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Nicholson S. Risk, regulation and offshore windfarms: Ways to manage environmental uncertainty and over-precaution. Mar Pollut Bull 2024; 202:116292. [PMID: 38554684 DOI: 10.1016/j.marpolbul.2024.116292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 03/21/2024] [Indexed: 04/02/2024]
Abstract
Globally there are concerns over a warming climate and the UK has declared a climate and ecological emergency and has an ambitious programme for the growth of offshore windfarms to contribute to commitments to achieving a legally binding Net Zero for greenhouse gas emissions by 2050. Offshore windfarm consenting is comparatively mature in the UK but evidence gaps to inform impact assessment and uncertainty to inform decision making has led to a precautionary approach that slows the speed of consent decisions. This paper examines the approach to UK offshore windfarm consenting, reviews the precautionary but risk-based approach that environmental decision makers have adopted in light of evidence gaps, and summarises how the collection of empirical data and reviews of evidence collected from operational windfarms has improved scientific knowledge and focussed decision making. A summary is also provided of the enduring legislative safeguards that apply during the lifetime of any consent and recommendations are made on the risk appetite that advisers and decision makers should adopt in view of policy that seeks to accelerate sectoral growth whilst enhancing nature recovery.
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Affiliation(s)
- S Nicholson
- Marine Management Organisation, Lancaster House, Newcastle upon Tyne NE4 7YH, United Kingdom
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2
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Subramanian K, Martinez J, Castellanos SH, Ivanidze J, Nagar H, Nicholson S, Youn T, Nauseef JT, Tagawa S, Osborne JR. Complex implementation factors demonstrated when evaluating cost-effectiveness and monitoring racial disparities associated with [ 18F]DCFPyL PET/CT in prostate cancer men. Sci Rep 2023; 13:8321. [PMID: 37221397 DOI: 10.1038/s41598-023-35567-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 05/20/2023] [Indexed: 05/25/2023] Open
Abstract
Prostate cancer (PC) staging with conventional imaging often includes multiparametric magnetic resonance (MR) of the prostate, computed tomography (CT) of the chest, abdomen, and pelvis, and whole-body bone scintigraphy. The recent development of highly sensitive and specific prostate specific membrane antigen (PSMA) positron emission tomography (PET) has suggested that prior imaging techniques may be insufficiently sensitive or specific, particularly when evaluating small pathologic lesions. As PSMA PET/CT is considered to be superior for multiple clinical indications, it is being deployed as the new multidisciplinary standard-of-care. Given this, we performed a cost-effectiveness analysis of [18F]DCFPyL PSMA PET/CT imaging in the evaluation of PC relative to conventional imaging and anti-3-[18F]FACBC (18F-Fluciclovine) PET/CT. We also conducted a single institution review of PSMA PET/CT scans performed primarily for research indications from January 2018 to October 2021. Our snapshot of this period of time in our catchment demonstrated that PSMA PET/CT imaging was disproportionately accessed by men of European ancestry (EA) and those residing in zip codes associated with a higher median household income. The cost-effectiveness analysis demonstrated that [18F]DCFPyL PET/CT should be considered as an alternative to anti-3-[18F]FACBC PET/CT and standard of care imaging for prostate cancer staging. [18F]DCFPyL PET/CT is a new imaging modality to evaluate PC patients with higher sensitivity and specificity in detecting disease than other prostate specific imaging studies. Despite this, access may be inequitable. This discrepancy will need to be addressed proactively as the distribution network of the radiotracer includes both academic and non-academic sites nationwide.
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Affiliation(s)
- Kritika Subramanian
- Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
| | - Juana Martinez
- Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Sandra Huicochea Castellanos
- Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jana Ivanidze
- Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Sean Nicholson
- Department of Policy Analysis and Management, Sloan, Cornell Institute for Public Affairs, New York, NY, USA
| | - Trisha Youn
- Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jones T Nauseef
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Scott Tagawa
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Joseph R Osborne
- Division of Molecular Imaging and Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
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McLeod C, Ramsay J, Flanagan KL, Plebanski M, Marshall H, Dymock M, Marsh J, Estcourt MJ, Wadia U, Williams PCM, Tjiam MC, Blyth C, Subbarao K, Nicholson S, Faust S, Thornton RB, Mckenzie A, Snelling TL, Richmond P. Core protocol for the adaptive Platform Trial In COVID-19 Vaccine priming and BOOsting (PICOBOO). Trials 2023; 24:202. [PMID: 36934272 PMCID: PMC10024280 DOI: 10.1186/s13063-023-07225-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The need for coronavirus 2019 (COVID-19) vaccination in different age groups and populations is a subject of great uncertainty and an ongoing global debate. Critical knowledge gaps regarding COVID-19 vaccination include the duration of protection offered by different priming and booster vaccination regimens in different populations, including homologous or heterologous schedules; how vaccination impacts key elements of the immune system; how this is modified by prior or subsequent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and future variants; and how immune responses correlate with protection against infection and disease, including antibodies and effector and T cell central memory. METHODS The Platform Trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, multi-arm, Bayesian, adaptive, randomised controlled platform trial. PICOBOO will expeditiously generate and translate high-quality evidence of the immunogenicity, reactogenicity and cross-protection of different COVID-19 priming and booster vaccination strategies against SARS-CoV-2 and its variants/subvariants, specific to the Australian context. While the platform is designed to be vaccine agnostic, participants will be randomised to one of three vaccines at trial commencement, including Pfizer's Comirnaty, Moderna's Spikevax or Novavax's Nuvaxovid COVID-19 vaccine. The protocol structure specifying PICOBOO is modular and hierarchical. Here, we describe the Core Protocol, which outlines the trial processes applicable to all study participants included in the platform trial. DISCUSSION PICOBOO is the first adaptive platform trial evaluating different COVID-19 priming and booster vaccination strategies in Australia, and one of the few established internationally, that is designed to generate high-quality evidence to inform immunisation practice and policy. The modular, hierarchical protocol structure is intended to standardise outcomes, endpoints, data collection and other study processes for nested substudies included in the trial platform and to minimise duplication. It is anticipated that this flexible trial structure will enable investigators to respond with agility to new research questions as they arise, such as the utility of new vaccines (such as bivalent, or SARS-CoV-2 variant-specific vaccines) as they become available for use. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12622000238774. Registered on 10 February 2022.
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Affiliation(s)
- C McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia.
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia.
