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Chiang CY, Bern H, Goodall R, Chien ST, Rusen ID, Nunn A. Radiographic characteristics of rifampicin-resistant tuberculosis in the STREAM stage 1 trial and their influence on time to culture conversion in the short regimen. BMC Infect Dis 2024; 24:144. [PMID: 38291393 PMCID: PMC10825976 DOI: 10.1186/s12879-024-09039-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/20/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Stage 1 of the STREAM trial demonstrated that the 9 month (Short) regimen developed in Bangladesh was non-inferior to the 20 month (Long) 2011 World Health Organization recommended regimen. We assess the association between HIV infection and radiographic manifestations of tuberculosis and factors associated with time to culture conversion in Stage 1 of the STREAM trial. METHODS Reading of chest radiographs was undertaken independently by two clinicians, and films with discordant reading were read by a third reader. Recording of abnormal opacity of the lung parenchyma included location (right upper, right lower, left upper, and left lower) and extent of disease (minimal, moderately-advanced, and far advanced). Time to culture conversion was defined as the number of days from initiation of treatment to the first of two consecutive negative culture results, and compared using the log-rank test, stratified by country. Cox proportional hazards models, stratified by country and adjusted for HIV status, were used to identify factors associated with culture conversion. RESULTS Of the 364 participants, all but one had an abnormal chest X-ray: 347 (95%) had opacities over upper lung fields, 318 (87%) had opacities over lower lung fields, 124 (34%) had far advanced pulmonary involvement, and 281 (77%) had cavitation. There was no significant association between HIV and locations of lung parenchymal opacities, extent of opacities, the presence of cavitation, and location of cavitation. Participants infected with HIV were significantly less likely to have the highest positivity grade (3+) of sputum culture (p = 0.035) as compared to participants not infected with HIV. Cavitation was significantly associated with high smear positivity grades (p < 0.001) and high culture positivity grades (p = 0.004) among all participants. Co-infection with HIV was associated with a shorter time to culture conversion (hazard ratio 1.59, 95% CI 1.05-2.40). CONCLUSIONS Radiographic manifestations of tuberculosis among the HIV-infected in the era of anti-retroviral therapy may not differ from that among those who were not infected with HIV. Radiographic manifestations were not consistently associated with time to culture conversion, perhaps indicating that the Short regimen is sufficiently powerful in achieving sputum conversion across the spectrum of radiographic pulmonary involvements. TRIAL REGISTRATION ISRCTN ISRCTN78372190. Registered 14/10/2010. The date of first registration 10/02/2016.
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Affiliation(s)
- Chen-Yuan Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, 111 Hsin-Long Road, Section 3, Taipei, 116, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan.
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, London, UK
| | | | - Shun-Tien Chien
- Chest Hospital, Ministry of Health and Welfare, Tainan, Taiwan
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Chicco M, Borsky K, Goodall R, Harrison C, Rodrigues J. Outcomes of skin cancer excision in frail patients: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2023; 84:32-36. [PMID: 37320949 DOI: 10.1016/j.bjps.2023.05.016] [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: 07/27/2022] [Revised: 04/23/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC) is the most common cancer type and incidence increases with age. As a consequence, an increasing number of frail patients are being referred for consideration of skin cancer surgery. However, some of these patients may not live long enough to experience benefit from surgery, while being at risk of postoperative complications. OBJECTIVES To investigate the treatment burden of surgical excision of skin cancers in frail individuals. METHODS We conducted a single-center retrospective cohort study analyzing outcomes of skin cancer excision in frail versus non-frail patients. RESULTS Eighty-eight patients were included. The complication rate was higher in frail versus non-frail patients: 12 (27.9%) versus 9 (18.8%), with 5 unplanned postoperative hospital attendances leading to 3 hospital admissions in the frail cohort. Nine patients in the frail group (21%) died within 6 months of their procedure versus no deaths in the non-frail group (p < 0.001 Fisher's Exact test), with no deaths attributed to skin cancer. CONCLUSION Treatment-related complications and mortality are common in frail patients after surgical excision of skin lesions clinically suspicious for skin cancer. Careful consideration should be given, and patients should be adequately counseled about treatment risks and alternative management options, including active surveillance, in particular, if the lesions are expected to remain asymptomatic.
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Affiliation(s)
- M Chicco
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK.
| | - K Borsky
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK
| | - R Goodall
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK
| | - C Harrison
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - J Rodrigues
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK; Warwick Clinical Trials Unit, University of Warwick, UK
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3
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Salciccioli I, Mariano M, Goodall R, Shalhoub J, Marshall D, Salciccioli J. PRIMARY IMMUNODEFICIENCY DISEASE MORTALITY TRENDS ACROSS EU15+ COUNTRIES: AN EPIDEMIOLOGICAL ANALYSIS. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.663] [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: 11/11/2022]
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4
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Ojha U, Marshall D, Salciccioli J, Al-Khayatt B, Goodall R, Borsky K, Crowley C, Shalhoub J, Hartley A. An observational analysis of trends in rheumatic heart disease incidence and mortality in EU15+ countries over 29 years. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2237] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Rheumatic heart disease (RHD) is a debilitating sequela of acute rheumatic fever (ARF), caused by Group A streptococcus (GAS) infection. Repeated episodes of ARF results in valvular damage over time. As a preventable disorder which was once common worldwide, RHD has largely been eradicated in affluent nations due to widespread availability of penicillin, improvement in socioeconomic standards and advancements in health and social infrastructures. However, it has been speculated that the global refugee crisis, especially in Europe, might contribute to a resurgence of RHD cases in these regions.
Purpose
This observational study aimed to analyse trends in RHD incidence and mortality rates in European Union 15+ (EU15+) over a 29-year period.
Methods
Data was obtained from the Global Burden of Disease database. Age-standardised mortality and incidence rates for RHD were extracted for the EU15+ countries for the years 1990–2019. Trends were subsequently analysed using Joinpoint regression analysis.
Results
Over the 29-year period, an overall declining trend in RHD incidence and mortality across EU 15+ nations was observed. The United Kingdom demonstrated the largest decrease in RHD incidence amongst females (−54.9%) and Finland amongst males (−55.3%). Both RHD incidence and mortality were higher among females compared to males across EU15+ countries over the observed period. The most recent incidence trends, starting predominantly after 2014, demonstrated a rise in RHD incidence in most countries. For both sexes, increases were seen in Australia, Belgium, Ireland, Italy, Netherlands, Norway, Sweden and USA. For males specifically, increase in RHD incidence was seen in Spain, and Finland, and for females only in Canada and Ireland. The recent increasing RHD incidence rates ranged from +0.4% to + 24.7% for males and +0.6% to +11.4% for females.
Conclusion
Whilst overall there are decreases in incidence and mortality from RHD, we observe more than half of EU15+ countries have increasing incidence trends in RHD in recent years. This increasing trend primarily started after 2014, overlapping with the start of the European migration crisis. Although speculative, disparities in access to healthcare for migrants, amongst other socioeconomic factors, may be potential causes; subsequently, further efforts by governments and public health officials are required to recognise and control the resurgence of RHD in high income nations.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- U Ojha
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
| | - D Marshall
- National Heart and Lung Institute , London , United Kingdom
| | - J Salciccioli
- Brigham and Women's Hospital , Boston , United States of America
| | - B Al-Khayatt
- Surrey and Sussex Healthcare Trust , Redhill , United Kingdom
| | - R Goodall
- Mid Essex Hospital NHS Trust , Chelmsford , United Kingdom
| | - K Borsky
- Stoke Mandeville Hospital , Aylesbury , United Kingdom
| | - C Crowley
- Lahey Hospital & Medical Center , Burlington , United States of America
| | - J Shalhoub
- Imperial College Healthcare NHS Trust , London , United Kingdom
| | - A Hartley
- National Heart and Lung Institute , London , United Kingdom
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Pham TM, Tweed CD, Carpenter JR, Kahan BC, Nunn AJ, Crook AM, Esmail H, Goodall R, Phillips PPJ, White IR. Rethinking intercurrent events in defining estimands for tuberculosis trials. Clin Trials 2022; 19:522-533. [PMID: 35850542 PMCID: PMC9523802 DOI: 10.1177/17407745221103853] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND/AIMS Tuberculosis remains one of the leading causes of death from an infectious disease globally. Both choices of outcome definitions and approaches to handling events happening post-randomisation can change the treatment effect being estimated, but these are often inconsistently described, thus inhibiting clear interpretation and comparison across trials. METHODS Starting from the ICH E9(R1) addendum's definition of an estimand, we use our experience of conducting large Phase III tuberculosis treatment trials and our understanding of the estimand framework to identify the key decisions regarding how different event types are handled in the primary outcome definition, and the important points that should be considered in making such decisions. A key issue is the handling of intercurrent (i.e. post-randomisation) events (ICEs) which affect interpretation of or preclude measurement of the intended final outcome. We consider common ICEs including treatment changes and treatment extension, poor adherence to randomised treatment, re-infection with a new strain of tuberculosis which is different from the original infection, and death. We use two completed tuberculosis trials (REMoxTB and STREAM Stage 1) as illustrative examples. These trials tested non-inferiority of new tuberculosis treatment regimens versus a control regimen. The primary outcome was a binary composite endpoint, 'favourable' or 'unfavourable', which was constructed from several components. RESULTS We propose the following improvements in handling the above-mentioned ICEs and loss to follow-up (a post-randomisation event that is not in itself an ICE). First, changes to allocated regimens should not necessarily be viewed as an unfavourable outcome; from the patient perspective, the potential harms associated with a change in the regimen should instead be directly quantified. Second, handling poor adherence to randomised treatment using a per-protocol analysis does not necessarily target a clear estimand; instead, it would be desirable to develop ways to estimate the treatment effects more relevant to programmatic settings. Third, re-infection with a new strain of tuberculosis could be handled with different strategies, depending on whether the outcome of interest is the ability to attain culture negativity from infection with any strain of tuberculosis, or specifically the presenting strain of tuberculosis. Fourth, where possible, death could be separated into tuberculosis-related and non-tuberculosis-related and handled using appropriate strategies. Finally, although some losses to follow-up would result in early treatment discontinuation, patients lost to follow-up before the end of the trial should not always be classified as having an unfavourable outcome. Instead, loss to follow-up should be separated from not completing the treatment, which is an ICE and may be considered as an unfavourable outcome. CONCLUSION The estimand framework clarifies many issues in tuberculosis trials but also challenges trialists to justify and improve their outcome definitions. Future trialists should consider all the above points in defining their outcomes.
