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Pike CM, Zwarycz B, McQueen BE, Castillo M, Barron C, Morowitz JM, Levi JA, Phadke D, Balik-Meisner M, Mav D, Shah R, Cunningham Glasspoole DL, Laetham R, Thelin W, Bunger MK, Boazak EM. Characterization and optimization of variability in a human colonic epithelium culture model. ALTEX 2024. [PMID: 38641922 DOI: 10.14573/altex.2309221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
Animal models have historically been poor preclinical predictors of gastrointestinal (GI) directed therapeutic efficacy and drug-induced GI toxicity. Human stem and primary cell-derived culture systems are a major focus of efforts to create biologically relevant models that enhance preclinical predictive value of intestinal efficacy and toxicity. The inherent variability in stem-cell-based cultures makes development of useful models a challenge; the stochastic nature of stem-cell differentiation interferes with the ability to build and validate reproducible assays that query drug responses and pharmacokinetics. In this study, we aimed to characterize and reduce sources of variability in a complex stem cell-derived intestinal epithelium model, termed RepliGut® Planar, across cells from multiple human donors, cell lots, and passage numbers. Assessment criteria included barrier formation and integrity, gene expression, and cytokine responses. Gene expression and culture metric analyses revealed that controlling cell passage number reduces variability and maximizes physiological relevance of the model. In a case study where passage number was optimized, distinct cytokine responses were observed among four human donors, indicating that biological variability can be detected in cell cultures originating from diverse human sources. These findings highlight key considerations for designing assays that can be applied to additional primary-cell derived systems, as well as establish utility of the RepliGut® Planar platform for robust development of human-predictive drug-response assays.
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Abbasi R, Ackermann M, Adams J, Agarwalla SK, Aguilar JA, Ahlers M, Alameddine JM, Amin NM, Andeen K, Anton G, Argüelles C, Ashida Y, Athanasiadou S, Axani SN, Bai X, Balagopal VA, Baricevic M, Barwick SW, Basu V, Bay R, Beatty JJ, Becker Tjus J, Beise J, Bellenghi C, Benning C, BenZvi S, Berley D, Bernardini E, Besson DZ, Blaufuss E, Blot S, Bontempo F, Book JY, Boscolo Meneguolo C, Böser S, Botner O, Böttcher J, Bourbeau E, Braun J, Brinson B, Brostean-Kaiser J, Burley RT, Busse RS, Butterfield D, Campana MA, Carloni K, Carnie-Bronca EG, Chattopadhyay S, Chau N, Chen C, Chen Z, Chirkin D, Choi S, Clark BA, Classen L, Coleman A, Collin GH, Connolly A, Conrad JM, Coppin P, Correa P, Cowen DF, Dave P, De Clercq C, DeLaunay JJ, Delgado D, Deng S, Deoskar K, Desai A, Desiati P, de Vries KD, de Wasseige G, DeYoung T, Diaz A, Díaz-Vélez JC, Dittmer M, Domi A, Dujmovic H, DuVernois MA, Ehrhardt T, Eller P, Ellinger E, El Mentawi S, Elsässer D, Engel R, Erpenbeck H, Evans J, Evenson PA, Fan KL, Fang K, Farrag K, Fazely AR, Feigl N, Fiedlschuster S, Fienberg AT, Finley C, Fischer L, Fox D, Franckowiak A, Fritz A, Fürst P, Gallagher J, Ganster E, Garcia A, Gerhardt L, Ghadimi A, Glaser C, Glauch T, Glüsenkamp T, Goehlke N, Gonzalez JG, Goswami S, Grant D, Gray SJ, Gries O, Griffin S, Griswold S, Groth KM, Günther C, Gutjahr P, Haack C, Hallgren A, Halliday R, Halve L, Halzen F, Hamdaoui H, Ha Minh M, Hanson K, Hardin J, Harnisch AA, Hatch P, Haungs A, Helbing K, Hellrung J, Henningsen F, Heuermann L, Heyer N, Hickford S, Hidvegi A, Hill C, Hill GC, Hoffman KD, Hori S, Hoshina K, Hou W, Huber T, Hultqvist K, Hünnefeld M, Hussain R, Hymon K, In S, Ishihara A, Jacquart M, Janik O, Jansson M, Japaridze GS, Jeong M, Jin M, Jones BJP, Kang D, Kang W, Kang X, Kappes A, Kappesser D, Kardum L, Karg T, Karl M, Karle A, Katz U, Kauer M, Kelley JL, Khatee Zathul A, Kheirandish A, Kiryluk J, Klein SR, Kochocki A, Koirala R, Kolanoski H, Kontrimas T, Köpke L, Kopper C, Koskinen DJ, Koundal P, Kovacevich M, Kowalski M, Kozynets T, Krishnamoorthi J, Kruiswijk K, Krupczak E, Kumar A, Kun E, Kurahashi N, Lad N, Lagunas Gualda C, Lamoureux M, Larson MJ, Latseva S, Lauber F, Lazar JP, Lee JW, Leonard DeHolton K, Leszczyńska A, Lincetto M, Liu QR, Liubarska M, Lohfink E, Love C, Lozano Mariscal CJ, Lucarelli F, Luszczak W, Lyu Y, Madsen J, Mahn KBM, Makino Y, Manao E, Mancina S, Marie Sainte W, Mariş IC, Marka S, Marka Z, Marsee M, Martinez-Soler I, Maruyama R, Mayhew F, McElroy T, McNally F, Mead JV, Meagher K, Mechbal S, Medina A, Meier M, Merckx Y, Merten L, Micallef J, Mitchell J, Montaruli T, Moore RW, Morii Y, Morse R, Moulai M, Mukherjee T, Naab R, Nagai R, Nakos M, Naumann U, Necker J, Negi A, Neumann M, Niederhausen H, Nisa MU, Noell A, Novikov A, Nowicki SC, Obertacke Pollmann A, O'Dell V, Oehler M, Oeyen B, Olivas A, Orsoe R, Osborn J, O'Sullivan E, Pandya H, Pankova DV, Park N, Parker GK, Paudel EN, Paul L, Pérez de Los Heros C, Peterson J, Philippen S, Pizzuto A, Plum M, Pontén A, Popovych Y, Prado Rodriguez M, Pries B, Procter-Murphy R, Przybylski GT, Raab C, Rack-Helleis J, Rawlins K, Rechav Z, Rehman A, Reichherzer P, Renzi G, Resconi E, Reusch S, Rhode W, Riedel B, Rifaie A, Roberts EJ, Robertson S, Rodan S, Roellinghoff G, Rongen M, Rott C, Ruhe T, Ruohan L, Ryckbosch D, Safa I, Saffer J, Salazar-Gallegos D, Sampathkumar P, Sanchez Herrera SE, Sandrock A, Santander M, Sarkar S, Sarkar S, Savelberg J, Savina P, Schaufel M, Schieler H, Schindler S, Schlickmann L, Schlüter B, Schlüter F, Schmeisser N, Schmidt T, Schneider J, Schröder FG, Schumacher L, Schwefer G, Sclafani S, Seckel D, Seikh M, Seunarine S, Shah R, Sharma A, Shefali S, Shimizu N, Silva M, Skrzypek B, Smithers B, Snihur R, Soedingrekso J, Søgaard A, Soldin D, Soldin P, Sommani G, Spannfellner C, Spiczak GM, Stamatikos M, Stanev T, Stezelberger T, Stürwald T, Stuttard T, Sullivan GW, Taboada I, Ter-Antonyan S, Thiesmeyer M, Thompson WG, Thwaites J, Tilav S, Tollefson K, Tönnis C, Toscano S, Tosi D, Trettin A, Tung CF, Turcotte R, Twagirayezu JP, Ty B, Unland Elorrieta MA, Upadhyay AK, Upshaw K, Valtonen-Mattila N, Vandenbroucke J, van Eijndhoven N, Vannerom D, van Santen J, Vara J, Veitch-Michaelis J, Venugopal M, Vereecken M, Verpoest S, Veske D, Vijai A, Walck C, Weaver C, Weigel P, Weindl A, Weldert J, Wen AY, Wendt C, Werthebach J, Weyrauch M, Whitehorn N, Wiebusch CH, Willey N, Williams DR, Witthaus L, Wolf A, Wolf M, Wrede G, Xu XW, Yanez JP, Yildizci E, Yoshida S, Young R, Yu F, Yu S, Zhang Z, Zhelnin P, Zilberman P, Zimmerman M. Observation of Seven Astrophysical Tau Neutrino Candidates with IceCube. Phys Rev Lett 2024; 132:151001. [PMID: 38682982 DOI: 10.1103/physrevlett.132.151001] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 05/01/2024]
Abstract
We report on a measurement of astrophysical tau neutrinos with 9.7 yr of IceCube data. Using convolutional neural networks trained on images derived from simulated events, seven candidate ν_{τ} events were found with visible energies ranging from roughly 20 TeV to 1 PeV and a median expected parent ν_{τ} energy of about 200 TeV. Considering backgrounds from astrophysical and atmospheric neutrinos, and muons from π^{±}/K^{±} decays in atmospheric air showers, we obtain a total estimated background of about 0.5 events, dominated by non-ν_{τ} astrophysical neutrinos. Thus, we rule out the absence of astrophysical ν_{τ} at the 5σ level. The measured astrophysical ν_{τ} flux is consistent with expectations based on previously published IceCube astrophysical neutrino flux measurements and neutrino oscillations.
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Affiliation(s)
- R Abbasi
- Department of Physics, Loyola University Chicago, Chicago, Illinois 60660, USA
| | - M Ackermann
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - J Adams
- Department of Physics and Astronomy, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
| | - S K Agarwalla
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J A Aguilar
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - M Ahlers
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - J M Alameddine
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - N M Amin
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - K Andeen
- Department of Physics, Marquette University, Milwaukee, Wisconsin 53201, USA
| | - G Anton
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - C Argüelles
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - Y Ashida
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84112, USA
| | - S Athanasiadou
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - S N Axani
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - X Bai
- Physics Department, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - V A Balagopal
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Baricevic
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S W Barwick
- Department of Physics and Astronomy, University of California, Irvine, California 92697, USA
| | - V Basu
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - R Bay
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - J J Beatty
- Department of Astronomy, Ohio State University, Columbus, Ohio 43210, USA
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - J Becker Tjus
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - J Beise
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - C Bellenghi
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - C Benning
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - S BenZvi
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - D Berley
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - E Bernardini
- Dipartimento di Fisica e Astronomia Galileo Galilei, Università Degli Studi di Padova, 35122 Padova PD, Italy
| | - D Z Besson
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - E Blaufuss
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S Blot
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - F Bontempo
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - J Y Book
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C Boscolo Meneguolo
- Dipartimento di Fisica e Astronomia Galileo Galilei, Università Degli Studi di Padova, 35122 Padova PD, Italy
| | - S Böser
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - O Botner
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - J Böttcher
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - E Bourbeau
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - J Braun
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B Brinson
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - J Brostean-Kaiser
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - R T Burley
- Department of Physics, University of Adelaide, Adelaide, 5005, Australia
| | - R S Busse
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - D Butterfield
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M A Campana
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - K Carloni
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - E G Carnie-Bronca
- Department of Physics, University of Adelaide, Adelaide, 5005, Australia
| | - S Chattopadhyay
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - N Chau
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - C Chen
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - Z Chen
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, New York 11794-3800, USA
| | - D Chirkin
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Choi
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - B A Clark
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - L Classen
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - A Coleman
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - G H Collin
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Connolly
- Department of Astronomy, Ohio State University, Columbus, Ohio 43210, USA
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - J M Conrad
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - P Coppin
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - P Correa
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - D F Cowen
- Department of Astronomy and Astrophysics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - P Dave
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - C De Clercq
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - J J DeLaunay
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - D Delgado
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - S Deng
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - K Deoskar
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - A Desai
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - P Desiati
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K D de Vries
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - G de Wasseige
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - T DeYoung
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Diaz
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J C Díaz-Vélez
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Dittmer
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - A Domi
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - H Dujmovic
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M A DuVernois
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - T Ehrhardt
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - P Eller
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - E Ellinger
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - S El Mentawi
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - D Elsässer
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - R Engel
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - H Erpenbeck
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Evans
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - P A Evenson
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - K L Fan
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - K Fang
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Farrag
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - A R Fazely
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - N Feigl
- Institut für Physik, Humboldt-Universität zu Berlin, D-12489 Berlin, Germany
| | - S Fiedlschuster
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - A T Fienberg
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - C Finley
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - L Fischer
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - D Fox
- Department of Astronomy and Astrophysics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - A Franckowiak
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - A Fritz
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - P Fürst
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - J Gallagher
- Department of Astronomy, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - E Ganster
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - A Garcia
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - L Gerhardt
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - A Ghadimi
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - C Glaser
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - T Glauch
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - T Glüsenkamp
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - N Goehlke
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - J G Gonzalez
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - S Goswami
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - D Grant
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - S J Gray
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - O Gries
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - S Griffin
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Griswold
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - K M Groth
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - C Günther
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - P Gutjahr
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - C Haack
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - A Hallgren
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - R Halliday
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - L Halve
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - F Halzen
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - H Hamdaoui
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, New York 11794-3800, USA
| | - M Ha Minh
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - K Hanson
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Hardin
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A A Harnisch
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - P Hatch
- Department of Physics, Engineering Physics, and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - A Haungs
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - K Helbing
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - J Hellrung
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - F Henningsen
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - L Heuermann
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - N Heyer
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - S Hickford
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - A Hidvegi
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - C Hill
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - G C Hill
- Department of Physics, University of Adelaide, Adelaide, 5005, Australia
| | - K D Hoffman
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S Hori
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Hoshina
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - W Hou
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - T Huber
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - K Hultqvist
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - M Hünnefeld
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - R Hussain
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Hymon
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - S In
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - A Ishihara
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - M Jacquart
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - O Janik
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - M Jansson
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - G S Japaridze
- CTSPS, Clark-Atlanta University, Atlanta, Georgia 30314, USA
| | - M Jeong
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - M Jin
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - B J P Jones
- Department of Physics, University of Texas at Arlington, 502 Yates St., Science Hall Rm 108, Box 19059, Arlington, Texas 76019, USA
| | - D Kang
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - W Kang
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - X Kang
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - A Kappes
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - D Kappesser
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - L Kardum
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - T Karg
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - M Karl
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - A Karle
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - U Katz
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - M Kauer
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J L Kelley
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Khatee Zathul
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Kheirandish
- Department of Physics & Astronomy, University of Nevada, Las Vegas, Nevada, 89154, USA
- Nevada Center for Astrophysics, University of Nevada, Las Vegas, Nevada 89154, USA
| | - J Kiryluk
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, New York 11794-3800, USA
| | - S R Klein
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - A Kochocki
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - R Koirala
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - H Kolanoski
- Institut für Physik, Humboldt-Universität zu Berlin, D-12489 Berlin, Germany
| | - T Kontrimas
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - L Köpke
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - C Kopper
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - D J Koskinen
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - P Koundal
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - M Kovacevich
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - M Kowalski
- Institut für Physik, Humboldt-Universität zu Berlin, D-12489 Berlin, Germany
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - T Kozynets
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - J Krishnamoorthi
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Kruiswijk
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - E Krupczak
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Kumar
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - E Kun
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - N Kurahashi
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - N Lad
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - C Lagunas Gualda
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - M Lamoureux
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - M J Larson
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S Latseva
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - F Lauber
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - J P Lazar
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J W Lee
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - K Leonard DeHolton
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - A Leszczyńska
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - M Lincetto
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - Q R Liu
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Liubarska
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - E Lohfink
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - C Love
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - C J Lozano Mariscal
