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Ng MTH, Borst R, Gacaferi H, Davidson S, Ackerman JE, Johnson PA, Machado CC, Reekie I, Attar M, Windell D, Kurowska-Stolarska M, MacDonald L, Alivernini S, Garvilles M, Jansen K, Bhalla A, Lee A, Charlesworth J, Chowdhury R, Klenerman P, Powell K, Hackstein CP, Furniss D, Rees J, Gilroy D, Coles M, Carr AJ, Sansom SN, Buckley CD, Dakin SG. A single cell atlas of frozen shoulder capsule identifies features associated with inflammatory fibrosis resolution. Nat Commun 2024; 15:1394. [PMID: 38374174 PMCID: PMC10876649 DOI: 10.1038/s41467-024-45341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Frozen shoulder is a spontaneously self-resolving chronic inflammatory fibrotic human disease, which distinguishes the condition from most fibrotic diseases that are progressive and irreversible. Using single-cell analysis, we identify pro-inflammatory MERTKlowCD48+ macrophages and MERTK + LYVE1 + MRC1+ macrophages enriched for negative regulators of inflammation which co-exist in frozen shoulder capsule tissues. Micro-cultures of patient-derived cells identify integrin-mediated cell-matrix interactions between MERTK+ macrophages and pro-resolving DKK3+ and POSTN+ fibroblasts, suggesting that matrix remodelling plays a role in frozen shoulder resolution. Cross-tissue analysis reveals a shared gene expression cassette between shoulder capsule MERTK+ macrophages and a respective population enriched in synovial tissues of rheumatoid arthritis patients in disease remission, supporting the concept that MERTK+ macrophages mediate resolution of inflammation and fibrosis. Single-cell transcriptomic profiling and spatial analysis of human foetal shoulder tissues identify MERTK + LYVE1 + MRC1+ macrophages and DKK3+ and POSTN+ fibroblast populations analogous to those in frozen shoulder, suggesting that the template to resolve fibrosis is established during shoulder development. Crosstalk between MerTK+ macrophages and pro-resolving DKK3+ and POSTN+ fibroblasts could facilitate resolution of frozen shoulder, providing a basis for potential therapeutic resolution of persistent fibrotic diseases.
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Affiliation(s)
| | | | | | | | | | | | - Caio C Machado
- University of Oxford, Oxford, UK
- University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | - Lucy MacDonald
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), University of Glasgow, Glasgow, UK
| | - Stefano Alivernini
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
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Vazquez-Montes MDLA, Fanshawe TR, Stoesser N, Walker AS, Butler C, Hayward G. Epidemiology and microbiology of recurrent UTI in women in the community in Oxfordshire, UK. JAC Antimicrob Resist 2024; 6:dlad156. [PMID: 38204597 PMCID: PMC10781434 DOI: 10.1093/jacamr/dlad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Background Recurrent urinary tract infection (rUTI) contributes to significant morbidity and antibiotic usage. Objectives To characterize the age of women experiencing rUTI, the microbiology of rUTIs, and the risk of further rUTIs in Oxfordshire, UK. Patients and methods We retrospectively analysed de-identified linked microbiology and hospital admissions data (Infections in Oxfordshire Research Database), between 2008 and 2019, including positive urine cultures from women aged ≥16 years in community settings. We defined rUTI as ≥2 positive urine cultures within 6 months or ≥3 within 12 months. Results Of 201 927 women with urine culture performed, 84 809 (42%) had ≥1 positive culture, and 15 617 (18%) of these experienced ≥1 rUTI over a median (IQR) follow-up of 6 (3-9) years. Women with rUTI were 17.0 (95% CI: 16.3-17.7) years older on average. rUTI was commonest (6204; 40%) in those aged 70-89 years. Post-rUTI, the risk of further UTI within 6 months was 29.4% (95% CI: 28.7-30.2). Escherichia coli was detected in 65% of positive cultures. Among rUTIs where the index UTI was E. coli associated, the second UTI was also E. coli associated in 81% of cases. Conclusions rUTIs represent a substantial healthcare burden, particularly in women >60 years. One-third of women experiencing rUTI have a further microbiologically confirmed UTI within 6 months.
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Affiliation(s)
- Maria D L A Vazquez-Montes
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Nicole Stoesser
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Modernising Medical Microbiology Consortium, University of Oxford, Experimental Medicine Division, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Christopher Butler
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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Rao S, Nazarzadeh M, Li Y, Canoy D, Mamouei M, Salimi-Khorshidi G, Rahimi K. Systolic blood pressure, chronic obstructive pulmonary disease and cardiovascular risk. Heart 2023; 109:1216-1222. [PMID: 37080767 PMCID: PMC10423512 DOI: 10.1136/heartjnl-2023-322431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE In individuals with complex underlying health problems, the association between systolic blood pressure (SBP) and cardiovascular disease is less well recognised. The association between SBP and risk of cardiovascular events in patients with chronic obstructive pulmonary disease (COPD) was investigated. METHODS AND ANALYSIS In this cohort study, 39 602 individuals with a diagnosis of COPD aged 55-90 years between 1990 and 2009 were identified from validated electronic health records (EHR) in the UK. The association between SBP and risk of cardiovascular end points (composite of ischaemic heart disease, heart failure, stroke and cardiovascular death) was analysed using a deep learning approach. RESULTS In the selected cohort (46.5% women, median age 69 years), 10 987 cardiovascular events were observed over a median follow-up period of 3.9 years. The association between SBP and risk of cardiovascular end points was found to be monotonic; the lowest SBP exposure group of <120 mm Hg presented nadir of risk. With respect to reference SBP (between 120 and 129 mm Hg), adjusted risk ratios for the primary outcome were 0.99 (95% CI 0.93 to 1.05) for SBP of <120 mm Hg, 1.02 (0.97 to 1.07) for SBP between 130 and 139 mm Hg, 1.07 (1.01 to 1.12) for SBP between 140 and 149 mm Hg, 1.11 (1.05 to 1.17) for SBP between 150 and 159 mm Hg and 1.16 (1.10 to 1.22) for SBP ≥160 mm Hg. CONCLUSION Using deep learning for modelling EHR, we identified a monotonic association between SBP and risk of cardiovascular events in patients with COPD.
