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Buchan JC, Norridge CFE, Low L, Shah V, Donachie PHJ. The Royal College of Ophthalmologists' National Ophthalmology Database Study of Cataract Surgery: Report 13, monitoring post-cataract surgery endophthalmitis rates-the rule of X. Eye (Lond) 2024; 38:1386-1389. [PMID: 38200322 DOI: 10.1038/s41433-023-02917-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Cataract surgical safety has improved over recent decades, with endophthalmitis rates before 2006 typically 0.13-0.15% compared with the most recent UK national estimate of 0.02%. There remains, however, substantial variation in reported rates from different centres. Due to the low event rate, this disparity may not be noticed and opportunities to improve therefore be missed. We propose a method of monitoring post-cataract endophthalmitis rates that would help centres with higher rates identify this. METHODS A statistical tool, available to download or use online, permits comparison of local endophthalmitis rate with the estimated UK rate of 0.02%. Centres are encouraged to maintain a register of endophthalmitis cases, and when the number reaches a threshold (X cases), either in a certain time period or in a fixed number of procedures, then the centre can consider itself as an outlier and trigger local investigations to improve infection control. RESULTS Example outputs are offered, such as for a unit doing 5000 cataracts annually, a value of X is suggested such that the third case of endophthalmitis (X = 3) in a 12-month period would give 85% confidence, the fourth case 90% confidence and the fifth case 95% confidence that the true endophthalmitis rate for that unit was higher than the national average. CONCLUSIONS This statistical tool provides a basis for units to set a threshold number of cases of endophthalmitis within a given period that would trigger local processes, thus helping inform local monitoring processes for this rare but potentially catastrophic complication of cataract surgery.
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Affiliation(s)
- John C Buchan
- The Royal College of Ophthalmologists' National Ophthalmology Database Audit, London, UK.
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Charlotte F E Norridge
- The Royal College of Ophthalmologists' National Ophthalmology Database Audit, London, UK
- Gloucestershire Hospitals NHS Foundation NHS Trust, Cheltenham, UK
| | - Liying Low
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Vishal Shah
- King's College Hospital NHS Foundation Trust, London, UK
| | - Paul H J Donachie
- The Royal College of Ophthalmologists' National Ophthalmology Database Audit, London, UK
- Gloucestershire Hospitals NHS Foundation NHS Trust, Cheltenham, UK
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2
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McCarver S, Hanna L, Samant A, Thompson AA, Seierstad M, Saha A, Wu D, Lord B, Sutton SW, Shah V, Milligan CM, Wennerholm M, Shelton J, Lebold TP, Shireman BT. Structure-Based Optimization of Selective and Brain Penetrant CK1δ Inhibitors for the Treatment of Circadian Disruptions. ACS Med Chem Lett 2024; 15:486-492. [PMID: 38628796 PMCID: PMC11017389 DOI: 10.1021/acsmedchemlett.3c00523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 04/19/2024] Open
Abstract
Neuropsychiatric disorders such as major depressive disorders and schizophrenia are often associated with disruptions to the normal 24 h sleep wake cycle. Casein kinase 1 (CK1δ) is an integral part of the molecular machinery that regulates circadian rhythms. Starting from a cluster of bicyclic pyrazoles identified from a virtual screening effort, we utilized structure-based drug design to identify and reinforce a unique "hinge-flip" binding mode that provides a high degree of selectivity for CK1δ versus the kinome. Pharmacokinetics, brain exposure, and target engagement as measured by ex vivo autoradiography are described for advanced analogs.
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Affiliation(s)
- Stefan McCarver
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | | | | | - Aaron A. Thompson
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Mark Seierstad
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Arjun Saha
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Dongpei Wu
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Brian Lord
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Steven W. Sutton
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Vishal Shah
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Cynthia M. Milligan
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Michelle Wennerholm
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Jonathan Shelton
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Terry P. Lebold
- Janssen Research and Development, San Diego, California 92121-1126, United
States
| | - Brock T. Shireman
- Janssen Research and Development, San Diego, California 92121-1126, United
States
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3
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Mohamed AA, Shah V, Njeru JW, Wieland ML, Rutten LJF, Prokop LJ, Murad MH. Interventions to Increase Cancer Screening Adherence Among Somali Immigrants in the US and Europe: A Systematic Review. J Immigr Minor Health 2024; 26:385-394. [PMID: 37612453 DOI: 10.1007/s10903-023-01532-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
Cancer screening rates among immigrant and refugee populations in high income countries is significantly lower than native born populations. The objective of this study is to systematically review the effectiveness of interventions to improve screening adherence for breast, cervical and colorectal cancer among Somali immigrants. A literature search was conducted for the years 2000-2021 and eight studies met eligibility criteria. The following intervention components were found to increase adherence to cervical cancer screening: home HPV test, educational workshop for women and education for general practitioners. A patient navigator intervention was found to increase screening for breast cancer. Educational workshops motivated or increased knowledge regarding cancer screening for breast, cervical and colorectal cancer. However, most of the studies had limitations due to methodology with potential for introduction of bias. Therefore, future studies comparing effectiveness of specific intervention components to reduce disparities in cancer screening among Somali immigrants and refugees are encouraged.
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Affiliation(s)
- Ahmed A Mohamed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Vishal Shah
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Jane W Njeru
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mark L Wieland
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
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4
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Rier L, Rhodes N, Pakenham D, Boto E, Holmes N, Hill RM, Reina Rivero G, Shah V, Doyle C, Osborne J, Bowtell RW, Taylor M, Brookes MJ. The neurodevelopmental trajectory of beta band oscillations: an OPM-MEG study. bioRxiv 2024:2024.01.04.573933. [PMID: 38260246 PMCID: PMC10802362 DOI: 10.1101/2024.01.04.573933] [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] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Neural oscillations mediate the coordination of activity within and between brain networks, supporting cognition and behaviour. How these processes develop throughout childhood is not only an important neuroscientific question but could also shed light on the mechanisms underlying neurological and psychiatric disorders. However, measuring the neurodevelopmental trajectory of oscillations has been hampered by confounds from instrumentation. In this paper, we investigate the suitability of a disruptive new imaging platform - Optically Pumped Magnetometer-based magnetoencephalography (OPM-MEG) - to study oscillations during brain development. We show how a unique 192-channel OPM-MEG device, which is adaptable to head size and robust to participant movement, can be used to collect high-fidelity electrophysiological data in individuals aged between 2 and 34 years. Data were collected during a somatosensory task, and we measured both stimulus-induced modulation of beta oscillations in sensory cortex, and whole-brain connectivity, showing that both modulate significantly with age. Moreover, we show that pan-spectral bursts of electrophysiological activity drive task-induced beta modulation, and that their probability of occurrence and spectral content change with age. Our results offer new insights into the developmental trajectory of beta oscillations and provide clear evidence that OPM-MEG is an ideal platform for studying electrophysiology in neurodevelopment.
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5
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Schofield H, Hill RM, Feys O, Holmes N, Osborne J, Doyle C, Bobela D, Corvilian P, Wens V, Rier L, Bowtell R, Ferez M, Mullinger KJ, Coleman S, Rhodes N, Rea M, Tanner Z, Boto E, de Tiège X, Shah V, Brookes MJ. A Novel, Robust, and Portable Platform for Magnetoencephalography using Optically Pumped Magnetometers. bioRxiv 2024:2024.03.06.583313. [PMID: 38558964 PMCID: PMC10979878 DOI: 10.1101/2024.03.06.583313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Magnetoencephalography (MEG) measures brain function via assessment of magnetic fields generated by neural currents. Conventional MEG uses superconducting sensors, which place significant limitations on performance, practicality, and deployment; however, the field has been revolutionised in recent years by the introduction of optically-pumped-magnetometers (OPMs). OPMs enable measurement of the MEG signal without cryogenics, and consequently the conception of 'OPM-MEG' systems which ostensibly allow increased sensitivity and resolution, lifespan compliance, free subject movement, and lower cost. However, OPM-MEG remains in its infancy with limitations on both sensor and system design. Here, we report a new OPM-MEG design with miniaturised and integrated electronic control, a high level of portability, and improved sensor dynamic range (arguably the biggest limitation of existing instrumentation). We show that this system produces equivalent measures when compared to an established instrument; specifically, when measuring task-induced beta-band, gamma-band and evoked neuro-electrical responses, source localisations from the two systems were highly comparable and temporal correlation was >0.7 at the individual level and >0.9 for groups. Using an electromagnetic phantom, we demonstrate improved dynamic range by running the system in background fields up to 8 nT. We show that the system is effective in gathering data during free movement (including a sitting-to-standing paradigm) and that it is compatible with simultaneous electroencephalography (EEG - the clinical standard). Finally, we demonstrate portability by moving the system between two laboratories. Overall, our new system is shown to be a significant step forward for OPM-MEG technology and offers an attractive platform for next generation functional medical imaging.
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Affiliation(s)
- Holly Schofield
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Cerca Magnetics Limited, 2 Castlebridge Office Village, Kirtley Drive, Nottingham, NG7 1LD, Nottingham, UK
| | - Ryan M. Hill
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Cerca Magnetics Limited, 2 Castlebridge Office Village, Kirtley Drive, Nottingham, NG7 1LD, Nottingham, UK
| | - Odile Feys
- Université libre de Bruxelles, ULB Neuroscience Institute, Laboratoire de neuroanatomie et neuroimagerie translationelles, Brussels, Belgium
- Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Department of neurology, Brussels, Belgium
| | - Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Cerca Magnetics Limited, 2 Castlebridge Office Village, Kirtley Drive, Nottingham, NG7 1LD, Nottingham, UK
| | - James Osborne
- QuSpin Inc. 331 South 104 Street, Suite 130, Louisville, Colorado, 80027, USA
| | - Cody Doyle
- QuSpin Inc. 331 South 104 Street, Suite 130, Louisville, Colorado, 80027, USA
| | - David Bobela
- QuSpin Inc. 331 South 104 Street, Suite 130, Louisville, Colorado, 80027, USA
| | - Pierre Corvilian
- Université libre de Bruxelles, ULB Neuroscience Institute, Laboratoire de neuroanatomie et neuroimagerie translationelles, Brussels, Belgium
| | - Vincent Wens
- Université libre de Bruxelles, ULB Neuroscience Institute, Laboratoire de neuroanatomie et neuroimagerie translationelles, Brussels, Belgium
- Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Department of translational neuroimaging, Brussels, Belgium
| | - Lukas Rier
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Maxime Ferez
- Université libre de Bruxelles, ULB Neuroscience Institute, Laboratoire de neuroanatomie et neuroimagerie translationelles, Brussels, Belgium
| | - Karen J. Mullinger
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, UK
| | - Sebastian Coleman
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Natalie Rhodes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Molly Rea
- Cerca Magnetics Limited, 2 Castlebridge Office Village, Kirtley Drive, Nottingham, NG7 1LD, Nottingham, UK
| | - Zoe Tanner
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Cerca Magnetics Limited, 2 Castlebridge Office Village, Kirtley Drive, Nottingham, NG7 1LD, Nottingham, UK
| | - Elena Boto
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Cerca Magnetics Limited, 2 Castlebridge Office Village, Kirtley Drive, Nottingham, NG7 1LD, Nottingham, UK
| | - Xavier de Tiège
- Université libre de Bruxelles, ULB Neuroscience Institute, Laboratoire de neuroanatomie et neuroimagerie translationelles, Brussels, Belgium
- Université libre de Bruxelles, Hôpital Universitaire de Bruxelles, Hôpital Erasme, Department of translational neuroimaging, Brussels, Belgium
| | - Vishal Shah
- QuSpin Inc. 331 South 104 Street, Suite 130, Louisville, Colorado, 80027, USA
| | - Matthew J. Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Cerca Magnetics Limited, 2 Castlebridge Office Village, Kirtley Drive, Nottingham, NG7 1LD, Nottingham, UK
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6
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Nagpal S, Png Yi Jie J, Malinovskaya J, Kovshova T, Jain P, Naik S, Khopade A, Bhowmick S, Shahi P, Chakra A, Bhokari A, Shah V, Gelperina S, Wacker MG. A Design-Conversed Strategy Establishes the Performance Safe Space for Doxorubicin Nanosimilars. ACS Nano 2024; 18:6162-6175. [PMID: 38359902 PMCID: PMC10906076 DOI: 10.1021/acsnano.3c08290] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
Nanomedicines exhibit multifaceted performances, yet their biopharmaceutics remain poorly understood and present several challenges in the translation from preclinical to clinical research. To address this issue and promote the production of high-quality nanomedicines, a systematic screening of the design space and in vivo performance is necessary. Establishing formulation performance specifications early on enables an informed selection of candidates and promotes the development of nanosimilars. The deconvolution of the pharmacokinetics enables the identification of key characteristics that influence their performances and disposition. Using an in vitro-in vivo rank-order relationship for doxorubicin nanoformulations, we defined in vitro release specifications for Doxil/Caelyx-like follow-on products. Additionally, our model predictions were used to establish the bioequivalence of Lipodox, a nanosimilar of Doxil/Caelyx. Furthermore, a virtual safe space was established, providing crucial insights into expected disposition kinetics and informing formulation development. By addressing bottlenecks in biopharmaceutics and formulation screening, our research advances the translation of nanomedicine from bench to bedside.