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - F Lucarelli
- Département de physique nucléaire et corpusculaire, Université de Genève, CH-1211 Genève, Switzerland
| | - W Luszczak
- Department of Astronomy, Ohio State University, Columbus, Ohio 43210, USA
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - Y Lyu
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J Madsen
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K B M Mahn
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - Y Makino
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - E Manao
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - S Mancina
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
- Dipartimento di Fisica e Astronomia Galileo Galilei, Università Degli Studi di Padova, 35122 Padova PD, Italy
| | - W Marie Sainte
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - I C Mariş
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - S Marka
- Columbia Astrophysics and Nevis Laboratories, Columbia University, New York, New York 10027, USA
| | - Z Marka
- Columbia Astrophysics and Nevis Laboratories, Columbia University, New York, New York 10027, USA
| | - M Marsee
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - I Martinez-Soler
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - R Maruyama
- Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - F Mayhew
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - T McElroy
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - F McNally
- Department of Physics, Mercer University, Macon, Georgia 31207-0001, USA
| | - J V Mead
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - K Meagher
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Mechbal
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - A Medina
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - M Meier
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - Y Merckx
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - L Merten
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - J Micallef
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Mitchell
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - T Montaruli
- Département de physique nucléaire et corpusculaire, Université de Genève, CH-1211 Genève, Switzerland
| | - R W Moore
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - Y Morii
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - R Morse
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Moulai
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - T Mukherjee
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - R Naab
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - R Nagai
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - M Nakos
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - U Naumann
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - J Necker
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - A Negi
- Department of Physics, University of Texas at Arlington, 502 Yates St., Science Hall Rm 108, Box 19059, Arlington, Texas 76019, USA
| | - M Neumann
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - H Niederhausen
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - M U Nisa
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Noell
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - A Novikov
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - S C Nowicki
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Obertacke Pollmann
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - V O'Dell
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Oehler
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - B Oeyen
- Department of Physics and Astronomy, University of Gent, B-9000 Gent, Belgium
| | - A Olivas
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - R Orsoe
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - J Osborn
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - E O'Sullivan
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - H Pandya
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - D V Pankova
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - N Park
- Department of Physics, Engineering Physics, and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - G K Parker
- Department of Physics, University of Texas at Arlington, 502 Yates St., Science Hall Rm 108, Box 19059, Arlington, Texas 76019, USA
| | - E N Paudel
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - L Paul
- Department of Physics, Marquette University, Milwaukee, Wisconsin 53201, USA
- Physics Department, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - C Pérez de Los Heros
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - J Peterson
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Philippen
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - A Pizzuto
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Plum
- Physics Department, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - A Pontén
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - Y Popovych
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - M Prado Rodriguez
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B Pries
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - R Procter-Murphy
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - G T Przybylski
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C Raab
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - J Rack-Helleis
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - K Rawlins
- Department of Physics and Astronomy, University of Alaska Anchorage, 3211 Providence Dr., Anchorage, Alaska 99508, USA
| | - Z Rechav
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Rehman
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - P Reichherzer
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - G Renzi
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - E Resconi
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - S Reusch
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - W Rhode
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - B Riedel
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Rifaie
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - E J Roberts
- Department of Physics, University of Adelaide, Adelaide, 5005, Australia
| | - S Robertson
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - S Rodan
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - G Roellinghoff
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - M Rongen
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - C Rott
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84112, USA
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - T Ruhe
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - L Ruohan
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - D Ryckbosch
- Department of Physics and Astronomy, University of Gent, B-9000 Gent, Belgium
| | - I Safa
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Saffer
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - D Salazar-Gallegos
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - P Sampathkumar
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - S E Sanchez Herrera
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Sandrock
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - M Santander
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - S Sarkar
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - S Sarkar
- Department of Physics, University of Oxford, Parks Road, Oxford OX1 3PU, United Kingdom
| | - J Savelberg
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - P Savina
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Schaufel
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - H Schieler
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - S Schindler
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - L Schlickmann
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - B Schlüter
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - F Schlüter
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - N Schmeisser
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - T Schmidt
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - J Schneider
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - F G Schröder
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - L Schumacher
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - G Schwefer
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - S Sclafani
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - D Seckel
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - M Seikh
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - S Seunarine
- Department of Physics, University of Wisconsin, River Falls, Wisconsin 54022, USA
| | - R Shah
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - A Sharma
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - S Shefali
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - N Shimizu
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - M Silva
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B Skrzypek
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - B Smithers
- Department of Physics, University of Texas at Arlington, 502 Yates St., Science Hall Rm 108, Box 19059, Arlington, Texas 76019, USA
| | - R Snihur
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Soedingrekso
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - A Søgaard
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - D Soldin
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - P Soldin
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - G Sommani
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - C Spannfellner
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - G M Spiczak
- Department of Physics, University of Wisconsin, River Falls, Wisconsin 54022, USA
| | - M Stamatikos
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - T Stanev
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - T Stezelberger
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - T Stürwald
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - T Stuttard
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - G W Sullivan
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - I Taboada
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - S Ter-Antonyan
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - M Thiesmeyer
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - W G Thompson
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J Thwaites
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Tilav
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - K Tollefson
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Tönnis
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - S Toscano
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - D Tosi
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Trettin
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - C F Tung
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - R Turcotte
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - J P Twagirayezu
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - B Ty
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M A Unland Elorrieta
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - A K Upadhyay
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Upshaw
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - N Valtonen-Mattila
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - J Vandenbroucke
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - N van Eijndhoven
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - D Vannerom
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J van Santen
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - J Vara
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - J Veitch-Michaelis
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Venugopal
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - M Vereecken
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - S Verpoest
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - D Veske
- Columbia Astrophysics and Nevis Laboratories, Columbia University, New York, New York 10027, USA
| | - A Vijai
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - C Walck
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - C Weaver
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - P Weigel
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Weindl
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - J Weldert
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - A Y Wen
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C Wendt
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Werthebach
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - M Weyrauch
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - N Whitehorn
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - C H Wiebusch
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - N Willey
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - D R Williams
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - L Witthaus
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - A Wolf
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - M Wolf
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - G Wrede
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - X W Xu
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - J P Yanez
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - E Yildizci
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Yoshida
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - R Young
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - F Yu
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - S Yu
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - Z Zhang
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, New York 11794-3800, USA
| | - P Zhelnin
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - P Zilberman
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Zimmerman
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
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Shah R, Finlay AY, Ali FM, Allen H, Nixon SJ, Nixon M, Otwombe K, Ingram JR, Salek MS. Measurement of the major ignored burden of multiple myeloma, pernicious anaemia and of other haematological conditions on partners and family members: A cross-sectional study. Eur J Haematol 2024. [PMID: 38577720 DOI: 10.1111/ejh.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Having a haematological condition can adversely affect the quality of life (QoL) of family members/partners of patients. It is important to measure this often ignored burden in order to implement appropriate supportive interventions. OBJECTIVE To measure current impact of haematological conditions on the QoL of family members/partners of patients, using the Family Reported Outcome Measure-16 (FROM-16). METHODS A cross-sectional study, recruited online through patient support groups, involved UK family members/partners of people with haematological conditions completing the FROM-16. RESULTS 183 family members/partners (mean age = 60.5 years, SD = 13.2; females = 62.8%) of patients (mean age = 64.1, SD = 12.8; females = 46.4%) with 12 haematological conditions completed the FROM-16. The FROM-16 mean total score was 14.0 (SD = 7.2), meaning 'a moderate effect on QoL'. The mean FROM-16 scores of family members of people with multiple myeloma (mean = 15.8, SD = 6.3, n = 99) and other haematological malignancies (mean = 13.9, SD = 7.8, n = 29) were higher than of people with pernicious anaemia (mean = 10.7, SD = 7.5, n = 47) and other non-malignant conditions (mean = 11, SD = 7.4, n = 56, p < .01). Over one third (36.1%, n = 183) of family members experienced a 'very large effect' (FROM-16 score>16) on their quality of life. CONCLUSIONS Haematological conditions, in particular those of malignant type, impact the QoL of family members/partners of patients. Healthcare professionals can now, using FROM-16, identify those most affected and should consider how to provide appropriate holistic support within routine practice.
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Affiliation(s)
- R Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | | | - S J Nixon
- Multiple Sclerosis Society, Cardiff, UK
| | - M Nixon
- Multiple Sclerosis Society, Cardiff, UK
| | - K Otwombe
- Statistics and Data Management Centre, Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - J R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
- Institute of Medicines Development, Cardiff, UK
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Shah R, Finlay AY, Salek MS, Allen H, Nixon SJ, Nixon M, Otwombe K, Ali FM, Ingram JR. Responsiveness and minimal important change of the Family Reported Outcome Measure (FROM-16). J Patient Rep Outcomes 2024; 8:38. [PMID: 38530614 DOI: 10.1186/s41687-024-00703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND The FROM-16 is a generic family quality of life (QoL) instrument that measures the QoL impact of patients' disease on their family members/partners. The study aimed to assess the responsiveness of FROM-16 to change and determine Minimal Important Change (MIC). METHODS Responsiveness and MIC for FROM-16 were assessed prospectively with patients and their family members recruited from outpatient departments of the University Hospital Wales and University Hospital Llandough, Cardiff, United Kingdom. Patients completed the EQ-5D-3L and a global severity question (GSQ) online at baseline and at 3-month follow-up. Family members completed FROM-16 at baseline and a Global Rating of Change (GRC) in addition to FROM-16 at follow-up. Responsiveness was assessed using the distribution-based (effect size-ES, standardized response mean -SRM) and anchor-based (area under the receiver operating characteristics curve ROC-AUC) approaches and by testing hypotheses on expected correlation strength between FROM-16 change score and patient assessment tools (GSQ and EQ-5D). Cohen's criteria were used for assessing ES. The AUC ≥ 0.7 was considered a good measure of responsiveness. MIC was calculated using anchor-based (ROC analysis and adjusted predictive modelling) and distribution methods based on standard deviation (SD) and standard error of the measurement (SEM). RESULTS Eighty-three patients with 15 different health conditions and their relatives completed baseline and follow-up questionnaires and were included in the responsiveness analysis. The mean FROM-16 change over 3 months = 1.43 (SD = 4.98). The mean patient EQ-5D change over 3 months = -0.059 (SD = 0.14). The responsiveness analysis showed that the FROM-16 was responsive to change (ES = 0.2, SRM = 0.3; p < 0.01). The ES and SRM of FROM-16 change score ranged from small (ES = 0.2; SRM = 0.3) for the distribution-based method to large (ES = 0.8, SRM = 0.85) for anchor-based methods. The AUC value was above 0.7, indicating good responsiveness. There was a significant positive correlation between the FROM-16 change scores and the patient's disease severity change scores (p < 0.001). The MIC analysis was based on data from 100 family members of 100 patients. The MIC value of 4 was suggested for FROM-16. CONCLUSIONS The results of this study confirm the longitudinal validity of FROM-16 which refers to the degree to which an instrument is able to measure change in the construct to be measured. The results yield a MIC value of 4 for FROM-16. These psychometric attributes of the FROM-16 instrument are useful in both clinical research as well as clinical practice.
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Affiliation(s)
- R Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M S Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - S J Nixon
- Multiple Sclerosis Society, Cardiff, UK
| | - M Nixon
- Multiple Sclerosis Society, Cardiff, UK
| | - K Otwombe
- Statistics and Data Management Centre, Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - F M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - J R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Shah R, Salek MS, Finlay AY, Kay R, Nixon SJ, Otwombe K, Ali FM, Ingram JR. Mapping of Family Reported Outcome Measure (FROM-16) scores to EQ-5D: algorithm to calculate utility values. Qual Life Res 2024:10.1007/s11136-023-03590-z. [PMID: 38402530 DOI: 10.1007/s11136-023-03590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Although decision scientists and health economists encourage inclusion of family member/informal carer utility in health economic evaluation, there is a lack of suitable utility measures comparable to patient utility measures such those based on the EQ-5D. This study aims to predict EQ-5D-3L utility values from Family Reported Outcome Measure (FROM-16) scores, to allow the use of FROM-16 data in health economic evaluation when EQ-5D data is not available. METHODS Data from 4228 family members/partners of patients recruited to an online cross-sectional study through 58 UK-based patient support groups, three research support platforms and Welsh social services departments were randomly divided five times into two groups, to derive and test a mapping model. Split-half cross-validation was employed, resulting in a total of ten multinomial logistic regression models. The Monte Carlo simulation procedure was used to generate predicted EQ-5D-3L responses, and utility scores were calculated and compared against observed values. Mean error and mean absolute error were calculated for all ten validation models. The final model algorithm was derived using the entire sample. RESULTS The model was highly predictive, and its repeated fitting using multinomial logistic regression demonstrated a stable model. The mean differences between predicted and observed health utility estimates ranged from 0.005 to 0.029 across the ten modelling exercises, with an average overall difference of 0.015 (a 2.2% overestimate, not of clinical importance). CONCLUSIONS The algorithm developed will enable researchers and decision scientists to calculate EQ-5D health utility estimates from FROM-16 scores, thus allowing the inclusion of the family impact of disease in health economic evaluation of medical interventions when EQ-5D data is not available.