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Affiliation(s)
| | | | - James R Carpenter
- MRC Clinical Trials Unit at UCL, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Patrick PJ Phillips
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
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Ali R, Sugand K, Goodall R, Salciccioli J, Marshall D, Schuster-Bruce J, Abdul-Jabar HB, Shalhoub J. 12 Trends in Neck of Femur Fracture Incidence in EU15+ Countries From 1990–2017. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.447] [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: 11/07/2022]
Abstract
Abstract
Background
Neck of femur fractures (NOFF) pose significant socio-economic costs to society with a high degree of morbidity and mortality. Its incidence rate has been collated within the Global Burden of Disease (GBD) database; however, to date, no comparison across countries has been reported.
Method
NOFF age-standardised incidence rates (ASIR) per 100,000 population were extracted from the GBD database for European Union (EU) 15+ countries over the period 1990 to 2017. Joinpoint regression analysis of the data identified trends in ASIR and associated estimated annual percentage changes (EAPC). These were analysed by specified timeframe, country, and gender.
Results
Of the 19 EU15+ countries, 11 (58%) had overall increases in NOFF ASIRs in 2017 compared to 1990. The median ASIRs were 240/100,000 and 322/100,000 for males and females, respectively, in 1990. By 2017, this had increased to 259/100,000 and 325/100,000, respectively. Females consistently had relatively higher NOFF ASIRs with a median gender fracture gap of 62/100,000 in 2017. Males had a higher percentage change in increasing ASIRs, with a smaller percentage change in decreasing ASIRs for all included countries. The highest national ASIRs was observed in Australia, followed by Finland and Belgium. Conversely the Mediterranean countries demonstrated the lowest ASIRs, closely followed by the USA.
Conclusions
Despite significant advances in primary and secondary hip fracture prevention strategies over the 28-year study period, significant increases in NOFF ASIRs among most EU15+ countries were observed, especially with respect to gender.
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Affiliation(s)
- R Ali
- Queen Elizabeth The Queen Mother, East Kent Hospitals University NHS Foundation Trust , Margate , United Kingdom
| | - K Sugand
- Trauma & Orthopaedic Surgery Unit, Imperial College Healthcare NHS Trust , London , United Kingdom
| | - R Goodall
- Department of Plastic Surgery , Buckinghamshire Healthcare NHS Trust, Oxford , United Kingdom
| | | | - D Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford , Oxford , United Kingdom
| | - J Schuster-Bruce
- Department of Ear, Nose and Throat, Head and Neck Surgery, St Georges University Hospitals NHS Trust , London , United Kingdom
| | - HB Abdul-Jabar
- Trauma & Orthopaedic Surgery Unit, London Northwest University NHS Trust , London , United Kingdom
| | - J Shalhoub
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust , London , United Kingdom
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7
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Goodall R, Chicco M, Wietek N, Borsky K, Harrison C, Rodrigues J. O045 A systematic review of observational management of cutaneous basal cell carcinoma. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.045] [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: 11/07/2022]
Abstract
Abstract
Background
Cutaneous basal cell carcinoma (BCC) is the commonest cancer in the United Kingdom. Surgical excision is the most common treatment. This review summarises all published outcomes of observational/non-interventional management of BCC.
Methods
This PRISMA-compliant systematic review searched MEDLINE, EMBASE and CENTRAL databases from inception-June 2021. All studies reporting outcomes of observational management for BCC were included.
Results
From 2529 titles, four full-text articles reporting on 2298 individuals were eligible. Two studies were randomised controlled trials (RCTs) comparing histological clearance rates and adverse events following treatment with an inactive strategy (placebo cream) versus topical 5%-imiquimod (at different frequencies) for 6–12 weeks. Clearance rates ranged from 52–100% for imiquimod and 2–19% for placebo, with more adverse events associated with imiquimod. The other two studies used prospective cohort designs. One study assessed the natural history of BCCs managed expectantly in 39 individuals aged ≥80years. During the 15.8-month follow-up, 46.2% of lesions did not increase in size and 10.3% resolved. The remaining study compared treatment patterns of 1360 patients with non-melanoma skin cancer (NMSC) in individuals with or without limited life-expectancy (LLE). The LLE subgroup had a 5-year mortality rate of 43.3%, with no deaths attributed to NMSC. Only 3.3% of individuals with LLE underwent observational treatment. No study examined quality-of-life or cost-effectiveness.
Conclusion
There has been limited investigation of observational management of BCC, despite possible advantages of this strategy. Future RCTs should compare quality-of-life outcomes and utility adjusted survival following interventional or observational management of BCC.
Take-home message
This systemic review identifies a lack of data reporting outcomes following observational management of BCC, despite possible advantages of this treatment strategy. Future RCTs should compare quality of life outcomes and utility-adjusted survival following interventional or observational management of BCC.
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Affiliation(s)
- R Goodall
- Buckinghamshire Healthcare NHS Trust
| | - M Chicco
- Buckinghamshire Healthcare NHS Trust
| | | | - K Borsky
- Buckinghamshire Healthcare NHS Trust
| | | | - J Rodrigues
- Buckinghamshire Healthcare NHS Trust
- University of Warwick
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8
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Goodall R, Chicco M, Wietek N, Borsky K, Harrison C, Rodrigues J. A systematic review of observational management of cutaneous basal cell carcinoma. J Plast Reconstr Aesthet Surg 2022; 75:2277-2285. [PMID: 35680535 DOI: 10.1016/j.bjps.2022.04.056] [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: 12/19/2021] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous basal cell carcinoma (BCC) is the commonest cancer in the United Kingdom and United States. Surgical excision is the most common treatment. This review summarises all published outcomes of observational/non-interventional management of cutaneous BCC. METHODS This PRISMA-compliant systematic review searched MEDLINE, EMBASE and CENTRAL databases from inception-June 2021. All studies reporting outcomes of observational management for BCC were included. RESULTS We identified 2529 titles, from which 4 full-text articles were eligible, reporting on 2298 individuals. Two studies were randomised controlled trials (RCTs) comparing histological clearance rates and adverse events following treatment with an inactive strategy (placebo cream) versus topical 5%-imiquimod (at different frequencies) for 6-12 weeks. Clearance rates ranged from 52-100% for imiquimod and 2-19% for placebo, with more adverse events associated with imiquimod. The other two studies used prospective cohort designs. One study assessed the natural history of BCCs managed expectantly in 39 individuals aged ≥80years. During the 15.8-month follow-up, 46.2% of lesions did not increase in size and 10.3% resolved. The remaining study compared treatment patterns of 1360 patients with non-melanoma skin cancer (NMSC) in individuals with or without limited life-expectancy (LLE). The LLE subgroup had a 5-year mortality rate of 43.3%, with no deaths attributed to NMSC. Only 3.3% of individuals with LLE underwent observational treatment. No study examined quality-of-life or cost-effectiveness. CONCLUSION There has been limited investigation of observational management of BCC, despite possible advantages of this strategy. Future RCTs should compare quality-of-life outcomes and utility-adjusted survival following interventional or observational management of BCC.
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Affiliation(s)
- R Goodall
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK; Department of Surgery and Cancer, Imperial College London, UK.
| | - M Chicco
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK
| | - N Wietek
- Nuffield Department of Women's & Reproductive Health, University of Oxford, UK
| | - K Borsky
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK
| | - C Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
| | - J Rodrigues
- Department of Plastic Surgery, Buckinghamshire Healthcare NHS Trust, UK; Warwick Clinical Trials Unit, University of Warwick, UK
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Jesson J, Crichton S, Quartagno M, Yotebieng M, Abrams EJ, Chokephaibulkit K, Le Coeur S, Aké‐Assi M, Patel K, Pinto J, Paul M, Vreeman R, Davies M, Ben‐Farhat J, Van Dyke R, Judd A, Mofenson L, Vicari M, Seage G, Bekker L, Essajee S, Gibb D, Penazzato M, Collins IJ, Wools‐Kaloustian K, Slogrove A, Powis K, Williams P, Matshaba M, Thahane L, Nyasulu P, Lukhele B, Mwita L, Kekitiinwa‐Rukyalekere A, Wanless S, Goetghebuer T, Thorne C, Warszawski J, Galli L, van Rossum AM, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaya L, Navarro M, Frick A, Naver L, Kahlert C, Volokha A, Chappell E, Pape JW, Rouzier V, Marcelin A, Succi R, Sohn AH, Kariminia A, Edmonds A, Lelo P, Lyamuya R, Ogalo EA, Odhiambo FA, Haas AD, Bolton C, Muhairwe J, Tweya H, Sylla M, D'Almeida M, Renner L, Abzug MJ, Oleske J, Purswani M, Teasdale C, Nuwagaba‐Biribonwoha H, Goodall R, Leroy V. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871. [PMID: 35255197 PMCID: PMC8901148 DOI: 10.1002/jia2.25871] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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Hammond-Haley M, Hartley A, Delago AJ, Goodall R, Marshall D, Salciccioli JD, Shalhoub J. Trends in infective endocarditis mortality in the United Kingdom and EU 15+ countries between 1990–2019: an analysis of the Global Burden of Diseases database. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3165] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Infective Endocarditis (IE) is a relatively uncommon but lethal condition, with no convincing evidence to date of improving mortality trends (1). The epidemiology of IE is complex, driven by a wide range of constantly evolving factors. While marked international variation has been recently reported (2), temporal trends in mortality over recent decades remain unclear.
Purpose
To describe trends in IE mortality in high income countries over the last 30 years.
Methods
Age-standardised mortality rates (ASMR) for IE, stratified by sex, were extracted from the Global Burden of Disease (GBD) database (3) between 1990 and 2019. The United Kingdom and selected countries with comparable health expenditure (EU15+ countries) were included. Relative changes in ASMR over the observation period were determined and trends were analysed using Joinpoint regression analysis.
Results
Between 1990–2019 ASMR from IE increased for both sexes in all included countries except Finland (−20.1% in males, −15.1% in females) and Austria (−8.98% in males, −22.6% in females). The largest increase in ASMR in males was observed in Greece (+197%), while the largest increase in females was observed in Italy (246%). Joinpoint regression analysis identified multiple significant trends within this observation period (Figure 1; clear squares indicate males, filled circles indicate females and lines represent modelled trends based on joinpoint data). At the end of the observation period the Netherlands had the highest ASMR in both males and females (2.28/100,000 in males and 2.37/100,000 in females), while Finland had the lowest ASMR in both males and females (0.45/100,000 and 0.23/100,000 respectively).
Conclusions
Significant international variation in IE mortality rates were observed. While mortality from IE has generally increased over the last 30 years, recent data suggest this trend may now be plateauing or even reversing in certain countries.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- M Hammond-Haley
- King's College London, British Heart Foundation Centre of Research Excellence, London, United Kingdom
| | - A Hartley
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A J Delago
- Harvard Medical School, Department of Medicine, Cambridge, United States of America
| | - R Goodall
- Imperial College London, Academic Section of Vascular Surgery, Department of Surgery & Cancer, London, United Kingdom
| | - D Marshall
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - J D Salciccioli
- Harvard Medical School, Department of Medicine, Cambridge, United States of America
| | - J Shalhoub
- Imperial College London, Academic Section of Vascular Surgery, Department of Surgery & Cancer, London, United Kingdom
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11
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Goodall R, Hughes W, Salciccioli J, Marshall D, Davies AH, Shalhoub J. 1447 Trends in Lower Extremity Amputation Incidence in European Union 15+ Countries 1990-2017. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
To assess trends in lower extremity amputation (LEA) incidence in European Union (EU15+) countries for the years 1990-2017.
