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Accordino MK, Lee S, Leu CS, Levin B, Trivedi MS, Crew KD, Kalinsky K, Raghunathan R, Faheem K, Harden E, Taboada A, de Oliveira BD, Larson E, Franks L, Honan E, Law C, Hershman DL. Randomized adaptive selection trial of cryotherapy, compression therapy, and placebo to prevent taxane-induced peripheral neuropathy in patients with breast cancer. Breast Cancer Res Treat 2024; 204:49-59. [PMID: 38060077 PMCID: PMC10840989 DOI: 10.1007/s10549-023-07172-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating adverse effect of taxane therapy. Small non-randomized studies in patients with early-stage breast cancer (ESBC) suggest both cryotherapy and compression therapy may prevent CIPN. It is unknown which is more effective. METHODS We conducted a randomized phase IIB adaptive sequential selection trial of cryotherapy vs. compression therapy vs. placebo ("loose" gloves/socks) during taxane chemotherapy. Participants were randomized in triplets. Garments were worn for 90-120 min, beginning 15 min prior and continuing for 15 min following the infusion. The primary goal was to select the best intervention based on a Levin-Robbins-Leu sequential selection procedure. The primary endpoint was a < 5-point decrease in the Functional Assessment of Cancer Therapy Neurotoxicity (FACT-NTX) at 12 weeks. An arm was eliminated if it had four or more fewer successes than the currently leading arm. Secondary endpoints included intervention adherence and patient-reported comfort/satisfaction. RESULTS Between April 2019 and April 2021, 63 patients were randomized (cryotherapy (20); compression (22); placebo (21)). Most patients (60.3%) were treated with docetaxel. The stopping criterion was met after the 17th triplet (n = 51) was evaluated; success at 12 weeks occurred in 11 (64.7%) on compression therapy, 7 (41.1%) on cryotherapy, and 7 (41.1%) on placebo. Adherence to the intervention was lowest with cryotherapy (35.0%) compared to compression (72.7%) and placebo (76.2%). CONCLUSION Compression therapy was the most effective intervention in this phase IIB selection trial to prevent CIPN and was well tolerated. Compression therapy for the prevention of CIPN should be evaluated in a phase III study. CLINICAL TRIAL REGISTRATION ClinicaTrials.gov Identifier: NCT03873272.
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Affiliation(s)
- Melissa K Accordino
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA.
| | - Shing Lee
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
- Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Cheng Shiun Leu
- Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Bruce Levin
- Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Meghna S Trivedi
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
| | - Katherine D Crew
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
| | - Kevin Kalinsky
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Rohit Raghunathan
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
- Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Khadija Faheem
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
| | - Erik Harden
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
| | - Alessandra Taboada
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
| | | | - Elisabeth Larson
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
| | - Lauren Franks
- Department of Biostatistics, Columbia University Medical Center, New York, NY, USA
| | - Erin Honan
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
| | - Cynthia Law
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
| | - Dawn L Hershman
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Ft Washington Ave #1071, New York, NY, 212-305-1945, USA
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Irvine MK, Abdelqader F, Levin B, Thomas J, Avoundjian T, Peterson M, Zimba R, Braunstein SL, Robertson MM, Nash D. Study protocol for data to suppression (D2S): a cluster-randomised, stepped-wedge effectiveness trial of a reporting and capacity-building intervention to improve HIV viral suppression in housing and behavioural health programmes in New York City. BMJ Open 2023; 13:e076716. [PMID: 37451738 PMCID: PMC10351323 DOI: 10.1136/bmjopen-2023-076716] [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: 07/18/2023] Open
Abstract
INTRODUCTION With progress in the 'diagnose', 'link' and 'retain' stages of the HIV care continuum, viral suppression (VS) gains increasingly hinge on antiretroviral adherence among people with HIV (PWH) retained in care. The Centers for Disease Control and Prevention estimate that unsuppressed viral load among PWH in care accounts for 20% of onward transmission. HIV intervention strategies include 'data to care' (D2C)-using surveillance to identify out-of-care PWH for follow-up. However, most D2C efforts target care linkage, not antiretroviral adherence, and limit client-level data sharing to medical (versus support-service) providers. Drawing on lessons learnt in D2C and successful local pilots, we designed a 'data-to-suppression' intervention that offers HIV support-service programmes surveillance-based reports listing their virally unsuppressed clients and capacity-building assistance for quality-improvement activities. We aimed to scale and test the intervention in agencies delivering Ryan White HIV/AIDS Programme-funded behavioural health and housing services. METHODS AND ANALYSIS To estimate intervention effects, this study applies a cross-sectional, stepped-wedge design to the intervention's rollout to 27 agencies randomised within matched pairs to early or delayed implementation. Data from three 12-month periods (pre-implementation, partial implementation and full implementation) will be examined to assess intervention effects on timely VS (within 6 months of a report listing the client as needing follow-up for VS). Based on projected enrolment (n=1619) and a pre-implementation outcome probability of 0.40-0.45, the detectable effect size with 80% power is an OR of 2.12 (relative risk: 1.41-1.46). ETHICS AND DISSEMINATION This study was approved by the New York City Department of Health and Mental Hygiene's institutional review board (protocol: 21-036) with a waiver of informed consent. Findings will be disseminated via publications, conferences and meetings including provider-agency representatives. TRIAL REGISTRATION NUMBER NCT05140421.