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Affiliation(s)
- R Shah
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.
| | - M S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - R Kay
- RK Statistics, Bakewell, UK
| | - S J Nixon
- Multiple Sclerosis Society, Cardiff, UK
| | - K Otwombe
- Statistics and Data Management Centre, Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - F M Ali
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - J R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Lloyd D, House JS, Akhtari FS, Schmitt CP, Fargo DC, Scholl EH, Phillips J, Choksi S, Shah R, Hall JE, Motsinger-Reif AA. Interactive data sharing for multiple questionnaire-based exposome-wide association studies and exposome correlations in the Personalized Environment and Genes Study. Exposome 2024; 4:osae003. [PMID: 38425336 PMCID: PMC10899804 DOI: 10.1093/exposome/osae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/20/2023] [Accepted: 01/01/2024] [Indexed: 03/02/2024]
Abstract
The correlations among individual exposures in the exposome, which refers to all exposures an individual encounters throughout life, are important for understanding the landscape of how exposures co-occur, and how this impacts health and disease. Exposome-wide association studies (ExWAS), which are analogous to genome-wide association studies (GWAS), are increasingly being used to elucidate links between the exposome and disease. Despite increased interest in the exposome, tools and publications that characterize exposure correlations and their relationships with human disease are limited, and there is a lack of data and results sharing in resources like the GWAS catalog. To address these gaps, we developed the PEGS Explorer web application to explore exposure correlations in data from the diverse North Carolina-based Personalized Environment and Genes Study (PEGS) that were rigorously calculated to account for differing data types and previously published results from ExWAS. Through globe visualizations, PEGS Explorer allows users to explore correlations between exposures found to be associated with complex diseases. The exposome data used for analysis includes not only standard environmental exposures such as point source pollution and ozone levels but also exposures from diet, medication, lifestyle factors, stress, and occupation. The web application addresses the lack of accessible data and results sharing, a major challenge in the field, and enables users to put results in context, generate hypotheses, and, importantly, replicate findings in other cohorts. PEGS Explorer will be updated with additional results as they become available, ensuring it is an up-to-date resource in exposome science.
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Affiliation(s)
- Dillon Lloyd
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - John S House
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Farida S Akhtari
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Charles P Schmitt
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - David C Fargo
- Office of the Director, National Institute of Environmental Health Sciences, Durham, NC, USA
| | | | | | | | | | - Janet E Hall
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Alison A Motsinger-Reif
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
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Fu H, Novak A, Robert D, Kumar S, Tanamala S, Oke J, Bhatia K, Shah R, Romsauerova A, Das T, Espinosa A, Grzeda MT, Narbone M, Dharmadhikari R, Harrison M, Vimalesvaran K, Gooch J, Woznitza N, Salik N, Campbell A, Khan F, Lowe DJ, Shuaib H, Ather S. AI assisted reader evaluation in acute CT head interpretation (AI-REACT): protocol for a multireader multicase study. BMJ Open 2024; 14:e079824. [PMID: 38346874 PMCID: PMC10862304 DOI: 10.1136/bmjopen-2023-079824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION A non-contrast CT head scan (NCCTH) is the most common cross-sectional imaging investigation requested in the emergency department. Advances in computer vision have led to development of several artificial intelligence (AI) tools to detect abnormalities on NCCTH. These tools are intended to provide clinical decision support for clinicians, rather than stand-alone diagnostic devices. However, validation studies mostly compare AI performance against radiologists, and there is relative paucity of evidence on the impact of AI assistance on other healthcare staff who review NCCTH in their daily clinical practice. METHODS AND ANALYSIS A retrospective data set of 150 NCCTH will be compiled, to include 60 control cases and 90 cases with intracranial haemorrhage, hypodensities suggestive of infarct, midline shift, mass effect or skull fracture. The intracranial haemorrhage cases will be subclassified into extradural, subdural, subarachnoid, intraparenchymal and intraventricular. 30 readers will be recruited across four National Health Service (NHS) trusts including 10 general radiologists, 15 emergency medicine clinicians and 5 CT radiographers of varying experience. Readers will interpret each scan first without, then with, the assistance of the qER EU 2.0 AI tool, with an intervening 2-week washout period. Using a panel of neuroradiologists as ground truth, the stand-alone performance of qER will be assessed, and its impact on the readers' performance will be analysed as change in accuracy (area under the curve), median review time per scan and self-reported diagnostic confidence. Subgroup analyses will be performed by reader professional group, reader seniority, pathological finding, and neuroradiologist-rated difficulty. ETHICS AND DISSEMINATION The study has been approved by the UK Healthcare Research Authority (IRAS 310995, approved 13 December 2022). The use of anonymised retrospective NCCTH has been authorised by Oxford University Hospitals. The results will be presented at relevant conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT06018545.
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Affiliation(s)
- Howell Fu
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Novak
- Emergency Medicine Research Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - Jason Oke
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kanika Bhatia
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruchir Shah
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Tilak Das
- Department of Clinical Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Abdalá Espinosa
- Emergency Medicine Research Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | - Mark Harrison
- Emergency Department, Northumbria Specialist Emergency Care Hospital, Cramlington, UK
| | - Kavitha Vimalesvaran
- Clinical Scientific Computing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Gooch
- College of Health, Psychology & Social Care, University of Derby, Derby, UK
| | - Nicholas Woznitza
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | | | - Alan Campbell
- Radiology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farhaan Khan
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Haris Shuaib
- Clinical Scientific Computing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarim Ather
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Lloyd D, House JS, Akhtari FS, Schmitt CP, Fargo DC, Scholl EH, Phillips J, Choksi S, Shah R, Hall JE, Motsinger-Reif AA. Questionnaire-based exposome-wide association studies for common diseases in the Personalized Environment and Genes Study. Exposome 2024; 4:osae002. [PMID: 38450326 PMCID: PMC10914401 DOI: 10.1093/exposome/osae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024]
Abstract
The exposome collectively refers to all exposures, beginning in utero and continuing throughout life, and comprises not only standard environmental exposures such as point source pollution and ozone levels but also exposures from diet, medication, lifestyle factors, stress, and occupation. The exposome interacts with individual genetic and epigenetic characteristics to affect human health and disease, but large-scale studies that characterize the exposome and its relationships with human disease are limited. To address this gap, we used extensive questionnaire data from the diverse North Carolina-based Personalized Environment and Genes Study (PEGS, n = 9, 429) to evaluate exposure associations in relation to common diseases. We performed an exposome-wide association study (ExWAS) to examine single exposure models and their associations with 11 common complex diseases, namely allergic rhinitis, asthma, bone loss, fibroids, high cholesterol, hypertension, iron-deficient anemia, ovarian cysts, lower GI polyps, migraines, and type 2 diabetes. Across diseases, we found associations with lifestyle factors and socioeconomic status as well as asbestos, various dust types, biohazardous material, and textile-related exposures. We also found disease-specific associations such as fishing with lead weights and migraines. To differentiate between a replicated result and a novel finding, we used an AI-based literature search and database tool that allowed us to examine the current literature. We found both replicated findings, especially for lifestyle factors such as sleep and smoking across diseases, and novel findings, especially for occupational exposures and multiple diseases.
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Affiliation(s)
- Dillon Lloyd
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - John S House
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Farida S Akhtari
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Charles P Schmitt
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - David C Fargo
- Office of the Director, National Institute of Environmental Health Sciences, Durham, NC, USA
| | | | | | | | | | - Janet E Hall
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Alison A Motsinger-Reif
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
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9
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Fladt J, Guo J, Specht JL, Wang M, Chan LL, Mctaggart R, Buck BH, Aviv R, Swartz RH, Field TS, Tarpley J, Shah R, Goyal M, Tymianski M, Hill MD, Demchuk A, d'Esterre C, Barber P. Infarct Evolution on MR-DWI After Thrombectomy in Acute Stroke Patients Randomized to Nerinetide or Placebo: The REPERFUSE-NA1 Study. Neurology 2024; 102:e207976. [PMID: 38165335 DOI: 10.1212/wnl.0000000000207976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The neuroprotectant nerinetide has shown promise in reducing infarct volumes in primate models of ischemia reperfusion. We hypothesized that early secondary infarct growth after endovascular therapy (EVT) (1) may be a suitable surrogate biomarker for testing neuroprotective compounds, (2) is feasible to assess in the acute setting using sequential MRI, and (3) can be modified by treatment with nerinetide. METHODS REPERFUSE-NA1 was a prospective, multisite MRI substudy of the randomized controlled trial ESCAPE-NA1 (ClinicalTrials.gov NCT02930018) that involved patients with acute disabling large vessel occlusive stroke undergoing EVT within 12 hours of onset who were randomized to receive intravenous nerinetide or placebo. Patients enrolled in REPERFUSE-NA1 underwent sequential MRI <5 hours post-EVT (day 1) and at 24 hours (day 2). The primary outcome was total diffusion-weighted MRI infarct growth early after EVT, defined as the lesion volume difference between day 2 and day 1. The secondary outcome was region-specific infarct growth in different brain tissue compartments. Statistical analyses were performed using the Mann-Whitney U test and multiple linear regression. RESULTS Sixty-seven of 71 patients included had MRI of sufficient quality. The median infarct volume post-EVT was 12.98 mL (IQR, 5.93-28.08) in the nerinetide group and 10.80 mL (IQR, 3.11-24.45) in the control group (p = 0.59). Patients receiving nerinetide showed a median early secondary infarct growth of 5.92 mL (IQR, 1.09-21.30) compared with 10.80 mL (interquartile range [IQR], 2.54-21.81) in patients with placebo (p = 0.30). Intravenous alteplase modified the effect of nerinetide on region-specific infarct growth in white matter and basal ganglia compartments. In patients with no alteplase, the infarct growth rate was reduced by 120% (standard error [SE], 60%) in the white matter (p = 0.03) and by 340% (SE, 140%) in the basal ganglia (p = 0.02) in the nerinetide group compared with placebo after adjusting for confounders. DISCUSSION This study highlights the potential of using MR imaging as a biomarker to estimate the effect of a neuroprotective agent in acute stroke treatment. Patients with acute large vessel occlusive stroke exhibited appreciable early infarct growth both in the gray matter and the white matter after undergoing EVT. Acknowledging relatively small overall infarct volumes in this study, treatment with nerinetide was associated with slightly reduced percentage infarct growth in the white matter and basal ganglia compared with placebo in patients not receiving intravenous alteplase and had no effect on the total early secondary infarct growth. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT02930018. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with acute large vessel ischemic stroke undergoing EVT, nerinetide did not significantly decrease early post-EVT infarct growth compared with placebo.
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Affiliation(s)
- Joachim Fladt
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Jen Guo
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Jacinta L Specht
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Meng Wang
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Leona L Chan
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Ryan Mctaggart
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Brian H Buck
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Richard Aviv
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Richard H Swartz
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Thalia S Field
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Jason Tarpley
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Ruchir Shah
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Mayank Goyal
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Michael Tymianski
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Michael D Hill
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Andrew Demchuk
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Christopher d'Esterre
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
| | - Philip Barber
- From the Calgary Stroke Program (J.F., J.G., J.L.S., M.W., L.L.C., M.G., M.D.H., A.D., C.E., P.B.), Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary,Canada; Stroke Center and Department of Neurology (J.F.), University Hospital Basel and University of Basel, Switzerland; Department of Neurology and Neurosurgery (R.M.), Rhode Island Medical Imaging, Providence, RI; Division of Neurology (B.H.B.), University of Alberta, Edmonton; Department of Radiology (R.A.), Radiation Oncology and Medical Physics, University of Ottawa, The Ottawa Hospital; Department of Medical Imaging (R.H.S.), University of Toronto, Sunnybrook Health Sciences Centre; Vancouver Stroke Program (T.S.F.), University of British Columbia, Canada; Pacific Neuroscience Institute (J.T.), Providence Little Company of Mary Medical Center, Torrance, CA; and UT Erlanger Neurology (R.S.), Chattanooga, TN; NoNO Inc (M.T.), Toronto, Canada
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Rubin MN, Shah R, Devlin T, Youn TS, Waters MF, Volpi JJ, Stayman A, Douville CM, Lowenkopf T, Tsivgoulis G, Alexandrov AV. Robot-Assisted Transcranial Doppler Versus Transthoracic Echocardiography for Right to Left Shunt Detection. Stroke 2023; 54:2842-2850. [PMID: 37795589 PMCID: PMC10589435 DOI: 10.1161/strokeaha.123.043380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/14/2023] [Accepted: 08/10/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Right to left shunt (RLS), including patent foramen ovale, is a recognized risk factor for stroke. RLS/patent foramen ovale diagnosis is made by transthoracic echocardiography (TTE), which is insensitive, transesophageal echocardiography, which is invasive, and transcranial Doppler (TCD), which is noninvasive and accurate but scarce. METHODS We conducted a prospective, single-arm device clinical trial of robot-assisted TCD (raTCD) versus TTE for RLS diagnosis at 6 clinical sites in patients who presented with an event suspicious for embolic cerebrovascular ischemia from October 6, 2020 to October 20, 2021. raTCD was performed with standard TCD bubble study technique. TTE bubble study was performed per local standards. The primary outcome was rate of RLS detection by raTCD versus TTE. RESULTS A total of 154 patients were enrolled, 129 evaluable (intent to scan) and 121 subjects had complete data per protocol. In the intent to scan cohort, mean age was 60±15 years, 47% were women, and all qualifying events were diagnosed as ischemic stroke or transient ischemic attack. raTCD was positive for RLS in 82 subjects (64%) and TTE was positive in 26 (20%; absolute difference 43.4% [95% CI, 35.2%-52.0%]; P<0.001). On prespecified secondary analysis, large RLS was detected by raTCD in 35 subjects (27%) versus 13 (10%) by TTE (absolute difference 17.0% [95% CI, 11.5%-24.5%]; P<0.001). There were no serious adverse events. CONCLUSIONS raTCD was safe and ≈3 times more likely to diagnose RLS than TTE. TTE completely missed or underdiagnosed two thirds of large shunts diagnosed by raTCD. The raTCD device, used by health professionals with no prior TCD training, may allow providers to achieve the known sensitivity of TCD for RLS and patent foramen ovale detection without the need for an experienced operator to perform the test. Pending confirmatory studies, TCD appears to be the superior screen for RLS compared with TTE (funded by NeuraSignal). REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04604015.