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Affiliation(s)
- Shishir Rao
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Milad Nazarzadeh
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Yikuan Li
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Dexter Canoy
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mohammad Mamouei
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Gholamreza Salimi-Khorshidi
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
| | - Kazem Rahimi
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Deep Medicine, Oxford Martin School, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Marchi E, Ramamurthy N, Ansari MA, Harrer CE, Barnes E, Klenerman P. Defining the key intrahepatic gene networks in HCV infection driven by sex. Gut 2023; 72:984-994. [PMID: 35613843 PMCID: PMC10086281 DOI: 10.1136/gutjnl-2021-326314] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The transcriptional response in the liver during HCV infection is critical for determining clinical outcomes. This issue remains relatively unexplored as tissue access to address this at scale is usually limited. We aimed to profile the transcriptomics of HCV-infected livers to describe the expression networks involved and assess the effect on them of major predictors of clinical outcome such as IFNL4 (interferon lambda 4) host genotype and sex. DESIGN We took advantage of a large clinical study of HCV therapy accompanied by baseline liver biopsy to examine the drivers of transcription in tissue samples in 195 patients also genotyped genome-wide for host and viral single nucleotide polymorphisms. We addressed the role of host factors (disease status, sex, genotype, age) and viral factors (load, mutation) on transcriptional responses. RESULTS We observe key modules of transcription which can be impacted differentially by host and viral factors. Underlying cirrhotic state had the most substantial impact, even in a stable, compensated population. Notably, sex had a major impact on antiviral responses in concert with IL28B (interleukin 28B)/IFNL4 genotype, with stronger interferon and humoral responses in females. Males tended towards a dominant cellular immune response. In both sexes, there was a strong influence of the underlying host disease status and of specific viral mutations, and sex-specific expression quantitative trait loci were also observed. CONCLUSION These features help define the major influences on tissue responses in HCV infection, impacting on the response to treatment and with broader implications for responses in other sex-biased infections.
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Affiliation(s)
- Emanuele Marchi
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - M Azim Ansari
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
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Jones N, Oke J, Marsh S, Nikbin K, Bowley J, Dijkstra HP, Hobbs FR, Greenhalgh T. Face masks while exercising trial (MERIT): a cross-over randomised controlled study. BMJ Open 2023; 13:e063014. [PMID: 36604128 PMCID: PMC9827243 DOI: 10.1136/bmjopen-2022-063014] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Physical exertion is a high-risk activity for aerosol emission of respiratory pathogens. We aimed to determine the safety and tolerability of healthy young adults wearing different types of face mask during moderate-to-high intensity exercise. DESIGN Cross-over randomised controlled study, completed between June 2021 and January 2022. PARTICIPANTS Volunteers aged 18-35 years, who exercised regularly and had no significant pre-existing health conditions. INTERVENTIONS Comparison of wearing a surgical, cloth and filtering face piece (FFP3) mask to no mask during 4×15 min bouts of exercise. Exercise was running outdoors or indoor rowing at moderate-to-high intensity, with consistency of distance travelled between bouts confirmed using a smartphone application (Strava). Each participant completed each bout in random order. OUTCOMES The primary outcome was change in oxygen saturations. Secondary outcomes were change in heart rate, perceived impact of face mask wearing during exercise and willingness to wear a face mask for future exercise. RESULTS All 72 volunteers (mean age 23.9) completed the study. Changes in oxygen saturations did not exceed the prespecified non-inferiority margin (2% difference) with any mask type compared with no mask. At the end of exercise, the estimated average difference in oxygen saturations for cloth mask was -0.07% (95% CI -0.39% to 0.25%), for surgical 0.28% (-0.04% to 0.60%) and for FFP3 -0.21% (-0.53% to 0.11%). The corresponding estimated average difference in heart rate for cloth mask was -1.20 bpm (95% CI -4.56 to 2.15), for surgical 0.36 bpm (95% CI -3.01 to 3.73) and for FFP3 0.52 bpm (95% CI -2.85 to 3.89). Wearing a face mask caused additional symptoms such as breathlessness (n=13, 18%) and dizziness (n=7, 10%). 33 participants broadly supported face mask wearing during exercise, particularly indoors, but 22 were opposed. CONCLUSION This study adds to previous findings (mostly from non-randomised studies) that exercising at moderate-to-high intensity wearing a face mask appears to be safe in healthy, young adults. TRIAL REGISTRATION NUMBER NCT04932226.