Method
This was an observational study using data obtained from the 2017 Global Burden of Disease (GBD) Study. Age standardised incidence rates (ASIRs) for LEA (stratified into toe amputation, and LEA proximal to toes) were extracted from the GBD Results Tool (http://ghdx.healthdata.org/gbd-results-tool) for EU15+ countries for each of the years 1990-2017. Trends were analysed using Joinpoint regression analysis.
Results
Between 1990 and 2017, variable trends in the incidence of LEA were observed in EU15+ countries. For LEAs proximal to toes, increasing trends were observed in six of 19 countries and decreasing trends in nine of 19 countries, with four countries showing varying trends between sexes. For toe amputation, increasing trends were observed in eight of 19 countries and decreasing trends in eight of 19 countries for both sexes, with three countries showing varying trends between sexes. Australia had the highest ASIRs for both sexes in all LEAs at all time points, with steadily increasing trends. The USA observed the greatest reduction in all LEAs in both sexes over the time period analysed (LEAs proximal to toes: female patients 22.93%, male patients 29.76%; toe amputation: female patients 29.93%, male patients 32.67%). The greatest overall increase in incidence was observed in Australia.
Conclusions
Variable trends in LEA incidence were observed across EU15+ countries. These trends do not reflect previously observed reductions in incidence of PAOD over the same time period.
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Affiliation(s)
- R Goodall
- Imperial College London, London, United Kingdom
| | - W Hughes
- Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - D Marshall
- Imperial College London, London, United Kingdom
| | - A H Davies
- Imperial College London, London, United Kingdom
| | - J Shalhoub
- Imperial College London, London, United Kingdom
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12
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Hughes W, Goodall R, Salciccioli J, Marshall D, Davies A, Shalhoub J. Trends in Lower Extremity Amputation Incidence in European Union 15+ Countries 1990–2017. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.08.044] [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: 10/23/2022]
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13
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Jani C, Marshall D, Goodall R, Singh H, Shalhoub J, Salciccioli J, Thomson C. 1788P Persistent sex-differences in lung cancer mortality between 2001 and 2017 in the US and EU. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1549] [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: 10/23/2022] Open
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14
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Al-Balah A, Goodall R, Salciccioli JD, Marshall DC, Shalhoub J. Mortality from abdominal aortic aneurysm: trends in European Union 15+ countries from 1990 to 2017. Br J Surg 2020; 107:1459-1467. [PMID: 32391589 DOI: 10.1002/bjs.11635] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/20/2020] [Accepted: 03/23/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND This observational study assessed trends in abdominal aortic aneurysm (AAA) death rates in European Union (EU) 15+ countries for the years 1990 to 2017. METHODS Age-standardized death rates (ASDRs) were extracted from the Global Burden of Disease Study Global Health Data Exchange. Trends were analysed using joinpoint regression analysis. RESULTS Between 1990 and 2017, ASDRs from AAA decreased in all 19 EU15+ countries for women, and in 18 of 19 countries for men. Increasing AAA mortality was observed only for men in Greece (+5·3 per cent). The largest relative decreases in ASDR between 1990 and 2017 were observed in Australia (men -65·6 per cent, women -50·4 per cent) and Canada (men -60·8 per cent, women -48·6 per cent). Over the 28-year interval, the smallest decreases in ASDR for women were noted in Greece (-2·3 per cent) and in Italy (-2·5 per cent). In 2017, the highest mortality rates were observed in the UK for both men and women (7·5 per 100 000 and 3·7 per 100 000 respectively). The lowest ASDR was observed in Portugal for men (2·8 per 100 000) and in Spain for women (1·0 per 100 000). ASDRs for AAA in 2017 were higher for men than women in all 19 EU15+ countries. The most recent trends demonstrated increasing AAA ASDRs in 14 of 19 countries for both sexes; the increases were relatively small compared with the improvements in the preceding years. CONCLUSION This observational study identified decreasing mortality from AAA across EU15+ countries since 1990. The most recent trends demonstrated relatively small increases in AAA mortality across the majority of EU15+ countries since 2012.
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Affiliation(s)
- A Al-Balah
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, and Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - R Goodall
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, and Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - J D Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - D C Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - J Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, and Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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15
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Velasco-Castro M, Hernández-Nava E, Figueroa IA, Todd I, Goodall R. The effect of oxygen pickup during selective laser melting on the microstructure and mechanical properties of Ti-6Al-4V lattices. Heliyon 2019; 5:e02813. [PMID: 31872099 PMCID: PMC6911884 DOI: 10.1016/j.heliyon.2019.e02813] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/19/2018] [Accepted: 11/07/2019] [Indexed: 11/29/2022] Open
Abstract
Additive manufacturing techniques such as Selective Laser Melting (SLM) can produce complex shapes with relatively thin sections and fine detail. However, common materials for the process, such as Ti–6Al–4V, have microstructure and properties that are sensitive to the pickup of interstitial impurities, such as oxygen, which the material will be exposed to during the process. This problem would be especially severe for parts with thin sections, where surface effects can be more significant, and where poor properties may coincide with locally-elevated stress. Here we explore the effects of oxygen level in thin sections with the use of lattice materials (materials which can be considered to consist exclusively of near-surface material). Oxygen levels are artificially raised using repeated melting passes to result in more pickup, leading to significantly reduced ductility and hence reduced strength measured in compression. A ductile to brittle transition in strut failure mechanism is found with increasing number of melting passes, with significant modification in chemistry and crystallographic structure, despite the presence of a similar fine plate-like microstructure throughout.
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Affiliation(s)
- M Velasco-Castro
- Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Cd. Universitaria, México, DF, C.P. 04510, Mexico
| | - E Hernández-Nava
- Department of Material Science & Engineering, The University of Sheffield, Sir Robert Hadfield Building, Mappin St, Sheffield, S13 JD, UK
| | - I A Figueroa
- Instituto de Investigaciones en Materiales, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Cd. Universitaria, México, DF, C.P. 04510, Mexico
| | - I Todd
- Department of Material Science & Engineering, The University of Sheffield, Sir Robert Hadfield Building, Mappin St, Sheffield, S13 JD, UK
| | - R Goodall
- Department of Material Science & Engineering, The University of Sheffield, Sir Robert Hadfield Building, Mappin St, Sheffield, S13 JD, UK
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16
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Goodall R. Data of the maximum solid solubility limits of binary systems of elements. Data Brief 2019; 26:104515. [PMID: 31667278 PMCID: PMC6811886 DOI: 10.1016/j.dib.2019.104515] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022] Open
Abstract
This paper gives the available data for the maximum equilibrium solubility limits of each of the first 83 elements (H to Bi) of the periodic table in each of the others. This is expressed in the form of the maximum value of the equilibrium solid solubility for terminal solid solutions, expressed in atomic percentage (at%), occurring at any temperature where the room temperature phase of the pure element acting as the solvent is stable. The values thus represent the compatibility between different elements in the formation of alloys and similar combinations, and will be of use for research into fundamental solid state physics relating to elemental interactions, for the interpretation of phase structures in materials research and for the design of alloys and materials involving elemental mixing of the elements.
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Affiliation(s)
- R Goodall
- Department of Materials Science & Engineering, The University of Sheffield, United Kingdom
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17
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Jalali S, Budde A, Guimaraes O, Araujo R, Tiedeman M, Goodall R, Engle T. PSXIV-34 The influence of microencapsulated plant secondary compounds (MPSC/Activo Premium®) on performance and carcass characteristics of growing and finishing feedlot beef cattle. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Jalali
- Colorado State University, Department of Animal Sciences,Fort Collins, CO, United States
| | - A Budde
- Colorado State University, Department of Animal Sciences,Fort Collins, CO, United States
| | - O Guimaraes
- Colorado State University, Department of Animal Sciences,Fort Collins, CO, United States
| | - R Araujo
- GRASP Indústria e Comércio LTDA,Curitiba, Brazil
| | - M Tiedeman
- EW Nutrition USA, Inc., Dallas Center, IA, United States
| | - R Goodall
- EW Nutrition USA, Inc., Dallas Center, IA, United States
| | - T Engle
- Colorado State University,Fort Collins, CO, United States
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18
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Slogrove AL, Schomaker M, Davies MA, Williams P, Balkan S, Ben-Farhat J, Calles N, Chokephaibulkit K, Duff C, Eboua TF, Kekitiinwa-Rukyalekere A, Maxwell N, Pinto J, Seage G, Teasdale CA, Wanless S, Warszawski J, Wools-Kaloustian K, Yotebieng M, Timmerman V, Collins IJ, Goodall R, Smith C, Patel K, Paul M, Gibb D, Vreeman R, Abrams EJ, Hazra R, Van Dyke R, Bekker LG, Mofenson L, Vicari M, Essajee S, Penazzato M, Anabwani G, Q. Mohapi E, N. Kazembe P, Hlatshwayo M, Lumumba M, Goetghebuer T, Thorne C, Galli L, van Rossum A, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaia L, Rojo P, Fortuny C, Naver L, Rudin C, Le Coeur S, Volokha A, Rouzier V, Succi R, Sohn A, Kariminia A, Edmonds A, Lelo P, Ayaya S, Ongwen P, Jefferys LF, Phiri S, Mubiana-Mbewe M, Sawry S, Renner L, Sylla M, Abzug MJ, Levin M, Oleske J, Chernoff M, Traite S, Purswani M, Chadwick EG, Judd A, Leroy V. The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis. PLoS Med 2018; 15:e1002514. [PMID: 29494593 PMCID: PMC5832192 DOI: 10.1371/journal.pmed.1002514] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
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Affiliation(s)
| | - Amy L. Slogrove
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paige Williams
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Suna Balkan
- Epicentre, Médecins Sans Frontières, Paris, France
| | | | - Nancy Calles
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | | | - Charlotte Duff
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Tanoh François Eboua
- Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | | | - Nicola Maxwell
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jorge Pinto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - George Seage
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Chloe A. Teasdale
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Sebastian Wanless
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Josiane Warszawski
- Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marcel Yotebieng
- College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Venessa Timmerman
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Intira J. Collins
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Ruth Goodall
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Colette Smith
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mary Paul
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Rachel Vreeman
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Rohan Hazra
- National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America