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Affiliation(s)
- Mark N. Rubin
- Edward Hines, Jr. Veterans Affairs Medical Center, IL (M.N.R.)
| | - Ruchir Shah
- CHI Memorial Hospital, Chattanooga, TN (R.S., T.D.)
| | | | - Teddy S. Youn
- Barrow Neurological Institute, Phoenix, AZ (T.S.Y., M.F.W.)
| | | | | | | | | | - Ted Lowenkopf
- Providence Brain and Spine Institute, Portland, OR (T.L.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Greece (G.T.)
| | - Andrei V. Alexandrov
- Department of Neurology, Banner University Hospital, University of Arizona College of Medicine, Phoenix (A.V.A.)
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Pike CM, Zwarycz B, McQueen BE, Castillo M, Barron C, Morowitz JM, Levi JA, Phadke D, Balik-Meisner M, Mav D, Shah R, Glasspoole DLC, Laetham R, Thelin W, Bunger MK, Boazak EM. Characterization and optimization of variability in a human colonic epithelium culture model. bioRxiv 2023:2023.09.22.559007. [PMID: 37790345 PMCID: PMC10542543 DOI: 10.1101/2023.09.22.559007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Animal models have historically been poor preclinical predictors of gastrointestinal (GI) directed therapeutic efficacy and drug-induced GI toxicity. Human stem and primary cell-derived culture systems are a major focus of efforts to create biologically relevant models that enhance preclinical predictive value of intestinal efficacy and toxicity. The inherent variability in stem-cell-based complex cultures makes development of useful models a challenge; the stochastic nature of stem-cell differentiation interferes with the ability to build and validate robust, reproducible assays that query drug responses and pharmacokinetics. In this study, we aimed to characterize and reduce potential sources of variability in a complex stem cell-derived intestinal epithelium model, termed RepliGut® Planar, across cells from multiple human donors, cell lots, and passage numbers. Assessment criteria included barrier formation and integrity, gene expression, and cytokine responses. Gene expression and culture metric analyses revealed that controlling for stem/progenitor-cell passage number reduces variability and maximizes physiological relevance of the model. After optimizing passage number, donor-specific differences in cytokine responses were observed in a case study, suggesting biologic variability is observable in cell cultures derived from multiple human sources. Our findings highlight key considerations for designing assays that can be applied to additional primary-cell derived systems, as well as establish utility of the RepliGut® Planar platform for robust development of human-predictive drug-response assays.
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12
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Goyack L, Garcha G, Shah R, Ortiz Gonzalez Y, Vollenweider M, Salimian M, Cheung W. Rapid effect of benralizumab in fulminant eosinophilic myocarditis in the setting of uncontrolled eosinophilic asthma. J Cardiol Cases 2023; 28:100-104. [PMID: 37671259 PMCID: PMC10477040 DOI: 10.1016/j.jccase.2023.04.012] [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] [Received: 07/05/2022] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 09/07/2023] Open
Abstract
A 51-year-old male with uncontrolled asthma and recent convalescence from severe acute respiratory syndrome coronavirus-2c pneumonia presented with cough, dyspnea, and chest pain. Evaluation revealed significant peripheral eosinophilia, elevated troponin, and biventricular failure resulting in cardiogenic shock. He was diagnosed with eosinophilic myocarditis and was subsequently started on high-dose steroids. As he was also diagnosed with eosinophilic asthma and continued to clinically decline requiring inotropic support, he received benralizumab, an anti-eosinophilic monoclonal antibody, as rescue therapy. After benralizumab administration he demonstrated improvement in his left ventricular ejection fraction, normalization of his right ventricular function, and improvement in symptoms with resolution of his hypereosinophilia. Currently, benralizumab is approved for add-on maintenance treatment of patients with an eosinophilic phenotype of severe asthma. To date, only few observational studies have been published revealing rapid improvement in symptoms of acute, severe eosinophilic asthma and eosinophilic myocarditis caused by eosinophilic granulomatosis with polyangiitis after administration of benralizumab. This clinical case demonstrates that benralizumab can be used safely in conjunction with steroid therapy for eosinophilic myocarditis. This case also emphasizes the need for further clinical research for utilizing benralizumab in the treatment of eosinophilic myocarditis, eosinophilic asthma, and other hypereosinophilic syndromes in the acute setting. Learning objective Benralizumab has been approved for add-on maintenance treatment of patients with an eosinophilic phenotype of severe asthma. However, few cases have been published demonstrating the drug's use in acute severe exacerbations. This case presents a patient with fulminant eosinophilic myocarditis and asthma with improvement after administration of benralizumab in addition to high-dose steroids. The future role of the drug in acute eosinophilic exacerbation should continue to be explored.
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Asher S, Shah R, Ings S, Horder J, Newrick F, Nesr G, Kesse Adu R, Streetly M, Trompeter S, Lee L, Wisniowski B, Mahmood S, Xu K, Papanikalaou X, McMillan A, Popat R, Yong K, Sive J, Kyriakou C, Rabin N. Haematopoietic stem cell mobilisation followed by high-dose chemotherapy and autologous stem cell transplantation for patients with sickle cell disease and myeloma. Br J Haematol 2023; 202:1224-1227. [PMID: 37488061 DOI: 10.1111/bjh.18990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/12/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Affiliation(s)
- S Asher
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - R Shah
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - S Ings
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - J Horder
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - F Newrick
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - G Nesr
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - R Kesse Adu
- Department of Haematology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - M Streetly
- Department of Haematology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - S Trompeter
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - L Lee
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - B Wisniowski
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - S Mahmood
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - K Xu
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - X Papanikalaou
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - A McMillan
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - R Popat
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - K Yong
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - J Sive
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - C Kyriakou
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
| | - N Rabin
- Department of Haematology, University College Hospital London NHS Foundation Trust, London, UK
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Shah R, Minhas K, Patel PA. Is There Really No Kit for Kids? Quantification of Manufacturer Recommendations Regarding Paediatric Use For High-Volume IR Devices. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03472-4. [PMID: 37311838 DOI: 10.1007/s00270-023-03472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/16/2023] [Indexed: 06/15/2023]
Abstract
AIMS The development of paediatric specific devices appears to lag behind advancements in our specialty. Children could therefore be limited in the number of procedures available to them unless we continue to use and modify adult devices 'off-label'. This study quantifies the proportion of IR devices in which paediatric use is indicated by the manufacturer. MATERIALS & METHODS Cross-sectional analysis of device instructions for use (IFU), assessing inclusion of children was performed. Vascular access, biopsy, drainage, and enteral feeding devices, from 28 companies who sponsored BSIR, CIRSE and SIR (2019-2020) as determined by the meeting websites, were included. Devices for which the IFU was not available were excluded. RESULTS 190 (106 vascular access, 40 biopsy, 39 drainage and 5 feeding) devices with IFU's from 18 medical device manufacturers were assessed. 49/190 (26%) IFU's referenced children. 6/190 (3%) explicitly stated the device could be used in children and 1/190 (0.5%) explicitly stated the device was not for use in children. 55/190 (29%) implied they could be used in children through caution notes. The most common caution was a reference to the size of the device that could be accommodated in a child (26/190, 14%). CONCLUSIONS This data identifies an unmet need for paediatric IR devices and could be used to support the future development of devices intended for the children we treat. There is potentially a larger proportion (29%) of devices suitable for paediatric use, but which lack manufacturer explicit support. LEVEL OF EVIDENCE Level 2c, Cross-Sectional study.
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Affiliation(s)
- Ruchir Shah
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Kishore Minhas
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Premal A Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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15
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Singh N, Cimflova P, Ospel JM, Kashani N, Marko M, Mayank A, Nogueira RG, McTaggart RA, Demchuk AM, Poppe AY, Rempel JL, Field TS, Dowlatshahi D, van Adel B, Swartz RH, Shah R, Sauvageau E, Puetz V, Silver FL, Campbell B, Chapot R, Tymianski M, Goyal M, Almekhlafi MA, Hill MD. Infarcts in a New Territory: Insights From the ESCAPE-NA1 Trial. Stroke 2023; 54:1477-1483. [PMID: 37082967 DOI: 10.1161/strokeaha.122.042200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Infarct in a new territory (INT) is a known complication of endovascular stroke therapy. We assessed the incidence of INT, outcomes after INT, and the impact of concurrent treatments with intravenous thrombolysis and nerinetide. METHODS Data are from ESCAPE-NA1 trial (Safety and Efficacy of Nerinetide [NA-1] in Subjects Undergoing Endovascular Thrombectomy for Stroke), a multicenter, international randomized study that assessed the efficacy of intravenous nerinetide in subjects with acute ischemic stroke who underwent endovascular thrombectomy within 12 hours from onset. Concurrent treatment and outcomes were collected as part of the trial protocol. INTs were identified on core lab imaging review of follow-up brain imaging and defined by the presence of infarct in a new vascular territory, outside the baseline target occlusion(s) on follow-up brain imaging (computed tomography or magnetic resonance imaging). INTs were classified by maximum diameter (<2, 2-20, and >20 mm), number, and location. The association between INT and clinical outcomes (modified Rankin Scale and death) was assessed using standard descriptive techniques and adjusted estimates of effect were derived from Poisson regression models. RESULTS Among 1092 patients, 103 had INT (9.3%, median age 69.5 years, 49.5% females). There were no differences in baseline characteristics between those with versus without INT. Most INTs (91/103, 88.3%) were not associated with visible occlusions on angiography and 39 out of 103 (37.8%) were >20 mm in maximal diameter. The most common INT territory was the anterior cerebral artery (27.8%). Almost half of the INTs were multiple (46 subjects, 43.5%, range, 2-12). INT was associated with poorer outcomes as compared to no INT on the primary outcome of modified Rankin Scale score of 0 to 2 at 90 days (adjusted risk ratio, 0.71 [95% CI, 0.57-0.89]). Infarct volume in those with INT was greater by a median of 21 cc compared with those without, and there was a greater risk of death as compared to patients with no INT(adjusted risk ratio, 2.15 [95% CI, 1.48-3.13]). CONCLUSIONS Infarcts in a new territory are common in individuals undergoing endovascular thrombectomy for acute ischemic stroke and are associated with poorer outcomes. Optimal therapeutic approaches, including technical strategies, to reduce INT represent a new target for incremental quality improvement of endovascular thrombectomy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02930018.
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Affiliation(s)
- Nishita Singh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (N.S., M.M., A.M.D., M.A.A., M.D.H.)
- Department of Internal Medicine, Health Sciences Center, University of Manitoba, Winnipeg, Canada (N.S.)
| | - Petra Cimflova
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (P.C., J.M.O., N.K., A.M., M.G., M.A.A., M.D.H.)
| | - Johanna Maria Ospel
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (P.C., J.M.O., N.K., A.M., M.G., M.A.A., M.D.H.)
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Switzerland (J.M.O.)
| | - Nima Kashani
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (P.C., J.M.O., N.K., A.M., M.G., M.A.A., M.D.H.)
| | - Martha Marko
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (N.S., M.M., A.M.D., M.A.A., M.D.H.)
- Department of Neurology, Medical University of Vienna, Austria (M.M.)
| | - Arnuv Mayank
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (P.C., J.M.O., N.K., A.M., M.G., M.A.A., M.D.H.)
| | - Raul G Nogueira
- Department of Neurology, Emory University School of Medicine, Atlanta (R.G.N.)
| | - Ryan A McTaggart
- Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence (R.A.M.)
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (N.S., M.M., A.M.D., M.A.A., M.D.H.)
| | | | - Jeremy L Rempel
- Department of Radiology, University of Alberta Hospital, Edmonton, Canada (J.L.R.)
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, Canada (T.S.F.)
| | - Dar Dowlatshahi
- Department of Neurology, Ottawa Hospital, University of Ottawa, Canada (D.D.)
| | - Brian van Adel
- Departments of Radiology and Neurosurgery, McMaster University, Hamilton, Canada (B.v.A.)
| | - Richard H Swartz
- Department of Neurology, Sunnybrook Health Sciences Centre, University Health Network, University of Toronto, Canada. (R.H.S.)
| | - Ruchir Shah
- Department of Neurology, Erlanger Hospital, Chattanooga (R.S.)
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville (E.S.)
| | - Volker Puetz
- Department of Neurology and Dresden Neurovascular Center, University Hospital Carl Gustav Carus at the Technical University Dresden, Germany (V.P.)
| | - Frank L Silver
- Department of Neurology, University Health Network, University of Toronto, Canada. (F.L.S.)
| | - Bruce Campbell
- Department of Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.)
| | - René Chapot
- Department of Neuroradiology, Alfred Krupp Krankenhaus Essen, Essen, Germany (R.C.)
| | | | - Mayank Goyal
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (P.C., J.M.O., N.K., A.M., M.G., M.A.A., M.D.H.)
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (N.S., M.M., A.M.D., M.A.A., M.D.H.)
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (P.C., J.M.O., N.K., A.M., M.G., M.A.A., M.D.H.)
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (M.A.A., M.D.H.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (N.S., M.M., A.M.D., M.A.A., M.D.H.)
- Department of Radiology, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (P.C., J.M.O., N.K., A.M., M.G., M.A.A., M.D.H.)
- epartment of Medicine, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (M.D.H.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, AB, Canada. (M.D.H.)
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (M.A.A., M.D.H.)