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Affiliation(s)
- Mary K Irvine
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Faisal Abdelqader
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Jacinthe Thomas
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Tigran Avoundjian
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Meghan Peterson
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - Rebecca Zimba
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
| | - Sarah L Braunstein
- Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene, New York City, New York, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
- Department of Epidemiology and Biostatistics, City University of New York, New York City, New York, USA
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Irvine MK, Levin B, Abdelqader F, Carmona J, Avoundjian T, Thomas J, Braunstein SL, Robertson M, Nash D. Evaluation of the Revised Versus Original Ryan White Part A HIV Care Coordination Program in a Cluster-Randomized, Stepped-Wedge Trial. J Acquir Immune Defic Syndr 2023; 92:325-333. [PMID: 36729538 PMCID: PMC9936966 DOI: 10.1097/qai.0000000000003139] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND To address challenges with delivery of an evidence-based HIV care coordination program (CCP), the New York City Health Department initiated a CCP redesign. We conducted a site-randomized stepped-wedge trial to evaluate effectiveness of the revised versus the original model. SETTING The CCP is delivered in New York City hospitals, community health centers, and community-based organizations to people experiencing or at risk for poor HIV outcomes. METHODS The outcome, timely viral suppression (TVS), was defined as achievement of viral load <200 copies/mL within 4 months among enrollees with unsuppressed viral load (≥200 copies/mL). Seventeen original-CCP provider agencies were randomized within matched pairs to early (August 2018) or delayed (May 2019) starts of revised-model implementation. Data from 3 periods were examined to compare revised versus original CCP effects on TVS. The primary analysis of the intervention effect applied fully conditional maximum likelihood estimation together with an exact, conditional P -value and an exact test-based 95% CI. We assigned each trial enrollee the implementation level of their site (based on a three-component measure) and tested for association with TVS, adjusting for period and study arm. RESULTS Over 3 nine-month periods, 960 individuals were eligible for trial inclusion (intention to treat). The odds ratio of TVS versus no TVS comparing revised with original CCP was 0.88 (95% CI: 0.45, 1.7). Thus, the revised program yielded slightly lower TVS, although the effect was statistically nonsignificant. TVS was not significantly associated with revised-CCP implementation level. CONCLUSION Program revisions did not increase TVS, irrespective of the implementation level.
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Affiliation(s)
- Mary K. Irvine
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health (MSPH), Columbia University (CU); New York, NY; and
| | - Faisal Abdelqader
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Jennifer Carmona
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Tigran Avoundjian
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Jacinthe Thomas
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - Sarah L. Braunstein
- Bureau of Hepatitis, HIV and Sexually Transmitted Infections (BHHS), New York City Department of Health and Mental Hygiene (DOHMH); New York, NY
| | - McKaylee Robertson
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), Graduate School of Public Health and Health Policy, City University of New York (CUNY); New York, NY
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Levy G, Levin B, Engelhardt E. Advancing the Genetics of Lewy Body Disorders with Disease-Modifying Treatments in Mind. Adv Genet (Hoboken) 2022; 3:2200011. [PMID: 36911298 PMCID: PMC9993470 DOI: 10.1002/ggn2.202200011] [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: 02/09/2022] [Revised: 07/13/2022] [Indexed: 11/06/2022]
Abstract
In this article, a caveat for advancing the genetics of Lewy body disorders is raised, given the nosological controversy about whether to consider dementia with Lewy bodies (DLB) and Parkinson's disease (PD) as one entity or two separate entities. Using the framework of the sufficient and component causes model of causation, as further developed into an evolution-based model of causation, it is proposed that a disease of complex etiology is defined as having a relatively high degree of sharing of the component causes (a genetic or environmental factor), that is, a low degree of heterogeneity of the sufficient causes. Based on this definition, only if the sharing of component causes within each of two diseases is similar to their combined sharing can lumping be warranted. However, it is not known whether the separate and combined sharing are similar before conducting the etiologic studies. This means that lumping DLB and PD can be counterproductive as it can decrease the ability to detect component causes despite the potential benefit of conducting studies with larger sample sizes. In turn, this is relevant to the development of disease-modifying treatments, because non-overlapping causal genetic factors may result in distinct pathogenetic pathways providing promising targets for interventions.
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Affiliation(s)
| | - Bruce Levin
- Department of BiostatisticsMailman School of Public HealthColumbia UniversityNew York10032USA
| | - Eliasz Engelhardt
- Instituto de Neurologia Deolindo Couto and Instituto de PsiquiatriaUniversidade Federal do Rio de JaneiroRio de Janeiro22290‐140Brazil
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Levin B, Leu CS. Proof of a Key Inequality for Lattice Event Probabilities with Equal Odds. Seq Anal 2022. [DOI: 10.1080/07474946.2022.2129689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bruce Levin
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University, New York, New York, USA
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Levy G, Levin B, Engelhardt E. Echoes of William Gowers's concept of abiotrophy. J Hist Neurosci 2022; 31:425-449. [PMID: 34905460 DOI: 10.1080/0964704x.2021.1989649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Among William Gowers's many contributions to neurology, the concept of abiotrophy ("an essential failure of vitality") has been relatively overlooked. In this article, we review the echoes of Gowers's concept in neurology, ophthalmology, and aging research. We also argue that abiotrophy is broader than both heredodegeneration and neurodegeneration. Unlike the common view that it simply means premature aging, abiotrophy currently can be understood as a progressive degenerative process of a mature specialized tissue, which is nonsynchronous with normal aging and may affect organs or systems early in life, resulting from the age-dependent effects of genetic mutations or variants, even if environmental factors may also causally contribute to the process. Although the term has largely fallen out of use, there are likely to be everlasting echoes of Gowers's concept, through which he is to be considered a source of the modern thinking about the etiology and nosology of neurological diseases.
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Affiliation(s)
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Eliasz Engelhardt
- Instituto de Neurologia Deolindo Couto and Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Levy G, Levin B. An Evolution-Based Model of Causation for Aging-Related Diseases and Intrinsic Mortality: Explanatory Properties and Implications for Healthy Aging. Front Public Health 2022; 10:774668. [PMID: 35252084 PMCID: PMC8894190 DOI: 10.3389/fpubh.2022.774668] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/10/2022] [Indexed: 01/07/2023] Open
Abstract
Aging-related diseases are the most prevalent diseases in advanced countries nowadays, accounting for a substantial proportion of mortality. We describe the explanatory properties of an evolution-based model of causation (EBMC) applicable to aging-related diseases and intrinsic mortality. The EBMC takes the sufficient and component causes model of causation as a starting point and develops it using evolutionary and statistical theories. Genetic component causes are classified as “early-onset” or “late-onset” and environmental component causes as “evolutionarily conserved” or “evolutionarily recent.” Genetic and environmental component causes are considered to occur as random events following time-to-event distributions, and sufficient causes are classified according to whether or not their time-to-event distributions are “molded” by the declining force of natural selection with increasing age. We obtain for each of these two groups different time-to-event distributions for disease incidence or intrinsic mortality asymptotically (i.e., for a large number of sufficient causes). The EBMC provides explanations for observations about aging-related diseases concerning the penetrance of genetic risk variants, the age of onset of monogenic vs. sporadic forms, the meaning of “age as a risk factor,” the relation between frequency and age of onset, and the emergence of diseases associated with the modern Western lifestyle. The EBMC also provides an explanation of the Gompertz mortality model at the fundamental level of genetic causes and involving evolutionary biology. Implications for healthy aging are examined under the scenarios of health promotion and postponed aging. Most importantly from a public health standpoint, the EBMC implies that primary prevention through changes in lifestyle and reduction of environmental exposures is paramount in promoting healthy aging.
