre for Clinical Haematology, Nottingham, United Kingdom
| | - Richard Dillon
- Department of Medical and Molecular Genetics, King's College, London, United Kingdom
| | - Naeem Khan
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Nicholas McCarthy
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Sylvie D. Freeman
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
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10
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McCarthy N, Dahlan A, Cook TS, Hare NO, Ryan ML, St John B, Lawlor A, Curran KM. Enterprise imaging and big data: A review from a medical physics perspective. Phys Med 2021; 83:206-220. [DOI: 10.1016/j.ejmp.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 02/04/2023] Open
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11
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Chalmers RM, McCarthy N, Barlow KL, Stiff R. An evaluation of health protection practices for the investigation and management of Cryptosporidium in England and Wales. J Public Health (Oxf) 2019; 40:114-120. [PMID: 28039197 DOI: 10.1093/pubmed/fdw143] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Indexed: 11/13/2022] Open
Abstract
Background Cryptosporidium is a major cause of gastroenteritis (cryptosporidiosis). Case and outbreak report rates vary geographically, which may in part reflect public health practice. Methods To examine the public health management of cryptosporidiosis, an online questionnaire was administered to the 28 Health Protection Teams (HPTs) in England and Wales in 2014. Practices for investigation and management of cases and outbreaks were compared. Results Practice varied among the 24 (86%) respondents in terms of who undertook actions (HPT or Local Authority) to investigate and manage cryptosporidiosis. HPTs without exceedance monitoring detected fewer outbreaks (1/5, 20%) than those with it (13/19, 68%) (P = 0.12), and those that always administered a risk-factor questionnaire detected more outbreaks (12/19, 63%) than those who did this only sometimes (2/5, 40%) (P = 0.62). Significantly more HPTs with a system to detect common exposures reported at least one outbreak (14/19, 74%) compared to HPTs with no system (0/5) (P = 0.01). Conclusions Applying exceedance monitoring, using a standardized questionnaire taking into account the incubation period for Cryptosporidium, and having a structured system to detect common exposures increased outbreak detection. Information about all cases should be shared between local public health authorities, and current guidance used for the prevention of spread.
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Affiliation(s)
- R M Chalmers
- Public Health Wales Microbiology and Health Protection, Singleton Hospital, Swansea SA2 8QA, UK.,Swansea University Medical School, Grove Building, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - N McCarthy
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.,NIHR Health Protection Research Unit in GI Infections, University of Oxford, Oxford OX1 3PS, UK
| | - K L Barlow
- Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - R Stiff
- Health Protection Team, Public Health Wales, 2 Capital Quarter, Tyndall Street, Cardiff CF10 4BZ, UK
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12
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Auguste P, Madan J, Tsertsvadze A, Court R, McCarthy N, Sutcliffe P, Taylor-Phillips S, Pink J, Clarke A. Identifying latent tuberculosis in high-risk populations: systematic review and meta-analysis of test accuracy. Int J Tuberc Lung Dis 2019; 23:1178-1190. [DOI: 10.5588/ijtld.18.0743] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The relative accuracy of interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) in identifying latent tuberculosis infection (LTBI) is uncertain.OBJECTIVE: To perform a systematic review and meta-analysis to compare the sensitivity and
specificity of IGRAs and TST for the prediction of progression to clinical tuberculosis (TB).METHODS: We searched electronic databases (e.g., MEDLINE and EMBASE) from December 2009 to September 2018 for prospective studies that followed up individuals who had undergone testing with
commercial IGRAs and/or TST but had not received treatment based on the test result. The sensitivity and specificity estimates were pooled using a Bayesian bivariate random-effects model.RESULTS: Twenty-five studies, mostly with moderate to high risk of bias and a mean follow-up
time ranging from 1 to 5 years were included. TST (10–15 mm) tended to have lower sensitivity and higher specificity than QuantiFERON® Gold In-Tube, T-SPOT®.TB and TST (5 mm). The evidence did not indicate that any test outperformed the others due
to wide and overlapping 95% credible intervals.CONCLUSION: The evidence following individuals who had undergone testing for LTBI and had progressed to clinical TB is sparse. We did not find that IGRAs were superior to TST or vice versa; however, as our findings are based on a small
number of studies with methodological limitations and great uncertainty around the pooled estimates, the results should be interpreted with caution.
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Affiliation(s)
- P. Auguste
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - J. Madan
- Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry
| | - A. Tsertsvadze
- Evidence in Communicable Disease Epidemiology and Control, Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - R. Court
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - N. McCarthy
- Evidence in Communicable Disease Epidemiology and Control, Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - P. Sutcliffe
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - S. Taylor-Phillips
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - J. Pink
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
| | - A. Clarke
- Warwick Evidence, Warwick Medical School, University of Warwick, Coventry
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McCarthy N, Nathan N, Hope K, Sutherland R, Hodder R. Australian Secondary school student's attitudes to changing from traditional school uniforms to sports uniforms. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.116] [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: 10/25/2022]
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14
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Dowdy AJ, Ye H, Pepler A, Thatcher M, Osbrough SL, Evans JP, Di Virgilio G, McCarthy N. Future changes in extreme weather and pyroconvection risk factors for Australian wildfires. Sci Rep 2019; 9:10073. [PMID: 31296883 PMCID: PMC6624367 DOI: 10.1038/s41598-019-46362-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/26/2019] [Indexed: 11/09/2022] Open
Abstract
Extreme wildfires have recently caused disastrous impacts in Australia and other regions of the world, including events with strong convective processes in their plumes (i.e., strong pyroconvection). Dangerous wildfire events such as these could potentially be influenced by anthropogenic climate change, however, there are large knowledge gaps on how these events might change in the future. The McArthur Forest Fire Danger Index (FFDI) is used to represent near-surface weather conditions and the Continuous Haines index (CH) is used here to represent lower to mid-tropospheric vertical atmospheric stability and humidity measures relevant to dangerous wildfires and pyroconvective processes. Projected changes in extreme measures of CH and FFDI are examined using a multi-method approach, including an ensemble of global climate models together with two ensembles of regional climate models. The projections show a clear trend towards more dangerous near-surface fire weather conditions for Australia based on the FFDI, as well as increased pyroconvection risk factors for some regions of southern Australia based on the CH. These results have implications for fields such as disaster risk reduction, climate adaptation, ecology, policy and planning, noting that improved knowledge on how climate change can influence extreme wildfires can help reduce future impacts of these events.