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Daniello L, Elshiaty M, Lusky F, Blasi M, Schneider M, Bozorgmehr F, Shah R, Kazdal D, Angeles A, Liersch S, Eichhorn F, Allgäuer M, Janke F, Bischoff H, Thomas M, Sültmann H, Stenzinger A, Christopoulos P. 67P Blood cell gene expression and clinical characteristics in advanced non-small cell lung cancer with immune-related adverse events. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00321-0] [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: 04/04/2023]
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17
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Soulat K, Shah A, Damse S, Thiyagarajah P, Shah R. 195P Efficacy of mobile health intervention on quality of life and symptom burden in lung cancer. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00448-3] [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: 04/03/2023]
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18
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Shah R, Barrett TJ, Colcelli A, Oručević F, Trombettoni A, Krüger P. Probing the Degree of Coherence through the Full 1D to 3D Crossover. Phys Rev Lett 2023; 130:123401. [PMID: 37027886 DOI: 10.1103/physrevlett.130.123401] [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] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/03/2022] [Accepted: 01/09/2023] [Indexed: 06/19/2023]
Abstract
We experimentally study a gas of quantum degenerate ^{87}Rb atoms throughout the full dimensional crossover, from a one-dimensional (1D) system exhibiting phase fluctuations consistent with 1D theory to a three-dimensional (3D) phase-coherent system, thereby smoothly interpolating between these distinct, well-understood regimes. Using a hybrid trapping architecture combining an atom chip with a printed circuit board, we continuously adjust the system's dimensionality over a wide range while measuring the phase fluctuations through the power spectrum of density ripples in time-of-flight expansion. Our measurements confirm that the chemical potential μ controls the departure of the system from 3D and that the fluctuations are dependent on both μ and the temperature T. Through a rigorous study we quantitatively observe how inside the crossover the dependence on T gradually disappears as the system becomes 3D. Throughout the entire crossover the fluctuations are shown to be determined by the relative occupation of 1D axial collective excitations.
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Affiliation(s)
- R Shah
- Department of Physics and Astronomy, University of Sussex, Brighton BN1 9QH, United Kingdom
| | - T J Barrett
- Department of Physics and Astronomy, University of Sussex, Brighton BN1 9QH, United Kingdom
| | - A Colcelli
- SISSA and INFN, Sezione di Trieste, Via Bonomea 265, I-34136 Trieste, Italy
| | - F Oručević
- Department of Physics and Astronomy, University of Sussex, Brighton BN1 9QH, United Kingdom
| | - A Trombettoni
- SISSA and INFN, Sezione di Trieste, Via Bonomea 265, I-34136 Trieste, Italy
- Department of Physics, University of Trieste, Strada Costiera 11, I-34151 Trieste, Italy
| | - P Krüger
- Department of Physics and Astronomy, University of Sussex, Brighton BN1 9QH, United Kingdom
- Physikalisch-Technische Bundesanstalt, 10587 Berlin, Germany
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19
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Foley JF, Elgart B, Phadke D, Mav D, Tripodi I, Clausen N, Weick M, Gladwell W, Gerrish K, Shah R, Merrick BA. Whole exome and transcript profiling of liver following aflatoxin B1 exposure in rats. J Appl Toxicol 2023. [PMID: 36908029 DOI: 10.1002/jat.4463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
We recently developed a rat whole exome sequencing (WES) panel and used it to evaluate early somatic mutations in archival liver tissues from F344/N rats exposed to the hepatocarcinogen, Aflatoxin B1 (AFB1), a widely studied, potent mutagen and hepatocarcinogen associated with hepatocellular carcinoma (HCC). Rats were exposed to 1 ppm AFB1 in feed for 14, 90 and 90 days plus a recovery 60-day, non-exposure period (150-day) time point. Isolated liver DNA was exome sequenced. We identified 172 sequence variants across all time points, of which 101 were non-synonymous variants. Well-annotated genes carried a diverse set of 29 non-synonymous mutations at 14-days, increasing to 39 mutations at 90-days and then decreasing to 33 mutations following the 60-day recovery. Gene Set Enrichment Analysis conducted on previously reported, available RNA expression data of the same exome sequenced archival samples identified altered transcripts in pathways associated with malignant transformation. These included HALLMARK gene sets associated with cell proliferation (MYC Targets Version 1 and Version 2, E2F targets), cell cycle (G2M checkpoint, mitotic spindle), cell death (apoptosis), and DNA damage (DNA repair, UV response Up, Reactive oxygen species) pathways. DriverNet Impact analysis integrated exome-seq and expression data to reveal somatic mutations in Mcm8, Bdp1 and Cct6a that may drive cancer formation. Connectivity with transcript expression changes identified these genes as the top-ranked candidate driver genes associated with hepatocellular transformation. In conclusion, exome sequencing revealed early somatic mutations that may play a role in cancer cell transformation that are translatable to aflatoxin-induced HCC.
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Affiliation(s)
| | - Brian Elgart
- Molecular Genomics Core Laboratory, Signal Transduction Laboratory, Division of Intramural Research, NIEHS
| | | | | | | | - Nicholas Clausen
- Molecular Genomics Core Laboratory, Signal Transduction Laboratory, Division of Intramural Research, NIEHS
| | - Madeleine Weick
- Molecular Genomics Core Laboratory, Signal Transduction Laboratory, Division of Intramural Research, NIEHS
| | - Wes Gladwell
- Molecular Genomics Core Laboratory, Signal Transduction Laboratory, Division of Intramural Research, NIEHS
| | - Kevin Gerrish
- Molecular Genomics Core Laboratory, Signal Transduction Laboratory, Division of Intramural Research, NIEHS
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20
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Lewis P, Charalel R, Andrew C, Aliaksei S, Kassin M, Dubel G, Garg T, Brooks O, Shah R, Halin N, Kleedehn M, Johnson M. Abstract No. 235 Challenges, Successes and Barriers of Structured Report Templates: A Brief Report on Survey Results. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.297] [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: 02/26/2023] Open
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21
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Salvi A, Shah R, Higgins L, Menon P. Abstract No. 202 AI-Driven Regional Characterization of Peripheral Artery Disease from Maximum Intensity Projections. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.261] [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: 02/27/2023] Open
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22
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Jimenez C, Stanton E, Kondra K, Nickels EM, Jacob L, Shah R, Hammoudeh JA. NUT carcinoma of the mandible in a child: case report and systematic review. Int J Oral Maxillofac Surg 2023; 52:304-312. [PMID: 35868909 DOI: 10.1016/j.ijom.2022.07.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
Nuclear protein of the testis (NUT) carcinoma is a rare, undifferentiated carcinoma that is characterized by NUTM1 gene rearrangements. Patients with NUT carcinoma have an overall survival of approximately 5% at 5 years despite a multimodal treatment approach. This report illustrates the management of mandibular NUT carcinoma in a pediatric patient, complemented by a systematic review of head and neck NUT carcinoma. A 5-year-old female presented with an enlarging jaw mass that was diagnosed as BRD4-NUTM1 carcinoma and was treated with hemimandibulectomy and chemoradiation. She remains disease-free 21 months after completion of therapy. A total of 63 patient cases reported in 34 articles were identified in the review. Only 26.9% (14/52) of tumors were correctly diagnosed initially as NUT carcinoma, whereas 73.1% (38/52) were incorrectly diagnosed as another malignancy; the initial diagnosis was not reported for 11 patients. The mandibular tumor subtype was among the rarest reported (n = 1; 1.6%). Combination therapy, including surgery and chemoradiation, was the most common treatment (55.2%). The patient case presented here is a novel case of pediatric mandibular NUT carcinoma. Due to the poor overall survival of patients with NUT carcinoma, aggressive upfront resection with 2-cm margins followed by adjuvant chemoradiation is advocated.
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Affiliation(s)
- C Jimenez
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - E Stanton
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - K Kondra
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - E M Nickels
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - L Jacob
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Shah
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - J A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Oral and Maxillofacial Surgery, University of Southern California, Los Angeles, CA, USA.
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23
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Manimaran P, Shah R, Trivedi P, Mehta S. Primary cutaneous neuroendocrine tumor with axillary lymph node metastasis: A clinical masquerade. J Postgrad Med 2023; 69:118-119. [PMID: 36751760 DOI: 10.4103/jpgm.jpgm_254_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- P Manimaran
- Department of Oncopathology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - R Shah
- Department of Oncopathology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - P Trivedi
- Department of Oncopathology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - S Mehta
- Department of Oncopathology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
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24
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Rubin MN, Chang I, Waters M, Shah R, Devlin T, Alexandrov AV. Abstract TMP65: Robot-assisted Transcranial Doppler
Versus
Transthoracic Echocardiography For Right To Left Shunt Detection: “Real World” First-look. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tmp65] [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: 02/05/2023]
Abstract
Background:
Right to left shunt (RLS), including patent foramen ovale (PFO), is a recognized risk factor for stroke. RLS/PFO diagnosis can be made by transthoracic echocardiography (TTE) or transcranial Doppler (TCD). A multicenter, prospectively enrolled device trial of robot-assisted TCD (raTCD) vs TTE for RLS detection (BUBL, NCT04604015) was completed. This demonstrated raTCD detecting all and large RLS at approximately 3 times the rate of TTE (primary outcome, any RLS: raTCD 64% vs TTE 20% [absolute difference 43.4% (95% CI 34.3%-52.5%), p < 0.001]). It is unknown if these results are generalizable to routine practice.
Methods:
We conducted a multi-site retrospective review of prospectively collected “real-world” clinical data of raTCD for RLS diagnosis. All patients referred for a clinical study at the participating sites who underwent raTCD were included. raTCD was performed with standard TCD bubble study technique at all sites. Outcomes included demographics, rate of RLS detection, all and large (Spencer Logarithmic Scale ≥3), as well as “no window” rate. These results were compared to the results of BUBL with descriptive statistics and 2-sample proportion tests.
Results:
There were 350 patients who underwent clinical raTCD across three participating sites. In this population, the mean age was 56 ± 13 years compared to 59 ± 14 years in BUBL (p = 0.03, 95% CI 0.20-5.49). Both cohorts were 46% female. The clinical population had any RLS on raTCD in 54% (189/350) compared to 64% in BUBL, which was not a significant difference (p= 0.14, 95% CI -0.02-0.18). Large RLS was detected in 26% (91/350) of the clinical population as compared to 28% in BUBL, which was also not a significant difference (p = 0.89, 95% CI -0.08-0.11). The “no window” rate in the clinical population was 5% (18/350), compared to 8% in BUBL (p = 0.39, 95% CI -0.03-0.08).
Conclusions:
The same raTCD device that was safe and 3 times more likely to diagnose RLS than TTE in a device trial detected all and large RLS in clinical practice at a rate similar to that demonstrated in the device trial. These results further support the notion that raTCD may allow providers to achieve the known sensitivity of TCD for RLS and PFO detection without the need for an experienced operator, even in a “real world” clinical setting.
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25
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Gessner C, Griesinger F, Shah R, Talbot T, Venkateshan S, Vadanahalli Shankar A, Seluzhytsky A, Marsden D. 119TiP An observational study to assess the effectiveness and safety of cemiplimab in patients with advanced non-small cell lung cancer (NSCLC) in routine clinical practice within Europe (CEMI-LUNG). Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Homicsko K, Zygoura P, Tissot S, Norkin M, Popat S, Curioni-Fontecedro A, O'Brien M, Pope T, Shah R, Kammler R, Finn S, Coukos G, Dafni U, Peters S, Stahel R. 11P Association of VISTA-expressing CD66b-positive neutrophils, with response and survival benefit from pembrolizumab in advanced malignant pleural mesothelioma. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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27
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Shah R, Shah PP, Nahar P, Patidar S, Patidar S, Jain R. Spatial Relationship of Maxillary Posterior Teeth with Maxillary Sinus Floor in Sagittal, Coronal and Axial Planes by Using Cone-Beam Computed Tomography in a Subpopulation of Central India. Mymensingh Med J 2022; 31:1162-1169. [PMID: 36189567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Inadvertent perforation of the root apex during endodontic procedure in maxillary posterior teeth may unnecessarily invite the complications of sinusitis or inflammatory responses. This becomes even more important when performing endodontic surgical procedures. Thus, it is mandatory to have the precise knowledge of anatomic structures which are in close proximity to the apex of roots and its variations among different geographic area. This retrospective observational study was performed in the Central India to assess the spatial relationships between the maxillary second pre-molar (sPM), maxillary first molar (M1), maxillary second molar (M2) with the maxillary sinus floor using cone beam computed tomography (CBCT) in all three axial, sagittal and coronal sections from year 2016 to 2021. Three hundred and sixty teeth were examined through sixty full volumes CBCT scans of the patients in between year 2016-2021 in Indore, (MP, India). The Distances (D) between the examined roots and the sinus floor, were evaluated using CBCT in all three sections, and grouped in 7 classes. To simplify, Class 1 and 2 were grouped as Negative Configuration where apices are protruding into sinus floor, Class 3 as Zero and Class 4-7 as Positive configuration. The data were analyzed statistically using SPSS system. The prevalence of class 1 and 2 (negative configuration) was the highest for the Palatal of M1 (16.67%) followed by Distobuccal of M1 (13.34%). The prevalence of class 3 that is Zero configuration was the highest for the Mesiobuccal of M2 (63.33%). The results suggested all the three teeth roots showed closed proximity with sinus floor, closest relationship with the sinus floor was seen in palatal of M1 in this study.