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Affiliation(s)
- Gilberto Levy
- Independent Researcher, Rio de Janeiro, Brazil
- *Correspondence: Gilberto Levy
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
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Levin B, Leu CS. A key inequality for lower bound formulas for lattice event probabilities. Seq Anal 2022. [DOI: 10.1080/07474946.2021.2010417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Bruce Levin
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University, New York, New York, USA
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Kline J, Vardarajan B, Abhyankar A, Kytömaa S, Levin B, Sobreira N, Tang A, Thomas-Wilson A, Zhang R, Jobanputra V. Embryonic lethal genetic variants and chromosomally normal pregnancy loss. Fertil Steril 2021; 116:1351-1358. [PMID: 34756330 DOI: 10.1016/j.fertnstert.2021.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine whether rare damaging genetic variants are associated with chromosomally normal pregnancy loss and estimate the magnitude of the association. DESIGN Case-control. SETTING Cases were derived from a consecutive series of karyotyped losses at one New Jersey hospital. Controls were derived from the National Database for Autism Research. PATIENT(S) Cases comprised 19 chromosomally normal loss conceptus-parent trios. Controls comprised 547 unaffected siblings of autism case-parent trios. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The rate of damaging variants in the exome (loss of function and missense-damaging) and the proportions of probands with at least one such variant among cases vs. controls. RESULTS The proportions of probands with at least one rare damaging variant were 36.8% among cases and 22.9% among controls (odds ratio, 2.0; 99% confidence interval, 0.5-7.3). No case had a variant in a known fetal anomaly gene. The proportion with variants in possibly embryonic lethal genes increased in case probands (odds ratio, 14.5; 99% confidence interval, 1.5-89.7); variants occurred in BAZ1A, FBN2, and TIMP2. CONCLUSION(S) Rare genetic variants in the conceptus may be a cause of chromosomally normal pregnancy loss. A larger sample is needed to estimate the magnitude of the association with precision and identify relevant biologic pathways.
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Affiliation(s)
- Jennie Kline
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; Gertrude H. Sergievsky Center, Columbia University, New York, New York.
| | - Badri Vardarajan
- Gertrude H. Sergievsky Center, Columbia University, New York, New York
| | | | - Sonja Kytömaa
- Boston University School of Medicine, Boston, Massachusetts
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Andrew Tang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Ruiwei Zhang
- Life Sciences Practice, Charles River Associates, New York, New York
| | - Vaidehi Jobanputra
- Department of Pathology and Cell Biology, Columbia University, New York, New York; New York Genome Center, New York, New York
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Bray R, Palma AM, Philip NM, Brown K, Levin B, Thompson JLP(S, Ginindza C, Mulenga LB. Is Interview Length Associated With Blood Test Participation? Evidence From Three Population-Based HIV Impact Assessment Surveys Conducted From 2016 to 2017. J Acquir Immune Defic Syndr 2021; 87:S57-S66. [PMID: 34166313 PMCID: PMC10982955 DOI: 10.1097/qai.0000000000002705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND High response rates in surveys are critical to ensuring that findings are unbiased and representative of the target population. Questionnaire length affects response rates, with long interviews associated with partially complete surveys, higher item nonresponse ("don't know" and "refuse" responses), and willingness to participate in future surveys. Our aim is to determine the impact of questionnaire length on blood test participation in population-based HIV surveys. METHODS Data are from population-based HIV impact assessments conducted in Zambia, Eswatini, and Lesotho in 2016-2017. The population-based HIV impact assessments consist of an interview followed by a blood draw. Consent for blood draw was obtained before the interview in Eswatini and after the interview in Zambia and Lesotho. Interview length was measured by the survey tablet as the time to complete the survey (interview duration) and the number of questions answered by the participant (questionnaire length). We assessed the effects of questionnaire length and interview duration on blood test participation using logistic regression. RESULTS Across all 3 surveys, the median interview duration was 16 minutes and the median number of questions was 77. In adjusted analyses, there was a negative impact of interview duration on blood draw consent for individuals with unknown status in Lesotho and a positive relationship between questionnaire length and blood draw consent in Zambia for those with HIV-negative and unknown status. CONCLUSION Although interview length is an important consideration to reduce respondent burden, a longer questionnaire does not necessarily result in lower consent rates for blood testing.
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Affiliation(s)
| | - Anton M. Palma
- ICAP at Columbia University, New York, NY
- UC Irvine, Institute for Clinical and Translational Science (ICTS), Irvine, CA
| | | | - Kristin Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bruce Levin
- Department of Biostatistics, Columbia University, New York, NY
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Chaudhry W, Lee E, Worthy A, Weiss Z, Grabowicz M, Vega N, Levin B. Mucoidy, a general mechanism for maintaining lytic phage in populations of bacteria. FEMS Microbiol Ecol 2021; 96:5897354. [PMID: 32845324 PMCID: PMC7532286 DOI: 10.1093/femsec/fiaa162] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022] Open
Abstract
We present evidence that phage resistance resulting from overproduction of exopolysaccharides, mucoidy, provides a general answer to the longstanding question of how lytic viruses are maintained in populations dominated by bacteria upon which they cannot replicate. In serial transfer culture, populations of mucoid Escherichia coli MG1655 that are resistant to lytic phages with different receptors, and thereby requiring independent mutations for surface resistance, are capable of maintaining these phages with little effect on their total density. Based on the results of our analysis of a mathematical model, we postulate that the maintenance of phage in populations dominated by mucoid cells can be attributed primarily to high rates of transition from the resistant mucoid states to susceptible non-mucoid states. Our tests with both population dynamic and single cell experiments as well as genomic analysis are consistent with this hypothesis. We discuss reasons for the generalized resistance of these mucoid E. coli, and the genetic and molecular mechanisms responsible for the high rate of transition from mucoid to sensitive states responsible for the maintenance of lytic phage in mucoid populations of E. coli.