| | - Russell Van Dyke
- Tulane University, New Orleans, Louisiana, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | | | | | - Gabriel Anabwani
- Baylor International Pediatric AIDS Initiative, Gaborone, Botswana
| | - Edith Q. Mohapi
- Baylor International Pediatric AIDS Initiative, Maseru, Lesotho
| | - Peter N. Kazembe
- Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
| | | | - Mwita Lumumba
- Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania
| | | | - Claire Thorne
- Institute of Child Health, University College London, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Annemarie van Rossum
- Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | - Magdalena Marczynska
- Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | | | - Liubov Okhonskaia
- Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation
| | | | - Claudia Fortuny
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Sophie Le Coeur
- Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Regina Succi
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Andrew Edmonds
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Patricia Lelo
- Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Patricia Ongwen
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sam Phiri
- Lighthouse Trust Clinic, Lilongwe, Malawi
| | | | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | | | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Myron Levin
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - James Oleske
- Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Miriam Chernoff
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shirley Traite
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Murli Purswani
- Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America
| | - Ellen G. Chadwick
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America
| | - Ali Judd
- MRC Clinical Trials Unit at University College London, London, United Kingdom
- * E-mail: (AJ); (VL)
| | - Valériane Leroy
- Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France
- * E-mail: (AJ); (VL)
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Goodall R, Claireaux H, Hill J, Wilson E, Monsell F, BOAST 11 Collaborative, Tarassoli P. Comparison between a multicentre, collaborative, closed-loop audit assessing management of supracondylar fractures and the British Orthopaedic Association Standard for Trauma 11 (BOAST 11) guidelines. Bone Joint J 2018; 100-B:346-351. [DOI: 10.1302/0301-620x.100b3.bjj-2017-0780.r2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and may be associated with a neurovascular injury. The British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines describe best practice for supracondylar fracture management. This study aimed to assess whether emergency departments in the United Kingdom adhere to BOAST 11 standard 1: a documented assessment, performed on presentation, must include the status of the radial pulse, digital capillary refill time, and the individual function of the radial, median (including the anterior interosseous), and ulnar nerves. Materials and Methods Stage 1: We conducted a multicentre, retrospective audit of adherence to BOAST 11 standard 1. Data were collected from eight hospitals in the United Kingdom. A total of 433 children with Gartland type 2 or 3 supracondylar fractures were eligible for inclusion. A centrally created data collection sheet was used to guide objective analysis of whether BOAST 11 standard 1 was adhered to. Stage 2: We created a quality improvement proforma for use in emergency departments. This was piloted in one of the hospitals used in the primary audit and was re-audited using equivalent methodology. In all, 102 patients presenting between January 2016 and July 2017 were eligible for inclusion in the re-audit. Results Stage 1: Of 433 patient notes audited, adherence to BOAST 11 standard 1 was between 201 (46%) and 232 (54%) for the motor and sensory function of the individual nerves specified, 318 (73%) for radial pulse, and 247 (57%) for digital capillary refill time. Stage 2: Of 102 patient notes audited, adherence to BOAST 11 standard 1 improved to between 72 (71%) and 80 (78%) for motor and sensory function of the nerves, to 84 (82%) for radial pulse, and to 82 (80%) for digital capillary refill time. Of the 102 case notes reviewed in stage 2, only 44 (43%) used the quality improvement proforma; when the proforma was used, adherence improved to between 40 (91%) and 43 (98%) throughout. Conclusion Adherence to BOAST 11 standard 1 is poor in hospitals across the country. This is concerning as neurovascular deficit may be an indication for emergent surgery, and missed neurovascular injury can cause long-term, or even permanent, functional impairment. We present a simple proforma that improves adherence to this standard, can easily be implemented into emergency departments, and may improve patient safety. Cite this article: Bone Joint J 2018;100-B:346–51.
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Affiliation(s)
- R. Goodall
- Bristol Medical School, University of
Bristol, Senate House, Tyndall
Avenue, Bristol BS8 1TH, UK
| | - H. Claireaux
- Oxford University Clinical Academic School,
John Radcliffe Hospital, Headley Way, Headington, Oxford
OX3 9DU, UK
| | - J. Hill
- Department of Paediatric Orthopaedics,
Bristol Children’s Hospital, Upper Maudlin Street, Bristol
BS2 8BJ, UK
| | - E. Wilson
- Bristol Medical School, University of
Bristol, Senate House, Tyndall
Avenue, Bristol BS8 1TH, UK
| | - F. Monsell
- Department of Paediatric Orthopaedics,
Bristol Children’s Hospital, Upper Maudlin Street, Bristol
BS2 8BJ, UK
| | | | - P. Tarassoli
- Severn Deanery, Department of Orthopaedics,
Royal United Hospitals Bath, Combe Park, Avon
BA1 3NG, UK
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20
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Turkova A, Chappell E, Chalermpantmetagul S, Negra MD, Volokha A, Primak N, Solokha S, Rozenberg V, Kiselyova G, Yastrebova E, Miloenko M, Bashakatova N, Kanjanavanit S, Calvert J, Rojo P, Ansone S, Jourdain G, Malyuta R, Goodall R, Judd A, Thorne C. Tuberculosis in HIV-infected children in Europe, Thailand and Brazil: paediatric TB-HIV EuroCoord study. Int J Tuberc Lung Dis 2018; 20:1448-1456. [PMID: 27776584 DOI: 10.5588/ijtld.16.0067] [Citation(s) in RCA: 3] [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: 11/10/2022] Open
Abstract
SETTING Centres participating in the Paediatric European Network for Treatment of AIDS (PENTA), including Thailand and Brazil. OBJECTIVE To describe the incidence, presentation, treatment and treatment outcomes of tuberculosis (TB) in human immunodeficiency virus (HIV) infected children. DESIGN Observational study of TB diagnosed in HIV-infected children in 2011-2013. RESULTS Of 4265 children aged <16 years, 127 (3%) were diagnosed with TB: 6 (5%) in Western Europe, 80 (63%) in Eastern Europe, 27 (21%) in Thailand and 14 (11%) in Brazil, with estimated TB incidence rates of respectively 239, 982, 1633 and 2551 per 100 000 person-years (py). The majority (94%) had acquired HIV perinatally. The median age at TB diagnosis was 6.8 years (interquartile range 3.0-11.5). Over half (52%) had advanced/severe World Health Organization stage immunodeficiency; 67 (53%) were not on antiretroviral therapy (ART) at TB diagnosis. Preventive anti-tuberculosis treatment was given to 23% (n = 23) of 102 children diagnosed with HIV before TB. Eleven children had unfavourable TB outcomes: 4 died, 5 did not complete treatment, 1 had recurrent TB and 1 had an unknown outcome. In univariable analysis, previous diagnosis of acquired immune-deficiency syndrome, not being virologically suppressed on ART at TB diagnosis and region (Brazil) were significantly associated with unfavourable TB outcomes. CONCLUSION Most TB cases were from countries with high TB prevalence. The majority (91%) had favourable outcomes. Universal ART and TB prophylaxis may reduce missed opportunities for TB prevention.
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Affiliation(s)
- A Turkova
- Medical Research Council Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials & Methodology, London, UK
| | - E Chappell
- Medical Research Council Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials & Methodology, London, UK
| | - S Chalermpantmetagul
- Research Unit, Program for HIV Prevention and Treatment (Program for HIV Prevention and Treatment/Institut de Recherche pour le Développement Unités Mixtes Internationales 174), Chiang Mai, Thailand
| | - M Della Negra
- Instituto de Infectologia Emilio Ribas, São Paolo, São Paolo, Brazil
| | - A Volokha
- Kyiv City Centre for Prevention and Control of AIDS, Kyiv, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - N Primak
- Kryvyi Rih City Centre for Prevention and Control of AIDS, Kryvyi Rih, Ukraine
| | - S Solokha
- Donetsk Regional Centre for Prevention and Control of AIDS, Donetsk, Ukraine
| | - V Rozenberg
- Irkutsk Regional Centre for Prevention and Control of AIDS and Infectious Diseases, Irkutsk, Ukraine
| | - G Kiselyova
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - E Yastrebova
- St Petersburg City Centre for Prevention and Control of AIDS and Infectious Diseases, St Petersburg, Russian Federation
| | - M Miloenko
- Republican Clinical Hospital of Infectious Diseases, St Petersburg, Russian Federation
| | - N Bashakatova
- Marioupol City Centre for Prevention and Control of AIDS, Marioupol, Ukraine
| | - S Kanjanavanit
- Nakornping Hospital, Chiang Mai, Thailand; ***Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - J Calvert
- Medical Research Council Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials & Methodology, London, UK
| | - P Rojo
- Donetsk Regional Centre for Prevention and Control of AIDS, Donetsk, Ukraine
| | - S Ansone
- Riga East University Hospital, Latvian Centre of Infectious Diseases, Riga, Latvia
| | - G Jourdain
- Research Unit, Program for HIV Prevention and Treatment (Program for HIV Prevention and Treatment/Institut de Recherche pour le Développement Unités Mixtes Internationales 174), Chiang Mai, Thailand
| | - R Malyuta
- Perinatal Prevention of AIDS Initiative, Odessa, Ukraine
| | - R Goodall
- Medical Research Council Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials & Methodology, London, UK
| | - A Judd
- Medical Research Council Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials & Methodology, London, UK
| | - C Thorne
- Institute of Child Health, UCL, London, UK
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Judd A, Chappell E, Turkova A, Le Coeur S, Noguera-Julian A, Goetghebuer T, Doerholt K, Galli L, Pajkrt D, Marques L, Collins IJ, Gibb DM, González Tome MI, Navarro M, Warszawski J, Königs C, Spoulou V, Prata F, Chiappini E, Naver L, Giaquinto C, Thorne C, Marczynska M, Okhonskaia L, Posfay-Barbe K, Ounchanum P, Techakunakorn P, Kiseleva G, Malyuta R, Volokha A, Ene L, Goodall R. Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study. PLoS Med 2018; 15:e1002491. [PMID: 29381702 PMCID: PMC5790238 DOI: 10.1371/journal.pmed.1002491] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART) in 17 middle- and high-income countries, including some in Western and Central Europe (W&CE), Eastern Europe (Russia and Ukraine), and Thailand. METHODS AND FINDINGS Children with perinatal HIV aged <18 years initiating cART were followed until their 21st birthday, transfer to adult care, death, loss to follow-up, or last visit up until 31 December 2013. Rates of death and first AIDS-defining events were calculated. Baseline and time-updated risk factors for early/late (≤/>6 months of cART) death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4-9.3) years; 35% of children aged <5 years had a CD4 lymphocyte percentage <15% in 1997-2003, which fell to 15% of children in 2011 onwards (p < 0.001). Similarly, 53% and 18% of children ≥5 years had a CD4 count <200 cells/mm3 in 1997-2003 and in 2011 onwards, respectively (p < 0.001). Median follow-up was 5.6 (2.9-8.7) years. Of 94 deaths and 237 first AIDS-defining events, 43 (46%) and 100 (42%) were within 6 months of initiating cART, respectively. Multivariable predictors of early death were: being in the first year of life; residence in Russia, Ukraine, or Thailand; AIDS at cART start; initiating cART on a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen; severe immune suppression; and low BMI-for-age z-score. Current severe immune suppression, low current BMI-for-age z-score, and current viral load >400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC) disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time. CONCLUSIONS In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART) in countries in Europe and Thailand. We observed that over 40% of deaths occurred ≤6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at >6 months after initiation of cART.