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Affiliation(s)
- R Shah
- Dr Ruchi Shah, Reader, Department of Conservative Dentistry and Endodontics, KM Shah Dental College and Hospital, Sumandeep Vidhyapeeth, Vadodara, Gujarat, India; E-mail:
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Shah R. TCT-377 Automated Robotic TCD for RLS Detection in the Evaluation of Patients with Cryptogenic Stroke. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.442] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lusky F, Schindler H, Elshiaty M, Gaissmaier L, Daniello L, Bozorgmehr F, Kuon J, Shah R, Schneider M, Eichhorn F, Trudzinski F, Angeles A, Janke F, Kirchner M, Kazdal D, Stenzinger A, Sültmann H, Thomas M, Christopoulos P. EP08.01-031 Blood Gene Expression Changes in Metastatic Lung Cancer under second-line Immunotherapy according to Clinical Response. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.603] [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: 10/14/2022]
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Nathan P, Grob J, Dummer R, Ascierto P, Ribas A, Robert C, Schadendorf D, Flaherty K, Tawbi H, Hauschild A, Mandala M, Shah R, Banerjee H, Sarkar R, Lau M, Long G. 819P Efficacy of dabrafenib (D) trametinib (T) plus spartalizumab (S) by baseline site of metastases in patients (pts) with previously untreated BRAF V600-mutant unresectable or metastatic melanoma: Post hoc analysis of phase III COMBI-i trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Shah R. 1641TiP Adjuvant nivolumab with chemotherapy in pleural mesothelioma: The NICITA trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Shah R, Rahman S, Pywell M, Ibanez J. 107 A Rare Presentation of a Giant, Multi-Compartmental Lipoma of the Hand Causing Median Nerve Compression. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.115] [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: 11/05/2022]
Abstract
Abstract
Lipomas are the commonest benign tumour, made up exclusively of adipose tissue, and can arise anywhere in the body. However, giant lipomas of the hand, defined as greater than 5cm in diameter, are rare. They have the potential to invade and cause a multitude of symptoms due to the compression and proximity of underlying structures.
We describe a case of a 64-year-old woman who presents with a swelling of the left thenar eminence, associated with numbness and tingling in all fingers.
MRI and nerve conduction studies confirmed the diagnosis of a lipoma causing median nerve compression. The patient underwent elective surgical excision using a volar approach, with good postoperative recovery. The excised lesion, measuring 12x7x2.4cm, is the largest giant lipoma of the hand reported in literature, and the first to demonstrate invasion from the mid palmar space into both the dorsal sub-aponeurotic space and carpal tunnel.
Space occupying lesions, such as giant lipomas of the hand, are a rare but important secondary cause of compression neuropathies of the upper extremity and must be suspected when these neuropathies present with atypical symptomatology. Any patient presenting with a soft-tissue lesion of the hand demonstrating rapid growth, pain or large size must be thoroughly investigated to rule out malignancy. MRI forms an essential part of the workup in such cases due to its high diagnostic accuracy. Malignant transformation of giant lipomas of the hand is extremely rare, and such lesions can be removed by en bloc marginal resection with excellent postoperative results.
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Affiliation(s)
- R Shah
- Guys’ and St Thomas NHS foundation Trust , London , United Kingdom
| | - S Rahman
- Guys’ and St Thomas NHS Foundation Trust , London , United Kingdom
| | - M Pywell
- Guys’ and St Thomas NHS Foundation Trust , London , United Kingdom
| | - J Ibanez
- Guys’ and St Thomas NHS Foundation Trust , London , United Kingdom
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Shah R, Kiely A, McKirdy S. 709 Two-Layer Biodegradable Temporizing Matrix Reconstruction of Abdominal Wall Dermatofibrosarcoma Protuberans. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.149] [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: 11/05/2022]
Abstract
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive dermal sarcoma. The management is generally surgical, with wide local excision (WLE) forming the mainstay of treatment. Large abdominal wall defects are most aesthetically reconstructed using pedicled or free flaps; however, these require tumour-free surgical margins, and can cause donor site morbidity. We describe an alternative, aesthetic, and low-morbidity technique for abdominal wall reconstruction following WLE of DFSP, using 2 layers of a novel synthetic dermal matrix (NovoSorb® BTM).
25-year-old women presented with a large DFSP involving the right anterior-abdominal wall. After WLE with 3cm margins, BTM was implanted to the large sub-fascial abdominal wall defect. At 6 weeks, after histological confirmation of tumour-free margins, a second layer of BTM was applied to improve the significant contour deformity of the wound bed. After complete integration by 7 weeks, a split-thickness skin graft was harvested from the right thigh and fixed to the new dermis.
At 14-days postoperatively, the skin graft had fully taken, and donor site healed. By 8 weeks, the scar had started to mature with no obvious contour defect or contracture. Overall, the patient was satisfied with the functional and aesthetic outcome.
To our knowledge, a two-layer reconstruction using an artificial dermal matrix has never been described for abdominal wall reconstruction. We found that double-layer BTM is able to restore the inherent thickness and pliability of skin in complex abdominal wall reconstruction following WLE of DFSP and offers improved durability and cosmesis compared to skin grafting or indeed single layer skin substitutes alone.
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Affiliation(s)
- R Shah
- Royal Preston Hospital , Preston , United Kingdom
| | - A Kiely
- Royal Preston Hospital , Preston , United Kingdom
| | - S McKirdy
- Royal Preston Hospital , Preston , United Kingdom
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Parmekar S, Shah R, Gokulakrishnan G, Gowda S, Castillo D, Iniguez S, Gallegos J, Sisson A, Thammasitboon S, Pammi M. Components of interprofessional education programs in neonatal medicine: A focused BEME review: BEME Guide No. 73. Med Teach 2022; 44:823-835. [PMID: 35319316 DOI: 10.1080/0142159x.2022.2053086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Care delivery in neonatology is dependent on an interprofessional team. Collaborative learning and education amongst professionals can lead to successful management of critically ill patients. This focused BEME review synthesized the components, outcomes, and impact of such interprofessional education (IPE) programs in neonatal medicine. METHODS The authors systematically searched four online databases and hand-searched MedEdPublish up to 10 September 2020. Two authors independently screened titles, abstracts, full-texts, performed data extraction and risk of bias assessment related to study methodology and reporting. Discrepancies were resolved by a third author. We reported our findings based on BEME guidance and the STORIES (STructured apprOach to the Reporting in health education of Evidence Synthesis) statement. RESULTS We included 17 studies on IPE in neonatal medicine. Most studies were from North America with varying learners, objectives, instruction, and observed outcomes. Learners represented nurses, respiratory therapists, neonatal nurse practitioners, patient care technicians, parents, early interventionists, physicians, and medical trainees amongst others. Risk of bias assessment in reporting revealed poor reporting of resources and instructor training. Bias assessment for study methodology noted moderate quality evidence with validity evidence as the weakest domain. IPE instruction strategies included simulation with debriefing, didactics, and online instruction. Most studies reported level 1 Kirkpatrick outcomes (76%) and few reported level 3 or 4 outcomes (23%). Challenges include buy-in from leadership and the negative influence of hierarchy amongst learners. CONCLUSIONS This review highlights IPE program components within neonatal medicine and exemplary practices including a multimodal instructional approach, asynchronous instruction, an emphasis on teamwork, and elimination of hierarchy amongst learners. We identified a lack of reporting on program development and instructor training. Future work should address long term knowledge and skill retention and impact on patient outcomes and organizations.
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Affiliation(s)
- S Parmekar
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - R Shah
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - G Gokulakrishnan
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - S Gowda
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - D Castillo
- Texas Children's Hospital, Houston, TX, USA
| | - S Iniguez
- Texas Children's Hospital, Houston, TX, USA
| | - J Gallegos
- Texas Children's Hospital, Houston, TX, USA
| | - A Sisson
- The Texas Medical Center Library, Houston, TX, USA
| | - S Thammasitboon
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Center for Research, Innovation and Scholarship in medical Education, Texas Children's Hospital, Houston, TX, USA
| | - M Pammi
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Livingstone J, Raveh Y, Souki F, Shatz V, Shah R, Ibrahim T, Shuman M, Beduschi T, Vianna R, Alvarez R, Nicolau-Raducu R. Multivisceral Transplant in a Patient With Portopulmonary Hypertension: A Case Report. Transplant Proc 2022; 54:1664-1670. [PMID: 35914967 DOI: 10.1016/j.transproceed.2022.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Portopulmonary hypertension, a type of pulmonary arterial hypertension in the setting of cirrhotic or noncirrhotic portal hypertension, is associated with elevated morbidity and mortality during and after transplantation. Uncontrolled portopulmonary hypertension may prevent or delay listing for transplant candidates, and the prognosis without treatment and ultimately transplant is extremely poor. We present a 29-year-old White woman, who had a post-liver transplant at infancy due to biliary atresia. Later on, she developed extensive portal vein thrombosis and portopulmonary hypertension and underwent a multivisceral transplant (liver, stomach, pancreaticoduodenal complex, and small and large intestine). Preoperative mean pulmonary artery pressure was <30 mm Hg with a pulmonary vascular resistance of <300 dynes.s/cm5 on oral sildenafil and intravenous epoprostenol. Intraoperatively, management required comprehensive transfusion protocols, a careful balance between correcting blood loss and preventing thrombosis. Intravenous epoprostenol, sildenafil, milrinone, and inhaled nitric oxide were used to reduce elevated mean pulmonary artery pressure and right ventricular strain associated with vascular clamping, reperfusion, and massive fluid shifts. Nitric oxide and epoprostenol use unleashed antiplatelet effects on a patient already susceptible to coagulopathy. A multimodal and multidisciplinary approach continued throughout the surgery and in the postoperative period, which led to a successful outcome.
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Affiliation(s)
- J Livingstone
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Y Raveh
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - F Souki
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - V Shatz
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - R Shah
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida; Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - T Ibrahim
- Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - M Shuman
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - T Beduschi
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida; Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - R Vianna
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida; Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - R Alvarez
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - R Nicolau-Raducu
- Department of Anesthesia, University of Miami/Jackson Memorial Hospital, Miami, Florida.