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia.
| | - J Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - K L Flanagan
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - M Plebanski
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Melbourne, VIC, Australia
| | - H Marshall
- Women's and Children's Health Network, North Adelaide, Australia
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - M Dymock
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - J Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - M J Estcourt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - U Wadia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
| | - P C M Williams
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Westmead, Australia
- School of Women and Children's Health, UNSW, Kensington, Australia
| | - M C Tjiam
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
| | - K Subbarao
- WHO Collaborating Centre for Reference and Research On Influenza, University of Melbourne, Parkville, VIC, Australia
| | - S Nicholson
- Serology Laboratory, Victorian Infectious Diseases Research Laboratory, Melbourne, Australia
| | - S Faust
- Southampton Clinical Research Facility and Biomedical Research Centre, National Institute of Health Research, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R B Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
| | - A Mckenzie
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
| | - T L Snelling
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - P Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Centre for Child Health Research, The University of Western Australia, Crawley, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, Australia
- General Paediatrics and Immunology Departments, Perth Children's Hospital, Nedlands, Australia
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Zhang Y, Gupta A, Nicholson S, Li J. Elevated end-of-life spending: A new measure of potentially wasteful health care spending at the end of life. Health Serv Res 2023; 58:186-194. [PMID: 36303444 PMCID: PMC9836947 DOI: 10.1111/1475-6773.14093] [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] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To construct a new measure of end-of-life (EoL) spending-the elevated EoL spending-and examine its associations with measures of quality of care and patient and physician preferences in comparison with the commonly used total Medicare EoL spending measures. DATA SOURCES AND STUDY SETTING Medicare claims data for a 20% random sample of Medicare fee-for-service (FFS) patients, from the health care quality data for 2015-2016, from the Hospital Compare and the Medicare Geographic Variation public use file, and survey data about patient and physician preferences. STUDY DESIGN We constructed the elevated EoL spending measure as the differential monthly spending between decedents and survivors with the same one-year mortality risk, where the risk was predicted using machine learning models. We then examined the associations of the hospital referral region (HRR)-level elevated EoL spending with various health care quality measures and with the survey-elicited patient and provider preferences. We also examined analogous associations for monthly total EoL spending on decedents. DATA EXTRACTION METHODS Medicare FFS patients who were continuously enrolled in Medicare Parts A & B in 2015 and were alive as of January 1, 2016. PRINCIPAL FINDINGS We found a large variation in the elevated EoL spending across HRRs in the United States. There was no evidence of an association between HRR-level elevated EoL spending and established health care quality measures, including those specific to EoL care, whereas total EoL spending was positively associated with certain quality of care measures. We also found no evidence that elevated EoL spending was associated with patient preferences for EoL care. However, elevated EoL spending was positively and significantly associated with physician preferences for treatment intensity. CONCLUSIONS Our findings suggested that elevated EoL spending captures different resource use from conventional measures of EoL spending and may be more valuable in identifying potentially wasteful spending.
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Affiliation(s)
- Yongkang Zhang
- Department of Population Health SciencesWeill Cornell Medical College, Cornell UniversityNew YorkNew YorkUSA
| | - Atul Gupta
- Department of Health Care ManagementThe Wharton School, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sean Nicholson
- Department of EconomicsBrooks School of Public Policy, Cornell UniversityIthacaNew YorkUSA
| | - Jing Li
- The Comparative Health Outcomes, Policy and Economics Institute, Department of PharmacySchool of Pharmacy, University of WashingtonSeattleWashingtonUSA
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Subramanian K, Martinez J, Osborne JR, Nicholson S, Van Parys J, Singh P, An A, Heise R, Al-Hakim T, Buchanan M, Youn T. Access to cardiac PET/CT by sarcoidosis patients and cost-effectiveness analysis of cardiac PET/MR compared to the standard of care. Clin Imaging 2023; 94:50-55. [PMID: 36493682 PMCID: PMC9812891 DOI: 10.1016/j.clinimag.2022.11.021] [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: 07/16/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
IMPORTANCE Cardiac sarcoidosis is associated with a high mortality rate. Given multiple barriers to obtaining cardiac PET imaging, we suspect individuals with access to this imaging modality are not representative of the Sarcoid patient population, which in the United States are predominantly Black females. OBJECTIVE To evaluate the demographics of patients with cardiac PET access and the cost-effectiveness of cardiac PET/MR imaging relative to standard of care. DESIGN This is a retrospective, observational study. The demographic information of patients with suspected cardiac sarcoidosis and cardiac PET/CT imaging within a national registry of sarcoidosis were reviewed (n = 4561). An individual-level, continuous, time-state transition model was used for the evaluation of long-term cost-effectiveness for the combined cardiac PET/MR compared to standard of care cardiac MR followed by cardiac PET/CT. RESULTS Patients who underwent cardiac PET in the national registry had 88.35% higher odds of being male (p < 0.001) and 43.82% higher odds of being White (p = 0.003) than their counterparts who did not have cardiac PET imaging. Combined cardiac PET/MR had overall lower total lifetime costs ($8761 vs $10,777) and overall improved expected quality of life-years compared to the standard of care (0.77 vs 0.69). CONCLUSION AND RELEVANCE The findings suggest that patients with access to cardiac PET/CT are not representative of the patient population most likely to have cardiac sarcoidosis in this limited study evaluation. Universal insurance coverage should be considered for Cardiac PET imaging as same day cardiac PET and MR imaging has potential long-term cost and quality of life benefit.
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Affiliation(s)
- Kritika Subramanian
- Division of Molecular Imaging & Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America.
| | - Juana Martinez
- Division of Molecular Imaging & Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America
| | - Joseph R Osborne
- Division of Molecular Imaging & Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America
| | - Sean Nicholson
- Department of Policy Analysis and Management, Sloan, Cornell Institute for Public Affairs, New York, NY, United States of America
| | - Jessica Van Parys
- Department of Economics, Hunter College, City University of New York, New York, NY, United States of America
| | - Parmanand Singh
- Department of Cardiology, Weill Cornell Medicine, New York, NY, United States of America
| | - Anjile An
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Rachel Heise
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Tamara Al-Hakim
- Foundation for Sarcoidosis Research, Chicago, IL, United States of America
| | - Mindy Buchanan
- Foundation for Sarcoidosis Research, Chicago, IL, United States of America
| | - Trisha Youn
- Division of Molecular Imaging & Therapeutics, Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America
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Henderson B, Maguire P, Keartland S, Barr M, Crulhas B, Keating G, Fitzmaurice G, Gray S, Nicholson S, Finn S, Gately K. EP02.01-002 Development of Circulating and Tissue Biomarkers Predicting Immune Phenotype and Response to Immunotherapy in NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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7
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Lucarelli C, Nicholson S, Tilipman N. Price Indices and the Value of Innovation with Heterogenous Patients. J Health Econ 2022; 84:102625. [PMID: 35561551 DOI: 10.1016/j.jhealeco.2022.102625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/31/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Many countries use uniform cost-effectiveness criteria to determine whether to adopt a new medical technology for the entire population. This approach assumes homogeneous preferences for expected health benefits and side effects. We examine whether new prescription drugs generate welfare gains when accounting for heterogeneous preferences by constructing quality-adjusted price indices in the market for colorectal cancer drug treatments. We find that while the efficacy gains from newer drugs do not justify high prices for the population as a whole, innovation improves the welfare of sicker, late-stage cancer patients. A uniform evaluation criterion would not permit these innovations despite welfare gains to a subpopulation.