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Affiliation(s)
| | - Ali Judd
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
- * E-mail:
| | - Elizabeth Chappell
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Anna Turkova
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Sophie Le Coeur
- Institut National d'Etude Demographique (INED), Mortality, Health and Epidemiology Unit, Paris, France
- Institut de Recherche pour le Developpement (IRD), UMI 174/PHPT, Chiang Mai, Thailand
| | - Antoni Noguera-Julian
- Unitat d’Infectologia, Servei de Pediatria, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | | | - Katja Doerholt
- St George’s Healthcare NHS Trust, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Intira J. Collins
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Diana M. Gibb
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | | | - Marisa Navarro
- Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Josiane Warszawski
- Institut National de la Santé et de la Recherche (INSERM), Paris, France
| | - Christoph Königs
- University Hospital Frankfurt, Department of Paediatrics, Goethe University, Frankfurt, Germany
| | - Vana Spoulou
- University of Athens Medical School, Athens, Greece
| | | | - Elena Chiappini
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | - Carlo Giaquinto
- Paediatric European Network for the Treatment of AIDS (PENTA), Padova, Italy
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | | | | | | | | | - Galina Kiseleva
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Ruslan Malyuta
- Perinatal Prevention of AIDS Initiative, Odessa, Ukraine
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Ruth Goodall
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
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Krebs J, Rao SI, Verheyden S, Miko C, Goodall R, Curtin WA, Mortensen A. Cast aluminium single crystals cross the threshold from bulk to size-dependent stochastic plasticity. Nat Mater 2017; 16:730-736. [PMID: 28553960 DOI: 10.1038/nmat4911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
Metals are known to exhibit mechanical behaviour at the nanoscale different to bulk samples. This transition typically initiates at the micrometre scale, yet existing techniques to produce micrometre-sized samples often introduce artefacts that can influence deformation mechanisms. Here, we demonstrate the casting of micrometre-scale aluminium single-crystal wires by infiltration of a salt mould. Samples have millimetre lengths, smooth surfaces, a range of crystallographic orientations, and a diameter D as small as 6 μm. The wires deform in bursts, at a stress that increases with decreasing D. Bursts greater than 200 nm account for roughly 50% of wire deformation and have exponentially distributed intensities. Dislocation dynamics simulations show that single-arm sources that produce large displacement bursts halted by stochastic cross-slip and lock formation explain microcast wire behaviour. This microcasting technique may be extended to several other metals or alloys and offers the possibility of exploring mechanical behaviour spanning the micrometre scale.
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Affiliation(s)
- J Krebs
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - S I Rao
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - S Verheyden
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - C Miko
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - R Goodall
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - W A Curtin
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - A Mortensen
- Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
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Goodall R. Post-mastectomy breast reconstruction: Options for the patient. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sutherland KA, Parry CM, McCormick A, Kapaata A, Lyagoba F, Kaleebu P, Gilks CF, Goodall R, Spyer M, Kityo C, Pillay D, Gupta RK. Correction: Evidence for Reduced Drug Susceptibility without Emergence of Major Protease Mutations following Protease Inhibitor Monotherapy Failure in the SARA Trial. PLoS One 2016; 11:e0157094. [PMID: 27254277 PMCID: PMC4890937 DOI: 10.1371/journal.pone.0157094] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0137834.].
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Sutherland KA, Parry CM, McCormick A, Kapaata A, Lyagoba F, Kaleebu P, Gilks CF, Goodall R, Spyer M, Kityo C, Pillay D, Gupta RK. Evidence for Reduced Drug Susceptibility without Emergence of Major Protease Mutations following Protease Inhibitor Monotherapy Failure in the SARA Trial. PLoS One 2015; 10:e0137834. [PMID: 26382239 PMCID: PMC4575205 DOI: 10.1371/journal.pone.0137834] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/23/2015] [Indexed: 12/11/2022] Open
Abstract
Background Major protease mutations are rarely observed following failure with protease inhibitors (PI), and other viral determinants of failure to PI are poorly understood. We therefore characterized Gag-Protease phenotypic susceptibility in subtype A and D viruses circulating in East Africa following viral rebound on PIs. Methods Samples from baseline and treatment failure in patients enrolled in the second line LPV/r trial SARA underwent phenotypic susceptibility testing. Data were expressed as fold-change in susceptibility relative to a LPV-susceptible reference strain. Results We cloned 48 Gag-Protease containing sequences from seven individuals and performed drug resistance phenotyping from pre-PI and treatment failure timepoints in seven patients. For the six patients where major protease inhibitor resistance mutations did not emerge, mean fold-change EC50 to LPV was 4.07 fold (95% CI, 2.08–6.07) at the pre-PI timepoint. Following viral failure the mean fold-change in EC50 to LPV was 4.25 fold (95% CI, 1.39–7.11, p = 0.91). All viruses remained susceptible to DRV. In our assay system, the major PI resistance mutation I84V, which emerged in one individual, conferred a 10.5-fold reduction in LPV susceptibility. One of the six patients exhibited a significant reduction in susceptibility between pre-PI and failure timepoints (from 4.7 fold to 9.6 fold) in the absence of known major mutations in protease, but associated with changes in Gag: V7I, G49D, R69Q, A120D, Q127K, N375S and I462S. Phylogenetic analysis provided evidence of the emergence of genetically distinct viruses at the time of treatment failure, indicating ongoing viral evolution in Gag-protease under PI pressure. Conclusions Here we observe in one patient the development of significantly reduced susceptibility conferred by changes in Gag which may have contributed to treatment failure on a protease inhibitor containing regimen. Further phenotype-genotype studies are required to elucidate genetic determinants of protease inhibitor failure in those who fail without traditional resistance mutations whilst PI use is being scaled up globally.
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Affiliation(s)
| | - Chris M. Parry
- Uganda Research Unit on AIDS, Medical Research Council (MRC), Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Anne Kapaata
- Uganda Research Unit on AIDS, Medical Research Council (MRC), Uganda Virus Research Institute, Entebbe, Uganda
| | - Fred Lyagoba
- Uganda Research Unit on AIDS, Medical Research Council (MRC), Uganda Virus Research Institute, Entebbe, Uganda
| | - Pontiano Kaleebu
- Uganda Research Unit on AIDS, Medical Research Council (MRC), Uganda Virus Research Institute, Entebbe, Uganda
| | - Charles F. Gilks
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Ruth Goodall
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Moira Spyer
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Deenan Pillay
- University College London, London, United Kingdom
- Wellcome Trust Africa Centre for Health and Population Sciences, University of KwaZulu Natal, Mtubatuba, South Africa
- * E-mail: (DP); (RKG)
| | - Ravindra K. Gupta
- University College London, London, United Kingdom
- * E-mail: (DP); (RKG)
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Kayondo JK, Ndembi N, Parry CM, Cane PA, Hué S, Goodall R, Dunn DT, Kaleebu P, Pillay D, Mbisa JL. Intrapatient Evolutionary Dynamics of Human Immunodeficiency Virus Type 1 in Individuals Undergoing Alternative Treatment Strategies with Reverse Transcriptase Inhibitors. AIDS Res Hum Retroviruses 2015; 31:749-56. [PMID: 25953118 PMCID: PMC4505773 DOI: 10.1089/aid.2015.0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Structured treatment interruption (STI) has been trialed as an alternative to lifelong antiretroviral therapy (ART). We retrospectively performed single genome sequencing of the HIV-1 pol region from three patients representing different scenarios. They were either failing on continuous therapy (CT-F), failing STI (STI-F), or suppressing on STI (STI-S). Over 460 genomes were generated from three to five different time points over a 2-year period. We found multiple-linked-resistant mutations in both treatment failures. However, the CT-F patient showed a stepwise accumulation of diverse, linked mutations whereas the STI-F patient had lineage turnover between treatment periods with recirculation of wild-type and resistant variants from reservoirs. The STI-F patient showed a 7-fold increase in the third codon position substitution rate relative to the first and second positions compared to a 2-fold increase for CT-F and increased purifying selection in the pol gene (62 vs. 22 sites, respectively). An understanding of intrapatient viral dynamics could guide the future direction of treatment interruption strategies.
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Affiliation(s)
- Jonathan K. Kayondo
- Uganda Virus Research Institute (UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Nicaise Ndembi
- Medical Research Council (MRC)/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Chris M. Parry
- Medical Research Council (MRC)/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Patricia A. Cane
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Stephane Hué
- Department of Infection and Immunity, University College London, London, United Kingdom
| | - Ruth Goodall
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - David T. Dunn
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Pontiano Kaleebu
- Uganda Virus Research Institute (UVRI), Uganda Research Unit on AIDS, Entebbe, Uganda
- Medical Research Council (MRC)/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Deenan Pillay
- Department of Infection and Immunity, University College London, London, United Kingdom
| | - Jean L. Mbisa
- Virus Reference Department, Public Health England, London, United Kingdom
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Hultin S, Hotston M, Day A, Taylor A, Goodall R, Thomas P, Bahl A, Persad R, Gjini A. Audit of PSA requesting practices in primary care compared to guidelines established by the Prostate Cancer Risk Management programme in the Avon region of the South West of England. Journal of Clinical Urology 2014. [DOI: 10.1177/2051415813485945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is considerable challenge in transmitting the complicated information contained in the Prostate Cancer Risk Management (PCRM) programme in the primary care setting. 1 The practices surrounding requesting of PSA should be clearly understood by both GP and patient before requesting this investigation, and in order to further understand the needs and requirements of primary care practitioners in this regard we undertook an audit comparing practices in the Avon region of the Southwest of England compared to the guidelines of the PCRM programme. 1 Methods Our study identified a consistent year-on-year increase in PSA requests over the study period across all age categories and regions of the southwest of England. Results Questionnaire review of practices surrounding the PCRM programme revealed overall good practice but with space for improvement surrounding advice regarding the limitations of prostate biopsy and the relevance of testing in the elderly. Conclusions Despite requesting practices generally conforming to NICE guidelines, nearly half of all abnormal primary-care PSA tests are repeated. Requests in some cases may fall short of best practice.