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Affiliation(s)
- Nicholas Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seren Marsh
- University of Oxford Medical School, University of Oxford, Oxford, UK
| | - Kurosh Nikbin
- GKT School of Medical Education, King's College London, London, UK
| | - Jonathan Bowley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - H Paul Dijkstra
- Department of Continuing Education, University of Oxford, Oxford, UK
- Medical Education Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Ad Dawhah, Qatar
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Ward V, Wei J, Gordon W, Barnes E, Dunachie S, Jeffery K, Eyre D, O'Donnell AM. SARS-CoV-2 antibody responses post-vaccination in UK healthcare workers with pre-existing medical conditions: a cohort study. BMJ Open 2022; 12:e066766. [PMID: 36456004 PMCID: PMC9716410 DOI: 10.1136/bmjopen-2022-066766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To examine antibody responses after the second vaccination in healthcare workers (HCWs) with underlying health conditions. DESIGN Cohort study. SETTING Oxford University Hospitals in the United Kingdom. PARTICIPANTS Healthcare workers who had SARS-CoV-2 serological data available and received two SARS-CoV- 2 vaccinations. PRIMARY OUTCOME Peak SARS-CoV-2 anti-spike IgG responses after the second vaccination and associations with underlying health conditions and the estimated risk of severe COVID-19 using an occupational health risk assessment tool. METHODS We used univariable and multivariable linear regression models to investigate associations between antibody levels and demographics (age, sex, ethnicity), healthcare role, body mass index, underlying health conditions, vaccination status, prior infection and the Association of Local Authority Medical Advisors COVID-age risk score. RESULTS 1635 HCWs had anti-spike IgG measurements 14-84 days after second vaccination and data on any underlying health conditions. Only five HCWs (0.3%), all on immunosuppressive treatment, (including four organ transplant recipients), did not seroconvert after second vaccination. Antibody levels were independently lower with older age, diabetes, immunosuppression, respiratory disorders other than asthma and markedly so in organ transplant recipients. Levels were independently lower in ChAdOx1 versus BNT162b2 recipients and higher following previous infection. HCWs with 'very high' COVID-age risk scores had lower median antibody levels than those with 'low', 'medium' or 'high' risk scores; 4379 AU/mL, compared with 12 337 AU/mL, 9430 AU/mL and 10 524 AU/mL, respectively. CONCLUSIONS Two vaccine doses are effective in generating antibody responses among HCWs, including those with a high occupational risk. However, HCWs with underlying health conditions, especially diabetes, immunosuppression and organ transplant, had lower antibody levels, and vaccine response monitoring may be needed.
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Affiliation(s)
- Victoria Ward
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Medical Microbiology and Infectious Diseases, Oxford University Hospitals, Oxford, UK
| | - Jia Wei
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, UK
| | - William Gordon
- Department of Medical Microbiology and Infectious Diseases, Oxford University Hospitals, Oxford, UK
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Medical Microbiology and Infectious Diseases, Oxford University Hospitals, Oxford, UK
| | - Susie Dunachie
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Medical Microbiology and Infectious Diseases, Oxford University Hospitals, Oxford, UK
| | - Katie Jeffery
- Department of Medical Microbiology and Infectious Diseases, Oxford University Hospitals, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - David Eyre
- Department of Medical Microbiology and Infectious Diseases, Oxford University Hospitals, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anne-Marie O'Donnell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Occupational Health Department, Oxford Health NHS Foundation Trust, Oxford, UK
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Raisi-Estabragh Z, McCracken C, Condurache D, Aung N, Vargas JD, Naderi H, Munroe PB, Neubauer S, Harvey NC, Petersen SE. Left atrial structure and function are associated with cardiovascular outcomes independent of left ventricular measures: a UK Biobank CMR study. Eur Heart J Cardiovasc Imaging 2022; 23:1191-1200. [PMID: 34907415 PMCID: PMC9365306 DOI: 10.1093/ehjci/jeab266] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS We evaluated the associations of left atrial (LA) structure and function with prevalent and incident cardiovascular disease (CVD), independent of left ventricular (LV) metrics, in 25 896 UK Biobank participants. METHODS AND RESULTS We estimated the association of cardiovascular magnetic resonance (CMR) metrics [LA maximum volume (LAV), LA ejection fraction (LAEF), LV mass : LV end-diastolic volume ratio (LVM : LVEDV), global longitudinal strain, and LV global function index (LVGFI)] with vascular risk factors (hypertension, diabetes, high cholesterol, and smoking), prevalent and incident CVDs [atrial fibrillation (AF), stroke, ischaemic heart disease (IHD), myocardial infarction], all-cause mortality, and CVD mortality. We created uncorrelated CMR variables using orthogonal principal component analysis rotation. All five CMR metrics were simultaneously entered into multivariable regression models adjusted for sex, age, ethnicity, deprivation, education, body size, and physical activity. Lower LAEF was