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Affiliation(s)
- Claudio Lucarelli
- Department of Health Care Management, The Wharton School, University of Pennsylvania.
| | - Sean Nicholson
- Department of Policy Analysis & Management, Cornell University.
| | - Nicholas Tilipman
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago.
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Harding S, MacDonald K, Nicholson S, Tageldein M, Arrowsmith C. MO-0138 cGAS localization to micronuclei is dictated by nuclear chromatin status pre-DNA damage. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Bao Y, Zhang H, Wen K, Johnson P, Jeng PJ, Witkin LR, Nicholson S, Reid MC, Schackman BR. Robust Prescription Monitoring Programs and Abrupt Discontinuation of Long-term Opioid Use. Am J Prev Med 2021; 61:537-544. [PMID: 34233856 PMCID: PMC8455444 DOI: 10.1016/j.amepre.2021.04.019] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/12/2021] [Accepted: 04/09/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study assesses the associations between the recent implementation of robust features of state Prescription Drug Monitoring Programs and the abrupt discontinuation of long-term opioid therapies. METHODS Data were from a national commercial insurance database and included privately insured adults aged 18-64 years and Medicare Advantage enrollees aged ≥65 years who initiated a long-term opioid therapy episode between Quarter 2 of 2011 and Quarter 2 of 2017. State Prescription Drug Monitoring Programs were characterized as nonrobust, robust, and strongly robust. Abrupt discontinuation was measured on the basis of high daily morphine milligram equivalents over the last 30 days of a long-term opioid therapy episode or no sign of tapering before discontinuation. Difference-in-differences models were estimated in 2019‒2020 to assess the association between robust Prescription Drug Monitoring Programs and abrupt discontinuation. RESULTS Among nonelderly privately insured adults, robust Prescription Drug Monitoring Programs were associated with an increase from 14.8% to 15.4% (4% relative increase, p=0.02) in the rate of ending long-term opioid therapy with ≥60 daily morphine milligram equivalents. For older Medicare Advantage enrollees, strongly robust Prescription Drug Monitoring Programs were associated with a reduction from 4.8% to 4.3% (10.4%, p=0.01) and from 3.0% to 2.4% (17.3%, p=0.001) in the rate of ending long-term opioid therapy with ≥90 and 120 daily morphine milligram equivalents, respectively. Prescription Drug Monitoring Programs robustness was not associated with clinically meaningful changes in the rate of discontinuing long-term opioid therapy without tapering. CONCLUSIONS Discontinuation without tapering was the norm for long-term opioid therapies in the samples throughout the study years. Findings do not support the notion that policies aimed at enhancing Prescription Drug Monitoring Program use were associated with substantial increases in abrupt long-term opioid therapy discontinuation.
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Affiliation(s)
- Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York; Department of Psychiatry, Weill Cornell Medicine, New York, New York.
| | - Hao Zhang
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Katherine Wen
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, New York
| | - Phyllis Johnson
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Philip J Jeng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Lisa R Witkin
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York; Division of Pain Medicine, NewYork-Presbyterian Lower Manhattan Hospital, NewYork-Presbyterian, New York, New York
| | - Sean Nicholson
- Department of Policy Analysis and Management, College of Human Ecology, Cornell University, Ithaca, New York
| | | | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York; Department of Psychiatry, Weill Cornell Medicine, New York, New York; Department of Medicine, Weill Cornell Medicine, New York, New York
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Bond KA, Williams E, Nicholson S, Lim S, Johnson D, Cox B, Putland M, Gardiner E, Tippett E, Graham M, Mordant F, Catton M, Lewin SR, Subbarao K, Howden BP, Williamson DA. Longitudinal evaluation of laboratory-based serological assays for SARS-CoV-2 antibody detection. Pathology 2021; 53:773-779. [PMID: 34412859 PMCID: PMC8289701 DOI: 10.1016/j.pathol.2021.05.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/02/2021] [Accepted: 05/17/2021] [Indexed: 01/03/2023]
Abstract
Serological assays for SARS-CoV-2 infection are now widely available for use in diagnostic laboratories. Limited data are available on the performance characteristics in different settings, and at time periods remote from the initial infection. Validation of the Abbott (Architect SARS-CoV-2 IgG), DiaSorin (Liaison SARS-CoV-2 S1/S2 IgG) and Roche (Cobas Elecsys Anti-SARS-CoV-2) assays was undertaken utilising 217 serum samples from 131 participants up to 7 months following COVID-19 infection. The Abbott and DiaSorin assays were implemented into routine laboratory workflow, with outcomes reported for 2764 clinical specimens. Sensitivity and specificity were concordant with the range reported by the manufacturers for all assays. Sensitivity across the convalescent period was highest for the Roche at 95.2-100% (95% CI 81.0-100%), then the DiaSorin at 88.1-100% (95% CI 76.0-100%), followed by the Abbott 68.2-100% (95% CI 53.4-100%). Sensitivity of the Abbott assay fell from approximately 5 months; on this assay paired serum samples for 45 participants showed a significant drop in the signal-to-cut-off ratio and 10 sero-reversion events. When used in clinical practice, all samples testing positive by both DiaSorin and Abbott assays were confirmed as true positive results. In this low prevalence setting, despite high laboratory specificity, the positive predictive value of a single positive assay was low. Comprehensive validation of serological assays is necessary to determine the optimal assay for each diagnostic setting. In this low prevalence setting we found implementation of two assays with different antibody targets maximised sensitivity and specificity, with confirmatory testing necessary for any sample which was positive in only one assay.
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Affiliation(s)
- K A Bond
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia.
| | - E Williams
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - S Nicholson
- Victorian Infectious Diseases Reference Laboratory at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - S Lim
- Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of General Medicine, The University of Melbourne, Vic, Australia
| | - D Johnson
- Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of General Medicine, The University of Melbourne, Vic, Australia
| | - B Cox
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - M Putland
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - E Gardiner
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - E Tippett
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - M Graham
- Department of Microbiology and Infectious Diseases, Monash Health, Vic, Australia; The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Vic, Australia
| | - F Mordant
- WHO Collaborating Centre for Reference and Research on Influenza at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - M Catton
- Victorian Infectious Diseases Reference Laboratory at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - S R Lewin
- The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Vic, Australia; Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Vic, Australia
| | - K Subbarao
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; WHO Collaborating Centre for Reference and Research on Influenza at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - B P Howden
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Vic, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
| | - D A Williamson
- Department of Microbiology, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia; The Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Vic, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic, Australia
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Epstein J, Nicholson S, Wang LX, Hempstead K, Asin S. The Secret Menu in Health Care: A Cash Market for Imaging in California. Inquiry 2020; 57:46958020981449. [PMID: 33357108 PMCID: PMC7768312 DOI: 10.1177/0046958020981449] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In addition to the prices they negotiate with private health insurers, most providers also have a cash price schedule for patients who have the wherewithal to ask and are willing to pay in full when they receive a service. This is the first study that estimates the potential cost saving of allowing privately-insured consumers to observe both in-network negotiated prices and cash prices, which is of particular interest given the growing importance of high-deductible health plans and a recent executive order mandating greater price transparency. Using data from five private health insurers and 142 imaging facilities in the San Francisco Bay Area, we estimate that patients could save between 10% and 22% of their insurer’s in-network price by paying cash. Potential savings are much larger (between 45% and 64% of their insurer’s in-network price) if consumers observe both cash and in-network prices and select the facility in the region offering the lowest price for a particular service.