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Affiliation(s)
- Andrew J Dowdy
- Climate Research Section, Bureau of Meteorology, Melbourne, Australia.
| | - Hua Ye
- Climate Research Section, Bureau of Meteorology, Melbourne, Australia
| | - Acacia Pepler
- Climate Research Section, Bureau of Meteorology, Melbourne, Australia
| | | | | | - Jason P Evans
- Climate Change Research Centre, University of New South Wales, Sydney, Australia
- Australian Research Council Centre of Excellence for Climate Extremes, University of New South Wales, Sydney, Australia
| | - Giovanni Di Virgilio
- Climate Change Research Centre, University of New South Wales, Sydney, Australia
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15
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Mook P, Gardiner D, Kanagarajah S, Kerac M, Hughes G, Field N, McCarthy N, Rawlings C, Simms I, Lane C, Crook PD. Use of gender distribution in routine surveillance data to detect potential transmission of gastrointestinal infections among men who have sex with men in England. Epidemiol Infect 2018; 146:1468-1477. [PMID: 29923475 PMCID: PMC9133680 DOI: 10.1017/s0950268818001681] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/28/2018] [Revised: 04/20/2018] [Accepted: 05/23/2018] [Indexed: 11/06/2022] Open
Abstract
Detecting gastrointestinal (GI) infection transmission among men who have sex with men (MSM) in England is complicated by a lack of routine sexual behavioural data. We investigated whether gender distributions might generate signals for increased transmission of GI pathogens among MSM. We examined the percentage male of laboratory-confirmed patient-episodes for patients with no known travel history for 10 GI infections of public health interest in England between 2003 and 2013, stratified by age and region. An adult male excess was observed for Shigella spp. (annual maximum 71% male); most pronounced for those aged 25-49 years and living in London, Brighton and Manchester. An adult male excess was observed every year for Entamoeba histolytica (range 59.8-76.1% male), Giardia (53.1-57.6%) and Campylobacter (52.1-53.5%) and for a minority of years for hepatitis A (max. 69.8%) and typhoidal salmonella (max. 65.7%). This approach generated a signal for excess male episodes for six GI pathogens, including a characterised outbreak of Shigella among MSM. Stratified analyses by geography and age group were consistent with MSM transmission for Shigella. Optimisation and routine application of this technique by public health authorities elsewhere might help identify potential GI infection outbreaks due to sexual transmission among MSM, for further investigation.
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Affiliation(s)
- P. Mook
- Field Epidemiology Service, Public Health England, London, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - D. Gardiner
- Field Epidemiology Service, Public Health England, London, UK
| | - S. Kanagarajah
- Field Epidemiology Service, Public Health England, London, UK
| | - M. Kerac
- Field Epidemiology Service, Public Health England, London, UK
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Epidemiology & Public Health, Leonard Cheshire Disability & Inclusive Development Centre, University College London, London, UK
| | - G. Hughes
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - N. Field
- HIV and STI Department, National Infection Service, Public Health England, London, UK
- Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, UK
| | - N. McCarthy
- Field Epidemiology Service, Public Health England, London, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- National Institute Health Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, London, UK
| | - C. Rawlings
- Field Epidemiology Service, Public Health England, London, UK
| | - I. Simms
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - C. Lane
- Gastrointestinal, Emerging and Zoonotic Infections Department, Public Health England, London, UK
| | - P. D. Crook
- Field Epidemiology Service, Public Health England, London, UK
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16
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Desmet C, Sutherland R, Davies L, Wolfenden L, Butler P, McCarthy N, Cohen J, Nathan N. Objectively measuring children's physical activity levels in a free living environment. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.089] [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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17
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Scrace S, An F, Ghirelli C, Hoenderdos K, Huseni T, Laurent T, Kifle L, Kumar S, Lowe C, Myaskovsky A, McCarthy N, Moore J, Pai T, Steiger J, Zhao F. Cell based assays for immuno-oncology discovery research. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32907-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Lauritzen JS, Sigulinsky CL, Anderson JR, Kalloniatis M, Nelson NT, Emrich DP, Rapp C, McCarthy N, Kerzner E, Meyer M, Jones BW, Marc RE. Rod-cone crossover connectome of mammalian bipolar cells. J Comp Neurol 2016; 527:87-116. [PMID: 27447117 PMCID: PMC5823792 DOI: 10.1002/cne.24084] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/08/2016] [Accepted: 06/30/2016] [Indexed: 11/11/2022]
Abstract
The basis of cross-suppression between rod and cone channels has long been an enigma. Using rabbit retinal connectome RC1, we show that all cone bipolar cell (BC) classes inhibit rod BCs via amacrine cell (AC) motifs (C1-6); that all cone BC classes are themselves inhibited by AC motifs (R1-5, R25) driven by rod BCs. A sparse symmetric AC motif (CR) is presynaptic and postsynaptic to both rod and cone BCs. ON cone BCs of all classes drive inhibition of rod BCs via motif C1 wide-field GABAergic ACs (γACs) and motif C2 narrow field glycinergic ON ACs (GACs). Each rod BC receives ≈10 crossover AC synapses and each ON cone BC can target ≈10 or more rod BCs via separate AC processes. OFF cone BCs mediate monosynaptic inhibition of rod BCs via motif C3 driven by OFF γACs and GACs and disynaptic inhibition via motifs C4 and C5 driven by OFF wide-field γACs and narrow-field GACs, respectively. Motifs C4 and C5 form halos of 60-100 inhibitory synapses on proximal dendrites of AI γACs. Rod BCs inhibit surrounding arrays of cone BCs through AII GAC networks that access ON and OFF cone BC patches via motifs R1, R2, R4, R5 and a unique ON AC motif R3 that collects rod BC inputs and targets ON cone BCs. Crossover synapses for motifs C1, C4, C5, and R3 are 3-4× larger than typical feedback synapses, which may be a signature for synaptic winner-take-all switches. J. Comp. Neurol. 527:87-116, 2019. © 2016 The Authors The Journal of Comparative Neurology Published by Wiley Periodicals, Inc.
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Affiliation(s)
| | - Crystal L Sigulinsky
- Department of Ophthalmology, John A. Moran Vision Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James R Anderson
- Department of Ophthalmology, John A. Moran Vision Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael Kalloniatis
- Department of Optometry and Vision Science and Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Noah T Nelson
- Department of Ophthalmology, John A. Moran Vision Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daniel P Emrich
- Department of Ophthalmology, John A. Moran Vision Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Christopher Rapp
- Department of Ophthalmology, John A. Moran Vision Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nicholas McCarthy
- Department of Ophthalmology, John A. Moran Vision Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ethan Kerzner
- Scientific Computing and Imaging Institute, University of Utah School of Computing, Salt Lake City Utah, USA
| | - Miriah Meyer
- Scientific Computing and Imaging Institute, University of Utah School of Computing, Salt Lake City Utah, USA
| | - Bryan W Jones
- Department of Ophthalmology, John A. Moran Vision Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Robert E Marc
- Department of Ophthalmology, John A. Moran Vision Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Paranthaman K, McCarthy N, Rew V, van Zoelen S, Cockerill L. Pertussis vaccination for healthcare workers: staff attitudes and perceptions associated with high coverage vaccination programmes in England. Public Health 2016; 137:196-9. [PMID: 27026252 DOI: 10.1016/j.puhe.2016.02.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/08/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Affiliation(s)
- K Paranthaman
- Public Health England South East, Ashford, United Kingdom.