associated with diabetes, smoking, and all the prevalent and incident CVDs. Diabetes, smoking, and high cholesterol were associated with smaller LAV. Hypertension, IHD, AF (incident and prevalent), incident stroke, and CVD mortality were associated with larger LAV. LV and LA metrics were both independently informative in associations with prevalent disease, however LAEF showed the most consistent associations with incident CVDs. Lower LVGFI was associated with greater all-cause and CVD mortality. In secondary analyses, compared with LVGFI, LV ejection fraction showed similar but less consistent disease associations. CONCLUSION LA structure and function measures (LAEF and LAV) demonstrate significant associations with key prevalent and incident cardiovascular outcomes, independent of LV metrics. These measures have potential clinical utility for disease discrimination and outcome prediction.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre,
Queen Mary University of London, Charterhouse Square, London
EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS
Trust, London EC1A 7BE, UK
| | - Celeste McCracken
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine,
University of Oxford, National Institute for Health Research Oxford Biomedical
Research Centre, Oxford University Hospitals NHS Foundation Trust,
Oxford OX3 9DU, UK
| | - Dorina Condurache
- London North West University Healthcare NHS Trust,
Harrow HA1 3UJ, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre,
Queen Mary University of London, Charterhouse Square, London
EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS
Trust, London EC1A 7BE, UK
| | - Jose D Vargas
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre,
Queen Mary University of London, Charterhouse Square, London
EC1M 6BQ, UK
- MedStar Georgetown University Hospital,
Washington, DC 20007, USA
| | - Hafiz Naderi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre,
Queen Mary University of London, Charterhouse Square, London
EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS
Trust, London EC1A 7BE, UK
| | - Patricia B Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre,
Queen Mary University of London, Charterhouse Square, London
EC1M 6BQ, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine,
University of Oxford, National Institute for Health Research Oxford Biomedical
Research Centre, Oxford University Hospitals NHS Foundation Trust,
Oxford OX3 9DU, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton,
University Hospital Southampton NHS Foundation Trust,
Southampton, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre,
Queen Mary University of London, Charterhouse Square, London
EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS
Trust, London EC1A 7BE, UK
- Health Data Research UK, London,
UK
- Alan Turing Institute, London,
UK
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Lee LYW, Rozmanowski S, Pang M, Charlett A, Anderson C, Hughes GJ, Barnard M, Peto L, Vipond R, Sienkiewicz A, Hopkins S, Bell J, Crook DW, Gent N, Walker AS, Peto TEA, Eyre DW. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infectivity by Viral Load, S Gene Variants and Demographic Factors, and the Utility of Lateral Flow Devices to Prevent Transmission. Clin Infect Dis 2022; 74:407-415. [PMID: 33972994 PMCID: PMC8136027 DOI: 10.1093/cid/ciab421] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [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: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND How severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity varies with viral load is incompletely understood. Whether rapid point-of-care antigen lateral flow devices (LFDs) detect most potential transmission sources despite imperfect clinical sensitivity is unknown. METHODS We combined SARS-CoV-2 testing and contact tracing data from England between 1 September 2020 and 28 February 2021. We used multivariable logistic regression to investigate relationships between polymerase chain reaction (PCR)-confirmed infection in contacts of community-diagnosed cases and index case viral load, S gene target failure (proxy for B.1.1.7 infection), demographics, SARS-CoV-2 incidence, social deprivation, and contact event type. We used LFD performance to simulate the proportion of cases with a PCR-positive contact expected to be detected using 1 of 4 LFDs. RESULTS In total, 231 498/2 474 066 (9%) contacts of 1 064 004 index cases tested PCR-positive. PCR-positive results in contacts independently increased with higher case viral loads (lower cycle threshold [Ct] values), for example, 11.7% (95% confidence interval [CI] 11.5-12.0%) at Ct = 15 and 4.5% (95% CI 4.4-4.6%) at Ct = 30. B.1.1.7 infection increased PCR-positive results by ~50%, (eg, 1.55-fold, 95% CI 1.49-1.61, at Ct = 20). PCR-positive results were most common in household contacts (at Ct = 20.1, 8.7% [95% CI 8.6-8.9%]), followed by household visitors (7.1% [95% CI 6.8-7.3%]), contacts at events/activities (5.2% [95% CI 4.9-5.4%]), work/education (4.6% [95% CI 4.4-4.8%]), and least common after outdoor contact (2.9% [95% CI 2.3-3.8%]). Contacts of children were the least likely to test positive, particularly following contact outdoors or at work/education. The most and least sensitive LFDs would detect 89.5% (95% CI 89.4-89.6%) and 83.0% (95% CI 82.8-83.1%) of cases with PCR-positive contacts, respectively. CONCLUSIONS SARS-CoV-2 infectivity varies by case viral load, contact event type, and age. Those with high viral loads are the most infectious. B.1.1.7 increased transmission by ~50%. The best performing LFDs detect most infectious cases.