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Affiliation(s)
- Shakti Nagpal
- Department
of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, 4 Science Drive 2, Singapore 117544, Singapore
| | - Jordan Png Yi Jie
- Department
of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, 4 Science Drive 2, Singapore 117544, Singapore
| | - Julia Malinovskaya
- Dmitry
Mendeleev University of Chemical Technology of Russia, Miusskaya pl. 9, Moscow 125047, Russia
| | - Tatyana Kovshova
- Dmitry
Mendeleev University of Chemical Technology of Russia, Miusskaya pl. 9, Moscow 125047, Russia
| | - Pankaj Jain
- Sun
Pharma Advanced Research Company Ltd., 17 B Mahal Industrial Estate, Mahakali Caves Road,
Andheri (East), Mumbai, Maharashtra 400093, India
- Sun
Pharma Advanced Research Centre (SPARC), Tandalja, Vadodara, Gujarat 390 020, India
| | - Sachin Naik
- Sun
Pharma Advanced Research Company Ltd., 17 B Mahal Industrial Estate, Mahakali Caves Road,
Andheri (East), Mumbai, Maharashtra 400093, India
- Sun
Pharma Advanced Research Centre (SPARC), Tandalja, Vadodara, Gujarat 390 020, India
| | - Ajay Khopade
- Sun
Pharma Advanced Research Company Ltd., 17 B Mahal Industrial Estate, Mahakali Caves Road,
Andheri (East), Mumbai, Maharashtra 400093, India
- Sun
Pharma Advanced Research Centre (SPARC), Tandalja, Vadodara, Gujarat 390 020, India
| | - Subhas Bhowmick
- Sun
Pharma Advanced Research Company Ltd., 17 B Mahal Industrial Estate, Mahakali Caves Road,
Andheri (East), Mumbai, Maharashtra 400093, India
- Sun
Pharma Advanced Research Centre (SPARC), Tandalja, Vadodara, Gujarat 390 020, India
| | - Pradeep Shahi
- Sun
Pharma Advanced Research Company Ltd., 17 B Mahal Industrial Estate, Mahakali Caves Road,
Andheri (East), Mumbai, Maharashtra 400093, India
- Sun
Pharma Advanced Research Centre (SPARC), Tandalja, Vadodara, Gujarat 390 020, India
| | - Amaresh Chakra
- Sun
Pharma Advanced Research Company Ltd., 17 B Mahal Industrial Estate, Mahakali Caves Road,
Andheri (East), Mumbai, Maharashtra 400093, India
- Sun
Pharma Advanced Research Centre (SPARC), Tandalja, Vadodara, Gujarat 390 020, India
| | - Ashutosh Bhokari
- Sun
Pharma Advanced Research Company Ltd., 17 B Mahal Industrial Estate, Mahakali Caves Road,
Andheri (East), Mumbai, Maharashtra 400093, India
- Sun
Pharma Advanced Research Centre (SPARC), Tandalja, Vadodara, Gujarat 390 020, India
| | - Vishal Shah
- Sun
Pharma Advanced Research Company Ltd., 17 B Mahal Industrial Estate, Mahakali Caves Road,
Andheri (East), Mumbai, Maharashtra 400093, India
- Sun
Pharma Advanced Research Centre (SPARC), Tandalja, Vadodara, Gujarat 390 020, India
| | - Svetlana Gelperina
- Dmitry
Mendeleev University of Chemical Technology of Russia, Miusskaya pl. 9, Moscow 125047, Russia
| | - Matthias G. Wacker
- Department
of Pharmacy and Pharmaceutical Sciences, Faculty of Science, National University of Singapore, 4 Science Drive 2, Singapore 117544, Singapore
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7
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Stonerock DS, Clark K, Shah V, Irvine CC, Draper E, Soefje SA. Evaluating the Impact of Pharmacist Dual Verification of Anticancer Therapy in the Modern Era. J Pharm Technol 2023; 39:281-285. [PMID: 37974597 PMCID: PMC10640867 DOI: 10.1177/87551225231197346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: Pharmacist order verification is a critical step in ensuring medication safety for patients. While the second pharmacist verification (SPV) before dispensing anticancer therapies has been a longstanding practice, its continued necessity in the context of modern electronic health systems lacks robust evidence. Objective: This study aimed to assess the frequency of interventions performed by a second pharmacist to determine the ongoing effectiveness of the SPV process. Methods: This retrospective chart review was conducted at the Mayo Clinic, encompassing all anticancer therapy orders that necessitated an SPV. The study period extended from January 1, 2019, to June 30, 2021, and included inpatient and outpatient anticancer orders. The quantification and reporting of alterations made to discrete order fields subsequent to initial pharmacist verification of clinical significance were performed, utilizing the total number of anticancer therapy orders as the denominator. Results: Approximately 300 000 anticancer therapy orders were screened for inclusion criteria and 2.6% (N = 7634) of orders were modified on the SPV. Most changes were in the categories of rate (N = 1962), order start time (N = 1219), and pharmacy communication note (N = 777). Dosing changes greater than 10% accounted for 0.03% (N = 99) of the orders, with 10 anticancer therapies responsible for more than 50% of these changes. Conclusion and relevance: This study represents the largest report on the impact of SPV in a modern era. Our results suggest the SPV may be valuable for a small proportion of chemotherapy orders but raises questions about the necessity for broad application of this practice.
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Affiliation(s)
| | - Kaylee Clark
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Vishal Shah
- Department of pharmacy, Mayo Clinic, Phoenix, AZ, USA
| | | | - Evan Draper
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
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8
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Mamtora S, Naveed H, Hogg J, Juma Z, Ahmed S, Cowen S, Richardson J, Simpson S, Youssef A, Rufai S, Hunter G, Ahmed S, Cheng Z, El Salloukh A, Al-Mugheiry T, Henry M, Shah V, Gilmour K, George M, Burgess F. The current state of cataract surgery training in the independent sector. Eye (Lond) 2023; 37:3714-3715. [PMID: 37308597 PMCID: PMC10697933 DOI: 10.1038/s41433-023-02608-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
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9
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Low L, Shah V, Norridge CFE, Donachie PHJ, Buchan JC. Royal College of Ophthalmologists' National Ophthalmology Database, Report 10: Risk Factors for Post-Cataract Surgery Endophthalmitis. Ophthalmology 2023; 130:1228-1230. [PMID: 37499952 DOI: 10.1016/j.ophtha.2023.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Liying Low
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Vishal Shah
- The Royal College of Ophthalmologists' National Ophthalmology Database Audit, London, United Kingdom
| | - Charlotte F E Norridge
- The Royal College of Ophthalmologists' National Ophthalmology Database Audit, London, United Kingdom; Gloucestershire Hospitals NHS Foundation NHS Trust, Gloucestershire, United Kingdom
| | - Paul H J Donachie
- The Royal College of Ophthalmologists' National Ophthalmology Database Audit, London, United Kingdom; Gloucestershire Hospitals NHS Foundation NHS Trust, Gloucestershire, United Kingdom
| | - John C Buchan
- The Royal College of Ophthalmologists' National Ophthalmology Database Audit, London, United Kingdom; International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
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10
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Shumway DA, Corbin KS, Farah MH, Viola KE, Nayfeh T, Saadi S, Shah V, Hasan B, Shah S, Mohammed K, Riaz IB, Prokop LJ, Murad MH, Wang Z. Partial breast irradiation compared with whole breast irradiation: a systematic review and meta-analysis. J Natl Cancer Inst 2023; 115:1011-1019. [PMID: 37289549 PMCID: PMC10483267 DOI: 10.1093/jnci/djad100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Early-stage breast cancer is among the most common cancer diagnoses. Adjuvant radiotherapy is an essential component of breast-conserving therapy, and several options exist for tailoring its extent and duration. This study assesses the comparative effectiveness of partial-breast irradiation (PBI) compared with whole-breast irradiation (WBI). METHODS A systematic review was completed to identify relevant randomized clinical trials and comparative observational studies. Independent reviewers working in pairs selected studies and extracted data. Randomized trial results were pooled using a random effects model. Prespecified main outcomes were ipsilateral breast recurrence (IBR), cosmesis, and adverse events (AEs). RESULTS Fourteen randomized clinical trials and 6 comparative observational studies with 17 234 patients evaluated the comparative effectiveness of PBI. PBI was not statistically significantly different from WBI for IBR at 5 years (RR = 1.34, 95% CI = 0.83 to 2.18; high strength of evidence [SOE]) and 10 years (RR = 1.29, 95% CI = 0.87 to 1.91; high SOE). Evidence for cosmetic outcomes was insufficient. Statistically significantly fewer acute AEs were reported with PBI compared with WBI, with no statistically significant difference in late AEs. Data from subgroups according to patient, tumor, and treatment characteristics were insufficient. Intraoperative radiotherapy was associated with higher IBR at 5, 10, and over than 10 years (high SOE) compared with WBI. CONCLUSIONS Ipsilateral breast recurrence was not statistically significantly different between PBI and WBI. Acute AEs were less frequent with PBI. This evidence supports the effectiveness of PBI among selected patients with early-stage, favorable-risk breast cancer who are similar to those represented in the included studies.
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Affiliation(s)
- Dean A Shumway
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Kimberly S Corbin
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Magdoleen H Farah
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kelly E Viola
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Tarek Nayfeh
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Samer Saadi
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Vishal Shah
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bashar Hasan
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Sahrish Shah
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Khaled Mohammed
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Irbaz Bin Riaz
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
| | - Larry J Prokop
- Library Public Services, Mayo Clinic, Rochester, MN, USA
| | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA
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11
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Bhowmick SS, Mahajan SK, Shah V, Kashyap K. Unmistakable Truncal Dystonia Mistaken as Psychogenic: A Case Report of VAC14-Related Neurodegeneration. Mov Disord Clin Pract 2023; 10:S15-S20. [PMID: 37636228 PMCID: PMC10448624 DOI: 10.1002/mdc3.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Suvorit Subhas Bhowmick
- Movement Disorders ClinicVadodara Institute of Neurological SciencesVadodaraIndia
- Neurology ClinicSir Sayjirao General HospitalVadodaraIndia
| | | | | | - Kriti Kashyap
- CSIR‐Institute of Genomics and Integrative BiologyDelhiIndia
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12
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Villeneuve-Faure C, Boumaarouf A, Shah V, Gammon PM, Lüders U, Coq Germanicus R. SiC Doping Impact during Conducting AFM under Ambient Atmosphere. Materials (Basel) 2023; 16:5401. [PMID: 37570104 PMCID: PMC10419843 DOI: 10.3390/ma16155401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023]
Abstract
The characterization of silicon carbide (SiC) by specific electrical atomic force microscopy (AFM) modes is highly appreciated for revealing its structure and properties at a nanoscale. However, during the conductive AFM (C-AFM) measurements, the strong electric field that builds up around and below the AFM conductive tip in ambient atmosphere may lead to a direct anodic oxidation of the SiC surface due to the formation of a water nanomeniscus. In this paper, the underlying effects of the anodization are experimentally investigated for SiC multilayers with different doping levels by studying gradual SiC epitaxial-doped layers with nitrogen (N) from 5 × 1017 to 1019 at/cm3. The presence of the water nanomeniscus is probed by the AFM and analyzed with the force-distance curve when a negative bias is applied to the AFM tip. From the water meniscus breakup distance measured without and with polarization, the water meniscus volume is increased by a factor of three under polarization. AFM experimental results are supported by electrostatic modeling to study oxide growth. By taking into account the presence of the water nanomeniscus, the surface oxide layer and the SiC doping level, a 2D-axisymmetric finite element model is developed to calculate the electric field distribution nearby the tip contact and the current distributions at the nanocontact. The results demonstrate that the anodization occurred for the conductive regime in which the current depends strongly to the doping; its threshold value is 7 × 1018 at/cm3 for anodization. Finally, the characterization of a classical planar SiC-MOSFET by C-AFM is examined. Results reveal the local oxidation mechanism of the SiC material at the surface of the MOSFET structure. AFM topographies after successive C-AFM measurements show that the local oxide created by anodization is located on both sides of the MOS channel; these areas are the locations of the highly n-type-doped zones. A selective wet chemical etching confirms that the oxide induced by local anodic oxidation is a SiOCH layer.
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Affiliation(s)
- Christina Villeneuve-Faure
- LAPLACE (Laboratoire Plasma et Conversion d’Energie), Université de Toulouse, CNRS, UPS, INPT, 118 Route de Narbonne, CEDEX 9, 31062 Toulouse, France;
| | - Abdelhaq Boumaarouf
- CRISMAT UMR6508 (Laboratoire de Cristallographie et Sciences des Matériaux), Normandie University, Ensicaen, Unicaen, CNRS, 14000 Caen, France; (A.B.); (U.L.)
| | - Vishal Shah
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (V.S.); (P.M.G.)
| | - Peter M. Gammon
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (V.S.); (P.M.G.)
| | - Ulrike Lüders
- CRISMAT UMR6508 (Laboratoire de Cristallographie et Sciences des Matériaux), Normandie University, Ensicaen, Unicaen, CNRS, 14000 Caen, France; (A.B.); (U.L.)
| | - Rosine Coq Germanicus
- CRISMAT UMR6508 (Laboratoire de Cristallographie et Sciences des Matériaux), Normandie University, Ensicaen, Unicaen, CNRS, 14000 Caen, France; (A.B.); (U.L.)