| | - N McCarthy
- Public Health England South East, Chilton, United Kingdom
| | - V Rew
- Public Health England London, London, United Kingdom
| | - S van Zoelen
- Northampton General Hospital NHS Trust, Northampton, United Kingdom
| | - L Cockerill
- Northampton General Hospital NHS Trust, Northampton, United Kingdom
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20
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John T, Voysey M, Yu LM, McCarthy N, Baudin M, Richard P, Fiquet A, Kitchin N, Pollard AJ. Immunogenicity of a low-dose diphtheria, tetanus and acellular pertussis combination vaccine with either inactivated or oral polio vaccine compared to standard-dose diphtheria, tetanus, acellular pertussis when used as a pre-school booster in UK children: A 5-year follow-up of a randomised controlled study. Vaccine 2015; 33:4579-85. [PMID: 26165918 DOI: 10.1016/j.vaccine.2015.06.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/08/2015] [Accepted: 06/29/2015] [Indexed: 11/29/2022]
Abstract
This serological follow up study assessed the kinetics of antibody response in children who previously participated in a single centre, open-label, randomised controlled trial of low-dose compared to standard-dose diphtheria booster preschool vaccinations in the United Kingdom (UK). Children had previously been randomised to receive one of three combination vaccines: either a combined adsorbed tetanus, low-dose diphtheria, 5-component acellular pertussis and inactivated polio vaccine (IPV) (Tdap-IPV, Repevax(®); Sanofi Pasteur MSD); a combined adsorbed tetanus, low-dose diphtheria and 5-component acellular pertussis vaccine (Tdap, Covaxis(®); Sanofi Pasteur MSD) given concomitantly with oral polio vaccine (OPV); or a combined adsorbed standard-dose diphtheria, tetanus, 2-component acellular pertussis and IPV (DTap-IPV, Tetravac(®); Sanofi Pasteur MSD). Blood samples for the follow-up study were taken at 1, 3 and 5 years after participation in the original trial (median, 5.07 years of age at year 1), and antibody persistence to each vaccine antigen measured against defined serological thresholds of protection. All participants had evidence of immunity to diphtheria with antitoxin concentrations greater than 0.01IU/mL five years after booster vaccination and 75%, 67% and 79% of children who received Tdap-IPV, Tdap+OPV and DTap-IPV, respectively, had protective antitoxin levels greater than 0.1IU/mL. Long lasting protective immune responses to tetanus and polio antigens were also observed in all groups, though polio responses were lower in the sera of those who received OPV. Low-dose diphtheria vaccines provided comparable protection to the standard-dose vaccine and are suitable for use for pre-school booster vaccination.
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Affiliation(s)
- T John
- Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - M Voysey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - L M Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - N McCarthy
- Thames Valley Health Protection Unit, Oxford, UK.
| | - M Baudin
- Sanofi Pasteur MSD S.N.C., Lyon, France.
| | - P Richard
- Sanofi Pasteur MSD S.N.C., Lyon, France.
| | - A Fiquet
- Sanofi Pasteur MSD S.N.C., Lyon, France.
| | - N Kitchin
- Sanofi Pasteur MSD Ltd, Maidenhead, UK.
| | - A J Pollard
- Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
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21
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Mytton O, McCarthy N, Mannes T. Variation in incidence and notification of Campylobacter and Salmonella by general practice in the Thames Valley area. Public Health 2015; 129:258-65. [DOI: 10.1016/j.puhe.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 12/22/2014] [Accepted: 01/07/2015] [Indexed: 11/24/2022]
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22
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Smith W, Schutte R, Huisman HW, Van Rooyen JM, Ware LJ, Fourie CMT, Mels CMC, Kruger R, McCarthy N, Schutte AE. Leptin is positively associated with blood pressure in african men with a low body mass index: the SAfrEIC study. Horm Metab Res 2015; 47:145-51. [PMID: 25295418 DOI: 10.1055/s-0034-1389926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Severe underweight may be a risk factor for hypertension in developing countries, although the manner whereby this occurs is unknown. Leptin is known to exert both beneficial and detrimental vascular effects, and is predictive of poor cardiovascular outcome at high levels, but also at low levels. We explored the relationship between blood pressure and leptin in black men from South Africa with a body mass index (BMI) in the underweight to normal range. We included 113 African men (BMI≤25 kg/m(2)) and took anthropometric, biochemical and cardiovascular measures. The blood pressure-leptin relationship was then investigated along quintiles of leptin and within BMI stratified median split (20 kg/m(2)) groups. Blood pressure increased across leptin quintiles 1-3 (p for trend≤0.040), whereas no relationship was observed along quintiles 3 to 5 (p for trend≥0.14) (adjusted for age and waist circumference). Blood pressure was similar in the two BMI median split groups (p≥0.083). In the low BMI group only, blood pressure associated positively with leptin following unadjusted, partial, and full adjustment (systolic blood pressure and diastolic blood pressure: R(2)=0.20-0.27, β=0.32-0.34, p≤0.009). Decreasing leptin levels are not likely to contribute to hypertension prevalence in the underweight. Rather, in African men with a BMI≤20 kg/m(2), low leptin levels are positively and independently associated with elevated blood pressure, which is not seen at higher BMI (20-25 kg/m(2)). Our findings suggest a differential concentration dependent vascular effect of leptin in underweight and normal weight African men.
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Affiliation(s)
- W Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - H W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - J M Van Rooyen
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - L J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M T Fourie
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - C M C Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - N McCarthy
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - A E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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McCarthy N, Boyle F, Zdenkowski N, Bull J, Leong E, Simpson A, Kannourakis G, Francis PA, Chirgwin J, Abdi E, Gebski V, Veillard AS, Zannino D, Wilcken N, Reaby L, Lindsay DF, Badger HD, Forbes JF. Neoadjuvant chemotherapy with sequential anthracycline-docetaxel with gemcitabine for large operable or locally advanced breast cancer: ANZ 0502 (NeoGem). Breast 2014; 23:142-51. [PMID: 24393617 DOI: 10.1016/j.breast.2013.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 07/18/2013] [Revised: 11/04/2013] [Accepted: 12/04/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy has a sound rationale for use in women with large operable breast cancer, and achievement of pathological complete response (pCR) is prognostic. Epirubicin and cyclophosphamide followed by docetaxel is a standard chemotherapy regimen for early breast cancer. In metastatic breast cancer the combination of gemcitabine and a taxane has shown promising results. This phase II study investigated the efficacy and safety of incorporating gemcitabine into neoadjuvant therapy. METHODS Female patients with operable breast cancer that was clinically T2 (≥3 cm) or T3-4, N0-1, M0 were enrolled to receive 24 weeks of neoadjuvant chemotherapy using epirubicin and cyclophosphamide followed by docetaxel and gemcitabine, plus trastuzumab if HER2-positive. The primary endpoint was the pathological complete response (pCR) rate in the breast in separate HER2-negative and HER2-positive cohorts. Secondary endpoints included pCR in both the breast and axillary lymph nodes, clinical and radiological response rates, disease free survival and safety. RESULTS 81 patients were enrolled: 63 HER2-negative and 18 HER2-positive. 67 (84%) completed all cycles of chemotherapy, and 78 (96%) proceeded to surgery. pCR was achieved by 12 (20%) patients with HER2-negative, and 9 (53%) with HER2-positive disease. At the first interim analysis, addition of prophylactic G-CSF was recommended due to excess neutropenia. The HER2-negative cohort was closed to accrual because it did not meet the pre-specified target for pCR, and the HER2-positive cohort was closed due to slow accrual. At a median follow-up of 24 months, 12 of 81 (15%) patients had experienced a relapse of their breast cancer. CONCLUSION Neoadjuvant gemcitabine, when added to docetaxel, after epirubicin and cyclophosphamide, did not reach the pre-specified expectations for pCR rate in HER2-negative tumours. Excess neutropenia was observed, requiring growth factor support. Addition of gemcitabine to docetaxel in this schedule cannot be recommended. Australia and New Zealand Clinical Trials Registry (www.anzctr.org.au) registration number ACTRN12606000191594.