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Affiliation(s)
- Lennard Y W Lee
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Stefan Rozmanowski
- Department of Health and Social Care, UK Government, London, United Kingdom
| | - Matthew Pang
- Department of Health and Social Care, UK Government, London, United Kingdom
| | | | | | | | - Matthew Barnard
- Department of Health and Social Care, UK Government, London, United Kingdom
| | - Leon Peto
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | | | | | | | - John Bell
- Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Derrick W Crook
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - Nick Gent
- Public Health England, London,United Kingdom
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
| | - David W Eyre
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford,United Kingdom
- NIHR Health Protection Research Unit in in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Gadd DA, Hillary RF, McCartney DL, Zaghlool SB, Stevenson AJ, Cheng Y, Fawns-Ritchie C, Nangle C, Campbell A, Flaig R, Harris SE, Walker RM, Shi L, Tucker-Drob EM, Gieger C, Peters A, Waldenberger M, Graumann J, McRae AF, Deary IJ, Porteous DJ, Hayward C, Visscher PM, Cox SR, Evans KL, McIntosh AM, Suhre K, Marioni RE. Epigenetic scores for the circulating proteome as tools for disease prediction. eLife 2022; 11:e71802. [PMID: 35023833 PMCID: PMC8880990 DOI: 10.7554/elife.71802] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Protein biomarkers have been identified across many age-related morbidities. However, characterising epigenetic influences could further inform disease predictions. Here, we leverage epigenome-wide data to study links between the DNA methylation (DNAm) signatures of the circulating proteome and incident diseases. Using data from four cohorts, we trained and tested epigenetic scores (EpiScores) for 953 plasma proteins, identifying 109 scores that explained between 1% and 58% of the variance in protein levels after adjusting for known protein quantitative trait loci (pQTL) genetic effects. By projecting these EpiScores into an independent sample (Generation Scotland; n = 9537) and relating them to incident morbidities over a follow-up of 14 years, we uncovered 137 EpiScore-disease associations. These associations were largely independent of immune cell proportions, common lifestyle and health factors, and biological aging. Notably, we found that our diabetes-associated EpiScores highlighted previous top biomarker associations from proteome-wide assessments of diabetes. These EpiScores for protein levels can therefore be a valuable resource for disease prediction and risk stratification.
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Affiliation(s)
- Danni A Gadd
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Robert F Hillary
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Daniel L McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Shaza B Zaghlool
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education CityDohaQatar
- Computer Engineering Department, Virginia TechBlacksburgUnited States
| | - Anna J Stevenson
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Yipeng Cheng
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Chloe Fawns-Ritchie
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
- Department of Psychology, University of EdinburghEdinburghUnited Kingdom
| | - Cliff Nangle
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Robin Flaig
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Sarah E Harris
- Department of Psychology, University of EdinburghEdinburghUnited Kingdom
- Lothian Birth Cohorts, University of EdinburghEdinburghUnited Kingdom
| | - Rosie M Walker
- Centre for Clinical Brain Sciences, Chancellor’s Building, University of EdinburghEdinburghUnited Kingdom
| | - Liu Shi
- Department of Psychiatry, University of OxfordOxfordUnited Kingdom
| | - Elliot M Tucker-Drob
- Department of Psychology, The University of Texas at AustinAustinUnited States
- Population Research Center, The University of Texas at AustinAustinUnited States
| | - Christian Gieger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental HealthNeuherbergGermany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental HealthNeuherbergGermany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart AllianceMunichGermany
- German Center for Diabetes Research (DZD)NeuherbergGermany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental HealthNeuherbergGermany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart AllianceMunichGermany
- German Center for Diabetes Research (DZD)NeuherbergGermany
| | - Melanie Waldenberger
- Research Unit Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental HealthNeuherbergGermany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental HealthNeuherbergGermany
- German Center for Cardiovascular Research (DZHK), partner site Munich Heart AllianceMunichGermany
| | - Johannes Graumann
- Scientific Service Group Biomolecular Mass Spectrometry, Max Planck Institute for Heart and Lung Research, W.G. Kerckhoff InstituteBad NauheimGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Max Planck Institute of Heart and Lung ResearchBad NauheimGermany
| | - Allan F McRae
- Institute for Molecular Bioscience, University of QueenslandBrisbaneAustralia
| | - Ian J Deary
- Department of Psychology, University of EdinburghEdinburghUnited Kingdom
- Lothian Birth Cohorts, University of EdinburghEdinburghUnited Kingdom
| | - David J Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Caroline Hayward
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
- Medical Research Council Human Genetics Unit, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Peter M Visscher
- Institute for Molecular Bioscience, University of QueenslandBrisbaneAustralia
| | - Simon R Cox
- Department of Psychology, University of EdinburghEdinburghUnited Kingdom
- Lothian Birth Cohorts, University of EdinburghEdinburghUnited Kingdom
| | - Kathryn L Evans
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
| | - Andrew M McIntosh
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh HospitalEdinburghUnited Kingdom
| | - Karsten Suhre
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education CityDohaQatar
| | - Riccardo E Marioni
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of EdinburghEdinburghUnited Kingdom
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Ordóñez-Mena JM, Fanshawe TR, Foster D, Andersson M, Oakley S, Stoesser N, Walker AS, Hayward G. Frequencies and patterns of microbiology test requests from primary care in Oxfordshire, UK, 2008-2018: a retrospective cohort study of electronic health records to inform point-of-care testing. BMJ Open 2021; 11:e048527. [PMID: 34815274 PMCID: PMC8611454 DOI: 10.1136/bmjopen-2020-048527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To inform point-of-care test (POCT) development, we quantified the primary care demand for laboratory microbiology tests by describing their frequencies overall, frequencies of positives, most common organisms identified, temporal trends in testing and patterns of cotesting on the same and subsequent dates. DESIGN Retrospective cohort study. SETTING Primary care practices in Oxfordshire. PARTICIPANTS 393 905 patients (65% female; 49% aged 18-49). PRIMARY AND SECONDARY OUTCOME MEASURES The frequencies of all microbiology tests requested between 2008 and 2018 were quantified. Patterns of cotesting were investigated with heat maps. All analyses were done overall, by sex and age categories. RESULTS 1 596 752 microbiology tests were requested. Urine culture±microscopy was the most common of all tests (n=673 612, 42%), was mainly requested without other tests and was the most common test requested in follow-up within 7 and 14 days. Of all urine cultures, 180 047 (27%) were positive and 172 651 (26%) showed mixed growth, and Escherichia coli was the most prevalent organism (132 277, 73% of positive urine cultures). Antenatal urine cultures and blood tests in pregnancy (hepatitis B, HIV and syphilis) formed a common test combination, consistent with their use in antenatal screening. CONCLUSIONS The greatest burden of microbiology testing in primary care is attributable to urine culture ± microscopy; genital and routine antenatal urine and blood testing are also significant contributors. Further research should focus on the feasibility and impact of POCTs for these specimen types.