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Affiliation(s)
| | | | - Lucy Xiaolu Wang
- Cornell University, USA & Max Planck Institute for Innovation and Competition, Munich, Germany
| | | | - Sam Asin
- Stroll Health, Glendale, CA, USA
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12
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Chew S, Gleeson JP, McCarthy A, Watson GA, O'Dwyer R, Nicholson S, Capra M, Owens C, McDermott M, Daly P, Grant C. Leptomeningeal Relapse of Embryonal Rhabdomyosarcoma after 15 years. Ir Med J 2020; 112:1026. [PMID: 32311247] [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: 06/11/2023]
Abstract
Aim Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumour of childhood. We present the case of a late relapse of RMS to the leptomeninges after 15 years. Methods A 20 year old male presented with a 3 week history of headaches and nausea. He previously had RMS of his right ear diagnosed at age 5 years which was treated with concurrent chemoradiotherapy. An MRI Brain and Spine confirmed extensive leptomeningeal disease and CSF analysis confirmed the presence of recurrent embryonal RMS. Results He completed two cycles of cyclophosphamide and topotecan followed by 45Gy/25Fr of craniospinal radiotherapy. Conclusion Late relapses beyond five years can be seen in up to 9% of patients, however very late recurrences (>10 years) are exceedingly rare. Molecular based methods such as gene expression profiling can aid risk stratification and survivorship clinics may become increasingly useful in following patients with high risk features.
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Affiliation(s)
- S Chew
- Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
| | - J P Gleeson
- Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland
| | - A McCarthy
- Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
| | - G A Watson
- Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
| | - R O'Dwyer
- Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
| | - S Nicholson
- Department of Histopathology, St James's Hospital, Dublin 8, Ireland
| | - M Capra
- Department of Medical Oncology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - C Owens
- Department of Medical Oncology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - M McDermott
- Department of Histopathology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - P Daly
- Department of Radiation Oncology, St James's Hospital, Dublin 8, Ireland
| | - C Grant
- Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
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Affiliation(s)
- David A Asch
- From the University of Pennsylvania and the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center - both in Philadelphia (D.A.A.); Massachusetts General Hospital, Boston (J.G.); and Cornell University, Ithaca, NY (S.N.)
| | - Justin Grischkan
- From the University of Pennsylvania and the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center - both in Philadelphia (D.A.A.); Massachusetts General Hospital, Boston (J.G.); and Cornell University, Ithaca, NY (S.N.)
| | - Sean Nicholson
- From the University of Pennsylvania and the Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center - both in Philadelphia (D.A.A.); Massachusetts General Hospital, Boston (J.G.); and Cornell University, Ithaca, NY (S.N.)
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Abstract
BACKGROUND Sarcoidosis is occasionally seen in association with malignancy, both at the time of cancer diagnosis or during follow up. AIM The purpose of this study is to identify patients with paraneoplastic sarcoid, their associated malignancies and disease characteristics. METHODS We identified 289 patients diagnosed histologically with sarcoidosis over a 6-year period in one centre, from 2010 to 2016. Fifty of these patients had a prior or concomitant diagnosis of cancer. RESULTS 17.3% of sarcoid cases had an associated malignancy. The most common malignancies were Gastrointestinal (20%), Haematological (18%), Lung (12%), Gynaecological (12%) and Head and Neck cancer (12%). 74% of sarcoid cases had pulmonary disease with sarcoid diagnostic tissue obtained most frequently via endobronchial ultrasound fine needle aspiration (68%). Most sarcoid cases (66%) were diagnosed within the first year of their malignancy diagnosis. DISCUSSION Careful consideration needs to be given to the possibility that potential cancer recurrences suspected on imaging studies may indeed be sarcoid reactions.
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Affiliation(s)
- M Herron
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - S G Chong
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - L Gleeson
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
| | - S Nicholson
- Department of Pathology, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
- Department of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - R J Fahy
- Department of Respiratory Medicine, St James's Hospital, James's Street North, Ushers, Dublin 8, Ireland
- Department of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
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15
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Affiliation(s)
- David A Asch
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (D.A.A.); Cornell University, Ithaca, NY (S.N.); and New York (M.L.B.)
| | - Sean Nicholson
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (D.A.A.); Cornell University, Ithaca, NY (S.N.); and New York (M.L.B.)
| | - Marc L Berger
- From the University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center - both in Philadelphia (D.A.A.); Cornell University, Ithaca, NY (S.N.); and New York (M.L.B.)
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Abstract
OBJECTIVE To determine whether assigning a dedicated general practitioner (GP) to a nursing home reduces hospitalizations and readmissions. DATA SOURCES/STUDY SETTING Secondary data on hospitalizations and deaths by month for the universe of nursing home residents in Denmark from January 2011 through February 2014. STUDY DESIGN In 2012, Denmark initiated a program in seven nursing homes that volunteered to participate. We used a difference-in-differences model to estimate the effect of assigning a dedicated GP to a nursing home on the likelihood that a nursing home resident will be hospitalized, will experience a preventable hospitalization, and will be readmitted. The unit of observation is a resident-month. DATA COLLECTION/EXTRACTION METHODS Data were extracted from the Danish public administrative register dataset. PRINCIPAL FINDINGS We found that assigning a GP to a nursing home was associated with a 0.55 [95 percent CI, 0.08 to 1.02] percentage point reduction in the monthly probability of a preventable hospitalization, which was a 26 percent reduction from the preintervention level of 2.13 percentage points. The associated reduction in the monthly probability of a readmission was 0.68 [95 percent CI, -0.01 to 1.37] percentage points, which was a 25 percent reduction from the baseline level of 2.68 percentage points. Survey results indicated that the likely mechanism for the effect was more efficient and consistent communication between GPs and nursing home personnel. CONCLUSIONS Assigning a dedicated physician in a nursing home can reduce medical spending and improve patients' health.