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Affiliation(s)
- Waqas Chaudhry
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Esther Lee
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Andrew Worthy
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Zoe Weiss
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Marcin Grabowicz
- Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA 30322, USA.,Department of Microbiology & Immunology, Emory University School of Medicine, Atlanta, GA 30322, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Nicole Vega
- Department of Biology, Emory University, Atlanta, GA 30322, USA
| | - Bruce Levin
- Department of Biology, Emory University, Atlanta, GA 30322, USA.,Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA 30322, USA
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Levin B, Leu CS. Positivity of cumulative sums for multi-index function components explains the lower bound formula in the Levin-Robbins-Leu family of sequential subset selection procedures. Seq Anal 2021. [DOI: 10.1080/07474946.2020.1826792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Bruce Levin
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University, New York, New York, USA
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13
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Crawford N, Levin B, Amber G, Martinez-Tyson D, Huntington-Symons M, Masys A. Dementia Caregivers Perspectives of Caregiving, Burden, Emergencies, and Emergency Preparedness. Innov Aging 2020. [PMCID: PMC7741190 DOI: 10.1093/geroni/igaa057.3337] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Limited research has been conducted regarding the perspectives of caregivers of persons with dementia (PWD) regarding preparing for emergencies. The purpose of this study was to understand dementia caregivers’ perceptions of burden, emergencies, and emergency preparedness through the caregiving lens. Fourteen semi-structured interviews were conducted with a purposive sample of dementia caregivers who reside in Hillsborough County, Florida, to gain participants’ perspectives. Data were analyzed using the thematic analysis method. Caregivers discussed emergencies in terms of medical issues, mostly related to the PWD’s health, as well as natural disasters such as hurricanes. Caregivers discussed their perspectives of caregiving and burden as centered around their roles and experiences with the PWD, including ways in which they would deal with emergencies such as natural disasters. Caregivers reported that they were physically prepared for emergencies (i.e., hurricanes) but not mentally prepared for coping with or helping their loved ones cope with the stress of an emergency related event. The interviews presented opportunities to raise awareness of emergency preparedness resources and provide information specific to each caregivers’ situation. The results suggest the caregiver role may be essential to mitigating the adverse effects of emergencies on PWDs. Recommendations for practice include providing person-centered care, individualized emergency planning, and interprofessional collaboration.
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Affiliation(s)
| | - Bruce Levin
- University of South Florida, Tampa, Florida, United States
| | - Gum Amber
- University of South Florida, Tampa, Florida, United States
| | | | | | - Anthony Masys
- University of South Florida, Tampa, Florida, United States
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14
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Lee TC, Qian M, Liu Y, Graham S, Mann DL, Nakanishi K, Teerlink JR, Lip GYH, Freudenberger RS, Sacco RL, Mohr JP, Labovitz AJ, Ponikowski P, Lok DJ, Matsumoto K, Estol C, Anker SD, Pullicino PM, Buchsbaum R, Levin B, Thompson JLP, Homma S, Di Tullio MR. Cognitive Decline Over Time in Patients With Systolic Heart Failure: Insights From WARCEF. JACC Heart Fail 2020; 7:1042-1053. [PMID: 31779926 DOI: 10.1016/j.jchf.2019.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/28/2019] [Accepted: 09/10/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to characterize cognitive decline (CD) over time and its predictors in patients with systolic heart failure (HF). BACKGROUND Despite the high prevalence of CD and its impact on mortality, predictors of CD in HF have not been established. METHODS This study investigated CD in the WARCEF (Warfarin versus Aspirin in Reduced Ejection Fraction) trial, which performed yearly Mini-Mental State Examinations (MMSE) (higher scores indicate better cognitive function; e.g., normal score: 24 or higher). A longitudinal time-varying analysis was performed among pertinent covariates, including baseline MMSE and MMSE scores during follow-up, analyzed both as a continuous variable and a 2-point decrease. To account for a loss to follow-up, data at the baseline and at the 12-month visit were analyzed separately (sensitivity analysis). RESULTS A total of 1,846 patients were included. In linear regression, MMSE decrease was independently associated with higher baseline MMSE score (p < 0.0001), older age (p < 0.0001), nonwhite race/ethnicity (p < 0.0001), and lower education (p < 0.0001). In logistic regression, CD was independently associated with higher baseline MMSE scores (odds ratio [OR]: 1.13; 95% confidence interval [CI]: 1.07 to 1.20]; p < 0.001), older age (OR: 1.37; 95% CI: 1.24 to 1.50; p < 0.001), nonwhite race/ethnicity (OR: 2.32; 95% CI: 1.72 to 3.13 for black; OR: 1.94; 95% CI: 1.40 to 2.69 for Hispanic vs. white; p < 0.001), lower education (p < 0.001), and New York Heart Association functional class II or higher (p = 0.03). Warfarin and other medications were not associated with CD. Similar trends were seen in the sensitivity analysis (n = 1,439). CONCLUSIONS CD in HF is predicted by baseline cognitive status, demographic variables, and NYHA functional class. The possibility of intervening on some of its predictors suggests the need for the frequent assessment of cognitive function in patients with HF. (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction [WARCEF]; NCT00041938).