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Affiliation(s)
- N McCarthy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD 4029, Australia; University of Queensland, Brisbane, QLD, Australia.
| | - F Boyle
- The Mater Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - N Zdenkowski
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
| | - J Bull
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - E Leong
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - A Simpson
- Wellington Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - G Kannourakis
- Ballarat Oncology and Haematology Service, Ballarat, VIC, Australia
| | - P A Francis
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Medicine, St. Vincent's Hospital, University of Melbourne, VIC, Australia
| | - J Chirgwin
- University of Newcastle, Newcastle, NSW, Australia; Box Hill Hospital, Box Hill, VIC, Australia; Maroondah Breast Clinic, Maroondah Hospital, Ringwood East, VIC, Australia; Monash University, VIC, Australia
| | - E Abdi
- Tweed Hospital, Tweed Heads, NSW, Australia; Griffith University- Gold Coast, Southport, QLD, Australia
| | - V Gebski
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - A S Veillard
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - D Zannino
- National Health and Medical Research Council Clinical Trials Centre, Sydney, NSW, Australia
| | - N Wilcken
- Westmead Cancer Care Centre, Westmead Hospital, University of Sydney, NSW, Australia
| | - L Reaby
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - D F Lindsay
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - H D Badger
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia
| | - J F Forbes
- Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia; Department of Surgical Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
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Jameson LJ, Taori SK, Atkinson B, Levick P, Featherstone CA, van der Burgt G, McCarthy N, Hart J, Osborne JC, Walsh AL, Brooks TJ, Hewson R. Pet rats as a source of hantavirus in England and Wales, 2013. Euro Surveill 2013; 18:20415. [PMID: 23470018] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- L J Jameson
- Virology and Pathogenesis, Microbiology Services, Health Protection Agency, Porton Down, Wiltshire, United Kingdom.
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25
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Jameson LJ, Taori SK, Atkinson B, Levick P, Featherstone CA, van der Burgt G, McCarthy N, Hart J, Osborne JC, Walsh AL, Brooks TJ, Hewson R. Pet rats as a source of hantavirus in England and Wales, 2013. Euro Surveill 2013. [DOI: 10.2807/ese.18.09.20415-en] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the detection of a strain of Seoul hantavirus (SEOV) in pet rats in England and Wales. The discovery followed an investigation of a case of haemorrhagic fever with renal syndrome in Wales. Hantavirus RNA was detected via real-time reverse transcription-polymerase chain reaction (RT-PCR) and classic RT-PCR in pet rats belonging to the patient. Sequencing and phylogenetic analysis confirmed the virus to be a SEOV that is similar, but not identical, to a previously reported United Kingdom strain from wild rats.
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Affiliation(s)
- L J Jameson
- Virology and Pathogenesis, Microbiology Services, Health Protection Agency, Porton Down, Wiltshire, United Kingdom
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - S K Taori
- Rare and Imported Pathogens Department, Microbiology Services, Health Protection Agency, Porton Down, Wiltshire, United Kingdom
| | - B Atkinson
- Virology and Pathogenesis, Microbiology Services, Health Protection Agency, Porton Down, Wiltshire, United Kingdom
| | - P Levick
- Biological Investigations Group, Microbiology Services, Health Protection Agency, Porton Down, Wiltshire, United Kingdom
| | - C A Featherstone
- Animal Health and Veterinary Laboratories Agency, Thirsk, Yorkshire, United Kingdom
| | - G van der Burgt
- Animal Health and Veterinary Laboratories Agency, Luddington, Warwickshire, United Kingdom
| | - N McCarthy
- Thames Valley Health Protection Unit, Centre for Radiation, Chemical & Environmental Hazards, Health Protection Agency, Oxfordshire, United Kingdom
| | - J Hart
- Public Health Wales, Health Protection Team, Flintshire, United Kingdom
| | - J C Osborne
- Rare and Imported Pathogens Department, Microbiology Services, Health Protection Agency, Porton Down, Wiltshire, United Kingdom
| | - A L Walsh
- Gastrointestinal, Emerging and Zoonotic Infections Department, Health Protection Services, Health Protection Agency Colindale, London, United Kingdom
| | - T J Brooks
- Rare and Imported Pathogens Department, Microbiology Services, Health Protection Agency, Porton Down, Wiltshire, United Kingdom
| | - R Hewson
- Virology and Pathogenesis, Microbiology Services, Health Protection Agency, Porton Down, Wiltshire, United Kingdom
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Saldana L, Abid M, McCarthy N, Hunter N, Inglis R, Anders K. Factors affecting delay in initiation of treatment of tuberculosis in the Thames Valley, UK. Public Health 2013; 127:171-7. [PMID: 23313162 DOI: 10.1016/j.puhe.2012.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 08/15/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To quantify and determine factors associated with delay in initiation of tuberculosis (TB) treatment in the Thames Valley area, South East England, and the proportion of this delay that could be attributed to patient care-seeking or to delay within the National Health Service (NHS). STUDY DESIGN Retrospective analysis study reviewing medical notes and enhanced TB surveillance data. METHODS Demographic and clinical information was collected from medical notes and the Enhanced TB Surveillance database for patients who were diagnosed with TB and resident in the Thames Valley. Treatment delay was defined as the period between the onset of symptoms and the start of treatment. Patient delay was defined as the period between the onset of symptoms and the first presentation to the NHS. Health service delay was defined as the period between the first contact with the NHS and the start of treatment. Univariate and multivariate linear regression analyses were used to assess the association between delays and explanatory variables (age, gender, place of birth, ethnicity, disease site, sputum smear, culture, primary care trust of residence). RESULTS The study included 273 patients with TB. The median time between symptom onset and initiation of treatment was 73 days [95% confidence interval (CI) 65-89], of which the contributions of health service, patient and referral delays were 39 (95% CI 34-55), 29 (95% CI 22-36) and 16 (95% CI 12-24) days, respectively. On multivariate analysis, extrapulmonary TB (P = 0.010), female (P = 0.003) and UK-born (P = 0.008) patients were associated with longer health service delay. Age (P = 0.001) and extrapulmonary TB (P = 0.010) were associated with longer overall treatment delay. CONCLUSION Treatment delay for TB, especially delay after first presentation to the NHS, remains a public health concern. Differences in health service delay, for example by gender and country of birth, highlight that some of this should be open to health service intervention.
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Affiliation(s)
- L Saldana
- Thames Valley Heath Protection Unit, Centre for Radiation, Chemical and Environmental Hazards, Health Protection Agency, Chilton, Didcot, UK.