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Affiliation(s)
| | - Anne Toft Hansen
- University of Copenhagen and VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Sean Nicholson
- Department of Policy Analysis and Management, Cornell University, Ithaca, New York
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Barr M, Farrell R, Singh S, Foley E, He Y, Brady L, Young V, Ryan R, Nicholson S, Leonard N, Cuffe S, Finn S. MA06.09 XRCC6BP1: A DNA Repair Gene in Cisplatin Resistant Lung Cancer Stem Cells That May Predict Survival Outcomes in Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Barr M, Singh S, Farrell R, Foley E, He Y, Nicholson S, Leonard N, Brady L, Cuffe S, Finn S. PO-510 XRCC6BP1: a novel role in the DNA repair of platinum resistant NSCLC cells. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.1011] [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: 11/04/2022] Open
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Nicholson S, Fox M, Epenetos A, Rustin G. Immunoglobulin Ihhibiting Reagent®: Evaluation of a New Method for Eliminating Spurious Elevations in CA125 Caused by HAMA. Int J Biol Markers 2018; 11:46-9. [PMID: 8740642 DOI: 10.1177/172460089601100109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
Cancer therapy utilising radiolabelled murine monoclonal antibodies frequently leads to the production of Human Anti-Mouse Antibodies (HAMA) in the recipient. HAMA interferes with “sandwich” immunoassays, such as those for tumour markers, rendering results unreliable. Published methods for eliminating HAMA from serum are not suitable for use in a laboratory which is processing a large number of assays using an automated system. We report on the use of Immunoglobulin Inhibiting Reagent (IIR) in CA125 assays from recipients of intraperitoneal radioimmunotherapy who had spuriously elevated results due to HAMA. IIR was found to be comparable to the admixture of mouse serum as a way of eliminating the effect of HAMA. IIR is ideally suited to use with an automated assay process.
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Affiliation(s)
- S Nicholson
- Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K
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Nicholson S, Milner RH, Ragbir M. Soft Tissue Sarcoma of the Hand and Wrist: Epidemiology and Management Challenges. J Hand Microsurg 2018; 10:86-92. [PMID: 30154622 DOI: 10.1055/s-0038-1636728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 01/20/2018] [Indexed: 10/17/2022] Open
Abstract
Soft tissue sarcomas (STSs) of the hand and wrist are rare and confer a unique set of management challenges. We present a 15-year review and discussion of the epidemiology, tumor characteristics, treatment, and reconstructive strategies for such cases presenting to our regional sarcoma service. Three case examples are described. Of 218 STSs of the upper limb, 17 involved the hand or wrist. Alveolar rhabdomyosarcoma, synovial, and myxofibrosarcoma were the most common ones. Two patients required amputation for recurrence. Eight patients required flap reconstruction, of which five were free flaps with no failures or wound healing complications. Two-year overall survival rate was 92%. Local recurrence occurred in 12%. Limb-sparing surgery is possible in most patients, although there is often a degree of functional loss due to the surgical resection, and complex multistage reconstruction may be required. These lesions are still often incidental or unexpected findings when patients are treated for a presumed benign swelling. Clinicians treating localized swellings of the hand and wrist should maintain vigilance toward the possibility of a sarcoma diagnosis, to avoid delays in definitive treatment.
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Affiliation(s)
- S Nicholson
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - R H Milner
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
| | - M Ragbir
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom
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Shaker H, Heah J, Castle J, Pritchard S, Albadry H, Nicholson S, Lumsden L, Kirwan C. Extrinsic pathway markers predict survival in Early Breast Cancer. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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MacDonagh L, Gray S, Cuffe S, Finn S, Nicholson S, Ryan R, Young V, Leonard N, O’Byrne K, Barr M. In with the old! Repurposing disulfiram to target cancer stem cells (CSCs) and the root of cisplatin resistance. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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MacDonagh L, Gray S, Gallagher M, French B, Gasch C, Young V, Ryan R, Nicholson S, Leonard N, Finn S, Cuffe S, O’Byrne K, Barr M. Big applications for a microRNA signature: the diagnostic, prognostic and predictive biomarker potential of a novel 5-miR signature associated with cisplatin resistant NSCLC. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30037-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kelly AL, Gough T, Isreb M, Dhumal R, Jones JW, Nicholson S, Dennis AB, Paradkar A. In-process rheometry as a PAT tool for hot melt extrusion. Drug Dev Ind Pharm 2017; 44:670-676. [PMID: 29161918 DOI: 10.1080/03639045.2017.1408641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Real time measurement of melt rheology has been investigated as a Process Analytical Technology (PAT) to monitor hot melt extrusion of an Active Pharmaceutical Ingredient (API) in a polymer matrix. A developmental API was melt mixed with a commercial copolymer using a heated twin screw extruder at different API loadings and set temperatures. The extruder was equipped with an instrumented rheological slit die which incorporated three pressure transducers flush mounted to the die surface. Pressure drop measurements within the die at a range of extrusion throughputs were used to calculate rheological parameters, such as shear viscosity and exit pressure, related to shear and elastic melt flow properties, respectively. Results showed that the melt exhibited shear thinning behavior whereby viscosity decreased with increasing flow rate. Increase in drug loading and set extrusion temperature resulted in a reduction in melt viscosity. Shear viscosity and exit pressure measurements were found to be sensitive to API loading. These findings suggest that this technique could be used as a simple tool to measure material attributes in-line, to build better overall process understanding for hot melt extrusion.
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Affiliation(s)
- A L Kelly
- a Centre for Pharmaceutical Engineering Science , University of Bradford , Bradford , UK
| | - T Gough
- a Centre for Pharmaceutical Engineering Science , University of Bradford , Bradford , UK
| | - M Isreb
- a Centre for Pharmaceutical Engineering Science , University of Bradford , Bradford , UK
| | - R Dhumal
- a Centre for Pharmaceutical Engineering Science , University of Bradford , Bradford , UK
| | - J W Jones
- b Bristol-Myers Squibb Research and Development , Moreton , UK
| | - S Nicholson
- b Bristol-Myers Squibb Research and Development , Moreton , UK
| | - A B Dennis
- b Bristol-Myers Squibb Research and Development , Moreton , UK
| | - A Paradkar
- a Centre for Pharmaceutical Engineering Science , University of Bradford , Bradford , UK
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25
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Gray S, O’Brien O, O'Brien C, Wright M, Geoghegan O, Leonard N, Nicholson S, Wolfram J, Joerger M, Fabre A, Cuffe S, Finn S. P3.02-053 Optimization and Characterization of Assays to Identify Met Exon 14 Skipping in FFPE Embedded NSCLC Samples. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Donagh LM, Gray S, Gallagher M, Ffrench B, Gasch C, Young V, Ryan R, Nicholson S, Leonard N, Finn S, Cuffe S, O’Byrne K, Barr M. P2.02-064 A Novel 5-miR Signature Shows Potential as a Diagnostic Tool and as a Predictive Biomarker of Cisplatin Response in NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Freeman J, Vernon J, Pilling S, Morris K, Nicholson S, Shearman S, Longshaw C, Wilcox MH. The ClosER study: results from a three-year pan-European longitudinal surveillance of antibiotic resistance among prevalent Clostridium difficile ribotypes, 2011-2014. Clin Microbiol Infect 2017; 24:724-731. [PMID: 29066403 DOI: 10.1016/j.cmi.2017.10.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [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: 07/18/2017] [Revised: 09/29/2017] [Accepted: 10/12/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Until the introduction of fidaxomicin, antimicrobial treatment for Clostridium difficile infection (CDI) was limited to metronidazole and vancomycin. The changing epidemiology of CDI and the emergence of epidemic C. difficile PCR ribotype 027 necessitate continued surveillance to identify shifts in antibiotic susceptibility. ClosER, currently the largest pan-European epidemiological study of C. difficile ribotype distribution and antibiotic susceptibility, aimed to undertake antimicrobial resistance surveillance pre- and post-introduction of fidaxomicin. METHODS Between July 2011 and July 2014, 39 sites across 22 European countries submitted 2830 C. difficile isolates for ribotyping, toxin testing and susceptibility testing to metronidazole, vancomycin, fidaxomicin, rifampicin, moxifloxacin, clindamycin, imipenem, chloramphenicol and tigecycline. RESULTS Ribotypes 027, 014, 001, 078, 020, 002, 126, 015 and 005 were most frequently isolated, and emergent ribotypes 198 and 356 were identified in Hungary and Italy, respectively. All isolates were susceptible to fidaxomicin, with scarce resistance to metronidazole (0.2%, 6/2694), vancomycin (0.1%, 2/2694) and tigecycline (0%). Rifampicin, moxifloxacin and clindamycin resistance was evident in multiple ribotypes. Lack of ribotype diversity correlated with greater antimicrobial resistance. Epidemic ribotypes (027/001) were associated with multiple antimicrobial resistance, and ribotypes 017, 018 and 356 with high-level resistance. Additional factors may also influence local ribotype prevalence. CONCLUSIONS Fidaxomicin susceptibility was retained post-introduction, and resistance to metronidazole and vancomycin was rare. Continued surveillance is needed, with more accurate classification and clarification of ribotype subtypes to further understand their role in the spread of resistance. Other factors may also influence changes in prevalence of C. difficile ribotypes with reduced antibiotic susceptibility.