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Kouli O, Murray V, Bhatia S, Cambridge WA, Kawka M, Shafi S, Knight SR, Kamarajah SK, McLean KA, Glasbey JC, Khaw RA, Ahmed W, Akhbari M, Baker D, Borakati A, Mills E, Thavayogan R, Yasin I, Raubenheimer K, Ridley W, Sarrami M, Zhang G, Egoroff N, Pockney P, Richards T, Bhangu A, Creagh-Brown B, Edwards M, Harrison EM, Lee M, Nepogodiev D, Pinkney T, Pearse R, Smart N, Vohra R, Sohrabi C, Jamieson A, Nguyen M, Rahman A, English C, Tincknell L, Kakodkar P, Kwek I, Punjabi N, Burns J, Varghese S, Erotocritou M, McGuckin S, Vayalapra S, Dominguez E, Moneim J, Salehi M, Tan HL, Yoong A, Zhu L, Seale B, Nowinka Z, Patel N, Chrisp B, Harris J, Maleyko I, Muneeb F, Gough M, James CE, Skan O, Chowdhury A, Rebuffa N, Khan H, Down B, Fatimah Hussain Q, Adams M, Bailey A, Cullen G, Fu YXJ, McClement B, Taylor A, Aitken S, Bachelet B, Brousse de Gersigny J, Chang C, Khehra B, Lahoud N, Lee Solano M, Louca M, Rozenbroek P, Rozitis E, Agbinya N, Anderson E, Arwi G, Barry I, Batchelor C, Chong T, Choo LY, Clark L, Daniels M, Goh J, Handa A, Hanna J, Huynh L, Jeon A, Kanbour A, Lee A, Lee J, Lee T, Leigh J, Ly D, McGregor F, Moss J, Nejatian M, O'Loughlin E, Ramos I, Sanchez B, Shrivathsa A, Sincari A, Sobhi S, Swart R, Trimboli J, Wignall P, Bourke E, Chong A, Clayton S, Dawson A, Hardy E, Iqbal R, Le L, Mao S, Marinelli I, Metcalfe H, Panicker D, R HH, Ridgway S, Tan HH, Thong S, Van M, Woon S, Woon-Shoo-Tong XS, Yu S, Ali K, Chee J, Chiu C, Chow YW, Duller A, Nagappan P, Ng S, Selvanathan M, Sheridan C, Temple M, Do JE, Dudi-Venkata NN, Humphries E, Li L, Mansour LT, Massy-Westropp C, Fang B, Farbood K, Hong H, Huang Y, Joan M, Koh C, Liu YHA, Mahajan T, Muller E, Park R, Tanudisastro M, Wu JJG, Chopra P, Giang S, Radcliffe S, Thach P, Wallace D, Wilkes A, Chinta SH, Li J, Phan J, Rahman F, Segaran A, Shannon J, Zhang M, Adams N, Bonte A, Choudhry A, Colterjohn N, Croyle JA, Donohue J, Feighery A, Keane A, McNamara D, Munir K, Roche D, Sabnani R, Seligman D, Sharma S, Stickney Z, Suchy H, Tan R, Yordi S, Ahmed I, Aranha M, El Sabawy D, Garwood P, Harnett M, Holohan R, Howard R, Kayyal Y, Krakoski N, Lupo M, McGilberry W, Nepon H, Scoleri Y, Urbina C, Ahmad Fuad MF, Ahmed O, Jaswantlal D, Kelly E, Khan MHT, Naidu D, Neo WX, O'Neill R, Sugrue M, Abbas JD, Abdul-Fattah S, Azlan A, Barry K, Idris NS, Kaka N, Mc Dermott D, Mohammad Nasir MN, Mozo M, Rehal A, Shaikh Yousef M, Wong RH, Curran E, Gardner M, Hogan A, Julka R, Lasser G, Ní Chorráin N, Ting J, Browne R, George S, Janjua Z, Leung Shing V, Megally M, Murphy S, Ravenscroft L, Vedadi A, Vyas V, Bryan A, Sheikh A, Ubhi J, Vannelli K, Vawda A, Adeusi L, Doherty C, Fitzgerald C, Gallagher H, Gill P, Hamza H, Hogan M, Kelly S, Larry J, Lynch P, Mazeni NA, O'Connell R, O'Loghlin R, Singh K, Abbas Syed R, Ali A, Alkandari B, Arnold A, Arora E, Azam R, Breathnach C, Cheema J, Compton M, Curran S, Elliott JA, Jayasamraj O, Mohammed N, Noone A, Pal A, Pandey S, Quinn P, Sheridan R, Siew L, Tan EP, Tio SW, Toh VTR, Walsh M, Yap C, Yassa J, Young T, Agarwal N, Almoosawy SA, Bowen K, Bruce D, Connachan R, Cook A, Daniell A, Elliott M, Fung HKF, Irving A, Laurie S, Lee YJ, Lim ZX, Maddineni S, McClenaghan RE, Muthuganesan V, Ravichandran P, Roberts N, Shaji S, Solt S, Toshney E, Arnold C, Baker O, Belais F, Bojanic C, Byrne M, Chau CYC, De Soysa S, Eldridge M, Fairey M, Fearnhead N, Guéroult A, Ho JSY, Joshi K, Kadiyala N, Khalid S, Khan F, Kumar K, Lewis E, Magee J, Manetta-Jones D, Mann S, McKeown L, Mitrofan C, Mohamed T, Monnickendam A, Ng AYKC, Ortu A, Patel M, Pope T, Pressling S, Purohit K, Saji S, Shah Foridi J, Shah R, Siddiqui SS, Surman K, Utukuri M, Varghese A, Williams CYK, Yang JJ, Billson E, Cheah E, Holmes P, Hussain S, Murdock D, Nicholls A, Patel P, Ramana G, Saleki M, Spence H, Thomas D, Yu C, Abousamra M, Brown C, Conti I, Donnelly A, Durand M, French N, Goan R, O'Kane E, Rubinchik P, Gardiner H, Kempf B, Lai YL, Matthews H, Minford E, Rafferty C, Reid C, Sheridan N, Al Bahri T, Bhoombla N, Rao BM, Titu L, Chatha S, Field C, Gandhi T, Gulati R, Jha R, Jones Sam MT, Karim S, Patel R, Saunders M, Sharma K, Abid S, Heath E, Kurup D, Patel A, Ali M, Cresswell B, Felstead D, Jennings K, Kaluarachchi T, Lazzereschi L, Mayson H, Miah JE, Reinders B, Rosser A, Thomas C, Williams H, Al-Hamid Z, Alsadoun L, Chlubek M, Fernando P, Gaunt E, Gercek Y, Maniar R, Ma R, Matson M, Moore S, Morris A, Nagappan PG, Ratnayake M, Rockall L, Shallcross O, Sinha A, Tan KE, Virdee S, Wenlock R, Donnelly HA, Ghazal R, Hughes I, Liu X, McFadden M, Misbert E, Mogey P, O'Hara A, Peace C, Rainey C, Raja P, Salem M, Salmon J, Tan CH, Alves D, Bahl S, Baker C, Coulthurst J, Koysombat K, Linn T, Rai P, Sharma A, Shergill A, Ahmed M, Ahmed S, Belk LH, Choudhry H, Cummings D, Dixon Y, Dobinson C, Edwards J, Flint J, Franco Da Silva C, Gallie R, Gardener M, Glover T, Greasley M, Hatab A, Howells R, Hussey T, Khan A, Mann A, Morrison H, Ng A, Osmond R, Padmakumar N, Pervaiz F, Prince R, Qureshi A, Sawhney R, Sigurdson B, Stephenson L, Vora K, Zacken A, Cope P, Di Traglia R, Ferarrio I, Hackett N, Healicon R, Horseman L, Lam LI, Meerdink M, Menham D, Murphy R, Nimmo I, Ramaesh A, Rees J, Soame R, Dilaver N, Adebambo D, Brown E, Burt J, Foster K, Kaliyappan L, Knight P, Politis A, Richardson E, Townsend J, Abdi M, Ball M, Easby S, Gill N, Ho E, Iqbal H, Matthews M, Nubi S, Nwokocha JO, Okafor I, Perry G, Sinartio B, Vanukuru N, Walkley D, Welch T, Yates J, Yeshitila N, Bryans K, Campbell B, Gray C, Keys R, Macartney M, Chamberlain G, Khatri A, Kucheria A, Lee STP, Reese G, Roy choudhury J, Tan WYR, Teh JJ, Ting A, Kazi S, Kontovounisios C, Vutipongsatorn K, Amarnath T, Balasubramanian N, Bassett E, Gurung P, Lim J, Panjikkaran A, Sanalla A, Alkoot M, Bacigalupo V, Eardley N, Horton M, Hurry A, Isti C, Maskell P, Nursiah K, Punn G, Salih H, Epanomeritakis E, Foulkes A, Henderson R, Johnston E, McCullough H, McLarnon M, Morrison E, Cheung A, Cho SH, Eriksson F, Hedges J, Low Z, May C, Musto L, Nagi S, Nur S, Salau E, Shabbir S, Thomas MC, Uthayanan L, Vig S, Zaheer M, Zeng G, Ashcroft-Quinn S, Brown R, Hayes J, McConville R, French R, Gilliam A, Sheetal S, Shehzad MU, Bani W, Christie I, Franklyn J, Khan M, Russell J, Smolarek S, Varadarassou R, Ahmed SK, Narayanaswamy S, Sealy J, Shah M, Dodhia V, Manukyan A, O'Hare R, Orbell J, Chung I, Forenc K, Gupta A, Agarwal A, Al Dabbagh A, Bennewith R, Bottomley J, Chu TSM, Chu YYA, Doherty W, Evans B, Hainsworth P, Hosfield T, Li CH, McCullagh I, Mehta A, Thaker A, Thompson B, Virdi A, Walker H, Wilkins E, Dixon C, Hassan MR, Lotca N, Tong KS, Batchelor-Parry H, Chaudhari S, Harris T, Hooper J, Johnson C, Mulvihill C, Nayler J, Olutobi O, Piramanayagam B, Stones K, Sussman M, Weaver C, Alam F, Al Rawi M, Andrew F, Arrayeh A, Azizan N, Hassan A, Iqbal Z, John I, Jones M, Kalake O, Keast M, Nicholas J, Patil A, Powell K, Roberts P, Sabri A, Segue AK, Shah A, Shaik Mohamed SA, Shehadeh A, Shenoy S, Tong A, Upcott M, Vijayasingam D, Anarfi S, Dauncey J, Devindaran A, Havalda P, Komninos G, Mwendwa E, Norman C, Richards J, Urquhart A, Allan J, Cahya E, Hunt H, McWhirter C, Norton R, Roxburgh C, Tan JY, Ali Butt S, Hansdot S, Haq I, Mootien A, Sanchez I, Vainas T, Deliyannis E, Tan M, Vipond M, Chittoor Satish NN, Dattani A, De Carvalho L, Gaston-Grubb M, Karunanithy L, Lowe B, Pace C, Raju K, Roope J, Taylor C, Youssef H, Munro T, Thorn C, Wong KHF, Yunus A, Chawla S, Datta A, Dinesh AA, Field D, Georgi T, Gwozdz A, Hamstead E, Howard N, Isleyen N, Jackson N, Kingdon J, Sagoo KS, Schizas A, Yin L, Aung E, Aung YY, Franklin S, Han SM, Kim WC, Martin Segura A, Rossi M, Ross T, Tirimanna R, Wang B, Zakieh O, Ben-Arzi H, Flach A, Jackson E, Magers S, Olu abara C, Rogers E, Sugden K, Tan H, Veliah S, Walton U, Asif A, Bharwada Y, Bowley D, Broekhuizen A, Cooper L, Evans N, Girdlestone H, Ling C, Mann H, Mehmood N, Mulvenna CL, Rainer N, Trout I, Gujjuri R, Jeyaraman D, Leong E, Singh D, Smith E, Anderton J, Barabas M, Goyal S, Howard D, Joshi A, Mitchell D, Weatherby T, Badminton R, Bird R, Burtle D, Choi NY, Devalia K, Farr E, Fischer F, Fish J, Gunn F, Jacobs D, Johnston P, Kalakoutas A, Lau E, Loo YNAF, Louden H, Makariou N, Mohammadi K, Nayab Y, Ruhomaun S, Ryliskyte R, Saeed M, Shinde P, Sudul M, Theodoropoulou K, Valadao-Spoorenberg J, Vlachou F, Arshad SR, Janmohamed AM, Noor M, Oyerinde O, Saha A, Syed Y, Watkinson W, Ahmadi H, Akintunde A, Alsaady A, Bradley J, Brothwood D, Burton M, Higgs M, Hoyle C, Katsura C, Lathan R, Louani A, Mandalia R, Prihartadi AS, Qaddoura B, Sandland-Taylor L, Thadani S, Thompson A, Walshaw J, Teo S, Ali S, Bawa JH, Fox S, Gargan K, Haider SA, Hanna N, Hatoum A, Khan Z, Krzak AM, Li T, Pitt J, Tan GJS, Ullah Z, Wilson E, Cleaver J, Colman J, Copeland L, Coulson A, Davis P, Faisal H, Hassan F, Hughes JT, Jabr Y, Mahmoud Ali F, Nahaboo Solim ZN, Sangheli A, Shaya S, Thompson R, Cornwall H, De Andres Crespo M, Fay E, Findlay J, Groves E, Jones O, Killen A, Millo J, Thomas S, Ward J, Wilkins M, Zaki F, Zilber E, Bhavra K, Bilolikar A, Charalambous M, Elawad A, Eleni A, Fawdon R, Gibbins A, Livingstone D, Mala D, Oke SE, Padmakumar D, Patsalides MA, Payne D, Ralphs C, Roney A, Sardar N, Stefanova K, Surti F, Timms R, Tosney G, Bannister J, Clement NS, Cullimore V, Kamal F, Lendor J, McKay J, Mcswiggan J, Minhas N, Seneviratne K, Simeen S, Valverde J, Watson N, Bloom I, Dinh TH, Hirniak J, Joseph R, Kansagra M, Lai CKN, Melamed N, Patel J, Randev J, Sedighi T, Shurovi B, Sodhi J, Vadgama N, Abdulla S, Adabavazeh B, Champion A, Chennupati R, Chu K, Devi S, Haji A, Schulz J, Testa F, Davies P, Gurung B, Howell S, Modi P, Pervaiz A, Zahid M, Abdolrazaghi S, Abi Aoun R, Anjum Z, Bawa G, Bhardwaj R, Brown S, Enver M, Gill D, Gopikrishna D, Gurung D, Kanwal A, Kaushal P, Khanna A, Lovell E, McEvoy C, Mirza M, Nabeel S, Naseem S, Pandya K, Perkins R, Pulakal R, Ray M, Reay C, Reilly S, Round A, Seehra J, Shakeel NM, Singh B, 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Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Abstract
Methotrexate leading to hypercalcaemia is a rarely reported adverse event. We present three elderly patients with inflammatory arthritis who developed hypercalcemia probably due to methotrexate-induced granulomatous pneumonitis. All patients presented with worsening non-productive cough with dyspnea, nausea, loss of appetite, and confusion. Their clinical and radiologic features were consistent with methotrexate-induced pneumonitis. On evaluation, all patients concurrently had hypercalcemia with normal 25OH D3, and low PTH with markedly elevated levels of 1,25OH D3 seen in two patients. In all three patients, hypercalcemia and pneumonia responded to hydration, corticosteroids, and methotrexate withdrawal. There was no relapse of symptoms on long term follow-up. In these three patients with inflammatory arthritis, methotrexate-induced pneumonitis led to symptomatic hypercalcemia. Unless hypercalcemia is looked for and treated in this setting, the morbidity can be high.
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Affiliation(s)
- R Samant
- Department of Rheumatology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
| | - S Yadav
- Department of Rheumatology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
| | - A Khune
- Department of Rheumatology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
| | - R Shah
- Department of Rheumatology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India
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Mroue J, Saouma S, Lafferty J, Ali H, Mehta V, El-Khoury M, Weinberg M, Kowalski M, Epstein L, Akhrass P, Parikh V, Shah R, Yacoub H. 472 Proximity Of Coronary Arteries To Tricuspid Annulus As Determined By Computed Tomography. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.083] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Phyo AZZ, Ryan J, Gonzalez-Chica D, Stocks N, Woods R, Murray A, Reid C, Nelson M, Tonkin A, Storey E, Gasevic D, Orchard, Shah R, Freak-Poli R. 1005 HEALTH-RELATED QUALITY OF LIFE AND FUTURE RISK OF HEALTH OUTCOMES AMONG OLDER ADULTS LIVING IN AUSTRALIA AND THE UNITED STATES. Age Ageing 2022. [DOI: 10.1093/ageing/afac124.009] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Poor health-related quality of life (HRQoL) is associated with higher morbidity and mortality in patient populations. However, whether HRQoL is associated with health outcomes among community-dwelling older people requires further investigation. This study aimed to examine whether HRQoL predicts cognitive decline, dementia, cardiovascular disease (CVD), and mortality in community-dwelling older people living in Australia and the United States.
Method
A cohort of 19,106 individuals from the ASPirin in Reducing Events in the Elderly (ASPREE) study, aged 65–98 years, initially free of dementia or CVD, and who completed the HRQoL 12-item short form (SF-12, version-2) at baseline (2010–2014), were followed until June 2017. The physical (PCS) and mental component scores (MCS) of SF-12 were generated using standardized norm-based method.
Results
Over a median of 4.7 years, there were 2,412 cognitive declines, 574 dementia, 922 incident CVD events, and 1,052 deaths. Using Cox proportional-hazard regression adjusted for a range of covariates, every 10-unit increase in PCS was associated with a 6% lower risk of cognitive decline, a 14% lower risk of incident CVD, and 17% lower risk of all-cause mortality, but was not associated with incident dementia. In contrast, higher MCS was only associated with a 12% and 15% lower risk of cognitive decline and dementia, respectively. Findings did not differ by sex.
Conclusion
Our study provides some of the first evidence that HRQoL can be used in combination with clinical data to identify the future risks of health outcomes among older individuals living in the community. Our findings support the decision of the Australian Commission on Safety and Quality in Health Care to incorporate the SF-12 into the annual Patient-Reported Outcome Measures (PROMs assessment.