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Affiliation(s)
- Tetz C Lee
- Columbia University Medical Center, New York, NY
| | - Min Qian
- Columbia University Medical Center, New York, NY
| | - Yutong Liu
- Columbia University Medical Center, New York, NY
| | - Susan Graham
- Department of Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Douglas L Mann
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Ralph L Sacco
- Department of Neurology, University of Miami, Miami, Florida
| | - Jay P Mohr
- Columbia University Medical Center, New York, NY
| | | | | | - Dirk J Lok
- Deventer Hospital, Deventer, the Netherlands
| | | | - Conrado Estol
- Stroke Unit, Sanatorio Guemes, Buenos Aires, Argentina
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology, and Berlin-Brandenburg Center for Regenerative Therapies, Deutsches Zentrum für Herz-Kreislauf-Forschung partner site Berlin; Charité Universitätsmedizin Berlin, Germany; Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
| | | | | | - Bruce Levin
- Columbia University Medical Center, New York, NY
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15
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Levy G, Levin B, Engelhardt E. The Nosology of Lewy Body Disorders From Analytic-Epidemiologic and Statistical Vantage Points. Mov Disord 2020; 35:2156-2161. [PMID: 32936973 DOI: 10.1002/mds.28288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Eliasz Engelhardt
- Behavioral and Cognitive Neurology Unit, Neurological Institute, Center for Alzheimer's Disease, Psychiatric Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Irvine MK, Levin B, Robertson MM, Penrose K, Carmona J, Harriman G, Braunstein SL, Nash D. PROMISE (Program Refinements to Optimize Model Impact and Scalability based on Evidence): a cluster-randomised, stepped-wedge trial assessing effectiveness of the revised versus original Ryan White Part A HIV Care Coordination Programme for patients with barriers to treatment in the USA. BMJ Open 2020; 10:e034624. [PMID: 32718922 PMCID: PMC7389516 DOI: 10.1136/bmjopen-2019-034624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/29/2022] Open
Abstract
INTRODUCTION Growing evidence supports combining social, behavioural and biomedical strategies to strengthen the HIV care continuum. However, combination interventions can be resource-intensive and challenging to scale up. Research is needed to identify intervention components and delivery models that maximise uptake, engagement and effectiveness. In New York City (NYC), a multicomponent Ryan White Part A-funded medical case management intervention called the Care Coordination Programme (CCP) was launched at 28 agencies in 2009 in order to address barriers to care and treatment. Effectiveness estimates based on >7000 clients enrolled by April 2013 and their controls indicated modest CCP benefits over 'usual care' for short-term and long-term viral suppression, with substantial room for improvement. METHODS AND ANALYSIS Integrating evaluation findings and CCP service-provider and community-stakeholder input on modifications, the NYC Health Department packaged a Care Coordination Redesign (CCR) in a 2017 request for proposals. Following competitive re-solicitation, 17 of the original CCP-implementing agencies secured contracts. These agencies were randomised within matched pairs to immediate or delayed CCR implementation. Data from three 9-month periods (pre-implementation, partial implementation and full implementation) will be examined to compare CCR versus CCP effects on timely viral suppression (TVS, within 4 months of enrolment) among individuals with unsuppressed HIV viral load newly enrolling in the CCR/CCP. Based on current enrolment (n=933) and the pre-implementation outcome probability (TVS=0.54), the detectable effect size with 80% power is an OR of 2.75 (relative risk: 1.41). ETHICS AND DISSEMINATION This study was approved by the NYC Department of Health and Mental Hygiene Institutional Review Board (IRB, Protocol 18-009) and the City University of New York Integrated IRB (Protocol 018-0057) with a waiver of informed consent. Findings will be disseminated via publications, conferences, stakeholder meetings, and Advisory Board meetings with implementing agency representatives. TRIAL REGISTRATION NUMBER Registered with ClinicalTrials.gov under identifier: NCT03628287, V.2, 25 September 2019; pre-results.
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Affiliation(s)
- Mary K Irvine
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health (MSPH), Columbia University, New York, New York, USA
| | - McKaylee M Robertson
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Katherine Penrose
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jennifer Carmona
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Graham Harriman
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Sarah L Braunstein
- Bureau of HIV, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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17
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Chiriboga CA, Marra J, LaMarca NM, Young SD, Weimer LH, Levin B, McCabe B. Lack of effect on ambulation of dalfampridine-ER (4-AP) treatment in adult SMA patients. Neuromuscul Disord 2020; 30:693-700. [PMID: 32788051 DOI: 10.1016/j.nmd.2020.07.007] [Citation(s) in RCA: 8] [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] [Received: 10/17/2019] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
SMA is a genetically determined motor system disorder that results in muscle weakness, selective motor neuron death, muscle atrophy, and impaired functional mobility. In SMA model systems, long-term treatment with 4-aminopyridine (4-AP) has been shown to improve motor function. To assess tolerability and preliminary efficacy of 4-AP on walking ability, endurance and EMG in adult ambulatory SMA patients, we conducted a double blind, placebo control, crossover pilot study with dalfampridine (4-AP, 10 mg BID). The study is comprised of a short-term (2 weeks) treatment arm with 1-week washout and a long-term (6 weeks) treatment arm with a 2-week washout. The primary outcome measure, for which the study was powered, was the 6 min walk test (6MWT, distance and percent fatigue); secondary outcome measures were the Hammersmith Functional Motor Scale Expanded (HFMSE), Manual Muscle Testing (MMT), Myometry with Hand held Dynamometry, HHD) and Quantitative Gait Analyses. We performed electrophysiology, including CMAP and H-reflex, during the short-term treatment trial. The mean age of the 11 participants enrolled was 37.7 ± 11.9 years; 54.5% were male. Dalfampridine was safe and well tolerated and no patient suffered a serious adverse event related to treatment. We observed no statistically significant positive effects of dalfampridine treatment on our primary functional motor outcome (6MWT distance, fatigue). Dalfampridine had a positive effects on H-reflex and H/M ratio but not on CMAP amplitude. The effect on the H-reflex is of interest, as it suggests dalfampridine may enhance neuronal activity, an effect observed in SMA Drosophila and mouse models at doses (mg/kg) not recommended for clinical use. Larger studies with dalfampridine in SMA patients are needed to confirm our findings, especially in light of studies in other populations showing drug effects in only a subset of patients.
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Affiliation(s)
- Claudia A Chiriboga
- Division of Child Neurology, Department of Neurology, Columbia College of Physicians and Surgeons, Columbia University Medical Center, 180 Fort Washington Avenue # 552, New York, NY 10032-3791, United States.
| | - Jonathan Marra
- Division of Child Neurology, Department of Neurology, Columbia College of Physicians and Surgeons, Columbia University Medical Center, 180 Fort Washington Avenue # 552, New York, NY 10032-3791, United States
| | - Nicole M LaMarca
- Division of Child Neurology, Department of Neurology, Columbia College of Physicians and Surgeons, Columbia University Medical Center, 180 Fort Washington Avenue # 552, New York, NY 10032-3791, United States
| | | | - Louis H Weimer
- Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY, United States
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brian McCabe
- Brain Mind Institute, EPFL, Lausanne, Switzerland
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18
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19
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Spivack J, Cheng B, Levin B. Adding dose modifications into Phase II and Phase II/III seamless trials. Stat Methods Med Res 2020; 29:1315-1324. [PMID: 31267845 DOI: 10.1177/0962280219859387] [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: 11/16/2022]
Abstract
We present a technique for adding dose modifications into seamless Phase II and Phase II/III trials featuring dose selection at an interim analysis. The method is convenient to apply and can be used either in a fully prespecified, structured way or as a response to new considerations that emerge at interim. Strong control of the familywise error rate regarding false declarations of efficacy versus control is maintained. Two examples are given. One illustrates how the method could potentially "save" a trial performed in a Phase II context. The other is a seamless Phase II/III trial that uses an adaptive exploration strategy for an assumed nonmonotonic dose-response curve. It can result in greatly improved efficiency over a standard "promote the winner" rule.