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Affiliation(s)
- J Freeman
- Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK; Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
| | - J Vernon
- Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - S Pilling
- Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - K Morris
- Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - S Nicholson
- Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - S Shearman
- Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | | | - M H Wilcox
- Department of Microbiology, Leeds Teaching Hospitals Trust, Leeds, UK; Healthcare Associated Infections Research Group, Section of Molecular Gastroenterology, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
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Nicholson S, Fan M, Hodges R, Higgins M. Learning From Experience: Development of a Cognitive Task List to Perform a Caesarean Section in the Obese Parturient. Journal of Obstetrics and Gynaecology Canada 2017; 39:724-725. [DOI: 10.1016/j.jogc.2017.03.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
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Wright J, Nicholson S, Arrowsmith J. Effective positioning of the fingers for intraoperative x-rays. Ann R Coll Surg Engl 2017; 100:81. [PMID: 28841030 DOI: 10.1308/rcsann.2017.0126] [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: 11/22/2022] Open
Affiliation(s)
- J Wright
- Derby Teaching Hospitals NHS Foundation Trust , UK
| | - S Nicholson
- Derby Teaching Hospitals NHS Foundation Trust , UK
| | - J Arrowsmith
- Derby Teaching Hospitals NHS Foundation Trust , UK
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Eberle R, Maxwell LK, Nicholson S, Black D, Jones-Engel L. Genome sequence variation among isolates of monkey B virus (Macacine alphaherpesvirus 1) from captive macaques. Virology 2017; 508:26-35. [PMID: 28494342 PMCID: PMC5535784 DOI: 10.1016/j.virol.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/27/2017] [Revised: 04/17/2017] [Accepted: 05/02/2017] [Indexed: 12/15/2022]
Abstract
Complete genome sequences of 19 strains of monkey B virus (Macacine alphaherpesvirus 1; BV) isolated from several macaque species were determined. A low level of sequence variation was present among BV isolates from rhesus macaques. Most variation among BV strains isolated from rhesus macaques was located in regions of repetitive or quasi-repetitive sequence. Variation in coding sequences (polypeptides and miRNAs) was minor compared to regions of non-coding sequences. Non-coding sequences in the long and short repeat regions of the genome did however exhibit islands of conserved sequence. Oral and genital isolates from a single monkey were identical in sequence and varied only in the number of iterations of repeat units in several areas of repeats. Sequence variation between BV isolates from different macaque species (different BV genotypes) was much greater and was spread across the entire genome, confirming the existence of different genotypes of BV in different macaque species.
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Affiliation(s)
- R Eberle
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA.
| | - L K Maxwell
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - S Nicholson
- Department of Biochemistry and Molecular Biology, College of Agriculture Sciences and Natural Resources, Oklahoma State University, Stillwater, OK, USA
| | - D Black
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - L Jones-Engel
- Department of Anthropology, University of Washington, Seattle, WA, USA
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Nicholson S, Cleland JA. "It's making contacts": notions of social capital and implications for widening access to medical education. Adv Health Sci Educ Theory Pract 2017; 22:477-490. [PMID: 27844179 DOI: 10.1007/s10459-016-9735-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/31/2016] [Indexed: 06/06/2023]
Abstract
In the UK widening access (WA) activities and policies aim to increase the representation from lower socio-economic groups into Higher Education. Whilst linked to a political rhetoric of inclusive education such initiatives have however failed to significantly increase the number of such students entering medicine. This is compounded by a discourse that portrays WA applicants and students as lacking the essential skills or attributes to be successful in medical education. Much of the research in this area to date has been weak and it is critical to better understand how WA applicants and students negotiate medical admissions and education to inform change. To address this gap we amalgamated a larger dataset from three qualitative studies of student experiences of WA to medicine (48 participants in total). Inductively analysing the findings using social capital as a theoretical lens we created and clustered codes into categories, informed by the concepts of "weak ties" and "bridging and linking capital", terms used by previous workers in this field, to better understand student journeys in medical education. Successful applicants from lower socio-economic groups recognise and mobilise weak ties to create linking capital. However once in medical school these students seem less aware of the need for, or how to create, capital effectively. We argue WA activities should support increasing the social capital of under-represented applicants and students, and future selection policy needs to take into account the varying social capital of students, so as to not overtly disadvantage some social groups.
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Affiliation(s)
- S Nicholson
- Institute of Health Science Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 3rd Floor Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK.
| | - J A Cleland
- Division of Medical and Dental Education, University of Aberdeen, Polwarth Building, Foresterhill, AB25 2ZD, UK
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Nicholson S, Vujicic M, Wanchek T, Ziebert A, Menezes A. The effect of education debt on dentists' career decisions. J Am Dent Assoc 2017; 146:800-7. [PMID: 26514885 DOI: 10.1016/j.adaj.2015.05.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the study was to determine whether there is an association between the amount of education debt on completing dental school (initial debt) and certain career decisions. METHODS The authors surveyed 1,842 practicing dentists who completed dental school between 1996 and 2011 to ascertain their initial education debt, the balance on their debt in 2013, and a variety of specialization and practice decisions made during their careers. Data also included demographic characteristics and parental income and education levels. RESULTS Dentists with higher initial debt were less likely to specialize and more likely to enter private practice, accept high-paying jobs on graduation, and work longer hours. Choice of employment setting, practice ownership, and whether to provide Medicaid and charity care were associated with dentists' sexes and races but not debt. CONCLUSIONS High debt levels influenced some career decisions, but the magnitude of these effects was small compared with the effects of demographic characteristics, including race and sex, on career choices. PRACTICAL IMPLICATIONS Policy makers concerned about the influence of student debt on the professional decisions of dental school graduates should recognize that students' demographic characteristics may be more powerful in driving career choices.