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13
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El Zarif T, Nassar AH, Adib E, Fitzgerald BG, Huang J, Mouhieddine TH, Rubinstein PG, Nonato T, McKay RR, Li M, Mittra A, Owen DH, Baiocchi RA, Lorentsen M, Dittus C, Dizman N, Falohun A, Abdel-Wahab N, Diab A, Bankapur A, Reed A, Kim C, Arora A, Shah NJ, El-Am E, Kozaily E, Abdallah W, Al-Hader A, Abu Ghazal B, Saeed A, Drolen C, Lechner MG, Drakaki A, Baena J, Nebhan CA, Haykal T, Morse MA, Cortellini A, Pinato DJ, Dalla Pria A, Hall E, Bakalov V, Bahary N, Rajkumar A, Mangla A, Shah V, Singh P, Aboubakar Nana F, Lopetegui-Lia N, Dima D, Dobbs RW, Funchain P, Saleem R, Woodford R, Long GV, Menzies AM, Genova C, Barletta G, Puri S, Florou V, Idossa D, Saponara M, Queirolo P, Lamberti G, Addeo A, Bersanelli M, Freeman D, Xie W, Reid EG, Chiao EY, Sharon E, Johnson DB, Ramaswami R, Bower M, Emu B, Marron TU, Choueiri TK, Baden LR, Lurain K, Sonpavde GP, Naqash AR. Safety and Activity of Immune Checkpoint Inhibitors in People Living With HIV and Cancer: A Real-World Report From the Cancer Therapy Using Checkpoint Inhibitors in People Living With HIV-International (CATCH-IT) Consortium. J Clin Oncol 2023; 41:3712-3723. [PMID: 37192435 PMCID: PMC10351941 DOI: 10.1200/jco.22.02459] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/01/2023] [Accepted: 03/29/2023] [Indexed: 05/18/2023] Open
Abstract
PURPOSE Compared with people living without HIV (PWOH), people living with HIV (PWH) and cancer have traditionally been excluded from immune checkpoint inhibitor (ICI) trials. Furthermore, there is a paucity of real-world data on the use of ICIs in PWH and cancer. METHODS This retrospective study included PWH treated with anti-PD-1- or anti-PD-L1-based therapies for advanced cancers. Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Objective response rates (ORRs) were measured per RECIST 1.1 or other tumor-specific criteria, whenever feasible. Restricted mean survival time (RMST) was used to compare OS and PFS between matched PWH and PWOH with metastatic NSCLC (mNSCLC). RESULTS Among 390 PWH, median age was 58 years, 85% (n = 331) were males, 36% (n = 138) were Black; 70% (n = 274) received anti-PD-1/anti-PD-L1 monotherapy. Most common cancers were NSCLC (28%, n = 111), hepatocellular carcinoma ([HCC]; 11%, n = 44), and head and neck squamous cell carcinoma (HNSCC; 10%, n = 39). Seventy percent (152/216) had CD4+ T cell counts ≥200 cells/µL, and 94% (179/190) had HIV viral load <400 copies/mL. Twenty percent (79/390) had any grade immune-related adverse events (irAEs) and 7.7% (30/390) had grade ≥3 irAEs. ORRs were 69% (nonmelanoma skin cancer), 31% (NSCLC), 16% (HCC), and 11% (HNSCC). In the matched mNSCLC cohort (61 PWH v 110 PWOH), 20% (12/61) PWH and 22% (24/110) PWOH had irAEs. Adjusted 42-month RMST difference was -0.06 months (95% CI, -5.49 to 5.37; P = .98) for PFS and 2.23 months (95% CI, -4.02 to 8.48; P = .48) for OS. CONCLUSION Among PWH, ICIs demonstrated differential activity across cancer types with no excess toxicity. Safety and activity of ICIs were similar between matched cohorts of PWH and PWOH with mNSCLC.
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Affiliation(s)
| | | | - Elio Adib
- Dana-Farber Cancer Institute, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | - Paul G. Rubinstein
- Division of Hematology/Oncology, Ruth M. Rothstein CORE Center, Cook County Health and Hospital Systems (Cook County Hospital), University of Illinois Chicago Cancer Center, Chicago, IL
| | - Taylor Nonato
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | - Rana R. McKay
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | - Mingjia Li
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Arjun Mittra
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Dwight H. Owen
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Robert A. Baiocchi
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Michael Lorentsen
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christopher Dittus
- Division of Hematology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nazli Dizman
- Yale University School of Medicine, New Haven, CT
| | | | - Noha Abdel-Wahab
- University of Texas MD Anderson Cancer Center, Houston, TX
- Assiut University Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Adi Diab
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anand Bankapur
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL
| | - Alexandra Reed
- Department of Surgery, Division of Urology, Cook County Health, Chicago, IL
| | - Chul Kim
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Aakriti Arora
- Medstar/Georgetown-Washington Hospital Center, Washington, DC
| | - Neil J. Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edward El-Am
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Elie Kozaily
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Wassim Abdallah
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Ahmad Al-Hader
- Indiana University School of Medicine, Indiana Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | - Anwaar Saeed
- Kansas University Cancer Center, Kansas City, KS
- University of Pittsburgh Hillman Cancer Center, Pittsburgh, PA
| | - Claire Drolen
- University of California Los Angeles, Los Angeles, CA
| | | | | | - Javier Baena
- 12 de Octubre University Hospital, Madrid, Spain
| | - Caroline A. Nebhan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Tarek Haykal
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Michael A. Morse
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC
| | - Alessio Cortellini
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - David J. Pinato
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Department of Translational Medicine, Università Del Piemonte Orientale “A. Avogadro”, Novara, Italy
| | - Alessia Dalla Pria
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Evan Hall
- University of Washington, Seattle, WA
| | | | | | | | - Ankit Mangla
- Seidman Cancer Center, University Hospitals, Cleveland, OH
| | | | | | | | | | - Danai Dima
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ryan W. Dobbs
- Division of Hematology/Oncology, Ruth M. Rothstein CORE Center, Cook County Health and Hospital Systems (Cook County Hospital), University of Illinois Chicago Cancer Center, Chicago, IL
| | - Pauline Funchain
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Rabia Saleem
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Georgina V. Long
- Melanoma Institute Australia, Faculty of Medicine & Health, Charles Perkins Centre, The University of Sydney, and Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | | | - Carlo Genova
- UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna e Specialità Mediche (DiMI), Università degli Studi di Genova, Genova, Italy
| | - Giulia Barletta
- UO Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sonam Puri
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Vaia Florou
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Dame Idossa
- University of California San Francisco, San Francisco, CA
| | - Maristella Saponara
- Division of Melanoma and Sarcoma Medical Treatment, IEO European Institute of Oncology IRCCS Milan, Milan, Italy
| | - Paola Queirolo
- Division of Melanoma and Sarcoma Medical Treatment, IEO European Institute of Oncology IRCCS Milan, Milan, Italy
| | - Giuseppe Lamberti
- Department of Experimental, Diagnostic and Specialty Medicine, Università di Bologna, Bologna, Italy
| | - Alfredo Addeo
- Swiss Cancer Center Leman, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | | | | | | | - Erin G. Reid
- Moores Cancer Center, The University of California San Diego, La Jolla, CA
| | | | - Elad Sharon
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark Bower
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Brinda Emu
- Yale University School of Medicine, New Haven, CT
| | - Thomas U. Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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14
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Holmes N, Rea M, Hill RM, Leggett J, Edwards LJ, Hobson PJ, Boto E, Tierney TM, Rier L, Rivero GR, Shah V, Osborne J, Fromhold TM, Glover P, Brookes MJ, Bowtell R. Enabling ambulatory movement in wearable magnetoencephalography with matrix coil active magnetic shielding. Neuroimage 2023; 274:120157. [PMID: 37149237 PMCID: PMC10465235 DOI: 10.1016/j.neuroimage.2023.120157] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/13/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023] Open
Abstract
The ability to collect high-quality neuroimaging data during ambulatory participant movement would enable a wealth of neuroscientific paradigms. Wearable magnetoencephalography (MEG) based on optically pumped magnetometers (OPMs) has the potential to allow participant movement during a scan. However, the strict zero magnetic field requirement of OPMs means that systems must be operated inside a magnetically shielded room (MSR) and also require active shielding using electromagnetic coils to cancel residual fields and field changes (due to external sources and sensor movements) that would otherwise prevent accurate neuronal source reconstructions. Existing active shielding systems only compensate fields over small, fixed regions and do not allow ambulatory movement. Here we describe the matrix coil, a new type of active shielding system for OPM-MEG which is formed from 48 square unit coils arranged on two planes which can compensate magnetic fields in regions that can be flexibly placed between the planes. Through the integration of optical tracking with OPM data acquisition, field changes induced by participant movement are cancelled with low latency (25 ms). High-quality MEG source data were collected despite the presence of large (65 cm translations and 270° rotations) ambulatory participant movements.
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Affiliation(s)
- Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK; Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK.
| | - Molly Rea
- Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK; Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Ryan M Hill
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK; Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK
| | - James Leggett
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Lucy J Edwards
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Peter J Hobson
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Elena Boto
- Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK; Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Tim M Tierney
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, University College London, London WC1N 3AR, UK
| | - Lukas Rier
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Gonzalo Reina Rivero
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK; Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK
| | - Vishal Shah
- QuSpin Inc., 331 South 104th Street, Suite 130, Louisville, CO 80027, USA
| | - James Osborne
- QuSpin Inc., 331 South 104th Street, Suite 130, Louisville, CO 80027, USA
| | - T Mark Fromhold
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Paul Glover
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK; Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
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15
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Shah V, Marshall J, Abu-Bakra M, Flanagan D. Ophthalmology in England: how is training geared to supply our future workforce? Eye (Lond) 2023; 37:1951-1952. [PMID: 36352234 PMCID: PMC9645301 DOI: 10.1038/s41433-022-02304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Vishal Shah
- The Royal College of Ophthalmologists, 18 Stephenson Way, NW1 2HD, London, UK.
| | - Jordan Marshall
- The Royal College of Ophthalmologists, 18 Stephenson Way, NW1 2HD, London, UK
| | - Mohammed Abu-Bakra
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Declan Flanagan
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
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16
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Holmes N, Rea M, Hill RM, Boto E, Leggett J, Edwards LJ, Rhodes N, Shah V, Osborne J, Fromhold TM, Glover P, Montague PR, Brookes MJ, Bowtell R. Naturalistic Hyperscanning with Wearable Magnetoencephalography. Sensors (Basel) 2023; 23:5454. [PMID: 37420622 DOI: 10.3390/s23125454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
The evolution of human cognitive function is reliant on complex social interactions which form the behavioural foundation of who we are. These social capacities are subject to dramatic change in disease and injury; yet their supporting neural substrates remain poorly understood. Hyperscanning employs functional neuroimaging to simultaneously assess brain activity in two individuals and offers the best means to understand the neural basis of social interaction. However, present technologies are limited, either by poor performance (low spatial/temporal precision) or an unnatural scanning environment (claustrophobic scanners, with interactions via video). Here, we describe hyperscanning using wearable magnetoencephalography (MEG) based on optically pumped magnetometers (OPMs). We demonstrate our approach by simultaneously measuring brain activity in two subjects undertaking two separate tasks-an interactive touching task and a ball game. Despite large and unpredictable subject motion, sensorimotor brain activity was delineated clearly, and the correlation of the envelope of neuronal oscillations between the two subjects was demonstrated. Our results show that unlike existing modalities, OPM-MEG combines high-fidelity data acquisition and a naturalistic setting and thus presents significant potential to investigate neural correlates of social interaction.
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Affiliation(s)
- Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
- Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK
| | - Molly Rea
- Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Ryan M Hill
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
- Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK
| | - Elena Boto
- Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - James Leggett
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Lucy J Edwards
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Natalie Rhodes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Vishal Shah
- QuSpin Inc., 331 South 104th Street, Suite 130, Louisville, CO 80027, USA
| | - James Osborne
- QuSpin Inc., 331 South 104th Street, Suite 130, Louisville, CO 80027, USA
| | - T Mark Fromhold
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - Paul Glover
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - P Read Montague
- Fralin Biomedical Research Institute, Department of Physics, Virginia Tech, Roanoke, VA 24016, USA
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
- Cerca Magnetics Limited, Unit 2 Castlebridge Office Village, Kirtley Drive, Nottingham NG7 1LD, UK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
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17
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Rhodes N, Rea M, Boto E, Rier L, Shah V, Hill RM, Osborne J, Doyle C, Holmes N, Coleman SC, Mullinger K, Bowtell R, Brookes MJ. Measurement of Frontal Midline Theta Oscillations using OPM-MEG. Neuroimage 2023; 271:120024. [PMID: 36918138 PMCID: PMC10465234 DOI: 10.1016/j.neuroimage.2023.120024] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 11/17/2022] [Revised: 02/10/2023] [Accepted: 03/11/2023] [Indexed: 03/14/2023] Open
Abstract
Optically pumped magnetometers (OPMs) are an emerging lightweight and compact sensor that can measure magnetic fields generated by the human brain. OPMs enable construction of wearable magnetoencephalography (MEG) systems, which offer advantages over conventional instrumentation. However, when trying to measure signals at low frequency, higher levels of inherent sensor noise, magnetic interference and movement artefact introduce a significant challenge. Accurate characterisation of low frequency brain signals is important for neuroscientific, clinical, and paediatric MEG applications and consequently, demonstrating the viability of OPMs in this area is critical. Here, we undertake measurement of theta band (4-8 Hz) neural oscillations and contrast a newly developed 174 channel triaxial wearable OPM-MEG system with conventional (cryogenic-MEG) instrumentation. Our results show that visual steady state responses at 4 Hz, 6 Hz and 8 Hz can be recorded using OPM-MEG with a signal-to-noise ratio (SNR) that is not significantly different to conventional MEG. Moreover, we measure frontal midline theta oscillations during a 2-back working memory task, again demonstrating comparable SNR for both systems. We show that individual differences in both the amplitude and spatial signature of induced frontal-midline theta responses are maintained across systems. Finally, we show that our OPM-MEG results could not have been achieved without a triaxial sensor array, or the use of postprocessing techniques. Our results demonstrate the viability of OPMs for characterising theta oscillations and add weight to the argument that OPMs can replace cryogenic sensors as the fundamental building block of MEG systems.