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McCarthy N, Boyle F, Bull J, Leong E, Simpson A, Kannourakis G, Gebski V, Forbes JF, Wilcken N, Lindsay DF, Badger HD. P3-14-28: ANZ 0502 NeoGem: A Phase II Trial Evaluating the Efficacy and Safety of Epirubicin and Cyclophosphamide Followed by Docetaxel with Gemcitabine (+ Trastuzumab If HER2 Positive) as Neoadjuvant Chemotherapy for Women with Large Operable or Locally Advanced Breast Carcinoma. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-14-28] [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: 11/16/2022]
Abstract
Abstract
Background
Neoadjuvant chemotherapy may provide an early indication of treatment effect and pathologic complete response (pCR) rate is a surrogate measure of disease-free and overall survival. Anthracyclines remain an important component of chemotherapy regimens for breast cancer (BC), adding a taxane conveys additional survival benefit. Gemcitabine (G) has established safety and efficacy in metastatic breast cancer (MBC) and combining G with docetaxel (D) shows preclinical synergy but not overlapping toxicities. In MBC, efficacy of trastuzumab (T) combined with single agent taxanes and G has been demonstrated for tumours that over-express human epidermal growth factor receptor 2 (HER2+). NeoGem aimed to evaluate the efficacy and safety of neoadjuvant epirubicin (E) and cyclophosphamide (C), followed by D and G +/− T (depending on HER2 status) in women with large operable or locally advanced BC.
Methods: Eligible patients (pts), ≥18 years, had unilateral, operable (at presentation) T2 (≥3cm), T3-4, N0-1, M0 primary BC, no prior chemotherapy or hormonal therapy and ECOG status 0–2. All pts received E (90mg/m2 i.v.) in combination with C (600mg/m2 i.v.) on day 1 q 21 for 4 cycles followed by D (75mg/m2 i.v.) on day 1 in combination with G (1000mg/m2 i.v.) on days 1 and 8 q 21 for 4 cycles. HER2+ pts received T (4mg/kg loading then 2mg/kg i.v.) concurrent with DG on days 1, 8 and 15 q 21 for 4 cycles. HER2+ pts received post-surgical T (6mg/kg) 3 weekly, for a total of one year of T therapy. Using a Simon's 2 stage trial design, the decision to proceed to stage 2 followed interim analysis of stage 1. Primary endpoint, pCR, was defined as no histologic evidence of invasive cancer in the breast. Secondary endpoint, pCRax, was defined as no histologic evidence of invasive cancer in the breast and axilla. EC followed by DG/DGT was expected to achieve a pCR rate of 35% in HER2 negative (HER2−) pts and 40% in HER2+, with the lowest limit of therapeutic efficacy being a pCR rate of 22% (HER2−) and 24% (HER2+). Hence 84 HER2− and 63 HER2+ pts were needed to detect significant differences in pCR rates (power 80%, 95% level of significance).
Results: Over 32 months 81 pts (63 HER2− and 18 HER2+) were enrolled, 78 (96% [61 HER2− and 17 HER2+]) proceeded to surgery. Of 78 pts, 21 (27%) achieved pCR and 19 (24%) achieved pCRax. Of the 61 HER2− pts, 12 (20% [95% CI: 12%-31%]) achieved pCR compared with 9 (53% [95%CI: 31%-74%]) of 17 HER2+ pts. Planned chemotherapy was completed by 67 pts (83%), 9 pts (11%) discontinued due to adverse events. Thirteen pts (16%) required DG dose reductions compared with 7 (8%) pts during EC; 57 (70%) pts had ≥ grade 3 neutropenia.
Conclusion: Efficacy in the HER2− cohort did not reach predetermined levels of significance (interim analysis); HER2+ recruitment proved too slow to continue. High haematological toxicity during DG, particularly neutropenia required use of supportive therapy (GCSF). Despite relatively small patient numbers, 53% pCR in the HER2+ cohort warrants further investigation.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-28.
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Affiliation(s)
- N McCarthy
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - F Boyle
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - J Bull
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - E Leong
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - A Simpson
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - G Kannourakis
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - V Gebski
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - JF Forbes
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - N Wilcken
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - DF Lindsay
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
| | - HD Badger
- 1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; The Mater Hospital, Sydney, New South Wales, Australia; Wellington Hospital, Wellington, New Zealand; Ballarat Oncology and Haematology Service, Ballarat, Victoria, Australia; NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia; University of Newcastle, Newcastle, New South Wales, Australia; Calvary Mater Newcastle, Newcastle, New South Wales, Australia; Westmead Hospital, Sydney, New South Wales, Australia; Australian New Zealand Breast Cancer Trials Group, Newcastle, New South Wales, Australia
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Scaber J, Saeed S, Ihekweazu C, Efstratiou A, McCarthy N, O’Moore É. Group A streptococcal infections during the seasonal influenza outbreak 2010/11 in South East England. Euro Surveill 2011. [DOI: 10.2807/ese.16.05.19780-en] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We present a series of 19 cases of invasive Group A streptococcal (iGAS) infection reported to the Thames Valley Health Protection Unit from 1 December 2010 to 15 January 2011. Ten patients died and a prodrome of influenza-like illness was reported in 14 cases. Influenza B co-infection was confirmed in four cases, three of which were fatal. Our report provides further evidence that influenza B co-infection with iGAS has the potential to cause significant morbidity and mortality.
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Affiliation(s)
- J Scaber
- Thames Valley Health Protection Unit, Health Protection Agency, Chilton, Didcot, Oxfordshire, United Kingdom
| | - S Saeed
- South East Regional Epidemiology Unit, Health Protection Agency, London, United Kingdom
| | - C Ihekweazu
- South East Regional Epidemiology Unit, Health Protection Agency, London, United Kingdom
| | - A Efstratiou
- Streptococcus and Diphtheria Reference Unit, Respiratory and Systemic Infection Laboratory, Central Public Health Laboratory, Colindale, London, United Kingdom
| | - N McCarthy
- Thames Valley Health Protection Unit, Health Protection Agency, Chilton, Didcot, Oxfordshire, United Kingdom
| | - É O’Moore
- Thames Valley Health Protection Unit, Health Protection Agency, Chilton, Didcot, Oxfordshire, United Kingdom
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Scaber J, Saeed S, Ihekweazu C, Efstratiou A, McCarthy N, O'Moore E. Group A streptococcal infections during the seasonal influenza outbreak 2010/11 in South East England. Euro Surveill 2011; 16:19780. [PMID: 21315058] [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: 05/30/2023] Open
Abstract
We present a series of 19 cases of invasive Group A streptococcal (iGAS) infection reported to the Thames Valley Health Protection Unit from 1 December 2010 to 15 January 2011. Ten patients died and a prodrome of influenza-like illness was reported in 14 cases.Influenza B co-infection was confirmed in four cases,three of which were fatal. Our report provides further evidence that influenza B co-infection with iGAS has the potential to cause significant morbidity and mortality.
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Affiliation(s)
- J Scaber
- Thames Valley Health Protection Unit, Health Protection Agency, Chilton, Didcot, Oxfordshire, United Kingdom.