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Affiliation(s)
- John Spivack
- Department of Environmental Medicine and Public Health, Mount Sinai Medical Center, New York, NY, USA
| | - Bin Cheng
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - Bruce Levin
- Department of Biostatistics, Columbia University, New York, NY, USA
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20
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Robertson MM, Penrose K, Nash D, Harriman G, Braunstein SL, Levin B, Irvine MK. Impact of an HIV Care Coordination Program on the Timeliness of Viral Suppression and Immune Recovery Among Clients Newly Diagnosed with HIV. AIDS Behav 2020; 24:1237-1242. [PMID: 31728695 DOI: 10.1007/s10461-019-02732-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We compared the time to immune recovery and viral suppression (VS) among people newly diagnosed with HIV who enrolled in the HIV Care Coordination Program (CCP), a comprehensive medical case management program, with a propensity matched group of newly diagnosed people who did not enroll. CCP enrollees had more rapid VS (≤ 200 copies/mL) [hazards ratio (HR) 1.17; 95% confidence interval 1.02-1.34] but no more rapid immune recovery (≥ two successive CD4 counts > 500 cells/mm3) (HR 0.98; 0.84-1.13). Relative to usual care, the CCP may expedite VS (though not immune recovery) for newly diagnosed HIV patients and therefore lower forward transmission risk.
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Affiliation(s)
- McKaylee M Robertson
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), 55 W. 125th St, New York City, NY, 10027, USA.
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, NY, USA.
| | - Kate Penrose
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), 55 W. 125th St, New York City, NY, 10027, USA
- Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York City, NY, USA
| | - Graham Harriman
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Sarah L Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mary K Irvine
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York City, NY, USA
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21
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Levin B, Kuhn L, Leu CS, Tsai WY. Sequential tests of promise with discrete time-to-event data. Contemp Clin Trials 2019; 85:105818. [PMID: 31445172 DOI: 10.1016/j.cct.2019.105818] [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: 04/16/2019] [Revised: 07/25/2019] [Accepted: 08/04/2019] [Indexed: 11/24/2022]
Abstract
We introduce a family of sequential test procedures in the context of a futility study design, or as we prefer to call it, a formal test of promise, suitable for use with time-to-event data. The procedures are motivated by an actual trial that was undertaken to test the promise of very early antiretroviral therapy to achieve viral remission in infants with perinatally-acquired HIV. Important gains in efficiency are illustrated in terms of early stopping and statistical power compared with other methods such as Simon's two-stage design with binary outcomes. We show how to calculate the operating characteristics of the proposed sequential tests of promise and provide optimal or near-optimal boundaries for small or medium size samples which provide the typical context for the tests under consideration. The design features discussed in this article are also of immediate pertinence to trials designed to test disease cures which may require treatment interruption and small numbers of participants.
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Affiliation(s)
- Bruce Levin
- Department of Biostatistics, Columbia University, Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, USA.
| | - Louise Kuhn
- Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, USA.
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia University, Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, USA.
| | - Wei-Yann Tsai
- Department of Biostatistics, Columbia University, Mailman School of Public Health, 722 West 168(th) Street, New York, NY 10032, USA.
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22
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Domínguez-González C, Madruga-Garrido M, Mavillard F, Garone C, Aguirre-Rodríguez FJ, Donati MA, Kleinsteuber K, Martí I, Martín-Hernández E, Morealejo-Aycinena JP, Munell F, Nascimento A, Kalko SG, Sardina MD, Álvarez Del Vayo C, Serrano O, Long Y, Tu Y, Levin B, Thompson JLP, Engelstad K, Uddin J, Torres-Torronteras J, Jimenez-Mallebrera C, Martí R, Paradas C, Hirano M. Deoxynucleoside Therapy for Thymidine Kinase 2-Deficient Myopathy. Ann Neurol 2019; 86:293-303. [PMID: 31125140 DOI: 10.1002/ana.25506] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Thymidine kinase 2, encoded by the nuclear gene TK2, is required for mitochondrial DNA maintenance. Autosomal recessive TK2 mutations cause depletion and multiple deletions of mtDNA that manifest predominantly as a myopathy usually beginning in childhood and progressing relentlessly. We investigated the safety and efficacy of deoxynucleoside monophosphate and deoxynucleoside therapies. METHODS We administered deoxynucleoside monophosphates and deoxynucleoside to 16 TK2-deficient patients under a compassionate use program. RESULTS In 5 patients with early onset and severe disease, survival and motor functions were better than historically untreated patients. In 11 childhood and adult onset patients, clinical measures stabilized or improved. Three of 8 patients who were nonambulatory at baseline gained the ability to walk on therapy; 4 of 5 patients who required enteric nutrition were able to discontinue feeding tube use; and 1 of 9 patients who required mechanical ventilation became able to breathe independently. In motor functional scales, improvements were observed in the 6-minute walk test performance in 7 of 8 subjects, Egen Klassifikation in 2 of 3, and North Star Ambulatory Assessment in all 5 tested. Baseline elevated serum growth differentiation factor 15 levels decreased with treatment in all 7 patients tested. A side effect observed in 8 of the 16 patients was dose-dependent diarrhea, which did not require withdrawal of treatment. Among 12 other TK2 patients treated with deoxynucleoside, 2 adults developed elevated liver enzymes that normalized following discontinuation of therapy. INTERPRETATION This open-label study indicates favorable side effect profiles and clinical efficacy of deoxynucleoside monophosphate and deoxynucleoside therapies for TK2 deficiency. ANN NEUROL 2019;86:293-303.