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Affiliation(s)
- Natalie Rhodes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Molly Rea
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Elena Boto
- Cerca Magnetics Ltd. 2, Castlebridge Office Village, Kirtley Dr, Nottingham NG7 1LD; Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Lukas Rier
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Vishal Shah
- QuSpin Inc. 331 South 104th Street, Suite 130, Louisville, Colorado, 80027, USA
| | - Ryan M Hill
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK; Cerca Magnetics Ltd. 2, Castlebridge Office Village, Kirtley Dr, Nottingham NG7 1LD
| | - James Osborne
- QuSpin Inc. 331 South 104th Street, Suite 130, Louisville, Colorado, 80027, USA
| | - Cody Doyle
- QuSpin Inc. 331 South 104th Street, Suite 130, Louisville, Colorado, 80027, USA
| | - Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK; Cerca Magnetics Ltd. 2, Castlebridge Office Village, Kirtley Dr, Nottingham NG7 1LD
| | - Sebastian C Coleman
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Karen Mullinger
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK; Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK; Cerca Magnetics Ltd. 2, Castlebridge Office Village, Kirtley Dr, Nottingham NG7 1LD.
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18
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Schofield H, Boto E, Shah V, Hill RM, Osborne J, Rea M, Doyle C, Holmes N, Bowtell R, Woolger D, Brookes MJ. Quantum enabled functional neuroimaging: the why and how of magnetoencephalography using optically pumped magnetometers. Contemp Phys 2023; 63:161-179. [PMID: 38463461 PMCID: PMC10923587 DOI: 10.1080/00107514.2023.2182950] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/12/2024]
Abstract
Non-invasive imaging has transformed neuroscientific discovery and clinical practice, providing a non-invasive window into the human brain. However, whilst techniques like MRI generate ever more precise images of brain structure, in many cases, it's the function within neural networks that underlies disease. Here, we review the potential for quantum-enabled magnetic field sensors to shed light on such activity. Specifically, we describe how optically pumped magnetometers (OPMs) enable magnetoencephalographic (MEG) recordings with higher accuracy and improved practicality compared to the current state-of-the-art. The paper is split into two parts: first, we describe the work to date on OPM-MEG, detailing why this novel biomagnetic imaging technique is proving disruptive. Second, we explain how fundamental physics, including quantum mechanics and electromagnetism, underpins this developing technology. We conclude with a look to the future, outlining the potential for OPM-MEG to initiate a step change in the understanding and management of brain health.
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Affiliation(s)
- Holly Schofield
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Cerca Magnetics Limited, Nottingham, UK
| | - Elena Boto
- Cerca Magnetics Limited, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | | | - Ryan M Hill
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Cerca Magnetics Limited, Nottingham, UK
| | | | - Molly Rea
- Cerca Magnetics Limited, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | | | - Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Cerca Magnetics Limited, Nottingham, UK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | | | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Cerca Magnetics Limited, Nottingham, UK
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19
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Shah V, McNatty A, Simpson L, Ofori H, Raheem F. Amivantamab-Vmjw: A Novel Treatment for Patients with NSCLC Harboring EGFR Exon 20 Insertion Mutation after Progression on Platinum-Based Chemotherapy. Biomedicines 2023; 11:biomedicines11030950. [PMID: 36979929 PMCID: PMC10046583 DOI: 10.3390/biomedicines11030950] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE This study is a comprehensive review of the clinical pharmacology, pharmacokinetics, efficacy, safety, and clinical applicability of amivantamab-vmjw for metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion (exon20ins) mutation. DATA SYNTHESIS The literature search to identify clinical trials returned only the CHRYSALIS phase 1 study. In a phase I trial, amivantamab-vmjw was associated with an overall response rate (ORR) of 40% (95% CI, 29-51) in the EGFR exon20ins NSCLC patient population (n = 81) after platinum-based chemotherapy. There were 3 complete responses (CRs) and 29 partial responses (PRs). The median duration of response (DOR) was 11.1 months (95% CI, 6.9-not reached; NR). The median progression-free survival (PFS) was 8.3 months (95% CI, 6.5-10.9), and overall survival (OS) was 22.8 months (95% CI, 14.6-NR). APPLICATION TO CLINICAL PRACTICE This review summarizes the pharmacology, clinical evidence, and use of amivantamab-vmjw for patients with locally advanced or metastatic NSCLC with EGFR exon20ins mutation. CONCLUSION The FDA approval of amivantamab-vmjw, the first bispecific antibody to target the exon20ins mutation, represents an important advancement in the treatment of patients with NSCLC with limited effective treatment options. The initial findings of the CHRYSALIS trial demonstrate an overall tumor response benefit with an acceptable safety profile.
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Affiliation(s)
- Vishal Shah
- Department of Pharmacy, Mayo Clinic, 5881 E Mayo Blvd, Phoenix, AZ 85054, USA
| | | | - Lacey Simpson
- Department of Pharmacy, Mayo Clinic, 5881 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Henry Ofori
- Department of Pharmacy, Mayo Clinic, 5881 E Mayo Blvd, Phoenix, AZ 85054, USA
| | - Farah Raheem
- Department of Pharmacy, Mayo Clinic, 5881 E Mayo Blvd, Phoenix, AZ 85054, USA
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20
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Desai NK, Kralik SF, Edmond JC, Shah V, Huisman TAGM, Rech M, Schaaf CP. Common Neuroimaging Findings in Bosch-Boonstra-Schaaf Optic Atrophy Syndrome. AJNR Am J Neuroradiol 2023; 44:212-217. [PMID: 36702506 PMCID: PMC9891320 DOI: 10.3174/ajnr.a7758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/06/2022] [Indexed: 01/27/2023]
Abstract
Bosch-Boonstra-Schaaf optic atrophy syndrome (BBSOAS) is a rare autosomal dominant syndrome secondary to mutations in NR2F1 (COUP-TF1), characterized by visual impairment secondary to optic nerve hypoplasia and/or atrophy, developmental and cognitive delay, and seizures. This study reports common neuroimaging findings in a cohort of 21 individuals with BBSOAS that collectively suggest the diagnosis. These include mesial temporal dysgyria, perisylvian dysgyria, posterior predominant white matter volume loss, callosal abnormalities, lacrimal gland abnormalities, and optic nerve volume loss.
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Affiliation(s)
- N K Desai
- From the Department of Radiology (N.K.D., S.F.K., T.A.G.M.H.), Texas Children's Hospital Baylor College of Medicine Houston, Texas
| | - S F Kralik
- From the Department of Radiology (N.K.D., S.F.K., T.A.G.M.H.), Texas Children's Hospital Baylor College of Medicine Houston, Texas
| | - J C Edmond
- Department of Ophthalmology (J.C.E.), Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - V Shah
- Department of Ophthalmology (V.S.), Cincinnati Children's Hospital, Cincinnati, Ohio
| | - T A G M Huisman
- From the Department of Radiology (N.K.D., S.F.K., T.A.G.M.H.), Texas Children's Hospital Baylor College of Medicine Houston, Texas
| | - M Rech
- Sleep and Anxiety Center of Houston (M.R.), Department of Psychology, University of Houston, Houston, Texas
| | - C P Schaaf
- Institute of Human Genetics, Heidelberg University (C.P.S.), Heidelberg, Germany
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21
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Rea M, Boto E, Holmes N, Hill R, Osborne J, Rhodes N, Leggett J, Rier L, Bowtell R, Shah V, Brookes MJ. A 90-channel triaxial magnetoencephalography system using optically pumped magnetometers. Ann N Y Acad Sci 2022; 1517:107-124. [PMID: 36065147 PMCID: PMC9826099 DOI: 10.1111/nyas.14890] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Magnetoencephalography (MEG) measures the small magnetic fields generated by current flow in neural networks, providing a noninvasive metric of brain function. MEG is well established as a powerful neuroscientific and clinical tool. However, current instrumentation is hampered by cumbersome cryogenic field-sensing technologies. In contrast, MEG using optically pumped magnetometers (OPM-MEG) employs small, lightweight, noncryogenic sensors that provide data with higher sensitivity and spatial resolution, a natural scanning environment (including participant movement), and adaptability to any age. However, OPM-MEG is new and the optimum way to design a system is unknown. Here, we construct a novel, 90-channel triaxial OPM-MEG system and use it to map motor function during a naturalistic handwriting task. Results show that high-precision magnetic field control reduced background fields to ∼200 pT, enabling free participant movement. Our triaxial array offered twice the total measured signal and better interference rejection compared to a conventional (single-axis) design. We mapped neural oscillatory activity to the sensorimotor network, demonstrating significant differences in motor network activity and connectivity for left-handed versus right-handed handwriting. Repeatability across scans showed that we can map electrophysiological activity with an accuracy ∼4 mm. Overall, our study introduces a novel triaxial OPM-MEG design and confirms its potential for high-performance functional neuroimaging.
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Affiliation(s)
- Molly Rea
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Elena Boto
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Ryan Hill
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | | | - Natalie Rhodes
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - James Leggett
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Lukas Rier
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
| | | | - Matthew J. Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and AstronomyUniversity of NottinghamNottinghamUK
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22
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Velayutham B, Shah V, Mythily V, Gopalaswamy R, Kumar N, Mandal S, Parmar M, Padmapriyadarsini C. Factors influencing treatment outcomes in patients with isoniazid-resistant pulmonary TB. Int J Tuberc Lung Dis 2022; 26:1033-1040. [DOI: 10.5588/ijtld.21.0701] [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: 11/10/2022] Open
Abstract
INTRODUCTION: Patients with isoniazid (H, INH) resistant pulmonary TB but undetected rifampicin (R, RIF) resistance are treated with a 6-month regimen of levofloxacin-RIF-ethambutol-pyrazinamide (6LvxREZ) under India´s National TB Elimination Programme (NTEP).OBJECTIVE:
To describe the profile of and treatment outcomes in patients with pulmonary INH-resistant (INHR) TB initiated on TB treatment, and identify factors associated with unfavourable treatment outcomes (died, failed, treatment changed, lost to follow-up).METHODS: This was
a retrospective analysis of NTEP database (Ni-kshay) on pulmonary INHR TB patients initiated on treatment with “H mono/poly regimen” (6LvxREZ) between July 2019 and June 2020 with documented treatment outcomes. Proportions with 95% confidence interval (CI) was calculated
and logistic regression analysis was performed.RESULTS: Of the 11,519 patients with pulmonary INHR TB, 9,440 (82%) had treatment success (55.1% cured, 26.9% treatment completed). Unfavourable treatment outcome was observed in 1,901 (16.5%). Male sex, tobacco and alcohol
use, HIV reactive status were associated with unfavourable treatment outcome. Patients with katG mutations and resistance to fluoroquinolones were likely to have poor treatment outcomes.CONCLUSION: A levofloxacin-based regimen offers a treatment success rate of 82% in patients
with pulmonary INHR TB. Sex-specific strategies, interventions to address smoking and alcohol use, focus on HIV-reactive patients and optimising treatment regimens based on drug susceptibility should be considered for improving treatment outcomes.