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Affiliation(s)
| | - J Ryan
- Monash University , Australia
| | | | - N Stocks
- The University of Adelaide , Australia
| | - R Woods
- Monash University , Australia
| | - A Murray
- Berman Center for Outcomes and Clinical Research , Minneapolis, Minnesota, USA
| | - C Reid
- Monash University , Australia
- Curtin University , Australia
| | - M Nelson
- Monash University , Australia
- University of Tasmania , Australia
| | | | | | - D Gasevic
- Monash University , Australia
- University of Edinburgh , UK
| | - Orchard
- Monash University , Australia
| | - R Shah
- Rush University Medical Center , Chicago, Illinois, USA
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Sedykh A, Choksi NY, Allen DG, Casey WM, Shah R, Kleinstreuer NC. Mixtures-Inclusive In Silico Models of Ocular Toxicity Based on United States and International Hazard Categories. Chem Res Toxicol 2022; 35:992-1000. [PMID: 35549170 DOI: 10.1021/acs.chemrestox.1c00443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Computational modeling grounded in reliable experimental data can help design effective non-animal approaches to predict the eye irritation and corrosion potential of chemicals. The National Toxicology Program (NTP) Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM) has compiled and curated a database of in vivo eye irritation studies from the scientific literature and from stakeholder-provided data. The database contains 810 annotated records of 593 unique substances, including mixtures, categorized according to UN GHS and US EPA hazard classifications. This study reports a set of in silico models to predict EPA and GHS hazard classifications for chemicals and mixtures, accounting for purity by setting thresholds of 100% and 10% concentration. We used two approaches to predict classification of mixtures: conventional and mixture-based. Conventional models evaluated substances based on the chemical structure of its major component. These models achieved balanced accuracy in the range of 68-80% and 87-96% for the 100% and 10% test concentration thresholds, respectively. Mixture-based models, which accounted for all known components in the substance by weighted feature averaging, showed similar or slightly higher accuracy of 72-79% and 89-94% for the respective thresholds. We also noted a strong trend between the pH feature metric calculated for each substance and its activity. Across all the models, the calculated pH of inactive substances was within one log10 unit of neutral pH, on average, while for active substances, pH varied from neutral by at least 2 log10 units. This pH dependency is especially important for complex mixtures. Additional evaluation on an external test set of 673 substances obtained from ECHA dossiers achieved balanced accuracies of 64-71%, which suggests that these models can be useful in screening compounds for ocular irritation potential. Negative predictive value was particularly high and indicates the potential application of these models in a bottom-up approach to identify nonirritant substances.
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Affiliation(s)
- Alexander Sedykh
- Sciome LLC, 1920 E NC 54 Hwy, Suite 510, Durham, North Carolina 27713, United States
| | - Neepa Y Choksi
- Integrated Laboratory Systems Inc, 601 Keystone Park Drive, Suite 200, Morrisville, North Carolina 27560, United States
| | - David G Allen
- Integrated Laboratory Systems Inc, 601 Keystone Park Drive, Suite 200, Morrisville, North Carolina 27560, United States
| | - Warren M Casey
- NIH/NIEHS/DNTP/NICEATM, 530 Davis Drive, Morrisville, North Carolina 27560, United States
| | - Ruchir Shah
- Sciome LLC, 1920 E NC 54 Hwy, Suite 510, Durham, North Carolina 27713, United States
| | - Nicole C Kleinstreuer
- NIH/NIEHS/DNTP/NICEATM, 530 Davis Drive, Morrisville, North Carolina 27560, United States
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Bhattarai R, Acharya S, Shah R. P.47 Spinal anaesthesia for caesarean section in high altitude and low altitude: a comparative cross-sectional study. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103343] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah R, Dodd M, Allen E, Viner R, Bonell C. Is being a victim of bullying or cyberbullying in secondary school associated with subsequent risk-taking behavior in adolescence? A longitudinal study in secondary schools. J Adolesc 2022; 94:611-627. [PMID: 35484876 DOI: 10.1002/jad.12050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Neurobiological and social changes in adolescence can make victims of bullying more susceptible to subsequent impulsive behavior. With the high prevalence of bullying in schools and rise in cyberbullying in the United Kingdom, it is important that the health impacts of bullying victimization, including on risk-taking, are understood. Our study aims to investigate whether bullying/cyberbullying victimization is associated with subsequent health risk-taking behavior in adolescence. Risk-taking behavior includes electronic cigarette and cigarette smoking, alcohol consumption, illicit drug use, early sexual debut, weapon carrying, damaging property, and setting fire. METHODS A secondary quantitative analysis of data from 3337, English, secondary school students in the control arm of the INCLUSIVE trial, constituting an observational cohort. Bullying victimization was measured at baseline (age 11/12 years) using the gatehouse bullying scale and a separate question on cyberbullying victimization. Logistic regression was used to test for an association between bullying/cyberbullying victimization at baseline and risk-taking behavior at 36 months, adjusting for baseline risk-taking behavior and other potential confounders, and accounting for school clustering. RESULTS There was strong evidence (p ≤ .02) for a positive dose-responsive association between being bullied at baseline and nearly all risk-taking behavior at follow-up. Although there was no evidence for an association between being bullied at baseline and weapon carrying (p = .102), there was evidence for a positive association between being cyberbullied at baseline and weapon carrying (p = .036). CONCLUSIONS It is plausible that bullying/cyberbullying victimization increases the likelihood of subsequent risk-taking behavior in adolescence. Policy options should focus on implementing evidence-based antibullying school interventions.
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Affiliation(s)
- R Shah
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - M Dodd
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - E Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - R Viner
- Institute of Child Health, University College London, London, UK
| | - C Bonell
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Calabrese D, Singer J, Hays S, Leard L, Golden J, Kolaitis N, Kleinhenz M, Shah R, Venado A, Kukreja J, Belperio J, Weigt S, Greenland J, Looney M. Bronchoalveolar Lavage MICB is Associated with Severe Primary Graft Dysfunction, Prolonged Mechanical Ventilation, and Low Post-Transplant FEV1 in Lung Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.174] [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] Open
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Seijo L, Smith P, Greenland J, Gao Y, Kolaitis N, Venado A, Hays S, Thakur N, Kukreja J, Leard L, Golden J, Shah R, Kleinhenz M, Perez A, Trinh B, Betancourt L, Medikonda N, Calabrese D, Blanc P, Katz P, Singer J. Worsening in the Lung Transplant-Valued Life Activities Scale is Associated with Mortality in Lung Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1344] [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] Open
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Nguyen A, Trinh B, Deuse T, Singer J, Hays S, Venado A, Leard L, Shah R, Kleinhenz M, Kolaitis N, Calabrese D, Greenland J, Golden J, Brzezinski M, Kukreja J. Short-Term Outcomes of Lung Transplantation for COVID-19 ARDS: A Single Center Experience. J Heart Lung Transplant 2022. [PMCID: PMC8988588 DOI: 10.1016/j.healun.2022.01.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The outcomes of lung transplant (LTx) for COVID-19 related lung disease are continuing to be examined. This study describes our experience in the first 7 cases. Methods This study included all patients received double LTx (DLTx) for COVID-19 acute respiratory distress syndrome (ARDS) between November 2020 and October 2021. Patient pre-LTx and perioperative characteristics as well as post-LTx outcomes are presented. Results Seven patients underwent DLTx for COVID-19 ARDS. All required mechanical ventilation (MV) pre-LTx. Six patients were male (85%), 5 Hispanic (71%), with a median age of 48 (IQR 40-53) and median body mass index of 23.6 (IQR 21.7-25.6). Six patients (85%) were on veno-venous extracorporeal membrane oxygenation (VV-ECMO) pre-LTx (one conversion from VV to veno-arterial (VA)). Median duration of MV and ECMO pre-LTx was 140 days (IQR 82-165) and 71.5 days (IQR 58-149), respectively. Two patients developed acute kidney injury pre-LTx requiring continuous renal replacement therapy (CRRT). Median time from listing to transplant was 17 days (IQR 10-24). ECMO was discontinued in all but 1 patient post-LTx. Median length of stay in the hospital post-LTx was 30 days (IQR 15-57). All were discharged from the hospital (43% to rehabilitation facility). Two patients on pre-LTx CRRT remained hemodialysis dependent and had multi-drug resistant (MDR) bacterial infections post-LTx. One readmission occurred for presumed rejection, aspiration and infection with MDR Klebsiella now requiring oxygen. All surgical pathology showed diffuse interstitial fibrosis consistent with the fibrotic sequelae of alveolar damage due to COVID-19. At 3-month follow-up, 6 patients (85%) did not need supplemental oxygen and had good pulmonary function. Conclusion Lung transplantation for COVID-ARDS is feasible. However, pre-transplant multi-system involvement may be associated with a protracted post-LTx stay and MDR infection. Further studies are needed to assess the long-term outcomes in this cohort.
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Schindler H, Lusky F, Gaissmaier L, Daniello L, Elshiaty M, Bozorgmehr F, Kuon J, Shah R, Schneider M, Eichhorn F, Baum P, Angeles A, Janke F, Kriegsmann M, Kazdal D, Stenzinger A, Sültmann H, Thomas M, Christopoulos P. 65P Blood cytokine changes in patients with advanced NSCLC receiving immunotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Utekar T, Shah R. 49 Comparative study of manual vacuum aspiration syringe versus electrical suction for management of miscarriage and abortion. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oates TW, Guy V, Ni K, Ji C, Saito H, Shiau H, Shah R, Williams MA, Blasi G, Goloubeva O. Meta-regression Analysis of Study Heterogeneity for Systemic Outcomes after Periodontal Therapy. JDR Clin Trans Res 2022; 8:23800844211070467. [PMID: 35037489 DOI: 10.1177/23800844211070467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The contribution of periodontal disease to adverse systemic consequences remains controversial. This analysis examined 2 well-investigated conditions independently and combined-adverse pregnancy outcomes and glycemic control for patients with diabetes-based on shared pathogenic mechanisms of periodontal infection and inflammation. It was proposed that inconsistencies in study design significantly contribute to outcome discrepancies found between periodontal intervention studies undergoing meta-analysis. METHODS Meta-analyses evaluating periodontal interventions on the rate of preterm birth and changes in glycated hemoglobin A1c in type 2 diabetes populations were conducted based on a systematic review of randomized controlled trials. Meta-regression covariates for exploring heterogeneity included sample size, level of medical management, and bias risk as moderator variables in a random-effects meta-regression. RESULTS Systematic review identified 17 studies of diabetes and 13 of pregnancy outcomes. Analyses of these studies identified 0.50% reduction in HbA1c and 0.78 odds ratio for preterm births. The heterogeneity associated with the models was high (I2 = 92.4 and I2 = 62.7%, respectively). The adjusted models evaluating each systemic condition separately accounted for 52.2% of the effect for diabetes and 81.4% for pregnancy outcome effects independently, and 63.5% collectively, across interventional studies. CONCLUSION This systematic review with meta-regression analysis of heterogeneity demonstrates that disparate results seen in randomized controlled trials of periodontal therapy affecting systemic outcomes may be explained in large part by study design, specifically stringency in consideration of medical management and sample size. The potential for confounding factors to influence outcomes remains a concern in understanding the implications of oral health on systemic conditions. KNOWLEDGE TRANSFER STATEMENT The findings of this study demonstrate that much of the benefits seen from periodontal therapy on adverse systemic outcomes for diabetes and pregnancy are due to limitations in study design.
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Affiliation(s)
- T W Oates
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - V Guy
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Summerville, SC, USA
| | - K Ni
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Lancaster, PA, USA
| | - C Ji
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Division of Periodontology and Implant Dentistry, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - H Saito
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - H Shiau
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - R Shah
- University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: UCSF School of Dentistry, University of California, San Francisco, San Francisco, CA, USA
| | - M A Williams
- Health Sciences & Human Services Library, University of Maryland, Baltimore, MD, USA
| | - G Blasi
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Current affiliation: Private practice, Barcelona, Spain
| | - O Goloubeva
- Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Tandon A, Howard B, Ramaiahgari S, Maharana A, Ferguson S, Shah R, Merrick BA. Deep Learning Image Analysis of High-Throughput Toxicology Assay Images. SLAS Discov 2022; 27:29-38. [PMID: 35058173 PMCID: PMC8955414 DOI: 10.1016/j.slasd.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
High-throughput chemical screening approaches often employ microscopy to capture photomicrographs from multi-well cell culture plates, generating thousands of images that require time-consuming human analysis. To automate this subjective and time-consuming manual process, we have developed a method that uses deep learning to automatically classify digital assay images. We have trained a convolutional neural network (CNN) to perform binary and multi-class classification. The binary classifier binned assay images into healthy (comparable to untreated controls) and altered (not comparable to untreated-control) classes with >98% accuracy; the multi-class classifier assigned "Healthy," "Intermediate" and "Altered" labels to assay images with >95% accuracy. Our dataset comprised high-resolution assay images from primary human hepatocytes and undifferentiated (proliferating) and differentiated 2D cultures of HepaRG cells. In this study we have focused on testing and fine-tuning various CNN architectures, including ResNet 34, 50 and 101. To visualize regions in the images that the CNN model used for classification, we employed Class Activation Maps (CAM). This allowed us to better understand the inner workings of the neural network and led to additional optimizations of the algorithm. The results indicate a strong correspondence between dosage and classifier-predicted scores, suggesting that these scores might be useful in further characterizing benchmark dose. Together, these results clearly demonstrate that deep-learning based automated image classification of cell morphology changes upon chemical-induced stress can yield highly accurate and reproducible assessments of cytotoxicity across a variety of cell types.
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Affiliation(s)
| | | | - Sreenivasa Ramaiahgari
- National Toxicology Program Division, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | | | - Stephen Ferguson
- National Toxicology Program Division, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Ruchir Shah
- Sciome LLC, Research Triangle Park, NC, USA.
| | - B Alex Merrick
- National Toxicology Program Division, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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Karn RR, Acharya R, Rajbanshi AK, Singh SK, Thakur SK, Shah SK, Singh AK, Shah R, Upadhya Kafle S, Bhattachan M, Abrahamyan A, Shewade HD, Zachariah R. Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal. Public Health Action 2021; 11:1-5. [PMID: 34778008 PMCID: PMC8575382 DOI: 10.5588/pha.21.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
SETTING Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM). OBJECTIVE In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance. DESIGN A cohort study using hospital data, January 2018-January 2020. RESULTS Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery. CONCLUSION Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.
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Affiliation(s)
- R R Karn
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - R Acharya
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - A K Rajbanshi
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Singh
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Thakur
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S K Shah
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - A K Singh
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - R Shah
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - S Upadhya Kafle
- Nepal Netra Jyoti Sangh/Eastern Regional Eye Care - Programme/Biratnagar Eye Hospital, Biratnagar, Nepal
| | - M Bhattachan
- World Health Organization, Country Office, Kathmandu, Nepal
| | - A Abrahamyan
- Tuberculosis Research and Prevention Center, Yerevan, Armenia
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union, South East Asia, New Delhi, India
| | - R Zachariah
- United Nations Children's Fund/United Nations Development Programme/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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