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Affiliation(s)
- S Hultin
- General Medicine, Bristol Royal Infirmary, UK
| | - M Hotston
- Department of Urology, Royal Cornwall Hospital, UK
| | - A Day
- Department of Clinical Biochemistry, Weston Area Health NHS Trust, UK
| | - A Taylor
- Department of Clinical Biochemistry, Royal University Hospitals Bath, UK
| | - R Goodall
- Department of Clinical Biochemistry, North Bristol NHS Trust, UK
| | - P Thomas
- Department of Clinical Biochemistry, University Hospital Bristol NHS Trust, UK
| | - A Bahl
- Department of Urology, University Hospital Bristol NHS Trust, UK
| | - R Persad
- Department of Urology, University Hospital Bristol NHS Trust, UK
| | - A Gjini
- Department of Public Health, Bristol Public Health, UK
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Holodniy M, Brown ST, Cameron DW, Kyriakides TC, Angus B, Babiker A, Singer J, Owens DK, Anis A, Goodall R, Hudson F, Piaseczny M, Russo J, Schechter M, Deyton L, Darbyshire J. Results of antiretroviral treatment interruption and intensification in advanced multi-drug resistant HIV infection from the OPTIMA trial. PLoS One 2011; 6:e14764. [PMID: 21483491 PMCID: PMC3069000 DOI: 10.1371/journal.pone.0014764] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 01/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Guidance is needed on best medical management for advanced HIV disease with multidrug resistance (MDR) and limited retreatment options. We assessed two novel antiretroviral (ARV) treatment approaches in this setting. METHODS AND FINDINGS We conducted a 2×2 factorial randomized open label controlled trial in patients with a CD4 count≤300 cells/µl who had ARV treatment (ART) failure requiring retreatment, to two options (a) re-treatment with either standard (≤4 ARVs) or intensive (≥5 ARVs) ART and b) either treatment starting immediately or after a 12-week monitored ART interruption. Primary outcome was time to developing a first AIDS-defining event (ADE) or death from any cause. Analysis was by intention to treat. From 2001 to 2006, 368 patients were randomized. At baseline, mean age was 48 years, 2% were women, median CD4 count was 106/µl, mean viral load was 4.74 log(10) copies/ml, and 59% had a prior AIDS diagnosis. Median follow-up was 4.0 years in 1249 person-years of observation. There were no statistically significant differences in the primary composite outcome of ADE or death between re-treatment options of standard versus intensive ART (hazard ratio 1.17; CI 0.86-1.59), or between immediate retreatment initiation versus interruption before re-treatment (hazard ratio 0.93; CI 0.68-1.30), or in the rate of non-HIV associated serious adverse events between re-treatment options. CONCLUSIONS We did not observe clinical benefit or harm assessed by the primary outcome in this largest and longest trial exploring both ART interruption and intensification in advanced MDR HIV infection with poor retreatment options. TRIAL REGISTRATION Clinicaltrials.gov NCT00050089.
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Affiliation(s)
- Mark Holodniy
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Sheldon T. Brown
- James J. Peters VA Medical Center, Bronx, New York, United States of America
- Department of Medicine, Mt. Sinai School of Medicine, New York, New York, United States of America
| | - D. William Cameron
- University of Ottawa at The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
- * E-mail:
| | - Tassos C. Kyriakides
- VA Cooperative Studies Program Coordinating Center, West Haven, Connecticut, United States of America
| | - Brian Angus
- Nuffield Department of Medicine, The John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | | | - Joel Singer
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Douglas K. Owens
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Aslam Anis
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Ruth Goodall
- MRC Clinical Trials Unit, London, United Kingdom
| | - Fleur Hudson
- MRC Clinical Trials Unit, London, United Kingdom
| | - Mirek Piaseczny
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - John Russo
- VA Cooperative Studies Program Coordinating Center, West Haven, Connecticut, United States of America
| | - Martin Schechter
- Canadian HIV Trials Network, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Lawrence Deyton
- Department of Veterans Affairs, Office of Public Health and Environmental Hazards, Washington, D.C., United States of America
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Pillay D, Goodall R, Gilks CF, Yirrell D, Gibb D, Spyer M, Kaleebu P, Munderi P, Kityo C, McCormick A, Nkalubo J, Lyagoba F, Chirara M, Hakim J. Virological findings from the SARA trial: boosted PI monotherapy as maintenance second-line ART in Africa. J Int AIDS Soc 2010. [PMCID: PMC3112833 DOI: 10.1186/1758-2652-13-s4-o20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Grattoni A, Fine D, Ziemys A, Gill J, Zabre E, Goodall R, Ferrari M. Nanochannel Systems for Personalized Therapy and Laboratory Diagnostics. Curr Pharm Biotechnol 2010; 11:343-65. [DOI: 10.2174/138920110791233280] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 01/22/2010] [Indexed: 11/22/2022]
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Descamps D, Chazallon C, Loveday C, Bacheler L, Goodall R, Yéni P, Cooper DA, Babiker A, Aboulker JP, Brun-Vézinet F. Resistance and virological response analyses in a three initial treatment strategy trial: a substudy of the INITIO trial. HIV Clin Trials 2010; 10:385-93. [PMID: 20133269 DOI: 10.1310/hct1006-385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To study the impact of baseline resistance mutations and HIV-1 subtypes on virological response to first-line antiretroviral therapy and to analyse the concordance of the results of two antiretroviral resistance interpretation tools in the INITIO trial. METHOD Genotype and virco TYPE resistance analyses were studied at baseline, Year 2, Year 3, and at first therapeutic failure on plasma specimens stored at -80 degrees C. Relations between resistance mutations at baseline, subtype, initial virological response, and virological outcome after Week 24 were studied. RESULTS 781 participants had genotypic results available at baseline. Therapeutic failure occurred for 112 participants. Initial virological response as well as virological outcome after Week 24 were not associated with HIV subtype. Before Week 24, the proportion of participants remaining under strict initial regimen was lower in patients with resistance mutations at baseline than in those without any resistance mutations. Presenceof resistance mutations at baseline also impacted negatively long-term virological outcome. Few discrepancies were observed between genotypic and virco TYPE for resistance interpretation. CONCLUSION These data showed that presence of resistance mutations at baseline was associated with a poorer long-term virological outcome in the INITIO trial.
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Affiliation(s)
- Diane Descamps
- Laboratoire de Virologie, AP-HP Groupe Hospitalier Bichat-Claude Bernard and EA 4409 Université Paris-Diderot-Paris 7, Paris, France.
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Mugyenyi P, Walker AS, Hakim J, Munderi P, Gibb DM, Kityo C, Reid A, Grosskurth H, Darbyshire JH, Ssali F, Bray D, Katabira E, Babiker AG, Gilks CF, Grosskurth H, Munderi P, Kabuye G, Nsibambi D, Kasirye R, Zalwango E, Nakazibwe M, Kikaire B, Nassuna G, Massa R, Fadhiru K, Namyalo M, Zalwango A, Generous L, Khauka P, Rutikarayo N, Nakahima W, Mugisha A, Todd J, Levin J, Muyingo S, Ruberantwari A, Kaleebu P, Yirrell D, Ndembi N, Lyagoba F, Hughes P, Aber M, Lara AM, Foster S, Amurwon J, Wakholi BN, Whitworth J, Wangati K, Amuron B, Kajungu D, Nakiyingi J, Omony W, Fadhiru K, Nsibambi D, Khauka P, Mugyenyi P, Kityo C, Ssali F, Tumukunde D, Otim T, Kabanda J, Musana H, Akao J, Kyomugisha H, Byamukama A, Sabiiti J, Komugyena J, Wavamunno P, Mukiibi S, Drasiku A, Byaruhanga R, Labeja O, Katundu P, Tugume S, Awio P, Namazzi A, Bakeinyaga GT, Katabira H, Abaine D, Tukamushaba J, Anywar W, Ojiambo W, Angweng E, Murungi S, Haguma W, Atwiine S, Kigozi J, Namale L, Mukose A, Mulindwa G, Atwiine D, Muhwezi A, Nimwesiga E, Barungi G, Takubwa J, Murungi S, Mwebesa D, Kagina G, Mulindwa M, Ahimbisibwe F, Mwesigwa P, Akuma S, Zawedde C, Nyiraguhirwa D, Tumusiime C, Bagaya L, Namara W, Kigozi J, Karungi J, Kankunda R, Enzama R, Latif A, Hakim J, Robertson V, Reid A, Chidziva E, Bulaya-Tembo R, Musoro G, Taziwa F, Chimbetete C, Chakonza L, Mawora A, Muvirimi C, Tinago G, Svovanapasis P, Simango M, Chirema O, Machingura J, Mutsai S, Phiri M, Bafana T, Chirara M, Muchabaiwa L, Muzambi M, Mutowo J, Chivhunga T, Chigwedere E, Pascoe M, Warambwa C, Zengeza E, Mapinge F, Makota S, Jamu A, Ngorima N, Chirairo H, Chitsungo S, Chimanzi J, Maweni C, Warara R, Matongo M, Mudzingwa S, Jangano M, Moyo K, Vere L, Mdege N, Machingura I, Katabira E, Ronald A, Kambungu A, Lutwama F, Mambule I, Nanfuka A, Walusimbi J, Nabankema E, Nalumenya R, Namuli T, Kulume R, Namata I, Nyachwo L, Florence A, Kusiima A, Lubwama E, Nairuba R, Oketta F, Buluma E, Waita R, Ojiambo H, Sadik F, Wanyama J, Nabongo P, Oyugi J, Sematala F, Muganzi A, Twijukye C, Byakwaga H, Ochai R, Muhweezi D, Coutinho A, Etukoit B, Gilks C, Boocock K, Puddephatt C, Grundy C, Bohannon J, Winogron D, Gibb DM, Burke A, Bray D, Babiker A, Walker AS, Wilkes H, Rauchenberger M, Sheehan S, Spencer-Drake C, Taylor K, Spyer M, Ferrier A, Naidoo B, Dunn D, Goodall R, Darbyshire JH, Peto L, Nanfuka R, Mufuka-Kapuya C, Kaleebu P, Pillay D, Robertson V, Yirrell D, Tugume S, Chirara M, Katundu P, Ndembi N, Lyagoba F, Dunn D, Goodall R, McCormick A, Lara AM, Foster S, Amurwon J, Wakholi BN, Kigozi J, Muchabaiwa L, Muzambi M, Weller I, Babiker A, Bahendeka S, Bassett M, Wapakhabulo AC, Darbyshire JH, Gazzard B, Gilks C, Grosskurth H, Hakim J, Latif A, Mapuchere C, Mugurungi O, Mugyenyi P, Burke C, Jones S, Newland C, Pearce G, Rahim S, Rooney J, Smith M, Snowden W, Steens JM, Breckenridge A, McLaren A, Hill C, Matenga J, Pozniak A, Serwadda D, Peto T, Palfreeman A, Borok M, Katabira E. Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trial. Lancet 2010; 375:123-31. [PMID: 20004464 PMCID: PMC2805723 DOI: 10.1016/s0140-6736(09)62067-5] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND HIV antiretroviral therapy (ART) is often managed without routine laboratory monitoring in Africa; however, the effect of this approach is unknown. This trial investigated whether routine toxicity and efficacy monitoring of HIV-infected patients receiving ART had an important long-term effect on clinical outcomes in Africa. METHODS In this open, non-inferiority trial in three centres in Uganda and one in Zimbabwe, 3321 symptomatic, ART-naive, HIV-infected adults with CD4 counts less than 200 cells per microL starting ART were randomly assigned to laboratory and clinical monitoring (LCM; n=1659) or clinically driven monitoring (CDM; n=1662) by a computer-generated list. Haematology, biochemistry, and CD4-cell counts were done every 12 weeks. In the LCM group, results were available to clinicians; in the CDM group, results (apart from CD4-cell count) could be requested if clinically indicated and grade 4 toxicities were available. Participants switched to second-line ART after new or recurrent WHO stage 4 events in both groups, or CD4 count less than 100 cells per microL (LCM only). Co-primary endpoints were new WHO stage 4 HIV events or death, and serious adverse events. Non-inferiority was defined as the upper 95% confidence limit for the hazard ratio (HR) for new WHO stage 4 events or death being no greater than 1.18. Analyses were by intention to treat. This study is registered, number ISRCTN13968779. FINDINGS Two participants assigned to CDM and three to LCM were excluded from analyses. 5-year survival was 87% (95% CI 85-88) in the CDM group and 90% (88-91) in the LCM group, and 122 (7%) and 112 (7%) participants, respectively, were lost to follow-up over median 4.9 years' follow-up. 459 (28%) participants receiving CDM versus 356 (21%) LCM had a new WHO stage 4 event or died (6.94 [95% CI 6.33-7.60] vs 5.24 [4.72-5.81] per 100 person-years; absolute difference 1.70 per 100 person-years [0.87-2.54]; HR 1.31 [1.14-1.51]; p=0.0001). Differences in disease progression occurred from the third year on ART, whereas higher rates of switch to second-line treatment occurred in LCM from the second year. 283 (17%) participants receiving CDM versus 260 (16%) LCM had a new serious adverse event (HR 1.12 [0.94-1.32]; p=0.19), with anaemia the most common (76 vs 61 cases). INTERPRETATION ART can be delivered safely without routine laboratory monitoring for toxic effects, but differences in disease progression suggest a role for monitoring of CD4-cell count from the second year of ART to guide the switch to second-line treatment. FUNDING UK Medical Research Council, the UK Department for International Development, the Rockefeller Foundation, GlaxoSmithKline, Gilead Sciences, Boehringer-Ingelheim, and Abbott Laboratories.