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Affiliation(s)
- B. Velayutham
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - V. Shah
- Central TB Division, Ministry of Health and Family Welfare, New Delhi, India
| | - V. Mythily
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - R. Gopalaswamy
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
| | - N. Kumar
- Central TB Division, Ministry of Health and Family Welfare, New Delhi, India
| | - S. Mandal
- Central TB Division, Ministry of Health and Family Welfare, New Delhi, India
| | - M. Parmar
- Country Office, World Health Organisation, New Delhi, India
| | - C. Padmapriyadarsini
- Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India
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23
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Karpel H, Zaslavsky J, Algarroba G, Shah V, Huang K. 8117 OB/GYN Clinician Training in Addressing Sexual Trauma. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.369] [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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24
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Karpel H, Zaslavsky J, Shah V, Huang K. 7737 Assessment of Interoperative Transverse Abdominis Plane (TAP) Block in Minimally Invasive Gynecologic Surgery. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.329] [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: 11/25/2022]
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25
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Shah V, e Silva L, Farah W, Seisa M, Balla A, Christensen A, Farah M, Hasan B, Bellolio F, Murad M. 116 Diagnostic Accuracy of Neuroimaging in Emergency Department Patients With Acute Vertigo or Dizziness: A Systematic Review and Meta-analysis Supporting the Guidelines for Reasonable and Appropriate Care in Emergency Medicine. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.140] [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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26
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Gutovitz S, Phelps K, Broussard I, Shah V, Hart L, Root P. A Tale of Two D-Dimers: Comparison of Two Assay Methods to Evaluate Deep Vein Thrombosis or Pulmonary Embolism. J Emerg Med 2022; 63:389-398. [PMID: 36096961 DOI: 10.1016/j.jemermed.2022.04.006] [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: 10/10/2021] [Revised: 02/14/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND D-dimer testing rules out deep vein thrombosis (DVT) and pulmonary embolism (PE) in low-risk emergency department (ED) patients. Most research has measured fibrin-equivalent units (FEUs), however, many laboratories measure D-dimer units (DDUs). OBJECTIVE Our aim was to determine whether either DDU measurements or FEU measurements can rule out DVT/PE using traditional or age-related cutoff values. METHODS We performed a de-identified multicenter retrospective evaluation of D-dimer in nonpregnant adult ED patients to evaluate for DVT/PE. DDUs were multiplied by 2 to determine equivalent FEUs prior to analysis. Sensitivity measurements for D-dimer were calculated for FEUs, DDUs, combined FEU/DDUs, and multiple age-adjusted values. RESULTS We identified 47,088 ED patients with a D-dimer laboratory value (27,307 FEUs/19,781 DDUs) and 1623 DVT/PEs. The median combined FEU/DDU D-dimer was 400 ng/mL FEUs (interquartile range [IQR] 300-900 ng/mL FEUs) for patients without a DVT/PE vs 2530 ng/mL FEU (IQR 1094-6000 ng/mL FEUs) with a DVT/PE (p < 0.001), overall sensitivity of 87.3% (95% confidence interval [CI] 87.0-87.6%) and negative predictive value of 99.3% (95% CI 99.2-99.4%). Individually, FEUs performed better than DDUs, with sensitivities of 88.0% (95% CI 85.8-89.9%) and 86.1% (95% CI 83.1-88.7%), respectively; however, this difference was not statistically significant. Combined age-adjusted performance had a sensitivity of 90.3% (95% CI 88.3-92.0%); however, a new DDU-only age-adjusted criteria had the highest sensitivity of 91.1% (95% CI 87.9-93.6%). CONCLUSIONS Our undifferentiated D-dimer measurements had a slightly lower sensitivity to rule out DVT/PE than reported previously. Our data support using either DDU or FEU measurements for all ages or when using various age-adjusted criteria to rule out DVT/PE.
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Affiliation(s)
- Scott Gutovitz
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Kaitlyn Phelps
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Ian Broussard
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Vishal Shah
- Department of Emergency Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Leslie Hart
- College of Charleston, Charleston, South Carolina
| | - Preston Root
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia
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27
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Holmes N, Rea M, Chalmers J, Leggett J, Edwards LJ, Nell P, Pink S, Patel P, Wood J, Murby N, Woolger D, Dawson E, Mariani C, Tierney TM, Mellor S, O'Neill GC, Boto E, Hill RM, Shah V, Osborne J, Pardington R, Fierlinger P, Barnes GR, Glover P, Brookes MJ, Bowtell R. A lightweight magnetically shielded room with active shielding. Sci Rep 2022; 12:13561. [PMID: 35945239 PMCID: PMC9363499 DOI: 10.1038/s41598-022-17346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022] Open
Abstract
Magnetically shielded rooms (MSRs) use multiple layers of materials such as MuMetal to screen external magnetic fields that would otherwise interfere with high precision magnetic field measurements such as magnetoencephalography (MEG). Optically pumped magnetometers (OPMs) have enabled the development of wearable MEG systems which have the potential to provide a motion tolerant functional brain imaging system with high spatiotemporal resolution. Despite significant promise, OPMs impose stringent magnetic shielding requirements, operating around a zero magnetic field resonance within a dynamic range of ± 5 nT. MSRs developed for OPM-MEG must therefore effectively shield external sources and provide a low remnant magnetic field inside the enclosure. Existing MSRs optimised for OPM-MEG are expensive, heavy, and difficult to site. Electromagnetic coils are used to further cancel the remnant field inside the MSR enabling participant movements during OPM-MEG, but present coil systems are challenging to engineer and occupy space in the MSR limiting participant movements and negatively impacting patient experience. Here we present a lightweight MSR design (30% reduction in weight and 40-60% reduction in external dimensions compared to a standard OPM-optimised MSR) which takes significant steps towards addressing these barriers. We also designed a 'window coil' active shielding system, featuring a series of simple rectangular coils placed directly onto the walls of the MSR. By mapping the remnant magnetic field inside the MSR, and the magnetic field produced by the coils, we can identify optimal coil currents and cancel the remnant magnetic field over the central cubic metre to just |B|= 670 ± 160 pT. These advances reduce the cost, installation time and siting restrictions of MSRs which will be essential for the widespread deployment of OPM-MEG.
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Affiliation(s)
- Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Molly Rea
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - James Chalmers
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - James Leggett
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Lucy J Edwards
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Paul Nell
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Stephen Pink
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Prashant Patel
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Jack Wood
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Nick Murby
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - David Woolger
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Eliot Dawson
- Cerca Magnetics Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Christopher Mariani
- Cerca Magnetics Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Tim M Tierney
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, WC1N 3AR, UK
| | - Stephanie Mellor
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, WC1N 3AR, UK
| | - George C O'Neill
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, WC1N 3AR, UK
| | - Elena Boto
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Ryan M Hill
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Vishal Shah
- QuSpin Inc., 331 South 104th Street, Suite 130, Louisville, CO, 80027, USA
| | - James Osborne
- QuSpin Inc., 331 South 104th Street, Suite 130, Louisville, CO, 80027, USA
| | | | - Peter Fierlinger
- Department of Physics, Technical University Munich, 85748, Garching, Germany
| | - Gareth R Barnes
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, WC1N 3AR, UK
| | - Paul Glover
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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28
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Farah W, Breeher L, Shah V, Wang Z, Hainy C, Swift M. Coworkers are more likely than patients to transmit SARS-CoV-2 infection to healthcare personnel. Occup Environ Med 2022; 79:713-716. [PMID: 35927001 DOI: 10.1136/oemed-2022-108276] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare the impact of occupational exposures to SARS-CoV-2 positive patients and SARS-CoV-2 positive coworkers, by comparing the frequency of occupational exposure incidents and the rate of healthcare personnel (HCP) who developed a positive PCR test for SARS-COV-2 after occupational exposure to the two different types of infectious individuals. METHODS A retrospective analysis of all confirmed higher risk occupational exposure incidents that occurred in HCP from 20 March 2020 to 31 December 2020 at a large multisite US academic medical centre. Comparisons between groups for source type were performed using unpaired Student's t-test for continuous variables and the χ2 test for categorical variables, regression analysis was conducted to assess the associations between source type and risk of positive COVID-19 test after occupational exposure. RESULTS In total, 2253 confirmed medium or high-risk occupational exposures occurred during the study period. 57% were exposures from coworker sources. Each source individual exposed a mean of 2.6 (95% CI 2.3 to 2.9) HCP; during postexposure surveillance, 4.5% of exposed HCP tested positive within 14 days. A coworker source on average exposed 2.2 (95% CI 2.01 to 2.4) other HCP and infected 0.14 (95% CI 0.1 to 0.17) HCP, while patient sources exposed a mean of 3.4 (95% CI 2.6 to 4.2) HCP but only infected 0.07 (95% CI 0.04 to 0.11) HCP. The multivariate analysis demonstrated that exposure to a coworker source carried a higher risk of testing positive compared with exposure to a patient source (OR 3.22; 95% CI 1.72 to 6.04). CONCLUSION Occupational exposures to coworker sources were not only more frequent but also associated with triple the risk of developing COVID-19 infection, compared with exposures to patient sources.
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Affiliation(s)
- Wigdan Farah
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura Breeher
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Occupational Health Service, Mayo Clinic, Rochester, Minnesota, USA
| | - Vishal Shah
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Zhen Wang
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Caitlin Hainy
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Occupational Health Service, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie Swift
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA .,Occupational Health Service, Mayo Clinic, Rochester, Minnesota, USA
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Mistry J, Shah V, Mistry D. Tumor Thrombus in Hepatocellular Carcinoma: a Breaking Bad. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02919-7] [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] Open
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Morand E, Pike M, Merrill JT, Van Vollenhoven R, Werth VP, Hobar C, Delev N, Shah V, Sharkey B, Wegman T, Catlett I, Banerjee S, Singhal S. LB0004 EFFICACY AND SAFETY OF DEUCRAVACITINIB, AN ORAL, SELECTIVE, ALLOSTERIC TYK2 INHIBITOR, IN PATIENTS WITH ACTIVE SYSTEMIC LUPUS ERYTHEMATOSUS: A PHASE 2, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5020a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTyrosine kinase 2 (TYK2) mediates signaling of Type I interferons, IL-23, and IL-12, key cytokines involved in lupus pathogenesis. Deucravacitinib (DEUC) is an oral, selective, allosteric TYK2 inhibitor with a unique mechanism of action, distinct from Janus kinase (JAK) 1/2/3 inhibitors, and has shown efficacy in psoriasis and psoriatic arthritis.ObjectivesAssess efficacy and safety of DEUC in patients with active systemic lupus erythematosus (SLE).MethodsThis was a 48-week (wk), randomized, double-blind, placebo (PBO)-controlled, phase 2 trial (NCT03252587). Eligible patients met SLICC criteria, were seropositive (ANA/anti-dsDNA/anti-Sm), and had a SLEDAI-2K score ≥6 and ≥1 BILAG index A or >2 BILAG B manifestations from the musculoskeletal or mucocutaneous domain. Patients on standard background medications were randomized 1:1:1:1 to PBO or DEUC (3 mg BID, 6 mg BID, 12 mg QD). Oral corticosteroid tapering to 7.5 mg/day was required from wks 8-20; further tapering was optional from wks 32-40. The primary endpoint was the proportion of patients achieving SRI(4) at wk 32. Key secondary endpoints at wk 48 included SRI(4), BICLA, LLDAS, CLASI-50, and change from baseline in active (tender and swollen) joint count.ResultsA total of 363 patients were randomized, with baseline demographic and disease characteristics similar across treatment groups. Of randomized patients, 275 (76%) completed 48 wks of treatment. The primary endpoint at wk 32 was met, with significantly greater proportion of patients in DEUC 3 mg BID and 6 mg BID groups vs PBO achieving SRI(4) responses (PBO: 34.4%; DEUC 3 mg BID: 58.2%, P=0.0006; DEUC 6 mg BID: 49.5%, P=0.021; DEUC 12 mg QD: 44.9%, P=0.078). SRI(4) response was sustained across all DEUC groups up to 48 wks (Figure 1). At wk 48, the DEUC 3 mg BID group demonstrated statistical significance in BICLA, LLDAS, CLASI-50, and active joint count, and the two other DEUC groups demonstrated clinically meaningful differences vs PBO (Figure 1). Rates of adverse events (AEs), serious AEs, and AEs of interest were similar between DEUC and PBO groups (Table 1). Most common AEs (≥10%) with DEUC were upper respiratory tract infection, nasopharyngitis, headache, and urinary tract infection. No deaths, major cardiac events, thrombotic events, systemic opportunistic infections, or active tuberculosis occurred. Malignancies were rare with similar rates across all groups. No meaningful abnormalities in mean levels of hematology and chemistry laboratory parameters were observed.Table 1.Summary of Adverse Events Through Week 48AE, na(%)Placebo n = 90DEUC 3 mg BID n = 91DEUC 6 mg BID n = 93DEUC 12 mg QD n = 89AE79 (87.8)85 (93.4)81 (87.1)75 (84.3)SAE11 (12.2)7 (7.7)8 (8.6)7 (7.9)AEs leading to treatment discontinuation3 (3.3)8 (8.8)6 (6.5)11 (12.4)Skin-related AEsb12 (13.3)15 (16.5)32 (34.4)30 (33.7)Overall infections/infestations48 (53.3)60 (65.9)60 (64.5)45 (50.6)Serious infections/infestations1 (1.1)1 (1.1)2 (2.2)1 (1.1)Infections of interest Tuberculosis0000 Herpes zosterc4 (4.4)3 (3.3)3 (3.2)2 (2.2) Influenza1 (1.1)3 (3.3)1 (1.1)3 (3.4) COVID-193 (3.3)3 (3.3)5 (5.4)3 (3.4)Malignancy events1 (1.1)d1 (1.1)e01 (1.1)fMACE0000Thrombotic events0000an is the number of patients who experienced an event. bIncludes (≤8.6% in any arm) acne, rash, dermatitis acneiform, pruritus, skin lesion, urticaria. cIncludes herpes zoster, herpes ophthalmic, genital herpes zoster. dBasal cell carcinoma. eBreast carcinoma. fVaginal squamous cell carcinoma.AE, adverse event; COVID-19, coronavirus disease 2019; DEUC, deucravacitinib; MACE, major adverse cardiac events; SAE, serious adverse event.ConclusionIn patients with active SLE, DEUC showed statistically significant and sustained clinical efficacy in SRI(4), improvement across multiple composite and organ-specific measures up to 48 wks, and was well tolerated. DEUC shows promise as a novel therapy for SLE and warrants further investigation in phase 3 trials.AcknowledgementsThis study was sponsored by Bristol Myers Squibb. Professional medical writing assistance was provided by Julianne Hatfield, PhD at Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, USA, and funded by Bristol Myers Squibb. The authors acknowledge Christina Crater, MD, who was employed by Bristol Myers Squibb at the time the study was conducted, for contributions to study conduct.Disclosure of InterestsEric Morand Consultant of: AstraZeneca, Bristol Myers Squibb, Biogen, Eli Lilly, EMD Serono, Genentech, Servier, and Novartis , Grant/research support from: AbbVie, Amgen, AstraZeneca, Bristol Myers Squibb, Biogen, Eli Lilly, EMD Serono, Genentech, Janssen, and UCB , Marilyn Pike Consultant of: AstraZeneca, Bristol Myers Squibb, and Pfizer, Joan T. Merrill Consultant of: UCB, GlaxoSmithKline, AbbVie, EMD Serono, Remegen, Celgene/Bristol Myers Squibb, AstraZeneca, Amgen, Janssen, Lilly, Genentech, Aurinia, Astellas, Alexion, Sanofi, Zenas, and Provention , Grant/research support from: GlaxoSmithKline and AstraZeneca , Ronald van Vollenhoven Consultant of: UCB, Pfizer, AbbVie, AstraZeneca, Biogen, Biotest, Celgene, Galapagos, Gilead, Janssen, Servier, Paid instructor for: Roche, Pfizer, Speakers bureau: UCB, Pfizer, AbbVie, Galapagos, Janssen, Grant/research support from: Bristol Myers Squibb, GlaxoSmithKline, Eli Lilly, UCB, , Victoria P. Werth Consultant of: Celgene, Medimmune, Resolve, Genentech, Idera, Janssen, Lilly, Biogen, Bristol Myers Squibb, Gilead, Amgen, Medscape, Nektar, Incyte, EMD Serono, CSL Behring, Principia, Crisalis, Viela Bio, Argenx, Kirin, AstraZeneca, AbbVie, GSK, AstraZeneca, Cugene, UCB, Corcept, Beacon Bioscience , Grant/research support from: Celgene, Janssen, Biogen, Gilead, AstraZeneca, Viela, Amgen, Lupus Research Alliance/BMS , Coburn Hobar Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Nikolay Delev Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Vaishali Shah Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Brian Sharkey Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Thomas Wegman Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Ian Catlett Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Subhashis Banerjee Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb, Shalabh Singhal Shareholder of: Bristol Myers Squibb, Employee of: Bristol Myers Squibb
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Moniz K, Walker VK, Shah V. Antibiotic resistance in mucosal bacteria from high Arctic migratory salmonids. Environ Microbiol Rep 2022; 14:385-390. [PMID: 34109745 PMCID: PMC9292178 DOI: 10.1111/1758-2229.12975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/17/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
Two related salmonids, Arctic char (Salvelinus alpinus) and lake whitefish (Coregonus clupeaformis) sampled from the high Arctic region of Nunavut, Canada are anadromous fish, migrating annually from the same ice-covered freshwater waterbodies to spend summers in the marine waters of the Arctic Ocean. Microbiota associated with the skin-associated mucus undergo community change coincident with migration, and irrespective of this turnover, antibiotic resistance was detected in mixed bacterial cultures initiated with mucus samples. Although as expected most bacteria were unculturable, however, 5/7 isolates showed susceptibility to a panel of five common antibiotics. The fish were sampled under severe conditions and at remote locations far from human habitation. Regardless, two isolates, 'Carnobacterium maltaromaticum sm-2' and 'Arthrobacter citreus sm', showed multi-resistance to two or more antibiotics including ampicillin and streptomycin indicating multiple resistance genes. It is unknown if these fish bacteria have 'natural' resistance phenotypes or if resistance has been acquired. As result of these observations, we urge long-term monitoring of drug-resistant bacteria in the region and caution the assumption of a lack of drug-resistant organisms even in such extreme environments.