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Taylor L, Aujayeb A, Calder M, Nicholson S, Mackenzie J, Dickson M. 146: Treatment of loculated malignant effusions. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30196-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lin R, Reid G, Mutti L, Ryan A, Nicholson S, Leonard N, Young V, Ryan R, Finn S, Cuffe S, Gray S. 8: Are circRNAs potentially useful for the early detection of lung cancer? Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barr M, Singh S, Foley E, He Y, Young V, Ryan R, Nicholson S, Leonard N, O'Byrne K, Cuffe S, Finn S. 2: XRCC6BP1: A key player in cisplatin resistance and lung cancer stem cells. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30052-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mocciaro G, Ziauddeen N, Nicholson S, Almoosawi S, Ray S. Findings from a UK–Morocco training programme to improve capacity in nutrition surveillance, research and education. Public Health 2017; 142:208-211. [DOI: 10.1016/j.puhe.2016.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/23/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
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Lakdawalla D, Shafrin J, Lucarelli C, Nicholson S, Khan ZM, Philipson TJ. Quality-adjusted cost of care: a meaningful way to measure growth in innovation cost versus the value of health gains. Health Aff (Millwood) 2016; 34:555-61. [PMID: 25847636 DOI: 10.1377/hlthaff.2014.0639] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for.
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Affiliation(s)
- Darius Lakdawalla
- Darius Lakdawalla is the Quintiles Professor of Pharmaceutical Development and Regulatory Innovation at the Schaeffer Center for Health Policy and Economics, University of Southern California, in Los Angeles
| | - Jason Shafrin
- Jason Shafrin is a senior research economist at Precision Health Economics, in Los Angeles
| | - Claudio Lucarelli
- Claudio Lucarelli is a professor of economics at Universidad de los Andes, in Santiago, Chile
| | - Sean Nicholson
- Sean Nicholson is a professor in the Department of Policy Analysis and Management at Cornell University, in Ithaca, New York
| | - Zeba M Khan
- Zeba M. Khan is vice president of Corporate Responsibility at Celgene Corporation, in Summit, New Jersey
| | - Tomas J Philipson
- Tomas J. Philipson is the Daniel Levin Professor of Public Policy at the Irving B. Harris Graduate School for Public Policy Studies, University of Chicago, in Illinois
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Alarhayem A, Myers J, Dent D, Liao L, Muir M, Mueller D, Nicholson S, Cestero R, Johnson M, Stewart R, O'Keefe G, Eastridge B. Time is the enemy: Mortality in trauma patients with hemorrhage from torso injury occurs long before the “golden hour”. Am J Surg 2016; 212:1101-1105. [DOI: 10.1016/j.amjsurg.2016.08.018] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
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Maplethorpe N, Rooney K, Nicholson S. Sodium intake in England and Scotland: Assessment of dietary sodium. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.023] [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: 11/14/2022] Open
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Abstract
OBJECTIVES Most UK medical programmes use aptitude tests during student selection, but large-scale studies of predictive validity are rare. This study assesses the UK Clinical Aptitude Test (UKCAT: http://www.ukcat.ac.uk), and 4 of its subscales, along with individual and contextual socioeconomic background factors, as predictors of performance during, and on exit from, medical school. METHODS This was an observational study of 6294 medical students from 30 UK medical programmes who took the UKCAT from 2006 to 2008, for whom selection data from the UK Foundation Programme (UKFPO), the next stage of UK medical education training, were available in 2013. We included candidate demographics, UKCAT (cognitive domains; total scores), UKFPO Educational Performance Measure (EPM) and national exit situational judgement test (SJT). Multilevel modelling was used to assess relationships between variables, adjusting for confounders. RESULTS The UKCAT-as a total score and in terms of the subtest scores-has significant predictive validity for performance on the UKFPO EPM and SJT. UKFPO performance was also affected positively by female gender, maturity, white ethnicity and coming from a higher social class area at the time of application to medical school An inverse pattern was seen for a contextual measure of school, with those attending fee-paying schools performing significantly more weakly on the EPM decile, the EPM total and the total UKFPO score, but not the SJT, than those attending other types of school. CONCLUSIONS This large-scale study, the first to link 2 national databases-UKCAT and UKFPO, has shown that UKCAT is a predictor of medical school outcome. The data provide modest supportive evidence for the UKCAT's role in student selection. The conflicting relationships of socioeconomic contextual measures (area and school) with outcome adds to wider debates about the limitations of these measures, and indicates the need for further research.
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Affiliation(s)
- R K MacKenzie
- Institute of Education for Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - J A Cleland
- Institute of Education for Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - D Ayansina
- Department of Medical Statistics, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - S Nicholson
- Centre for Medical Education, Institute of Health Sciences Education, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Shaker H, Bundred NJ, Albadry H, Nicholson S, Castle J, Lumsden LJ, Pritchard S, Landberg G, Kirwan CC. PO-21 - Stromal fibroblasts in preinvasive breast cancer (ductal carcinoma in situ, DCIS) demonstrate a cancer-like procoagulant phenotypic switch that may facilitate invasion. Thromb Res 2016; 140 Suppl 1:S184. [PMID: 27161710 DOI: 10.1016/s0049-3848(16)30154-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ductal carcinoma in-situ (DCIS) is a preinvasive breast cancer where cancer cells remain confined within the ductal basement membrane. However, genotypic changes have been identified in stroma surrounding DCIS, outside the basement membrane. Stromal fibroblasts undergo phenotypic change in cancer to promote tumour angiogenesis, proliferation, immunosuppression and metastasis and in vivo can induce invasion of DCIS. Phenotypic changes in DCIS stromal fibroblasts may potentially act as a precursor for invasion. AIM To determine if stromal fibroblasts in DCIS have procoagulant changes similar to those seen in cancer-associated fibroblasts in invasive breast cancer. MATERIALS AND METHODS As part of the prospective cohort study CHAMPion (Cancer induced Hypercoagulabulity as a Marker of Prognosis), patients with DCIS (n=72) and invasive breast cancer (n=292) were recruited. Stromal fibroblasts in tumour and corresponding normal breast tissue (distant from the cancer) were quantified (percentage IHC stained) for tissue factor (TF), thrombin, PAR1 and PAR2. Fibroblasts were identified morphologically, at a minimum distance of 0.2mm from ductal tissue, to avoid myoepithelial scoring. Scoring was performed in duplicate by two independent pathologists. RESULTS Fibroblast TF expression was present in normal breast tissue (mean 43% ([SD 27%]) but markedly increased in DCIS (mean 62% [SD 27%], p=0.002). Fibroblast TF expression was further increased in invasive breast cancer (mean 74% [SD 23%], normal vs invasion, p<0.001; DCIS vs invasion, p=0.03). Fibroblast thrombin and PAR2, but not PAR1, expression was increased in DCIS compared to normal (thrombin: 60% vs 42%, p<0.001; PAR2: 58% vs 41%, p=0.002), however no further significant increase was seen in invasive cancer (thrombin 63%, PAR2 61%). Fibroblast tissue factor correlated with fibroblast thrombin expression (p<0.001, r=0.4) and fibroblast PAR2 expression (p<0.001, r=0.5), with thrombin and PAR2 expression also correlating (p<0.001, r=0.4). CONCLUSIONS Procoagulant phenotypic changes, in terms of increased TF, thrombin and PAR2 expression, occur in stromal fibroblasts at the preinvasive stage. It needs to be determined if this change is functional and therefore a potential therapeutic target for preventing transition to invasion.
