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Keet C, Sicherer SH, Bunyavanich S, Visness C, Fulkerson PC, Togias A, Davidson W, Perry S, Hamrah S, Calatroni A, Robinson K, Dunaway L, Davis CM, Anvari S, Leong-Kee SM, Hershey GK, DeFranco E, Devonshire A, Kim H, Joseph C, Davidson B, Strong NK, Tsuang AJ, Groetch M, Wang J, Dantzer J, Mudd K, Aina A, Shreffler W, Yuan Q, Simmons V, Leung DY, Hui-Beckman J, Ramos JA, Chinthrajah S, Winn V, Sindher T, Jones SM, Manning NA, Scurlock AM, Kim E, Stuebe A, Gern JE, Singh AM, Krupp J, Wood RA. The SunBEAm birth cohort: Protocol design. J Allergy Clin Immunol Glob 2023; 2:100124. [PMID: 37771674 PMCID: PMC10509956 DOI: 10.1016/j.jacig.2023.100124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 09/30/2023]
Abstract
Background Food allergy (FA) and atopic dermatitis (AD) are common conditions that often present in the first year of life. Identification of underlying mechanisms and environmental determinants of FA and AD is essential to develop and implement effective prevention and treatment strategies. Objectives: We sought to describe the design of the Systems Biology of Early Atopy (SunBEAm) birth cohort. Methods Funded by the National Institute of Allergy and Infectious Diseases (NIAID) and administered through the Consortium for Food Allergy Research (CoFAR), SunBEAm is a US population-based, multicenter birth cohort that enrolls pregnant mothers, fathers, and their newborns and follows them to 3 years. Questionnaire and biosampling strategies were developed to apply a systems biology approach to identify environmental, immunologic, and multiomic determinants of AD, FA, and other allergic outcomes. Results Enrollment is currently underway. On the basis of an estimated FA prevalence of 6%, the enrollment goal is 2500 infants. AD is defined on the basis of questionnaire and assessment, and FA is defined by an algorithm combining history and testing. Although any FA will be recorded, we focus on the diagnosis of egg, milk, and peanut at 5 months, adding wheat, soy, cashew, hazelnut, walnut, codfish, shrimp, and sesame starting at 12 months. Sampling includes blood, hair, stool, dust, water, tape strips, skin swabs, nasal secretions, nasal swabs, saliva, urine, functional aspects of the skin, and maternal breast milk and vaginal swabs. Conclusions The SunBEAm birth cohort will provide a rich repository of data and specimens to interrogate mechanisms and determinants of early allergic outcomes, with an emphasis on FA, AD, and systems biology.
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Affiliation(s)
- Corinne Keet
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Patricia C. Fulkerson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Alkis Togias
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Wendy Davidson
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Susan Perry
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Sanaz Hamrah
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | | | - Lars Dunaway
- Rho Inc, Federal Research Operations, Durham, NC
| | - Carla M. Davis
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Sara Anvari
- Department of Pediatrics, Baylor College of Medicine, Houston, Tex
| | - Susan M. Leong-Kee
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Tex
| | | | | | | | | | | | | | | | | | | | - Julie Wang
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Dantzer
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kim Mudd
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Abimbola Aina
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Qian Yuan
- Massachusetts General Hospital, Newton-Wellesley Hospital, Newton, Mass
| | - Virginia Simmons
- Massachusetts General Hospital, Newton-Wellesley Hospital, Newton, Mass
| | | | | | | | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Virginia Winn
- Division Maternal Fetal Medicine and Obstetrics, Stanford University, Palo Alto, Calif
| | - Tina Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, Calif
| | - Stacie M. Jones
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | | | - Amy M. Scurlock
- University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Ark
| | - Edwin Kim
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin, Madison, Wis
| | | | - Jennifer Krupp
- Maternal and Fetal Medicine, Obstetrics and Gynecology, SSM Health, Madison, Wis
| | - Robert A. Wood
- Department of Pediatrics, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Md
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Lenin RB, Lowery CL, Hitt WC, Manning NA, Lowery P, Eswaran H. Optimizing appointment template and number of staff of an OB/GYN clinic--micro and macro simulation analyses. BMC Health Serv Res 2015; 15:387. [PMID: 26376782 PMCID: PMC4572647 DOI: 10.1186/s12913-015-1007-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background The Department of Obstetrics and Gynecology (OB/GYN) at the University of Arkansas for Medical Sciences (UAMS) tested various, new system-restructuring ideas such as varying number of different types of nurses to reduce patient wait times for its outpatient clinic, often with little or no effect on waiting time. Witnessing little progress despite these time-intensive interventions, we sought an alternative way to intervene the clinic without affecting the normal clinic operations. Aim The aim is to identify the optimal (1) time duration between appointments and (2) number of nurses to reduce wait time of patients in the clinic. Methods We developed a discrete-event computer simulation model for the OB/GYN clinic. By using the patient tracker (PT) data, appropriate probability distributions of service times of staff were fitted to model different variability in staff service times. These distributions were used to fine-tune the simulation model. We then validated the model by comparing the simulated wait times with the actual wait times calculated from the PT data. The validated model was then used to carry out “what-if” analyses. Results The best scenario yielded 16 min between morning appointments, 19 min between afternoon appointments, and addition of one medical assistant. Besides removing all peak wait times and bottlenecks around noon and late in the afternoon, the best scenario yielded 39.84 % (p<.001), 30.31 % (p<.001), and 15.12 % (p<.001) improvement in patients’ average wait times for providers in the exam rooms, average total wait time at various locations and average total spent time in the clinic, respectively. This is achieved without any compromise in the utilization of the staff and in serving all patients by 5pm. Conclusions A discrete-event simulation model is developed, validated, and used to carry out “what-if” scenarios to identify the optimal time between appointments and number of nurses. Using the model, we achieved a significant improvement in wait time of patients in the clinic, which the clinic management initially had difficulty achieving through manual interventions. The model provides a tool for the clinic management to test new ideas to improve the performance of other UAMS OB/GYN clinics.