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Bart PA, Goodall R, Barber T, Harari A, Guimaraes-Walker A, Khonkarly M, Sheppard NC, Bangala Y, Frachette MJ, Wagner R, Liljeström P, Kraehenbuhl JP, Girard M, Goudsmit J, Esteban M, Heeney J, Sattentau Q, McCormack S, Babiker A, Pantaleo G, Weber J. EV01: a phase I trial in healthy HIV negative volunteers to evaluate a clade C HIV vaccine, NYVAC-C undertaken by the EuroVacc Consortium. Vaccine 2008; 26:3153-61. [PMID: 18502002 DOI: 10.1016/j.vaccine.2008.03.083] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 03/19/2008] [Indexed: 10/22/2022]
Abstract
NYVAC-C (vP2010), a recombinant vector expressing HIV subtype C gag, pol, env and nef antigens, was tested in a phase I study in healthy, HIV negative volunteers in London and Lausanne. Twenty-four participants were randomised to receive NYVAC-C (20) or matching placebo (4) at weeks 0 and 4, and assessed for safety and immunogenicity over 48 weeks. There were no serious adverse events, and no clinical or laboratory abnormalities or other events that led to withdrawal, interruption or dose reduction of the NYVAC-C/placebo. Half of the 10 assessed responded in the ELISpot assay under stringent criteria, which informed the sample size for a DNA-NYVAC-C comparison to NYVAC-C alone.
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Bucciardini R, Fragola V, Massella M, Polizzi C, Mirra M, Goodall R, Carey D, Hudson F, Zajdenverg R, Floridia M. Health-related quality of life outcomes in HIV-infected patients starting different combination regimens in a randomized multinational trial: the INITIO-QoL substudy. AIDS Res Hum Retroviruses 2007; 23:1215-22. [PMID: 17961107 DOI: 10.1089/aid.2007.0067] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The health-related quality of life (HRQoL) outcomes in HIV-infected, treatment-naive patients starting different HAART regimens in a 3-year, randomized, multinational trial were compared. HRQoL was measured in a subgroup of patients enrolled in the INITIO study (153/911), using a modified version of the MOS-HIV questionnaire. The regimens compared in the INITIO trial were composed by two NRTIs (didanosine + stavudine) plus either an NNRTI (efavirenz) or a PI (nelfinavir), or both (efavirenz + nelfinavir). Primary HRQoL outcomes were Physical and Mental Health Summary scores (PHS and MHS, respectively). During follow-up, an increase of PHS score was observed in all treatment arms. The MHS score remained substantially unchanged with the four-drug combination and showed with both NNRTI- and PI-based three-drug regimens a marked trend toward improvement, which became statistically significant when a multiple imputation method was used to adjust for missing data. Overall, starting all the combination regimens compared in the INITIO study was associated with a maintained or slightly improved HRQOL status, consistently with the positive immunological and virological changes observed in the main study. The observed differences in the MHS indicate a possible HRQoL benefit associated to the use of three-drug, two-class regimens and no additional benefit for the use of four-drug, three-class regimens, confirming that three-drug, two-class regimens that include two NRTIs plus either an NNRTI or a PI should be preferred as initial treatment of HIV infection.
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Affiliation(s)
- Raffaella Bucciardini
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Vincenzo Fragola
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Maurizio Massella
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Cosimo Polizzi
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Mirra
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Ruth Goodall
- Medical Research Council Clinical Trials Unit, London, UK
| | - Dianne Carey
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
| | - Fleur Hudson
- Medical Research Council Clinical Trials Unit, London, UK
| | | | - Marco Floridia
- Department of Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
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Samri A, Goodall R, Burton C, Imami N, Pantaleo G, Kelleher A, Poli G, Gotch F, Autran B. Three-Year Immune Reconstitution in PI-Sparing and PI-Containing Antiretroviral Regimens in Advanced HIV-1 Disease. Antivir Ther 2007. [DOI: 10.1177/135965350701200414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The long-term immunological benefit of protease inhibitor (PI)-sparing antiretroviral therapy (ART) using non-nucleoside reverse transcriptase inhibitors (NNRTIs) remains poorly investigated. Methods A total of 120 ART-naive, HIV-1-infected participants were included in the immunology substudy of INITIO, an international randomized trial comparing two NRTIs (didanosine + stavudine) combined with either: one NNRTI (efavirenz; EFV), one non-boosted PI (nelfinavir; NFV), or one NNRTI + one PI (EFV/NFV). CD4+ T-cell counts, HIV-1 plasma RNA load (VL), T-cell pheno-type, T-cell proliferation and IFN-γ production against opportunistic/recall and HIV-1 antigens/peptides were compared at baseline and at week (W) 96 and W156. Results Participants (37 EFV, 44 NFV, 39 EFV/NFV) had similar baseline VL; median CD4+ T-cell counts/mm3 were: 144 (64–303) EFV, 212 (42–313) NFV and 257 (86–331) EFV/NFV. At W156, the proportion of patients with VL ≤50 copies/ml was not different between the arms ( P=0.3). From baseline to W156 there was a significant increase in CD4+ T-cell counts ( P<0.001) and in naive CD4+ T cells ( P<0.001), with no difference between arms and percentages of total and activated CD8+ T cells decreased significantly ( P<0.001) in all arms. The decrease in activated memory CD4+T-cells was significantly greater in the EFV arm at W96 ( P=0.03) and W156 ( P=0.01), but did not persist after adjusting for baseline CD4+ T-cell counts. During follow-up, responses to opportunistic pathogens increased in all patients while specific T-cell responses to HIV-1-p24 and gp160 recombinant proteins or to Gag and Nef peptides were not restored. Conclusion Regimens using/sparing PIs provide similar levels of long-term immune reconstitution even in patients with low CD4+ T-cell counts.
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Affiliation(s)
- Assia Samri
- Laboratoire d'Immunologie Cellulaire, AP-HP, Hôpital Pitié-Salpêtrière; INSERM UMR S 543; Université Pierre et Marie Curie-Paris 6, Paris, France
| | | | | | - Nesrina Imami
- Department of Immunology, Imperial College, London, UK
| | - Giuseppe Pantaleo
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anthony Kelleher
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, Australia
| | - Guido Poli
- San Raffaele Scientific Institute, Milan, Italy
| | - Frances Gotch
- Department of Immunology, Imperial College, London, UK
| | - Brigitte Autran
- Laboratoire d'Immunologie Cellulaire, AP-HP, Hôpital Pitié-Salpêtrière; INSERM UMR S 543; Université Pierre et Marie Curie-Paris 6, Paris, France
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Samri A, Goodall R, Burton C, Imami N, Pantaleo G, Kelleher A, Poli G, Gotch F, Autran B. Three-year immune reconstitution in PI-sparing and PI-containing antiretroviral regimens in advanced HIV-1 disease. Antivir Ther 2007; 12:553-8. [PMID: 17668564] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND The long-term immunological benefit of protease inhibitor (PI)-sparing antiretroviral therapy (ART) using non-nucleoside reverse transcriptase inhibitors (NNRTIs) remains poorly investigated. METHODS A total of 120 ART-naive, HIV-1-infected participants were included in the immunology substudy of INITIO, an international randomized trial comparing two NRTIs (didanosine + stavudine) combined with either: one NNRTI (efavirenz; EFV), one non-boosted PI (nelfinavir; NFV), or one NNRTI + one PI (EFV/NFV). CD4+ T-cell counts, HIV-1 plasma RNA load (VL), T-cell phenotype, T-cell proliferation and IFN-gamma production against opportunistic/recall and HIV-1 antigens/peptides were compared at baseline and at week (W) 96 and W156. RESULTS Participants (37 EFV, 44 NFV, 39 EFV/NFV) had similar baseline VL; median CD4+ T-cell counts/mm3 were: 144 (64-303) EFV, 212 (42-313) NFV and 257 (86-331) EFV/NFV. At W156, the proportion of patients with VL < or =50 copies/ml was not different between the arms (P=0.3). From baseline to W156 there was a significant increase in CD4+ T-cell counts (P<0.001) and in naive CD4+ T cells (P<0.001), with no difference between arms and percentages of total and activated CD8+ T cells decreased significantly (P<0.001) in all arms. The decrease in activated memory CD4+ T-cells was significantly greater in the EFV arm at W96 (P=0.03) and W156 (P=0.01), but did not persist after adjusting for baseline CD4+ T-cell counts. During follow-up, responses to opportunistic pathogens increased in all patients while specific T-cell responses to HIV-1-p24 and gp160 recombinant proteins or to Gag and Nef peptides were not restored. CONCLUSION Regimens using/sparing PIs provide similar levels of long-term immune reconstitution even in patients with low CD4+ T-cell counts.