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Juraskova I, Butow P, Smith B, Seccombe M, Coates A, Boyle F, McCarthy N, Reaby L, Forbes JF. Abstract P5-09-01: Improving Informed Consent: Evaluating the First Decision Aid in a Clinical Trial Setting (IBIS-II Breast Cancer Prevention Trial). Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-09-01] [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: 11/16/2022]
Abstract
Abstract
Background: Recruitment to clinical trials is generally suboptimal, with both patients/consumers and clinicians reporting difficulties with the consent process. Decision Aids (DAs) are designed to facilitate doctor-patient communication and participation in decision-making, and may improve the consent process by ensuring patients/consumers make decisions that are informed and acted upon. While participant information sheets (PIS) provide information about the specific clinical trial, DAs present evidence-based information about all available management options (not just the clinical trial), including risks and benefits of each option. They also present both written and graphical forms of the information to enhance understanding, and explicit value clarification exercises to facilitate value-sensitive decisions. In screening and treatment settings, DAs have been found to reduce decisional conflict, improve patient knowledge, create more realistic expectations, and promote active decision-making without increasing anxiety. This RCT aimed to evaluate the efficacy of a DA for women at increased risk of breast cancer who are considering participation in the IBIS-II Prevention trial.
Methods: Women eligible for IBIS-II, who had not decided about participation, were invited to take part in the DA study. Participants from 12 Australian and New Zealand IBIS-II centres were randomised to receive either the standard IBIS-II information and consent materials alone (Control group, n=89), or in combination with a DA booklet (DA group, n=89). Participants completed standardised and purpose-designedmeasures 1 week and 3 months after deciding whether or not to participate in IBIS-II.
Results: In the Prevention arm, the majority of women (84%) reported the DA made it easier to understand IBIS-II compared to reading the PIS alone, and 89% recommended providing both the DA and PIS to potential IBIS-II participants. No group differences were detected in levels of decisional conflict or knowledge of IBIS-II/clinical trials in general, due to floor and ceiling effects respectively. Similarly, no group differences were found in levels of decisional regret and satisfaction at 3-month follow-up. Discussion: This is the first study to assess the effectiveness of DAs in a clinical trial setting. The use of DAs has been strongly endorsed by participating women and clinicians. Challenges of evaluating DAs in a Prevention breast cancer trial setting will be discussed. An RCT of a DA for the DCIS arm of IBIS-II is currently underway. The DAs have the potential to enhance the process of informed consent and reduce dropout rates in clinical trials.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-09-01.
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Affiliation(s)
- I Juraskova
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - P Butow
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - B Smith
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - M Seccombe
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - A Coates
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - F Boyle
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - N McCarthy
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - L Reaby
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - JF. Forbes
- The University of Sydney, NSW, Australia; The University of Newcastle, NSW, Australia; Royal Brisbane Hospital, Brisbane, QLD, Australia
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Paranthaman K, Pooransingh S, McCarthy N, Saunders P, Haworth E. Challenges in investigating transient rash illness in nursery children. J Public Health (Oxf) 2010; 32:173-7. [DOI: 10.1093/pubmed/fdp088] [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: 11/12/2022] Open
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Shipman AR, Jones SE, Smith G, Stewart B, McCarthy N. A case of verocytotoxin-producing Escherichia coli O157 from a private barbecue in South East England. Euro Surveill 2009; 14. [DOI: 10.2807/ese.14.29.19273-en] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The following case report describes a cluster of Escherichia coli O157 cases in the United Kingdom related to undercooked beef at a barbecue, resulting in an intensive care admission in France with haemolytic uraemic syndrome and highlighting the need to cook beef properly.
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Affiliation(s)
- A R Shipman
- Thames Valley Health Protection Agency, Oxford, United Kingdom
| | - S E Jones
- Health Protection Agency Food Water and Environmental Microbiology Network (Southampton Laboratory), Southampton, United Kingdom
| | - G Smith
- Laboratory of Gastrointestinal Pathogens, Health Protection Agency Centre for Infections, London, United Kingdom
| | - B Stewart
- South Oxfordshire Environmental Health Office, Wallingford, United Kingdom
| | - N McCarthy
- Thames Valley Health Protection Agency, Oxford, United Kingdom
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Juraskova I, Butow P, Lopez A, Seccombe M, Coates A, Boyle F, McCarthy N, Reaby L, Forbes JF. Improving informed consent: pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS). Health Expect 2008; 11:252-62. [PMID: 18816321 PMCID: PMC5060455 DOI: 10.1111/j.1369-7625.2008.00498.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [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] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients and clinicians report difficulties with the process of informed consent to clinical trials and audiotape audits show that critical information is often omitted or poorly presented. Decision aids (DAs) may assist in improving consent. AIMS This study piloted a DA booklet for a high priority breast cancer prevention trial, IBIS-II DCIS, which compares the efficacy of an aromatase inhibitor (anastrozole) with tamoxifen in women who have had surgery for ductal carcinoma in situ (DCIS). METHOD Thirty-one Australian women participating in the IBIS-I breast cancer prevention trial and who are currently in follow-up agreed to read the IBIS-II DCIS participant information sheet and the DCIS DA booklet, complete a set of standardized questionnaires, and provide feedback on the DA via a semi-structured phone interview. RESULTS Women found the DA helpful in deciding about trial participation, reporting that it aided their understanding over and above the approved IBIS-II DCIS participant information sheet and was not anxiety provoking. Women's understanding of the rationale and methods of clinical trials and the IBIS-II DCIS trial was very good; with more than 80% of items answered correctly. The only areas that were not understood well were the concepts of randomization and blinding. CONCLUSIONS This study suggests that the DA will be acceptable to and valued by potential participants in the IBIS-II DCIS study. The revised DA is currently being evaluated prospectively in a randomized controlled trial. If successful, such DAs could transform the consent process to large clinical trials and may also reduce dropout rates.
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Affiliation(s)
- I Juraskova
- Medical Psychology Research Unit, School of Psychology, University of Sydney, Sydney, NSW, Australia.
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Oh S, Griffiths D, John T, Lee Y, Yu L, McCarthy N, Heath P, Crook D, Ramsay M, Moxon E, Pollard A. School‐Aged Children: A Reservoir for Continued Circulation ofHaemophilus influenzaeType b in the United Kingdom. J Infect Dis 2008; 197:1275-81. [DOI: 10.1086/586716] [Citation(s) in RCA: 36] [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: 11/03/2022] Open
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Paranthaman K, Balakrishnan R, Choudhury K, Sharma A, Maduma-Butshe A, Murrell L, McCarthy N, Haworth E, Pooransingh S. Contact tracing following exposure to measles at a wedding party in the United Kingdom, October 2007. Euro Surveill 2007; 12:E071129.2. [PMID: 18053567 DOI: 10.2807/esw.12.48.03319-en] [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] [Indexed: 05/25/2023] Open
Abstract
On 22 October 2007, a case of suspected measles in an unvaccinated two-year-old was notified to Thames Valley Health Protection Unit by North East and North Central London Health Protection Unit.
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Affiliation(s)
- K Paranthaman
- Thames Valley Health Protection Unit, Oxford and Aylesbury, United Kingdom.