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Affiliation(s)
- R B Lenin
- Department of Mathematics, University of Central Arkansas, 201 Donaghey Avenue, Conway, 72035, Arkansas, USA.
| | - Curtis L Lowery
- Department of OB/GYN, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA.
| | - Wilbur C Hitt
- Department of OB/GYN, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA.
| | - Nirvana A Manning
- Department of OB/GYN, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA.
| | - Peter Lowery
- College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA.
| | - Hari Eswaran
- Department of OB/GYN, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, 72205, Arkansas, USA.
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Greenfield WW, Stratton SL, Myrick RS, Vaughn R, Donnalley LM, Coleman HN, Mercado M, Moerman-Herzog AM, Spencer HJ, Andrews-Collins NR, Hitt WC, Low GM, Manning NA, McKelvey SS, Smith D, Smith MV, Phillips AM, Quick CM, Jeffus SK, Hutchins LF, Nakagawa M. A phase I dose-escalation clinical trial of a peptide-based human papillomavirus therapeutic vaccine with Candida skin test reagent as a novel vaccine adjuvant for treating women with biopsy-proven cervical intraepithelial neoplasia 2/3. Oncoimmunology 2015; 4:e1031439. [PMID: 26451301 DOI: 10.1080/2162402x.2015.1031439] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 02/06/2015] [Revised: 03/02/2015] [Accepted: 03/15/2015] [Indexed: 01/09/2023] Open
Abstract
PURPOSE: Non-surgical treatments for cervical intraepithelial neoplasia 2/3 (CIN2/3) are needed as surgical treatments have been shown to double preterm delivery rate. The goal of this study was to demonstrate safety of a human papillomavirus (HPV) therapeutic vaccine called PepCan, which consists of four current good-manufacturing production-grade peptides covering the HPV type 16 E6 protein and Candida skin test reagent as a novel adjuvant. PATIENTS AND METHODS: The study was a single-arm, single-institution, dose-escalation phase I clinical trial, and the patients (n = 24) were women with biopsy-proven CIN2/3. Four injections were administered intradermally every 3 weeks in limbs. Loop electrical excision procedure (LEEP) was performed 12 weeks after the last injection for treatment and histological analysis. Six subjects each were enrolled (50, 100, 250, and 500 μg per peptide). RESULTS: The most common adverse events (AEs) were injection site reactions, and none of the patients experienced dose-limiting toxicities. The best histological response was seen at the 50 μg dose level with a regression rate of 83% (n = 6), and the overall rate was 52% (n = 23). Vaccine-induced immune responses to E6 were detected in 65% of recipients (significantly in 43%). Systemic T-helper type 1 (Th1) cells were significantly increased after four vaccinations (P = 0.02). CONCLUSION: This study demonstrated that PepCan is safe. A significantly increased systemic level of Th1 cells suggests that Candida, which induces interleukin-12 (IL-12) in vitro, may have a Th1 promoting effect. A phase II clinical trial to assess the full effect of this vaccine is warranted.
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Affiliation(s)
- William W Greenfield
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Shawna L Stratton
- College of Medicine; Translational Research Institute; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Rebecca S Myrick
- College of Medicine; Translational Research Institute; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Rita Vaughn
- College of Medicine; Translational Research Institute; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Lisa M Donnalley
- College of Medicine; Translational Research Institute; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Hannah N Coleman
- Pathology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Maria Mercado
- Pathology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | | | - Horace J Spencer
- Biostatistics; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Nancy R Andrews-Collins
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Wilbur C Hitt
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Gordon M Low
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Nirvana A Manning
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Samantha S McKelvey
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Dora Smith
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Michael V Smith
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Amy M Phillips
- Departments of Obstetrics and Gynecology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - C Matthew Quick
- Pathology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Susanne K Jeffus
- Pathology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Laura F Hutchins
- Medicine (Hematology-Oncology Division); University of Arkansas for Medical Sciences ; Little Rock, AR USA
| | - Mayumi Nakagawa
- Pathology; University of Arkansas for Medical Sciences ; Little Rock, AR USA
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