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Affiliation(s)
- Kristy Moniz
- Department of Biology and School of Environmental StudiesQueen's UniversityKingstonOntarioK7L 3N6Canada
| | - Virginia K. Walker
- Department of Biology and School of Environmental StudiesQueen's UniversityKingstonOntarioK7L 3N6Canada
| | - Vishal Shah
- College of the Sciences and MathematicsWest Chester UniversityWest ChesterPennsylvaniaUSA
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Farah W, Breeher L, Shah V, Hainy C, Tommaso CP, Swift MD. Disparities in COVID-19 vaccine uptake among health care workers. Vaccine 2022; 40:2749-2754. [PMID: 35361500 PMCID: PMC8947975 DOI: 10.1016/j.vaccine.2022.03.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND COVID-19 vaccine uptake by healthcare workers (HCWs) is critical to protect HCWs, the patients they care for, and the healthcare infrastructure. Our study aims to examine the actual COVID-19 vaccination rate among HCWs and identify risk factors associated with vaccine nonacceptance. STUDY DESIGN AND METHODS A retrospective analysis of COVID-19 vaccinations for HCWs at a large multi-site US academic medical center from 12/18/2020 through 05/04/2021. Comparisons between groups were performed using unpaired student t-test for continuous variables and the chi-square test for categorical variables. A logistic regression analysis was used to assess the associations between vaccine uptake and risk factor(s). RESULTS Of the 65,270 HCWs included in our analysis, the overall vaccination rate was 78.6%. Male gender, older age, White and Asian race, and direct patient care were associated with higher vaccination rates (P <.0001). Significant differences were observed between different job categories. Physicians and advanced practice staff, and healthcare professionals were more likely to be vaccinated than nurses and support staff. CONCLUSIONS Our data demonstrated higher initial vaccination rates among HCWs than the general population national average during the study period. We observed significant disparities among different high-risk HCWs groups, especially among different job categories, black HCWs and younger HCWs despite their high risk of contracting the infection. Interventions to address lower vaccination rate and vaccine hesitancy should be built with these disparities and differences in mind to create more targeted interventions.
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Affiliation(s)
- Wigdan Farah
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Laura Breeher
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA; Occupational Health Service, Mayo Clinic, Rochester, MN, USA.
| | - Vishal Shah
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Research Program, Mayo Clinic, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Caitlin Hainy
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA; Occupational Health Service, Mayo Clinic, Rochester, MN, USA.
| | | | - Melanie D Swift
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA; Occupational Health Service, Mayo Clinic, Rochester, MN, USA.
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Campbell K, Wang YJ, Savukov I, Schwindt PDD, Jau YY, Shah V. Gradient Field Detection Using Interference of Stimulated Microwave Optical Sidebands. Phys Rev Lett 2022; 128:163602. [PMID: 35522487 DOI: 10.1103/physrevlett.128.163602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
We demonstrate that stimulated microwave optical sideband generation using parametric frequency conversion can be utilized as a powerful technique for coherent state detection in atomic physics experiments. The technique has advantages over traditional absorption or polarization rotation-based measurements and enables the isolation of signal photons from probe photons. We outline a theoretical framework that accurately models sideband generation using a density matrix formalism. Using this technique, we demonstrate a novel intrinsic magnetic gradiometer that detects magnetic gradient fields between two spatially separated vapor cells by measuring the frequency of the beat note between sidebands generated within each cell. The sidebands are produced with high efficiency using parametric frequency conversion of a probe beam interacting with ^{87}Rb atoms in a coherent superposition of magnetically sensitive hyperfine ground states. Interference between the sidebands generates a low-frequency beat note whose frequency is determined by the magnetic field gradient between the two vapor cells. In contrast to traditional gradiometers the intermediate step of measuring the magnetic field experienced by the two vapor cells is unnecessary. We show that this technique can be readily implemented in a practical device by demonstrating a compact magnetic gradiometer sensor head with a sensitivity of 25 fT/cm/sqrt[Hz] with a 4.4 cm baseline, while operating in a noisy laboratory environment unshielded from Earth's field.
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Affiliation(s)
- Kaleb Campbell
- Sandia National Laboratory, 1515 Eubank SE, Albuquerque, New Mexico 87123, USA
- Center for Quantum Information and Control, Department of Physics and Astronomy, University of New Mexico, Albuquerque, New Mexico 87131, USA
| | - Ying-Ju Wang
- QuSpin Inc, 331S 104th St. Unit 130, Louisville, Colorado 80027, USA
| | - Igor Savukov
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Peter D D Schwindt
- Sandia National Laboratory, 1515 Eubank SE, Albuquerque, New Mexico 87123, USA
| | - Yuan-Yu Jau
- Sandia National Laboratory, 1515 Eubank SE, Albuquerque, New Mexico 87123, USA
| | - Vishal Shah
- QuSpin Inc, 331S 104th St. Unit 130, Louisville, Colorado 80027, USA
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Bu Y, Prince J, Mojtahed H, Kimball D, Shah V, Coleman T, Sarkar M, Rao R, Huang M, Schwindt P, Borna A, Lerman I. Peripheral Nerve Magnetoneurography With Optically Pumped Magnetometers. Front Physiol 2022; 13:798376. [PMID: 35370794 PMCID: PMC8975546 DOI: 10.3389/fphys.2022.798376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Electrodiagnosis is routinely integrated into clinical neurophysiology practice for peripheral nerve disease diagnoses, such as neuropathy, demyelinating disorders, nerve entrapment/impingement, plexopathy, or radiculopathy. Measured with conventional surface electrodes, the propagation of peripheral nerve action potentials along a nerve is the result of ionic current flow which, according to Ampere’s Law, generates a small magnetic field that is also detected as an “action current” by magnetometers, such as superconducting quantum interference device (SQUID) Magnetoencephalography (MEG) systems. Optically pumped magnetometers (OPMs) are an emerging class of quantum magnetic sensors with a demonstrated sensitivity at the 1 fT/√Hz level, capable of cortical action current detection. But OPMs were ostensibly constrained to low bandwidth therefore precluding their use in peripheral nerve electrodiagnosis. With careful OPM bandwidth characterization, we hypothesized OPMs may also detect compound action current signatures consistent with both Sensory Nerve Action Potential (SNAP) and the Hoffmann Reflex (H-Reflex). In as much, our work confirms OPMs enabled with expanded bandwidth can detect the magnetic signature of both the SNAP and H-Reflex. Taken together, OPMs now show potential as an emerging electrodiagnostic tool.
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Affiliation(s)
- Yifeng Bu
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Jacob Prince
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Hamed Mojtahed
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Donald Kimball
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | | | - Todd Coleman
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Mahasweta Sarkar
- Electrical and Computer Engineering Department, San Diego State University, Stanford, CA, United States
| | - Ramesh Rao
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Mingxiong Huang
- Department of Radiology, Radiology Imaging Laboratory, University of California San Diego, San Diego, CA, United States
| | - Peter Schwindt
- Quantum Information Sciences, Sandia National Laboratories, Albuquerque, NM, United States
| | - Amir Borna
- Quantum Information Sciences, Sandia National Laboratories, Albuquerque, NM, United States
| | - Imanuel Lerman
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, San Diego, CA, United States
- Veterans Health Administration, VA San Diego, Center for Stress and Mental Health, San Diego, CA, United States
- *Correspondence: Imanuel Lerman,
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Raheem F, Ofori H, Simpson L, Shah V. Abemaciclib: The First FDA-Approved CDK4/6 Inhibitor for the Adjuvant Treatment of HR+ HER2- Early Breast Cancer. Ann Pharmacother 2022; 56:10600280211073322. [PMID: 35135362 DOI: 10.1177/10600280211073322] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To review the new indication of cyclin-dependent kinase (CDK4/6) inhibitor abemaciclib for the adjuvant treatment of hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), axillary lymph node (LN) positive early breast cancer (EBC) at high risk of recurrence and a Ki-67 ≥20%. DATA SOURCES A literature search was performed through PubMed, ClinicalTrials.gov, and Food and Drug Administration (FDA) website (February 1, 2018, to December 23, 2021) to identify relevant information. STUDY SELECTION AND DATA EXTRACTION Human and animal studies related to pharmacology, pharmacokinetics, efficacy, and safety of abemaciclib were identified. DATA SYNTHESIS Addition of abemaciclib to standard of care endocrine therapy (ET) for patients with high-risk clinicopathologic features and Ki-67 ≥20% demonstrated 30% reduction in the risk of developing invasive disease and distant recurrence. At 15.5 months, abemaciclib + ET demonstrated a significant improvement in invasive disease-free survival (IDFS) vs ET alone (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.60-0.93, P = 0.01). At 27 months, IDFS benefit was maintained (HR, 0.70; 95% CI, 0.59-0.82, P < 0.0001). Diarrhea occurred in more than 80% of patients in the abemaciclib arm. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE This review describes the clinical applicability of adjuvant abemaciclib for patients with HR+, HER2- EBC at high risk for recurrence. CONCLUSION Adjuvant abemaciclib significantly reduces the risk for early development of invasive disease and distant recurrence in patients with HR+, HER2- node positive EBC. Longer follow-up is needed to determine the impact of adjuvant abemaciclib on late disease recurrence and survival outcomes.