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Frater AJ, Edwards CTT, McCarthy N, Fox J, Brown H, Milicic A, Mackie N, Pillay T, Drijfhout JW, Dustan S, Clarke JR, Holmes EC, Zhang HT, Pfafferott K, Goulder PJ, McClure MO, Weber J, Phillips RE, Fidler S. Passive sexual transmission of human immunodeficiency virus type 1 variants and adaptation in new hosts. J Virol 2006; 80:7226-34. [PMID: 16809328 PMCID: PMC1489048 DOI: 10.1128/jvi.02014-05] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [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: 11/20/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) genetic diversity is a major obstacle for the design of a successful vaccine. Certain viral polymorphisms encode human leukocyte antigen (HLA)-associated immune escape, potentially overcoming limited vaccine protection. Although transmission of immune escape variants has been reported, the overall extent to which this phenomenon occurs in populations and the degree to which it contributes to HIV-1 viral evolution are unknown. Selection on the HIV-1 env gene at transmission favors neutralization-sensitive variants, but it is not known to what degree selection acts on the internal HIV-1 proteins to restrict or enhance the transmission of immune escape variants. Studies have suggested that HLA class I may determine susceptibility to HIV-1 infection, but a definitive role for HLA at transmission remains unproven. Comparing populations of acute seroconverters and chronically infected patients, we found no evidence of selection acting to restrict transmission of HIV-1 variants. We found that statistical associations previously reported in chronic infection between viral polymorphisms and HLA class I alleles are not present in acute infection, suggesting that the majority of viral polymorphisms in these patients are the result of transmission rather than de novo adaptation. Using four episodes of HIV-1 transmission in which the donors and recipients were both sampled very close to the time of infection we found that, despite a transmission bottleneck, genetic variants of HIV-1 infection are transmitted in a frequency-dependent manner. As HIV-1 infections are seeded by unique donor-adapted viral variants, each episode is a highly individual antigenic challenge. Host-specific, idiosyncratic HIV-1 antigenic diversity will seriously tax the efficacy of immunization based on consensus sequences.
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Affiliation(s)
- A J Frater
- The James Martin 21st Century School, Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, United Kingdom
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McCarthy N, Kasten-Sportès C, Gress RE. Perspectives in post-transplantation immunotherapy in breast cancer. Breast Dis 2005; 14:69-79. [PMID: 15687637 DOI: 10.3233/bd-2001-14108] [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: 11/15/2022]
Abstract
High risk and metastatic breast cancer remain a major therapeutic challenge. Although the role of high dose chemotherapy followed by stem cell transplantation (SCT) in the overall treatment strategy is not yet well defined, it is clear that new forms of therapy such as immunotherapy will be needed to cure the majority of patients with advanced disease. We review important considerations for immunotherapy in the post-transplantation period. Experimental and clinical data suggest that immunotherapy may be most effective in a state of minimal residual disease such as that achieved following SCT. However, high dose therapy and autologous SCT result in an iatrogenic immune deficiency, which compounds the suppression of the immune system associated with tumor itself. Understanding reconstitution of a functional immune system post transplantation is critical in devising clinically effective immune interventions. A review of the clinical studies of post transplant immunotherapy for breast cancer is presented including autologous and allogeneic strategies, as well as perspectives for future development.
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Affiliation(s)
- N McCarthy
- Department of Experimental Transplantation & Immunology, Medicine Branch, National Cancer Institute, Bldg 10 Room 12 N226 10 Center Drive, MSC 1906, Bethesda, MD 20892, USA
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Collins CL, Salt P, McCarthy N, Chantler T, Lane L, Hemme F, Diggle L, Buttery J, Kitchin NRE, Moxon ER, Pollard AJ. Immunogenicity and safety of a low-dose diphtheria, tetanus and acellular pertussis combination vaccine with either inactivated or oral polio vaccine as a pre-school booster in UK children. Vaccine 2004; 22:4262-9. [PMID: 15474717 DOI: 10.1016/j.vaccine.2004.04.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [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: 01/26/2004] [Accepted: 04/26/2004] [Indexed: 11/24/2022]
Abstract
This open, randomised controlled trial studied the immunogenicity and reactogenicity of two combined low-dose diphtheria, tetanus and acellular pertussis vaccines (Td5aP-IPV, REPEVAX, Aventis Pasteur MSD; and Td5aP, COVAXIS, Aventis Pasteur MSD + OPV, GlaxoSmithKline) in comparison with a standard dose diphtheria pre-school booster vaccine (DT2aP-IPV, TETRAVAC, Aventis Pasteur MSD) in a population of 3.5-5-year-old children administered concomitantly with measles, mumps and rubella vaccine (M-M-R II, Aventis Pasteur MSD). A linked sub-study aimed to evaluate the immunogenicity and reactogenicity of Td5aP-IPV in a population of younger children, aged 3-3.5 years. This study demonstrated non-inferiority of seroprotection rates for diphtheria and tetanus for the study vaccines and comparable immunogenicity for pertussis and polio components of the vaccines. Reactogenicity was similar for all three vaccines. The study vaccines containing low-dose diphtheria antigen (Td5aP-IPV and Td5aP + OPV) are immunogenic and have acceptable reactogenicity for use as a pre-school booster vaccine administered concomitantly with MMR.
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Affiliation(s)
- C L Collins
- Oxford Vaccine Group, Centre for Clinical Vaccinology & Tropical Medicine, University of Oxford, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, UK
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Rennie KL, McCarthy N, Yazdgerdi S, Marmot M, Brunner E. Association of the metabolic syndrome with both vigorous and moderate physical activity. Int J Epidemiol 2003; 32:600-6. [PMID: 12913036 DOI: 10.1093/ije/dyg179] [Citation(s) in RCA: 192] [Impact Index Per Article: 9.1] [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: 01/31/2023] Open
Abstract
BACKGROUND Cross-sectional relationships between moderate and vigorous physical activity and the metabolic syndrome (MS) were examined in the Whitehall II study of civil servants (age 45-68 years). We assessed cardiovascular fitness and body mass index (BMI) as possible mediators of the observed association. METHODS Measures of 2-hour glucose, systolic blood pressure, fasting triglycerides, waist-hip ratio, and high density lipoprotein (HDL) cholesterol were obtained in 5153 white European participants. Participants in the most adverse sex-specific quintile for three or more of these risk factors were classified as having MS. Self-reported leisure-time physical activity was categorized into separate moderate and vigorous activity classes. BMI and resting heart rate (HR) were used to estimate body fatness and cardiovascular fitness respectively. RESULTS The odds ratios (95% CI) for having the metabolic syndrome in the top categories of vigorous and moderate activity were 0.52 (95% CI: 0.40, 0.67) and 0.78 (95% CI: 0.63, 0.96) respectively, adjusted for age, sex, smoking, alcohol intake, socioeconomic status, and other activity. Adjustment for BMI and resting HR substantially attenuated both of the above associations. CONCLUSIONS Moderate and vigorous physical leisure-time activity are each associated with reduced risk of being classified with MS independently of age, smoking, and high alcohol intake. Both vigorous and moderate activities may be beneficial to the MS cluster of risk factors among middle-aged populations. Reduced BMI and increased cardiovascular fitness may be important mediators of this association for both intensities of activity.