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Affiliation(s)
- J M Ordóñez-Mena
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
- NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Thomas R Fanshawe
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
| | - Dona Foster
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Monique Andersson
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Sarah Oakley
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Nicole Stoesser
- NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UK
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - A Sarah Walker
- NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Gail Hayward
- Department of Primary Care Health Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
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11
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Collins GS, Dhiman P, Andaur Navarro CL, Ma J, Hooft L, Reitsma JB, Logullo P, Beam AL, Peng L, Van Calster B, van Smeden M, Riley RD, Moons KG. Protocol for development of a reporting guideline (TRIPOD-AI) and risk of bias tool (PROBAST-AI) for diagnostic and prognostic prediction model studies based on artificial intelligence. BMJ Open 2021; 11:e048008. [PMID: 34244270 PMCID: PMC8273461 DOI: 10.1136/bmjopen-2020-048008] [Citation(s) in RCA: 236] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/23/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The Transparent Reporting of a multivariable prediction model of Individual Prognosis Or Diagnosis (TRIPOD) statement and the Prediction model Risk Of Bias ASsessment Tool (PROBAST) were both published to improve the reporting and critical appraisal of prediction model studies for diagnosis and prognosis. This paper describes the processes and methods that will be used to develop an extension to the TRIPOD statement (TRIPOD-artificial intelligence, AI) and the PROBAST (PROBAST-AI) tool for prediction model studies that applied machine learning techniques. METHODS AND ANALYSIS TRIPOD-AI and PROBAST-AI will be developed following published guidance from the EQUATOR Network, and will comprise five stages. Stage 1 will comprise two systematic reviews (across all medical fields and specifically in oncology) to examine the quality of reporting in published machine-learning-based prediction model studies. In stage 2, we will consult a diverse group of key stakeholders using a Delphi process to identify items to be considered for inclusion in TRIPOD-AI and PROBAST-AI. Stage 3 will be virtual consensus meetings to consolidate and prioritise key items to be included in TRIPOD-AI and PROBAST-AI. Stage 4 will involve developing the TRIPOD-AI checklist and the PROBAST-AI tool, and writing the accompanying explanation and elaboration papers. In the final stage, stage 5, we will disseminate TRIPOD-AI and PROBAST-AI via journals, conferences, blogs, websites (including TRIPOD, PROBAST and EQUATOR Network) and social media. TRIPOD-AI will provide researchers working on prediction model studies based on machine learning with a reporting guideline that can help them report key details that readers need to evaluate the study quality and interpret its findings, potentially reducing research waste. We anticipate PROBAST-AI will help researchers, clinicians, systematic reviewers and policymakers critically appraise the design, conduct and analysis of machine learning based prediction model studies, with a robust standardised tool for bias evaluation. ETHICS AND DISSEMINATION Ethical approval has been granted by the Central University Research Ethics Committee, University of Oxford on 10-December-2020 (R73034/RE001). Findings from this study will be disseminated through peer-review publications. PROSPERO REGISTRATION NUMBER CRD42019140361 and CRD42019161764.
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Affiliation(s)
- Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Paula Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | | | - Jie Ma
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, Utrecht, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, Utrecht, Utrecht, Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, Utrecht, Utrecht, Netherlands
| | - Patricia Logullo
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Andrew L Beam
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lily Peng
- Google Health, Google, Palo Alto, California, USA
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, Netherlands
- EPI-Centre, KU Leuven, Leuven, Belgium
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, Utrecht, Utrecht, Netherlands
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - Karel Gm Moons
- Julius Center for Health Sciences and Primary Care, Utrecht, Utrecht, Netherlands
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, Utrecht, Utrecht, Netherlands
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12
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Smith JA, Abhari RE, Hussain Z, Heneghan C, Collins GS, Carr AJ. Industry ties and evidence in public comments on the FDA framework for modifications to artificial intelligence/machine learning-based medical devices: a cross sectional study. BMJ Open 2020; 10:e039969. [PMID: 33055121 PMCID: PMC7559037 DOI: 10.1136/bmjopen-2020-039969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES To determine the extent and disclosure of financial ties to industry and use of scientific evidence in comments on a US Food and Drug Administration (FDA) regulatory framework for modifications to artificial intelligence/machine learning (AI/ML)-based software as a medical device (SaMD). DESIGN Cross-sectional study. SETTING We searched all publicly available comments on the FDA 'Proposed Regulatory Framework for Modifications to Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device (SaMD)-Discussion Paper and Request for Feedback' from 2 April 2019 to 8 August 2019. MAIN OUTCOME MEASURES The proportion of articles submitted by parties with financial ties to industry, disclosing those ties, citing scientific articles, citing systematic reviews and meta-analyses, and using a systematic process to identify relevant literature. RESULTS We analysed 125 comments submitted on the proposed framework. 79 (63%) comments came from parties with financial ties; for 36 (29%) comments, it was not clear and the absence of financial ties could only be confirmed for 10 (8%) comments. No financial ties were disclosed in any of the comments that were not from industry submitters. The vast majority of submitted comments (86%) did not cite any scientific literature, just 4% cited a systematic review or meta-analysis and no comments indicated that a systematic process was used to identify relevant literature. CONCLUSIONS Financial ties to industry were common and undisclosed, and scientific evidence, including systematic reviews and meta-analyses, were rarely cited. To ensure regulatory frameworks best serve patient interests, the FDA should mandate disclosure of potential conflicts of interest (including financial ties) in comments, encourage the use of scientific evidence, and encourage engagement from non-conflicted parties.