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Affiliation(s)
- H Shaker
- Institute of Cancer Sciences, University of Manchester
| | - N J Bundred
- Institute of Cancer Sciences, University of Manchester; Department of Academic Surgery, University Hospital of South Manchester
| | - H Albadry
- Department of Histoathology, University Hospital of South Manchester; Manchester, United Kingdom
| | - S Nicholson
- Department of Histoathology, University Hospital of South Manchester; Manchester, United Kingdom
| | - J Castle
- Institute of Cancer Sciences, University of Manchester
| | - L J Lumsden
- Department of Histoathology, University Hospital of South Manchester; Manchester, United Kingdom
| | - S Pritchard
- Department of Histoathology, University Hospital of South Manchester; Manchester, United Kingdom
| | - G Landberg
- Institute of Cancer Sciences, University of Manchester; Sahlgrenska Cancer Center, University of Gothenburg, Sweden
| | - C C Kirwan
- Institute of Cancer Sciences, University of Manchester; Department of Academic Surgery, University Hospital of South Manchester
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Barr M, Foley E, He Y, Young V, Ryan R, Nicholson S, Leonard N, O'Byrne K, Cuffe S, Finn S. 80P XRCC6BP1: A key DNA repair gene in platinum-resistant NSCLC. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Barr M, MacDonagh L, Gray S, Reidy M, Sui JSY, Nicholson S, Leonard N, O'Byrne K, Cuffe S, Finn S. 70P Identification of a novel microRNA signature: Potential diagnostic biomarkers and predictors of cisplatin response? J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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MacDonagh L, Gray S, Cuffe S, Finn S, Young V, Ryan R, Nicholson S, Leonard N, O'Byrne K, Barr M. 6 Cisplatin induces the emergence and expansion of a distinct cancer stem cell (CSC) population in NSCLC. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Barr M, Foley E, He Y, Young V, Ryan R, Nicholson S, Leonard N, O'Byrne K, Finn S, Cuffe S. 4 Identification and targeting of the DNA repair gene, XRCC6BP1, in cisplatin resistant NSCLC. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30021-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ong KJ, Thornton AC, Fisher M, Hutt R, Nicholson S, Palfreeman A, Perry N, Stedman-Bryce G, Wilkinson P, Delpech V, Nardone A. Estimated cost per HIV infection diagnosed through routine HIV testing offered in acute general medical admission units and general practice settings in England. HIV Med 2015; 17:247-54. [PMID: 26394818 DOI: 10.1111/hiv.12293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Following national guidelines to expand HIV testing in high-prevalence areas in England, a number of pilot studies were conducted in acute general medical admission units (ACUs) and general practices (GPs) to assess the feasibility and acceptability of testing in these settings. The aim of this study was to estimate the cost per HIV infection diagnosed through routine HIV testing in these settings. METHODS Resource use data from four 2009/2010 Department of Health pilot studies (two ACUs; two GPs) were analysed. Data from the pilots were validated and supplemented with information from other sources. We constructed possible scenarios to estimate the cost per test carried out through expanded HIV testing in ACUs and GPs, and the cost per diagnosis. RESULTS In the pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs, respectively. In scenario analyses we fixed offer time, diagnostic test cost and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40% for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000 tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed by either hospital consultants or GPs. CONCLUSIONS Expanded HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of a shorter offer time, higher patient uptake, higher HIV positivity and lower diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV positivity, expanded HIV testing should be promoted in high HIV prevalence areas.
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Affiliation(s)
- K J Ong
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
| | - A C Thornton
- Department of Infection and Population Health, University College London, London, UK
| | - M Fisher
- Brighton and Sussex University Hospital, Brighton, UK
| | - R Hutt
- NHS South East London, Public Health Lewisham, London, UK
| | - S Nicholson
- Brighton and Hove City Council, Brighton, UK
| | | | - N Perry
- Brighton and Sussex University Hospital, Brighton, UK
| | | | - P Wilkinson
- Brighton and Hove City Council, Brighton, UK
| | - V Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
| | - A Nardone
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
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Shafaat M, Nicholson S, Fontaine E, Doran H, Rammohan K. F-101NEGATIVE PLEURAL BIOPSIES FOR SUSPECTED PLEURAL MALIGNANCY: TO TRUST OR NOT TO TRUST? Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ntlholang O, McDonagh R, Nicholson S, Brett F, Bradley D, Harbison J. Is Intimal Hyperplasia Associated with Cranial Arterial Stenosis in Cannabis-Associated Cerebral Infarction? Int J Stroke 2015. [DOI: 10.1111/ijs.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- O. Ntlholang
- Acute Stroke Service, St James Hospital, Dublin, Ireland
| | - R. McDonagh
- Acute Stroke Service, St James Hospital, Dublin, Ireland
| | - S. Nicholson
- Department of Pathology, St James Hospital, Dublin, Ireland
| | - F. Brett
- Department of Pathology, St James Hospital, Dublin, Ireland
| | - D. Bradley
- Acute Stroke Service, St James Hospital, Dublin, Ireland
| | - J. Harbison
- Acute Stroke Service, St James Hospital, Dublin, Ireland
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Nicholson S, Hanby A, Clements K, Kearins O, Lawrence G, Dodwell D, Bishop H, Thompson A. Variations in the management of the axilla in screen-detected Ductal Carcinoma In Situ: Evidence from the UK NHS Breast Screening Programme audit of screen detected DCIS. Eur J Surg Oncol 2015; 41:86-93. [DOI: 10.1016/j.ejso.2014.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022] Open
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Nicholson S, Southern S, Mariconda M, Smeraglia F. Re: Mariconda et al. Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal joint osteoarthritis: results after minimum 2 years of follow-up. J Hand Surg Eur. 2014, 39: 604-610. J Hand Surg Eur Vol 2014; 39:1014. [PMID: 25336674 DOI: 10.1177/1753193414553368] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Nicholson
- Department of Plastic Surgery, Pinderfields General Hospital, Wakefield, UK
| | - S Southern
- Department of Plastic Surgery, Pinderfields General Hospital, Wakefield, UK
| | - M Mariconda
- Departiment of Orthopaedic Surgery Federico II University, Naples, Italy
| | - F Smeraglia
- Departiment of Orthopaedic Surgery Federico II University, Naples, Italy
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