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Henry TD, Bairey Merz CN, Wei J, Corban MT, Quesada O, Joung S, Kotynski CL, Wang J, Lewis M, Schumacher AM, Bartel RL, Takagi H, Shah V, Lee A, Sietsema WK, Losordo DW, Lerman A. Autologous CD34+ Stem Cell Therapy Increases Coronary Flow Reserve and Reduces Angina in Patients With Coronary Microvascular Dysfunction. Circ Cardiovasc Interv 2022; 15:e010802. [PMID: 35067072 PMCID: PMC8843403 DOI: 10.1161/circinterventions.121.010802] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Coronary microvascular dysfunction results in angina and adverse outcomes in patients with evidence of ischemia and nonobstructive coronary artery disease; however, no specific therapy exists. CD34+ cell therapy increases microvasculature in preclinical models and improves symptoms, exercise tolerance, and mortality in refractory angina patients with obstructive coronary artery disease. The objective of this research was to evaluate the safety, tolerability, and efficacy of intracoronary CD34+ cell therapy in patients with coronary microvascular dysfunction. Methods: We conducted a 2-center, 20-participant trial of autologous CD34+ cell therapy (protocol CLBS16-P01; NCT03508609) in patients with ischemia and nonobstructive coronary artery disease with persistent angina and coronary flow reserve ≤2.5. Efficacy measures included coronary flow reserve, angina frequency, Canadian Cardiovascular Society angina class, Seattle Angina Questionnaire, SF-36, and modified Bruce exercise treadmill test obtained at baseline and 6 months after treatment. Autologous CD34+ cells (CLBS16) were mobilized by administration of granulocyte-colony stimulating factor 5µg/kg/day for 5 days and collected by leukapheresis. Participants received a single intracoronary left anterior descending infusion of isolated CD34+ cells in medium that enhances cell function. Results: Coronary flow reserve improved from 2.08±0.32 at baseline to 2.68±0.79 at 6 months after treatment (P<0.005). Angina frequency decreased (P<0.004), Canadian Cardiovascular Society class improved (P<0.001), and quality of life improved as assessed by the Seattle Angina Questionnaire (P≤0.03, all scales) and SF-36 (P≤0.04, all scales). There were no cell-related serious adverse events. Conclusions: In this pilot clinical trial of microvascular angina, patients with ischemia and nonobstructive coronary artery disease receiving intracoronary infusion of CD34+ cell therapy had higher coronary flow reserve, less severe angina, and better quality of life at 6 months. The current study supports a potential therapeutic role for CD34+ cells in patients with microvascular angina. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03508609.
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Affiliation(s)
- Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (O.Q., T.D.H.)
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.N.B.M., J.W., S.J.)
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.N.B.M., J.W., S.J.)
| | | | - Odayme Quesada
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH (O.Q., T.D.H.)
| | - Sandy Joung
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.N.B.M., J.W., S.J.)
| | - Christine L Kotynski
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Jian Wang
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Michelle Lewis
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Ann M Schumacher
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Ronnda L Bartel
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Hiroshi Takagi
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Vishal Shah
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Anna Lee
- Mayo Clinic, Rochester, MN (M.T.C., A.L.).,Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - William K Sietsema
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Douglas W Losordo
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
| | - Amir Lerman
- Caladrius Biosciences, Basking Ridge, NJ (C.L.K., J.W., M.L., A.M.S., R.L.B., H.T., V.S., A.L., W.K.S., D.W.L.)
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Ippersiel P, Shah V, Dixon PC. The impact of outdoor walking surfaces on lower-limb coordination and variability during gait in healthy adults. Gait Posture 2022; 91:7-13. [PMID: 34628219 DOI: 10.1016/j.gaitpost.2021.09.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/12/2021] [Accepted: 09/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inter-joint coordination and variability during gait provide insight into control and adaptability of the neuromuscular system. To date, coordination research has been restricted to laboratory settings, and it is unclear how these findings translate to real-world, outdoor walking environments. RESEARCH QUESTION Compared to flat walking, to what extent do outdoor surfaces impact lower-limb inter-joint coordination and variability during gait, in healthy adults? METHODS Data from inertial measurement units placed on the lower-back, thigh, and shank were extracted from thirty healthy young adults (15 females, 23.5 ± 4.2 years) during outdoor walking on flat (paved sidewalk); irregular (cobblestone, grass); sloped (slope-up, slope-down); and banked (banked-right, banked-left) surfaces. Sagittal joint angles for the right knee and hip were computed and partitioned by gait phase (stance and swing). Continuous Relative Phase analysis determined inter-joint coordination and variability for the knee-hip joint pair using Mean Absolute Relative Phase (MARP) and Deviation Phase (DP), respectively. One-way repeated measures ANOVAs tested surface effects. Post-hoc Bonferroni adjusted surface comparisons were assessed. RESULTS Significant knee-hip surface effects were seen during all gait phases for MARP (p < 0.001) and DP (p ≤ 0.001). Compared to flat walking, grass prompted more in-phase coordination (smaller MARP) during stance and swing phase (p ≤ 0.003). Slope-up caused more in-phase coordination during stance (p < 0.001), while slope-down caused more out-of-phase coordination during stance and swing (p ≤ 0.003), compared to the flat surface. Sloped surfaces prompted more variable (larger DP) knee-hip coordination (p ≤ 0.001), compared to flat walking during stance and swing phase. SIGNIFICANCE Compared to flat walking, changes in knee-hip coordination and variability were greatest on slope-up/slope-down surfaces. This could reflect greater changes in lower-limb kinematics on sloped surfaces and/or a neuromuscular response to the demands of a more challenging task.
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Affiliation(s)
- P Ippersiel
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Lethbridge-Layton-Mackay Rehabilitation Centre, Montreal, Québec, Canada
| | - V Shah
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada
| | - P C Dixon
- School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Canada; Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Canada.
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Shah V, Spence A, Bartels T, Betcher J, Soefje S. Decreasing drug waste, reducing drug costs, and improving workflow efficiency through the implementation of automated chemotherapy dose rounding rules in the electronic health record system. Am J Health Syst Pharm 2021; 79:676-682. [PMID: 34940791 DOI: 10.1093/ajhp/zxab479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE To decrease drug waste and cost by implementing automated chemotherapy dose rounding rules in the electronic health record (EHR). Dose rounding of chemotherapy is a recognized method for reducing drug waste, and professional organizations have published guidelines recommending dose rounding when possible. SUMMARY On the basis of current literature and guideline recommendations, Mayo Clinic developed system-wide consensus to allow dose rounding for biologic and chemotherapy agents to the nearest vial size if rounding resulted in the dose being within 10% of the originally calculated dose or to a convenient measurable volume, based on concentration of the drug, if rounding to the nearest vial size resulted in the dose being outside the 10% range. Oncology pharmacists reviewed and analyzed all drugs listed in the EHR used in injectable form for the treatment of cancer and developed dose rounding rules. The rules were implemented and applied at the dose calculation stage before provider signature. From January to June 2019, approximately 40,000 cancer treatment doses were administered. The rounding rules saved a total of 9,814 vials of drug, of which 5,329 were for biologic agents and 4,485 were for oncolytic drugs. This resulted in a total 6-month cost savings of $7,284,796 (in 2019 dollars; biologics, $5,727,402; oncolytics, $1,557,394). CONCLUSION Systematic implementation of dose rounding rules utilizing the EHR can result in significant reduction of drug waste and realization of savings.
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Affiliation(s)
- Vishal Shah
- Department of Pharmacy, Mayo Clinic, Phoenix, AZ, USA
| | - Alexis Spence
- Department of Pharmacy, Mayo Clinic, Phoenix, AZ, USA
| | - Trace Bartels
- Department of Pharmacy, Mayo Clinic, Phoenix, AZ, USA
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Shah V, van Dommelen J, Heijkoop S, Oude Vrielink M, Geers M. A numerical model for the recrystallization kinetics of tungsten monoblocks under cyclic heat loads. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shah V, Khan H, Komor J, Vig S. 951 More Than A Checkbox: Importance of Role-Modelling and Visibility Initiatives in Improving Perceptions of Diversity in Surgical Leadership. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.045] [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: 11/12/2022]
Abstract
Abstract
Introduction
The Royal College of Surgeons of England have committed themselves to championing diversity in surgery in light of recent socio-political events. Although there are now more trainees from underrepresented backgrounds entering the profession, this is not reflected in leadership roles which are key in establishing attitudes and cultures. This study evaluated whether an event showcasing surgeons from underrepresented groups holding leadership positions could improve student perceptions of diversity in surgical leadership.
Method
Participants attended an online event hosted by a student surgical society, where speakers with surgical leadership experience from a range of marginalised backgrounds highlighted topics of diversity and discrimination in surgery. Pre- and post-event questionnaires comprising Likert scales were completed to evaluate student perceptions of surgeons holding a leadership role from the following underrepresented groups: women (or gender non-conforming), BAME, LGBTQ+ and individuals with disabilities. Statistical significance was assessed using a Mann-Whitney U test with p < 0.05 denoting significance throughout.
Results
The event significantly increased attendee confidence in the idea of a surgeon being seen in a leadership role from all underrepresented groups evaluated: 9.3% for female/gender non-conforming individuals (p < 0.01), 12.3% for BAME individuals (p < 0.01), 7.5% for non-heterosexual individuals (p = 0.04) and 16.0% for individuals with a disability (p < 0.01).
Conclusions
Attendees felt significantly more confident in the belief that surgeons from underrepresented backgrounds could hold leadership positions following the event, indicating the benefit of such role-modelling initiatives. More investment is necessary in exploring factors dissuading specific underrepresented groups from pursuing surgical careers and for novel strategies to support these communities accordingly.
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Affiliation(s)
- V Shah
- Imperial College London School of Medicine, London, United Kingdom
| | - H Khan
- Imperial College London School of Medicine, London, United Kingdom
| | - J Komor
- Imperial College London School of Medicine, London, United Kingdom
| | - S Vig
- Croydon University Hospital, London, United Kingdom
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Whitham R, O'Callaghan J, Flintoft-Burt M, Shah V. 1526 Primary Hip and Knee Arthroplasty Documentation: Do Our Operation Notes Follow New GIRFT/BOA Guidelines? A Closed Loop Audit. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Operation notes provide essential information about the techniques and implants used in surgery. Accurate documentation is important to improve patient outcomes and reduce rising litigation costs within the NHS. The aim of this audit was to assess compliance to recent guidance for hip and knee arthroplasty documentation, issued by the Getting It Right First Time (GIRFT) programme in 2019.
Method
Data was collected retrospectively from operation notes of all primary total/unicompartmental knee and hip arthroplasties during August 2019 and again in October 2019 at a DGH. Documentation was audited against data items from the GIRFT knee and hip arthroplasty ‘best practice’ guidelines. Interventions between timeframes included clinician education and a discussion of the guidelines between local surgeons.
Results
In audit rounds 1 and 2 twenty-six and 34 patients had THRs and 23 and 28 had knee arthroplasties respectively. 100% compliance was seen in 5/23 THR criteria and 9/27 knee criteria. Average compliance for knee documentation rose from 71% to 74% but no improvement was seen for THR (68% vs 64%). Those with least improvement related to assessment of range of movement and vascular status at the end of surgery.
Conclusions
Although compliance was good against the majority of data points there was minimal change following a local education intervention. The development and use of fully compliant departmental operation note templates would provide further clarity about steps performed and surgeon rationale should patient care later be scrutinised. The template would also act as an invaluable educational tool for trainees reflecting on the case.
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Affiliation(s)
- R Whitham
- Great Western Hospital, Swindon, United Kingdom
| | | | | | - V Shah
- Great Western Hospital, Swindon, United Kingdom
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Abstract
To the best of our knowledge to date there are no scientific studies specifically investigating whether the SARS-CoV-2 virus is present in the air or on the various surfaces in the school environment. The aim of this study was to determine if SARS-CoV-2 is present on various high touch surfaces and in the air across the elementary, middle and high schools in the Chester County of Pennsylvania, USA. One hundred and fifty surface swab samples and 45 air samples were analysed for the presence of the virus. All the samples tested were negative for the presence of SARS-CoV-2. The results indicate that the spread of the virus through contact and through air in the school buildings across the USA is highly unlikely.
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Affiliation(s)
- Amit Thakar
- University of Wyoming, Laramie, WY, 82071, USA
| | | | - Timothy Hoffman
- Unionville Chadds-Ford School District, Kennett Square, PA, 19348, USA
| | - Paul Joyce
- West Chester Area School District, Exton, PA, 19341, USA
| | - Vishal Shah
- West Chester University, West Chester, PA, 19383, USA
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Agathis NT, Bhavaraju R, Shah V, Chen L, Haley CA, Goswami ND, Patrawalla A. Challenges in LTBI care in the United States identified using a nationwide TB medical consultation database. Public Health Action 2021; 11:162-166. [PMID: 34567993 DOI: 10.5588/pha.21.0026] [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: 04/07/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying and treating individuals with latent TB infection (LTBI) represents a critical and challenging component of national TB elimination. Medical consultations by the Centers for Disease Control and Prevention (CDC) funded TB Centers of Excellence (COEs) are an important resource for healthcare professionals (HCPs) caring for individuals with LTBI. This study aimed to identify the most common clinical concerns regarding LTBI care and to describe epidemiologic and clinical features of patients discussed in these consultations. METHODS This mixed-methods study randomly sampled 125 consultation inquiries related to LTBI from the COEs' medical consultation database in 2018. Text from consultation records were reviewed and coded to identify reasons for the inquiries and common epidemiologic and clinical patient characteristics. RESULTS The most common topics of inquiry for consultation included accurate LTBI diagnosis (36%), management of LTBI treatment-related issues (22%), and choice of appropriate LTBI treatment regimen (17%). Patients for whom consultations were requested commonly had another medical condition (34%), were non-U.S. born (31%), were children (25%), and had a history of travel to TB-endemic areas (18%). CONCLUSION Our findings emphasize the challenge of managing patients with either suspected or confirmed LTBI, highlighting the need for ongoing medical consultation support for nuanced clinical and epidemiologic scenarios.