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Affiliation(s)
- Assia Samri
- Laboratoire d'Immunologie Cellulaire, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
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Li P, Kadirkamanathan V, Goodall R. Estimation of parameters in a linear state space model using a Rao-Blackwellised particle filter. ACTA ACUST UNITED AC 2004. [DOI: 10.1049/ip-cta:20041008] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Psychd ST, Troop M, Burgess AP, Button J, Goodall R, Flynn R, Gazzard BG, Catalán J, Easterbrook PJ. The relationship of psychological variables and disease progression among long-term HIV-infected men. Int J STD AIDS 2000; 11:734-42. [PMID: 11089788 DOI: 10.1258/0956462001915165] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study investigated the contribution of psychological factors to disease progression among long-term HIV-1 infected gay men. Participants completed self-report measures including coping strategies, life events, social support, personality and psychological morbidity and were followed clinically for up to 30 months. Cox proportional hazards survival analyses were carried out to CD4<200 x 106/1 and AIDS-related complex (ARC) or AIDS diagnosis controlling for viral load, antiretroviral drug use and CD4 count. Only acceptance coping was a significant predictor of time to ARC or AIDS diagnosis: the risk of ARC or AIDS was almost 5 times greater for those scoring within the lowest tertile compared with those scoring in the highest tertile (HR=4.7, 95% CI 1.8-12.3).
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Affiliation(s)
- S T Psychd
- Psychological Medicine Unit, South Kensington & Chelsea Mental Health Centre, Chelsea & Westminster Hospital, London, UK
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Abstract
The objectives of this study were to describe the clinical and radiological features at presentation, and the natural history of HIV-related bronchopulmonary Kaposi's sarcoma. A retrospective review of medical records and chest radiographs was performed in 106 HIV-infected homosexual men with bronchopulmonary Kaposi's sarcoma diagnosed at bronchoscopy between September 1988 and November 1994. The majority of patients had evidence of advanced HIV disease at diagnosis (median CD4 cell count was 15 x 10(6)/l, range 0-288), and 93% had had a diagnosis of cutaneous Kaposi's sarcoma for a median duration of 11 months prior to diagnosis of their bronchopulmonary disease. The most frequent symptoms at presentation were cough (92%), dyspnoea (69%), pleuritic pain (20%), haemoptysis (13%) and wheezing (10%). The most common radiological finding in 73% of our series was of poorly defined and confluent opacities, with predominant middle and lower zone involvement. Median survival was 4 months (range 0-37 months) from diagnosis and 9 months (range 1-25) from the onset of symptoms. Treatment with either chemotherapy or radiotherapy was associated with a significantly reduced risk of death (hazards ratio (HR)=0.48, 95% CI=0.26-0.87). Factors associated with a poor survival, after adjustment for treatment effect were older age (HR=1.79, 95% CI=1.22-2.84) for each 10-year increase in age; a history of pleuritic pain (HR=2.97, 95% CI=1.39-6.32); presence of pleural effusion on X-ray (HR=2.01, 95% CI=1.13-3.59) and a prior diagnosis of cutaneous Kaposi's sarcoma (HR=1.8, 95% CI=1.00, 3.24). Bronchopulmonary Kaposi's sarcoma occurs mainly in patients with advanced HIV disease and a prior history of cutaneous disease. Survival is poor, and adverse prognostic factors include older age at diagnosis and the presence of pleural disease.
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Affiliation(s)
- F B Hannon
- Department of Radiotherapy and Oncology, Chelsea and Westminster Hospital, London, UK
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Zweit J, Carnochan P, Goodall R, Ott R. Nickel-57-doxorubicin, a potential radiotracer for pharmacokinetic studies using PET: production and radiolabelling. J Nucl Biol Med (1991) 1994; 38:18-21. [PMID: 7632762] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The clinical use of anthracyclines, such as doxorubicin (DXR), is hampered by tumour development of multidrug resistance (MDR). The drug efflux associated with MDR could be characterised in vivo using Positron Emission Tomography (PET) in conjunction with a suitable radiolabelled drug. We are investigating DXR labelled with the positron emitter 57Ni as a potential analogue of the parent drug. Essential to this work is the production of a high purity radionuclide in a suitable chemical form for the preparation of radiolabelled DXR. To optimise production parameters, excitation functions (reaction cross section as a function of beam energy) for proton induced reactions in cobalt were measured up to 60 MeV. The excitation function for the 59Co(p,3n)57Ni reaction shows a maximum cross section of 13.8 +/- 1.5 mb at 38 MeV. The optimum energy range for production of 57Ni was found to be 41-->26 MeV resulting in an experimental thick target yield of 17.8 MBq/muAh. The level of the 56Ni impurity is only 0.21% at the end of bombardment. A radiochemical procedure, based on cation-exchange chromatography, has been developed for the separation of radionickel from the cobalt target and other radiochemical and chemical impurities. The 57Ni activity was eluted, using 2M HCl, from a Dowex-50Wx8(H+) column, in a 95% radiochemical yield. Optimum labelling of DXR has been investigated in terms of pH, reaction time and temperature, achieving radiochemical yields > 94%. DXR labelled with 57Ni therefore shows promise as a radiotracer for pharmacokinetic studies using PET.
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Affiliation(s)
- J Zweit
- Department of Physics, Royal Marsden Hospital, Sutton, Surrey, UK
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Abstract
A second treatment room and beam line has been constructed at the Cyclotron Unit at Clatterbridge for the purpose of using 62 MeV protons for the treatment of ocular melanoma. A uniform beam is produced by a double foil scattering system. The initial Bragg peak is spread across the target volume by the use of beam modulators. These are rotating four-vaned stepped absorbers made from Perspex. Two beam lines can be configured with different positions of modulators and range limiters. The first has a maximum penetration of 31.9 +/- 0.2 mm in water and the second a penetration of 31.2 +/- 0.2 mm. The second configuration has the advantage of less variation in beam penumbra, with a typical value of 1.7 +/- 0.1 mm for the 90% to 10% decrement lines. The patients are treated with individually shaped collimators. Beam output varies by less than 2% over the range of collimator areas used. The resulting whole-body dose equivalent to patient has also been assessed. In the first three years of operation over 250 patients have been treated.
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Affiliation(s)
- D E Bonnett
- MRC Cyclotron Unit, Clatterbridge Hospital, Bebington, Merseyside, UK
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Abstract
In this study 6 commercially produced kinetic modeling packages utilizing a variable volume, single pool urea model, as well as formulae to determine the delivery of therapy, have been compared by applying to each the same set of rigorously collected data for a group of 12 patients. Comparison of the kinetically derived parameters (urea generation rate [G], urea distribution volume [V], delivery of therapy [Kt/V], and normalized protein catabolic rate [nPCR]) showed that the values obtained for both G and V differed between packages owing to the numerical methods and the clearance used in the solution of the differential equations. Although a broad agreement between the values established for Kt/V and nPCR was noted, the 95% limits of agreement indicated that it would be prudent to exercise caution when comparing results established by different modeling packages.
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Affiliation(s)
- N A Hoenich
- Department of Medicine, School of Clinical Medical Sciences, University of Newcastle upon Tyne, United Kingdom
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Goodall R. Continuous quality improvement revisited. Leadersh Health Serv 1993; 2:6-11. [PMID: 10126399] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The author re-examines the appropriateness of continuous quality improvement (CQI) management techniques in health care with reference to the stability of North America's work force, staff's difficulty in balancing new responsibilities with everyday tasks, the need to adjust after major change, the real value of group decision making, the proper use of analytical tools, the validity of "meeting customer expectations", cultural inconsistencies in evaluating CQI programs, and the tendency to focus on management techniques instead of larger issues in times of crisis. The author concludes that the health care field can utilize CQI most effectively by integrating its techniques into societal and organizational cultures.
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Affiliation(s)
- R Goodall
- University Hospital, British Columbia
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Goodall R. Assert yourself. Effective communication for nurses. AORN J 1993; 57:894-9. [PMID: 8466202 DOI: 10.1016/s0001-2092(07)69090-5] [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] [Indexed: 01/30/2023]
Affiliation(s)
- R Goodall
- British Columbia Health Association, Vancouver
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Zweit J, Goodall R, Cox M, Babich JW, Potter GA, Sharma HL, Ott RJ. Development of a high performance zinc-62/copper-62 radionuclide generator for positron emission tomography. Eur J Nucl Med 1992; 19:418-25. [PMID: 1618233 DOI: 10.1007/bf00177368] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Clinical utilisation of positron emission tomography could be enhanced by the availability of short-lived radionuclides derived from generator systems. The zinc-62/copper-62 combination is one such system which could be used as a source for a number of copper-62 radiopharmaceuticals. We have developed and optimised a high activity (5.6 GBq, 150 mCi) zinc-62/copper-62 generator to provide 62Cu in a form that is suitable for direct labelling of pyruvaldehyde-bis-(N4-methylthiosemicarbazone)-copper(II), Cu(PTSM). The distribution coefficients of Zn(II) and Cu(II) between anion-exchange resin and various hydrochloric acid/organic solvent mixtures were measured. Based on these measurements a generator eluent of 0.3 M HCl/40% ethanol provided 62Cu in greater than 90% yield in a 3-ml volume. A very low 62Zn breakthrough of less than 3 x 10(-7)% was achieved. Copper-PTSM was successfully labelled with the no-carrier-added 62Cu eluent directly from the generator with 94% radiochemical yield.
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Affiliation(s)
- J Zweit
- Joint Department of Physics, Royal Marsden Hospital, Sutton, Surrey, UK
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Davenport A, Goodall R. Aluminium and dementia. Lancet 1992; 339:1236. [PMID: 1349972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
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Hoenich NA, Woffindin C, Goodall R. Comment on "Red blood cell destruction in single-needle dialysis" by Dhaene et al. Clin Nephrol 1991; 36:154. [PMID: 1934673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Goodall R. Democratic management principles. Involving the staff in decision making. AORN J 1990; 51:1553-7. [PMID: 2357064 DOI: 10.1016/s0001-2092(07)66907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Participative management is consistent with our history and culture, and it can often improve morale and productivity among hospital staff. Participative management, however, is not a panacea, nor is it necessary for managerial success. It should be used with discretion, following some of the guidelines outlined in this article.
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Affiliation(s)
- R Goodall
- British Columbia Health Association, Vancouver
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