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Affiliation(s)
- Cristina Domínguez-González
- Neuromuscular Disorders Unit, Neurology Department, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación i + 12, Hospital 12 de Octubre, Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Marcos Madruga-Garrido
- Neuromuscular Disorders Unit, Pediatric Neurology Department, Instituto de Biomedicina de Sevilla, Hospital U. Virgen del Rocío, Consejo Superior de Investigaciones Científicas, University of Seville, Seville, Spain
| | - Fabiola Mavillard
- Neuromuscular Disorders Unit, Neurology Department, Instituto de Biomedicina de Sevilla, Hospital U. Virgen del Rocío, Consejo Superior de Investigaciones Científicas, University of Seville, Seville, Spain.,Center for Biomedical Network Research on Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Caterina Garone
- Medical Research Council Mitochondrial Biology Unit, Cambridge Biomedical Campus, Cambridge, UK
| | | | - M Alice Donati
- Metabolic and Neuromuscular Unit, Meyer Hospital, Florence, Italy
| | - Karin Kleinsteuber
- Pediatric Neurology Department, Faculty of Medicine, University of Chile, Las Condes Clinic, Santiago, Chile
| | - Itxaso Martí
- Pediatric Neurology Department, Donostia University Hospital, San Sebastian, Spain
| | - Elena Martín-Hernández
- Instituto de Investigación i + 12, Hospital 12 de Octubre, Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Hereditary Metabolic and Mitochondrial Disorders Unit, Pediatric Department, October 12 Hospital, Madrid, Spain
| | | | - Francina Munell
- Pediatric Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Andrés Nascimento
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Neuromuscular Unit, Neurology Department, Sant Joan de Déu Research Institute, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Susana G Kalko
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Neuromuscular Unit, Neurology Department, Sant Joan de Déu Research Institute, Sant Joan de Déu Hospital, Barcelona, Spain
| | - M Dolores Sardina
- Pediatric Neurology Department, Badajoz Hospital Complex, Badajoz, Spain
| | - Concepcion Álvarez Del Vayo
- Center for Biomedical Network Research on Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain.,Pharmacy Department, Virgin of el Rocío University Hospital, Seville, Spain
| | - Olga Serrano
- Pharmacy Department, October 12 Hospital, Madrid, Spain
| | - Yuelin Long
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Yuqi Tu
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - John L P Thompson
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - Kristen Engelstad
- Neurology Department, H. Houston Merritt Center, Columbia University Medical Center, New York, NY
| | - Jasim Uddin
- Neurology Department, H. Houston Merritt Center, Columbia University Medical Center, New York, NY
| | - Javier Torres-Torronteras
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Cecilia Jimenez-Mallebrera
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Neuromuscular Unit, Neurology Department, Sant Joan de Déu Research Institute, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Ramon Martí
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Paradas
- Neuromuscular Disorders Unit, Neurology Department, Instituto de Biomedicina de Sevilla, Hospital U. Virgen del Rocío, Consejo Superior de Investigaciones Científicas, University of Seville, Seville, Spain.,Center for Biomedical Network Research on Neurodegenerative Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - Michio Hirano
- Neurology Department, H. Houston Merritt Center, Columbia University Medical Center, New York, NY
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23
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Lee TC, Qian M, Mu L, Di Tullio MR, Graham S, Mann DL, Nakanishi K, Teerlink JR, Lip GYH, Freudenberger RS, Sacco RL, Mohr JP, Labovitz AJ, Ponikowski P, Lok DJ, Estol C, Anker SD, Pullicino PM, Buchsbaum R, Levin B, Thompson JLP, Homma S, Ye S. Association between mortality and implantable cardioverter-defibrillators by aetiology of heart failure: a propensity-matched analysis of the WARCEF trial. ESC Heart Fail 2019; 6:297-307. [PMID: 30816013 PMCID: PMC6437435 DOI: 10.1002/ehf2.12407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/12/2018] [Indexed: 12/28/2022] Open
Abstract
Aims There is debate on whether the beneficial effect of implantable cardioverter‐defibrillators (ICDs) is attenuated in patients with non‐ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial. Methods and results We performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity‐matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow‐up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all‐cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131). Conclusions The presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.
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Affiliation(s)
- Tetz C Lee
- Columbia University Irving Medical Center, New York, NY, USA
| | - Min Qian
- Columbia University Irving Medical Center, New York, NY, USA
| | - Lan Mu
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Susan Graham
- The State University of New York at Buffalo, Buffalo, NY, USA
| | - Douglas L Mann
- Washington University School of Medicine, St. Louis, MO, USA
| | - Koki Nakanishi
- Columbia University Irving Medical Center, New York, NY, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Jay P Mohr
- Columbia University Irving Medical Center, New York, NY, USA
| | | | | | - Dirk J Lok
- Deventer Hospital, Deventer, The Netherlands
| | - Conrado Estol
- Neurological Center for Treatment and Rehabilitation, Buenos Aires, Argentina
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology; and Berlin-Brandenburg Center for Regenerative Therapies; Deutsches Zentrum für Herz-Kreislauf-Forschung partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
| | | | | | - Bruce Levin
- Columbia University Irving Medical Center, New York, NY, USA
| | | | - Shunichi Homma
- Columbia University Irving Medical Center, New York, NY, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, New York, NY, USA
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Shah A, Holter MM, Rimawi F, Mark V, Dutia R, McGinty J, Levin B, Laferrère B. Insulin Clearance After Oral and Intravenous Glucose Following Gastric Bypass and Gastric Banding Weight Loss. Diabetes Care 2019; 42:311-317. [PMID: 30523032 PMCID: PMC6341286 DOI: 10.2337/dc18-1036] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Hepatic insulin clearance is a significant regulator of glucose homestasis. We hypothesized that the improvement in insulin clearance rates (ICRs) under fasting conditions and in response to oral and intravenous (IV) glucose would improve similarly after Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) as a function of weight loss; the difference in ICR after oral and IV glucose stimulation will be enhanced after RYGB compared with AGB, an effect mediated by glucagon-like peptide 1 (GLP-1). RESEARCH DESIGN AND METHODS In study 1, the ICR was calculated under fasting condition (F-ICR), after oral glucose (O-ICR), and after an isoglycemic IV glucose clamp (IV-ICR) in individuals from an established cohort with type 2 diabetes mellitus (T2DM) before, after 10% matched weight loss, and 1 year after either RYGB (n = 22) or AGB (n = 12). In study 2, O-ICR was studied in a separate cohort of individuals with T2DM (n = 22), before and 3 months after RYGB, with and without exendin(9-39) infusion. RESULTS In study 1, age, BMI, T2DM duration and control, and ICR did not differ between RYGB and AGB preintervention. Weight loss at 1 year was two times greater after RYGB than after AGB (31.6 ± 5.9% vs. 16.6 ± 9.8%; P < 0.05). RYGB and AGB both significantly increased F-ICR, O-ICR, and IV-ICR at 1 year. ICR was inversely associated with insulinemia. The difference between IV-ICR and O-ICR was significantly greater after RYGB versus AGB. GLP-1 antagonism with exendin(9-39) led to an increase in O-ICR in subjects post-RYGB. CONCLUSIONS Weight loss increased ICR, an effect more pronounced after RYGB compared with AGB. Our data support a potential role for endogenous GLP-1 in the control of postprandial ICR after RYGB.