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Affiliation(s)
- James Andrew Smith
- NDORMS, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Roxanna E Abhari
- NDORMS, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | - Zain Hussain
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK
| | - Carl Heneghan
- Primary Health Care, University of Oxford, Oxford, Oxfordshire, UK
| | - Gary S Collins
- NDORMS, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Andrew J Carr
- NDORMS, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
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13
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Hirst JA, Farmer AJ, Williams V. How point-of-care HbA 1c testing changes the behaviour of people with diabetes and clinicians - a qualitative study. Diabet Med 2020; 37:1008-1015. [PMID: 31876039 PMCID: PMC7318570 DOI: 10.1111/dme.14219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
AIM To explore adults with diabetes and clinician views of point-of-care HbA1c testing. METHODS Adults with diabetes and HbA1c ≥ 58 mmol/mol (7.5%) receiving HbA1c point-of-care testing in primary care were invited to individual interviews. Participants were interviewed twice, once prior to point-of-care testing and once after 6 months follow-up. Clinicians were interviewed once. A thematic framework based on an a priori framework was used to analyse the data. RESULTS Fifteen participants (eight women, age range 30-70 years, two Asians, 13 white Europeans) were interviewed. They liked point-of-care testing and found the single appointment more convenient than usual care. Receiving the test result at the appointment helped some people understand how some lifestyle behaviours affected their control of diabetes and motivated them to change behaviours. Receiving an immediate test result reduced the anxiety some people experience when waiting for a result. People thought there was little value in using point-of-care testing for their annual review. Clinicians liked the point-of-care testing but expressed concerns about costs. CONCLUSIONS This work suggests that several features of point-of-care testing may encourage behavioural change. It helped some people to link their HbA1c result to recent lifestyle behaviours, thereby motivating behavioural change and reinforcing healthy lifestyle choices.
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Affiliation(s)
- J. A. Hirst
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUK
| | - A. J. Farmer
- Nuffield Department of Primary Care Health ScienceUniversity of OxfordRadcliffe Observatory QuarterOxfordUK
- National Institute for Health Research (NIHR) Oxford Biomedical Research CentreOxfordUK
| | - V. Williams
- School of NursingNipissing UniversityNorth BayONUSA
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14
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Heus P, Damen JAAG, Pajouheshnia R, Scholten RJPM, Reitsma JB, Collins GS, Altman DG, Moons KGM, Hooft L. Uniformity in measuring adherence to reporting guidelines: the example of TRIPOD for assessing completeness of reporting of prediction model studies. BMJ Open 2019; 9:e025611. [PMID: 31023756 PMCID: PMC6501951 DOI: 10.1136/bmjopen-2018-025611] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/18/2018] [Accepted: 01/11/2019] [Indexed: 12/23/2022] Open
Abstract
To promote uniformity in measuring adherence to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement, a reporting guideline for diagnostic and prognostic prediction model studies, and thereby facilitate comparability of future studies assessing its impact, we transformed the original 22 TRIPOD items into an adherence assessment form and defined adherence scoring rules. TRIPOD specific challenges encountered were the existence of different types of prediction model studies and possible combinations of these within publications. More general issues included dealing with multiple reporting elements, reference to information in another publication, and non-applicability of items. We recommend our adherence assessment form to be used by anyone (eg, researchers, reviewers, editors) evaluating adherence to TRIPOD, to make these assessments comparable. In general, when developing a form to assess adherence to a reporting guideline, we recommend formulating specific adherence elements (if needed multiple per reporting guideline item) using unambiguous wording and the consideration of issues of applicability in advance.
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Affiliation(s)
- Pauline Heus
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna A A G Damen
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Romin Pajouheshnia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rob J P M Scholten
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes B Reitsma
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Karel G M Moons
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Walker AJ, Curtis HJ, Bacon S, Croker R, Goldacre B. Trends, geographical variation and factors associated with prescribing of gluten-free foods in English primary care: a cross-sectional study. BMJ Open 2018; 8:e021312. [PMID: 29661914 PMCID: PMC5905743 DOI: 10.1136/bmjopen-2017-021312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES There is substantial disagreement about whether gluten-free foods should be prescribed on the National Health Service. We aim to describe time trends, variation and factors associated with prescribing gluten-free foods in England. SETTING English primary care. PARTICIPANTS English general practices. PRIMARY AND SECONDARY OUTCOME MEASURES We described long-term national trends in gluten-free prescribing, and practice and Clinical Commissioning Group (CCG) level monthly variation in the rate of gluten-free prescribing (per 1000 patients) over time. We used a mixed-effect Poisson regression model to determine factors associated with gluten-free prescribing rate. RESULTS There were 1.3 million gluten-free prescriptions between July 2016 and June 2017, down from 1.8 million in 2012/2013, with a corresponding cost reduction from £25.4 million to £18.7 million. There was substantial variation in prescribing rates among practices (range 0 to 148 prescriptions per 1000 patients, IQR 7.3-31.8), driven in part by substantial variation at the CCG level, likely due to differences in prescribing policy. Practices in the most deprived quintile of deprivation score had a lower prescribing rate than those in the highest quintile (incidence rate ratio 0.89, 95% CI 0.87 to 0.91). This is potentially a reflection of the lower rate of diagnosed coeliac disease in more deprived populations. CONCLUSION Gluten-free prescribing is in a state of flux, with substantial clinically unwarranted variation between practices and CCGs.