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Affiliation(s)
- K L Rennie
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
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O'Toole G, MacKenzie D, Lindeman R, Buckley MF, Marucci D, McCarthy N, Poole M. Vascular endothelial growth factor gene therapy in ischaemic rat skin flaps. Br J Plast Surg 2002; 55:55-8. [PMID: 11783969 DOI: 10.1054/bjps.2001.3741] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gene therapy with the complementary DNA (cDNA) of the angiogenic cytokine vascular endothelial growth factor (VEGF) has emerged as a promising strategy in the treatment of myocardial and lower-limb ischaemia. The objective of this study was to determine whether these principles could be applied to a recognised model of skin-flap ischaemia. Plasmid vectors including the cDNA of green fluorescent protein (GFP) and one of three VEGF isoforms (A165, B167 or B186) were constructed, and their base sequences confirmed. GFP expression was used as a marker of successful in vitro transfection of human endothelial cells with each plasmid. The plasmids were then administered subcutaneously to rat abdominal skin flaps surgically rendered ischaemic, and the percentage of viable tissue was assessed at 1 week. Angiograms of the flaps and histological preparations of flap tissue were assessed for evidence of angiogenesis. The survival of flaps treated with VEGF A165 or B167 cDNA was significantly greater than that of controls (P < 0.05). The survival of flaps treated with VEGF B186 cDNA was greater than that of controls, but statistical significance was not reached. Angiograms and microvessel density counts failed to produce evidence of angiogenesis. With improved delivery strategies, VEGF may have a role in the management of surgical ischaemia.
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Affiliation(s)
- G O'Toole
- Department of Plastic and Reconstructive Surgery, St George Hospital, Sydney, New South Wales, Australia
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Iohom G, Collins I, Murphy D, Awad I, O'Connor G, McCarthy N, Shorten G. Postoperative changes in visual evoked potentials and cognitive function tests following sevoflurane anaesthesia. Br J Anaesth 2001; 87:855-9. [PMID: 11878686 DOI: 10.1093/bja/87.6.855] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We tested the hypothesis that minor disturbance of the visual pathway persists following general anaesthesia even when clinical discharge criteria are met. To test this, we measured visual evoked potentials (VEPs) in 13 ASA I or II patients who did not receive any pre-anaesthetic medication and underwent sevoflurane anaesthesia. VEPs were recorded on four occasions, before anaesthesia and at 30, 60, and 90 min after emergence from anaesthesia. Patients completed visual analogue scales (VAS) for sedation and anxiety, a Trieger Dot Test (TDT) and a Digit Symbol Substitution Test (DSST) immediately before each VEP recording. These results were compared using Student's t-test. P<0.05 was considered significant. VEP latency was prolonged (P<0.001) and amplitude diminished (P<0.05) at 30, 60, and 90 min after emergence from anaesthesia, when VAS scores for sedation and anxiety, TDT, and DSST had returned to pre-anaesthetic levels.
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Affiliation(s)
- G Iohom
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and National University of Ireland, Republic of Ireland
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Abstract
This study sought to: a) ascertain the effect on rates of violence by varying its operational definition and b) compare characteristics of violent and nonviolent patients. Aggressive behavior was recorded daily for every patient (N = 78) during a 2-year period. Standardized rating scales were used to rate psychopathology and functioning. Almost two thirds of patients were aggressive to others, and 26% violently assaulted another person. Official incident reports underestimated rates of violence to others, self- harm, and property damage. Multivariate predictive models that greatly improved accuracy over base rates showed that violent patients tended to be female, schizophrenic (nonparanoid type), and abusive of alcohol before admission. Violence is more common in treatment resistant psychotic inpatients than suggested by incident reports. Standardized definitions of violence are urged in order to accurately study its prevalence and correlates. Models combining both historical/demographic and clinical data may enhance prediction of violence.
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Affiliation(s)
- T S Ehmann
- Department of Psychiatry, St Vincent's Hospital, Vancouver, British Columbia, Canada
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Brunner E, McCarthy N. Adult obesity depends on genes and environment. BMJ 2001; 323:52. [PMID: 11464835 PMCID: PMC1120685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Abstract
Evidence of recent or ongoing Campylobacter jejuni infection has been found in approximately one out of every four cases of Guillain-Barré syndrome (GBS). It is increasingly accepted that C. jejuni infection is an important causal factor for GBS. However, the likelihood of GBS' occurring following an episode of C. jejuni gastroenteritis has not been measured. The authors measured the incidence of GBS in a large cohort of persons with laboratory-confirmed C. jejuni infection. Cases of C. jejuni infection were derived from the Swedish national laboratory reporting system for the years 1987--1995. Follow-up for GBS was carried out using the Swedish national hospital inpatient register. Nine cases of GBS were detected in the cohort, which comprised 29,563 cases of C. jejuni infection--a rate of 30.4 per 100,000 (95% confidence interval: 13.9, 57.8). This compares with an expected incidence of 0.3 per 100,000 in a 2-month period in the general population. GBS is an important but rare complication of C. jejuni infection. The risk of developing GBS during the 2 months following a symptomatic episode of C. jejuni infection is approximately 100 times higher than the risk in the general population.
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Affiliation(s)
- N McCarthy
- Swedish Institute for Infectious Disease Control, SE-171 82, Solna, Sweden.
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Abstract
In the general population, low birthweight (LBW) is associated with neurological and psychological problems during childhood and adolescence. LBW may result from premature birth or poor fetal growth, and the independent effects of these two events on childhood development are not fully understood. The rate of low weight births is increased in schizophrenia and is associated with social withdrawal during childhood and an early onset of illness. However, it is unclear whether this LBW reflects poor fetal growth or premature birth, or whether these two risk factors have distinct implications for childhood functioning and age at onset of schizophrenia. Subjects included 270 patients with schizophrenia for whom a detailed history of obstetric events could be obtained. The rate of low weight births was high and was associated with poorer premorbid functioning and an earlier age at illness onset. The rate of both premature births and poor fetal growth was high relative to the normal population. Prematurity, but not poor fetal growth, was associated with premorbid social withdrawal and an early age at illness onset. Poor fetal growth, but not prematurity, was associated with low educational achievement. These results suggest that poor fetal growth and prematurity are associated with distinct patterns of childhood maladjustment in individuals who develop schizophrenia.
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Affiliation(s)
- G N Smith
- Department of Psychiatry, University of British Columbia, Vancouver Hospital Research Pavilion, 828 West 10th Avenue, BC V5Z 1L8, Vancouver, BC, V5Z 1L8, Canada.
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Abstract
c-Myc and p53 are two proteins that have critical roles in the regulation of apoptosis and the cell cycle. The authors review how these two proteins are thought to control the opposing events of proliferation and apoptosis and examine whether their well-documented biological roles in tumorigenesis can be applied to the vascular system.
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Affiliation(s)
- N McCarthy
- Division of Cardiovascular Medicine, Addenbrookes Hospital, Cambridge, United Kingdom
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