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Affiliation(s)
- N T Agathis
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - R Bhavaraju
- Global Tuberculosis Institute at Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - V Shah
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - L Chen
- Curry International Tuberculosis Center, University of California, San Francisco, CA, USA
| | - C A Haley
- Southeastern National Tuberculosis Center, Gainesville, FL, USA
| | - N D Goswami
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Patrawalla
- Global Tuberculosis Institute at Rutgers, The State University of New Jersey, Newark, NJ, USA
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Di Fiore JM, Shah V, Patwardhan A, Sattar A, Wang S, Raffay T, Martin R, Jawdeh EA. Prematurity and postnatal alterations in intermittent hypoxaemia. Arch Dis Child Fetal Neonatal Ed 2021; 106:557-559. [PMID: 33597229 PMCID: PMC8462666 DOI: 10.1136/archdischild-2020-320961] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/02/2021] [Accepted: 01/29/2021] [Indexed: 11/04/2022]
Abstract
Intermittent hypoxaemia (IH) events are well described in extremely preterm infants, but the occurrence of IH patterns in more mature preterm infants remains unclear. The objective of this study was to characterise the effect of gestational age on early postnatal patterns of IH in extremely (<28 weeks), very (28-<32 weeks) and moderately (32-<34 weeks) preterm infants. As expected, extremely preterm infants had a significantly higher frequency of IH events of longer durations and greater time with hypoxaemia versus very and moderately preterm infants. In addition, the postnatal decrease in IH duration was comparable in the very and moderately preterm infants. This progression of IH events should assist clinicians and families in managing expectations for resolution of IH events during early postnatal life.
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Affiliation(s)
- J. M. Di Fiore
- Case Western Reserve University, Cleveland, (OH) USA,Rainbow Babies & Children’s Hospital, Cleveland, (OH) USA
| | - V. Shah
- Rainbow Babies & Children’s Hospital, Cleveland, (OH) USA
| | - A. Patwardhan
- Department of Biomedical Engineering, College of Engineering, University of Kentucky, Lexington, (KY) USA
| | - A. Sattar
- Department of Population and Quantitative Health Sciences, School of Medicine College of Medicine, Case Western Reserve University, Cleveland, (OH) USA
| | - S. Wang
- Department of Population and Quantitative Health Sciences, School of Medicine College of Medicine, Case Western Reserve University, Cleveland, (OH) USA
| | - T.M. Raffay
- Rainbow Babies & Children’s Hospital, Cleveland, (OH) USA
| | - R.J. Martin
- Rainbow Babies & Children’s Hospital, Cleveland, (OH) USA
| | - E.G. Abu Jawdeh
- Department of Biomedical Engineering, College of Engineering, University of Kentucky, Lexington, (KY) USA,Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, (KY) USA,Corresponding Author Elie G. Abu Jawdeh MD, PhD., Division of Neonatology – Department of Pediatrics, University of Kentucky 138 Leader Avenue, Lexington, KY 40508., Phone: 859-323-6117, Fax: 859-257-6066.,
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Miller C, Schatmeyer B, Landazuri P, Uysal U, Nazzaro J, Kinsman MJ, Camarata PJ, Ulloa CM, Hammond N, Pearson C, Shah V, Cheng JJ. sEEG for Expansion of a Surgical Epilepsy Program: Safety and Efficacy in 152 Consecutive Cases. Epilepsia Open 2021; 6:694-702. [PMID: 34388309 PMCID: PMC8633478 DOI: 10.1002/epi4.12535] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/13/2021] [Accepted: 08/06/2021] [Indexed: 11/28/2022] Open
Abstract
Objective Stereoelectroencephalography (sEEG) is an intracranial encephalography method of expanding use. The need for increased epilepsy surgery access has led to the consideration of sEEG adoption by new or expanding surgical epilepsy programs. Data regarding safety and efficacy are uncommon outside of high‐volume, well‐established centers, which may be less applicable to newer or low‐volume centers. The objective of this study was to add to the sEEG outcomes in the literature from the perspective of a rapidly expanding center. Methods A retrospective chart review of consecutive sEEG cases from January 2016 to December 2019 was performed. Data extraction included demographic data, surgical data, and outcome data, which pertinently examined surgical method, progression to therapeutic procedure, clinically significant adverse events, and Engel outcomes. Results One hundred and fifty‐two sEEG procedures were performed on 131 patients. Procedures averaged 10.5 electrodes for a total of 1603 electrodes. The majority (84%) of patients progressed to a therapeutic procedure. Six clinically significant complications occurred: three retained electrodes, two hemorrhages, and one failure to complete investigation. Only one complication resulted in a permanent deficit. Engel 1 outcome was achieved in 63.3% of patients reaching one‐year follow‐up after a curative procedure. Significance New or expanding epilepsy surgery centers can appropriately consider the use of sEEG. The complication rate is low and the majority of patients progress to therapeutic surgery. Procedural safety, progression to therapeutic intervention, and Engel outcomes are comparable to cohorts from long‐established epilepsy surgery programs.
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Affiliation(s)
- Christopher Miller
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Bryan Schatmeyer
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Patrick Landazuri
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Utku Uysal
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jules Nazzaro
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Michael J Kinsman
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Paul J Camarata
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Carol M Ulloa
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Nancy Hammond
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Caleb Pearson
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Vishal Shah
- Department of Neurology, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jennifer J Cheng
- Department of Neurosurgery, The University of Kansas School of Medicine, Kansas City, KS, USA
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Narang U, Maubon L, Shah V, Wagh V. Ocular trauma or Oedipism: completing the evisceration. GMS Ophthalmol Cases 2021; 11:Doc13. [PMID: 34540525 PMCID: PMC8422941 DOI: 10.3205/oc000186] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Self-enucleation, also known as Oedipism, is a rare form of ocular trauma. The objective of this clinical case report is to highlight the importance of diagnosing this unusual injury and thus ensuring its appropriate management. We herein describe a case of a 58-year-old man who presented to hospital with a bleeding left eye. Initially, limited history was provided, however, on further enquiry it was revealed that he had paranoid schizophrenia. The patient eventually had to be sectioned with assistance from the Police and Psychiatry team, upon discovery of self-inflicted mechanism of injury. Subsequently, the patient had evisceration of the left eye and afterwards, demonstrated insight into the pre-operative problems. Literature review emphasizes the importance of close cooperation required between medical specialities to ensure that the underlying cause, usually schizophrenia, is managed in conjunction to the eye injury in order to provide optimum care for the patient.
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Affiliation(s)
- Ujjwala Narang
- St. George’s, University of London, United Kingdom,*To whom correspondence should be addressed: Ujjwala Narang, St. George’s, University of London, Cranmer Terrace, SW17 0RE, London, United Kingdom, E-mail:
| | | | - Vishal Shah
- King’s College Hospital, London, United Kingdom
| | - Vijay Wagh
- St. Thomas’ Hospital, London, United Kingdom
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Rea M, Holmes N, Hill RM, Boto E, Leggett J, Edwards LJ, Woolger D, Dawson E, Shah V, Osborne J, Bowtell R, Brookes MJ. Precision magnetic field modelling and control for wearable magnetoencephalography. Neuroimage 2021; 241:118401. [PMID: 34273527 PMCID: PMC9248349 DOI: 10.1016/j.neuroimage.2021.118401] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 12/04/2020] [Revised: 06/30/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
Optically-pumped magnetometers (OPMs) are highly sensitive, compact magnetic field sensors, which offer a viable alternative to cryogenic sensors (superconducting quantum interference devices – SQUIDs) for magnetoencephalography (MEG). With the promise of a wearable system that offers lifespan compliance, enables movement during scanning, and provides higher quality data, OPMs could drive a step change in MEG instrumentation. However, this potential can only be realised if background magnetic fields are appropriately controlled, via a combination of optimised passive magnetic screening (i.e. enclosing the system in layers of high-permeability materials), and electromagnetic coils to further null the remnant magnetic field. In this work, we show that even in an OPM-optimised passive shield with extremely low (<2 nT) remnant magnetic field, head movement generates significant artefacts in MEG data that manifest as low-frequency interference. To counter this effect we introduce a magnetic field mapping technique, in which the participant moves their head to sample the background magnetic field using a wearable sensor array; resulting data are compared to a model to derive coefficients representing three uniform magnetic field components and five magnetic field gradient components inside the passive shield. We show that this technique accurately reconstructs the magnitude of known magnetic fields. Moreover, by feeding the obtained coefficients into a bi-planar electromagnetic coil system, we were able to reduce the uniform magnetic field experienced by the array from a magnitude of 1.3 ± 0.3 nT to 0.29 ± 0.07 nT. Most importantly, we show that this field compensation generates a five-fold reduction in motion artefact at 0–2 Hz, in a visual steady-state evoked response experiment using 6 Hz stimulation. We suggest that this technique could be used in future OPM-MEG experiments to improve the quality of data, especially in paradigms seeking to measure low-frequency oscillations, or in experiments where head movement is encouraged.
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Affiliation(s)
- Molly Rea
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Niall Holmes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Ryan M Hill
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Elena Boto
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - James Leggett
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Lucy J Edwards
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - David Woolger
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Eliot Dawson
- Magnetic Shields Limited, Headcorn Road, Staplehurst, Tonbridge, Kent, TN12 0DS, UK
| | - Vishal Shah
- QuSpin Inc., 331 South 104th Street, Suite 130, Louisville, 80027, Colorado, USA
| | - James Osborne
- QuSpin Inc., 331 South 104th Street, Suite 130, Louisville, 80027, Colorado, USA
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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Eckley CS, Luxton TP, Knightes CD, Shah V. Methylmercury Production and Degradation under Light and Dark Conditions in the Water Column of the Hells Canyon Reservoirs, USA. Environ Toxicol Chem 2021; 40:1829-1839. [PMID: 33729607 PMCID: PMC8745031 DOI: 10.1002/etc.5041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 05/28/2023]
Abstract
Methylmercury (MeHg) is a highly toxic form of mercury that can bioaccumulate in fish tissue. Methylmercury is produced by anaerobic bacteria, many of which are also capable of MeHg degradation. In addition, demethylation in surface waters can occur via abiotic sunlight-mediated processes. The goal of the present study was to understand the relative importance of microbial Hg methylation/demethylation and abiotic photodemethylation that govern the mass of MeHg within an aquatic system. The study location was the Hells Canyon complex of 3 reservoirs on the Idaho-Oregon border, USA, that has fish consumption advisories as a result of elevated MeHg concentrations. Our study utilized stable isotope addition experiments to trace MeHg formation and degradation within the water column of the reservoirs to understand the relative importance of these processes on the mass of MeHg using the Water Quality Analysis Simulation Program. The results showed that rates of MeHg production and degradation within the water column were relatively low (<0.07 d-1 ) but sufficient to account for most of the MeHg observed with the system. Most MeHg production within the water column appeared to occur in the spring when much of the water column was in the processes of becoming anoxic. In the surface waters, rates of photodemethylation were relatively large (up to -0.25 d-1 ) but quickly decreased at depths >0.5 m below the surface. These results can be used to identify the relative importance of MeHg processes that can help guide reservoir management decisions. Environ Toxicol Chem 2021;40:1829-1839. © 2021 SETAC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
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Affiliation(s)
- Chris S. Eckley
- US Environmental Protection Agency, Region-10, Seattle, Washington
| | - Todd P. Luxton
- Office of Research and Development, US Environmental Protection Agency, Cincinnati, Ohio
| | - Christopher D. Knightes
- Office of Research and Development, US Environmental Protection Agency, Narragansett, Rhode Island
| | - Vishal Shah
- College of the Sciences and Mathematics, West Chester University, West Chester, Pennsylvania, USA
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Mistry J, Mistry D, Salvi P, Shah V. Aberrant Isolated Segment V Duct: a Rare Anomaly and Cholecystectomy. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02914-y] [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] Open
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Karim S, Shah V, Adegbola S, Tewari S, Gupta V. 925 Is Routine Bloods Group and Save Required for Emergency Appendicectomy? Br J Surg 2021. [DOI: 10.1093/bjs/znab134.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Appendicectomy is commonly a safe and low bleeding risk procedure. However, some hospital guidelines stipulate a requirement for routine pre-operative blood group and save (G&S).We aim to determine if pre-operative G&S is required for appendicectomies by looking at the number of tests vs transfusion conducted.The cost of G&S is £4.14 per sample in our trust.
Method
A retrospective review was conducted over a 3-month period. Patient data and demographics were identified using the hospital coding, theatre records and transfusion departments.
Results
118 consecutive appendicectomies were identified. Of which, 99 laparoscopic vs 19 open (13 started open vs 6 converted to open) operations were performed. No patients required a blood transfusion during their admission. There was a total of 219 G&S conducted. Cross matching tests for these procedures cost a total of £906. We estimate a cost projection of £3624 for G&S tests over a year and £18120 over 3 years.
Conclusions
Bleeding complications requiring transfusion following appendicectomies are very uncommon. In our unit, 0% of patients identified required a transfusion during their admission. We suggest stopping routine pre-operative G&S for these patients would be clinically safe and would lead to financial savings and reduce pre-operative waiting time.
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Affiliation(s)
- S Karim
- Lister Hospital, Stevenage, United Kingdom
| | - V Shah
- Lister Hospital, Stevenage, United Kingdom
| | - S Adegbola
- Lister Hospital, Stevenage, United Kingdom
| | - S Tewari
- Lister Hospital, Stevenage, United Kingdom
| | - V Gupta
- Lister Hospital, Stevenage, United Kingdom
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