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Affiliation(s)
- Alex J Walker
- EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Helen J Curtis
- EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seb Bacon
- EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Ben Goldacre
- EBM DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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16
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Curtis HJ, Goldacre B. OpenPrescribing: normalised data and software tool to research trends in English NHS primary care prescribing 1998-2016. BMJ Open 2018; 8:e019921. [PMID: 29476029 PMCID: PMC5855401 DOI: 10.1136/bmjopen-2017-019921] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to compile and normalise England's national prescribing data for 1998-2016 to facilitate research on long-term time trends and create an open-data exploration tool for wider use. DESIGN We compiled data from each individual year's national statistical publications and normalised them by mapping each drug to its current classification within the national formulary where possible. We created a freely accessible, interactive web tool to allow anyone to interact with the processed data. SETTING AND PARTICIPANTS We downloaded all available annual prescription cost analysis datasets, which include cost and quantity for all prescription items dispensed in the community in England. Medical devices and appliances were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES We measured the extent of normalisation of data and aimed to produce a functioning accessible analysis tool. RESULTS All data were imported successfully. 87.5% of drugs were matched exactly on name to the current formulary and a further 6.5% to similar drug names. All drugs in core clinical chapters were reconciled to their current location in the data schema, with only 1.26% of drugs not assigned a current chemical code. We created an openly accessible interactive tool to facilitate wider use of these data. CONCLUSIONS Publicly available data can be made accessible through interactive online tools to help researchers and policy-makers explore time trends in prescribing.
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Affiliation(s)
- Helen J Curtis
- Evidence Based Medicine DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Goldacre
- Evidence Based Medicine DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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17
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Abstract
Information about the performance of diagnostic tests is typically presented in the form of measures of test accuracy such as sensitivity and specificity. These measures may be difficult to translate directly into decisions about patient treatment, for which information presented in the form of probabilities of disease after a positive or a negative test result may be more useful. These probabilities depend on the prevalence of the disease, which is likely to vary between populations. This article aims to clarify the relationship between pre-test (prevalence) and post-test probabilities of disease, and presents two free, online interactive tools to illustrate this relationship. These tools allow probabilities of disease to be compared with decision thresholds above and below which different treatment decisions may be indicated. They are intended to help those involved in communicating information about diagnostic test performance and are likely to be of benefit when teaching these concepts. A substantive example is presented using C reactive protein as a diagnostic marker for bacterial infection in the older adult population. The tools may also be useful for manufacturers of clinical tests in planning product development, for authors of test evaluation studies to improve reporting and for users of test evaluations to facilitate interpretation and application of the results.
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Affiliation(s)
- Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Michael Power
- NIHR Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Sara Graziadio
- NIHR Diagnostic Evidence Co-operative Newcastle, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Simpson
- NIHR Diagnostic Evidence Co-Operative Newcastle, Newcastle University, Newcastle upon Tyne, UK
| | - Joy Allen
- NIHR Diagnostic Evidence Co-Operative Newcastle, Newcastle University, Newcastle upon Tyne, UK
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Gerry S, Birks J, Bonnici T, Watkinson PJ, Kirtley S, Collins GS. Early warning scores for detecting deterioration in adult hospital patients: a systematic review protocol. BMJ Open 2017; 7:e019268. [PMID: 29203508 PMCID: PMC5736035 DOI: 10.1136/bmjopen-2017-019268] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Early warning scores (EWSs) are used extensively to identify patients at risk of deterioration in hospital. Previous systematic reviews suggest that studies which develop EWSs suffer methodological shortcomings and consequently may fail to perform well. The reviews have also identified that few validation studies exist to test whether the scores work in other settings. We will aim to systematically review papers describing the development or validation of EWSs, focusing on methodology, generalisability and reporting. METHODS We will identify studies that describe the development or validation of EWSs for adult hospital inpatients. Each study will be assessed for risk of bias using the Prediction model Risk of Bias ASsessment Tool (PROBAST). Two reviewers will independently extract information. A narrative synthesis and descriptive statistics will be used to answer the main aims of the study which are to assess and critically appraise the methodological quality of the EWS, to describe the predictors included in the EWSs and to describe the reported performance of EWSs in external validation. ETHICS AND DISSEMINATION This systematic review will only investigate published studies and therefore will not directly involve patient data. The review will help to establish whether EWSs are fit for purpose and make recommendations to improve the quality of future research in this area. PROSPERO REGISTRATION NUMBER CRD42017053324.
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Affiliation(s)
- Stephen Gerry
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jacqueline Birks
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Timothy Bonnici
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Peter J Watkinson
- Kadoorie Centre for Critical Care Research and Education, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Shona Kirtley
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
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