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Affiliation(s)
- Ankit Shah
- Divison of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Marlena M Holter
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Fatima Rimawi
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Victoria Mark
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Roxanne Dutia
- New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - James McGinty
- Bariatric Divsion, Department of Surgery, Mount Sinai St. Luke's, New York, NY
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Blandine Laferrère
- Divison of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY .,New York Obesity Nutrition Research Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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Jackman KB, Dolezal C, Levin B, Honig JC, Bockting WO. Stigma, gender dysphoria, and nonsuicidal self-injury in a community sample of transgender individuals. Psychiatry Res 2018; 269:602-609. [PMID: 30208349 PMCID: PMC6252073 DOI: 10.1016/j.psychres.2018.08.092] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 03/16/2018] [Revised: 07/03/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
We investigated rates of nonsuicidal self-injury (NSSI) and correlates of past-year NSSI among transgender people to better understand factors contributing to this health disparity. A community-based sample of 332 transgender people participated in quantitative in-person interviews. The mean age of participants was 34.56 years (SD = 13.78, range = 16-87). The sample was evenly divided between transfeminine spectrum (50.3%) and transmasculine spectrum identities (49.7%) and was diverse in race/ethnicity. We evaluated associations between sociodemographic characteristics, stigma, hypothesized resilience factors, and identity variables with past-year NSSI. 53.3% of participants reported ever having self-injured in their lifetime. Past-year NSSI was reported by 22.3% of the sample and did not significantly differ based on gender identity. In logistic regression models, past-year NSSI was associated with younger age and felt stigma (perceived or anticipated rejection), but not enacted stigma (actual experiences of discrimination), and with gender dysphoria. Efforts to address the high rates of NSSI among transgender people should aim to reduce felt stigma and gender dysphoria, and promote transgender congruence. Future research using a developmental approach to assess variations in NSSI across the life course and in relation to transgender identity development may illuminate additional processes that affect NSSI in this population.
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Affiliation(s)
- Kasey B Jackman
- School of Nursing, Columbia University, 630 West 168th St., Mail Code 6, New York, NY, USA.
| | - Curtis Dolezal
- New York State Psychiatric Institute/Department of Psychiatry, Columbia University, New York, NY, USA
| | - Bruce Levin
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Judy C Honig
- School of Nursing, Columbia University, 630 West 168th St., Mail Code 6, New York, NY, USA
| | - Walter O Bockting
- School of Nursing, Columbia University, 630 West 168th St., Mail Code 6, New York, NY, USA; New York State Psychiatric Institute/Department of Psychiatry, Columbia University, New York, NY, USA
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26
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Nash D, Robertson MM, Penrose K, Chamberlin S, Robbins RS, Braunstein SL, Myers JE, Abraham B, Kulkarni S, Waldron L, Levin B, Irvine MK. Short-term effectiveness of HIV care coordination among persons with recent HIV diagnosis or history of poor HIV outcomes. PLoS One 2018; 13:e0204017. [PMID: 30248136 PMCID: PMC6152971 DOI: 10.1371/journal.pone.0204017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/31/2018] [Indexed: 11/25/2022] Open
Abstract
The New York City HIV Care Coordination Program (CCP) combines multiple evidence-based strategies to support persons living with HIV (PLWH) at risk for, or with a recent history of, poor HIV outcomes. We assessed the comparative effectiveness of the CCP by merging programmatic data on CCP clients with population-based surveillance data on all New York City PLWH. A non-CCP comparison group of similar PLWH who met CCP eligibility criteria was identified using surveillance data. The CCP and non-CCP groups were matched on propensity for CCP enrollment within four baseline treatment status groups (newly diagnosed or previously diagnosed and either consistently unsuppressed, inconsistently suppressed or consistently suppressed). We compared CCP to non-CCP proportions with viral load suppression at 12-month follow-up. Among the 13,624 persons included, 15∙3% were newly diagnosed; among the 84∙7% previously diagnosed, 14∙2% were consistently suppressed, 28∙9% were inconsistently suppressed, and 41∙6% were consistently unsuppressed in the year prior to baseline. At 12-month follow-up, 59∙9% of CCP and 53∙9% of non-CCP participants had viral load suppression (Relative Risk = 1.11, 95%CI:1.08–1.14). Among those newly diagnosed and those consistently unsuppressed at baseline, the relative risk of viral load suppression in the CCP versus non-CCP participants was 1.15 (95%CI:1.09–1.23) and 1.32 (95%CI:1.23–1.42), respectively. CCP exposure shows benefits over no CCP exposure for persons newly diagnosed or consistently unsuppressed, but not for persons suppressed in the year prior to baseline. We recommend more targeted case finding for CCP enrollment and increased attention to viral load suppression maintenance.
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Affiliation(s)
- Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
- * E-mail:
| | - McKaylee M. Robertson
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Kate Penrose
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Stephanie Chamberlin
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Rebekkah S. Robbins
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Sarah L. Braunstein
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Julie E. Myers
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
- Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY United States of America
| | - Bisrat Abraham
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Levi Waldron
- Institute for Implementation Science in Population Health, City University of New York, New York, NY United States of America
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY United States of America
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY United States of America
| | - Mary K. Irvine
- Bureau of HIV/AIDS, New York City Department of Health and Mental Hygiene, New York, NY United States of America
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27
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Lee TC, Qian M, Lip GY, Di Tullio MR, Graham S, Mann DL, Nakanishi K, Teerlink JR, Freudenberger RS, Sacco RL, Mohr J, Labovitz AJ, Ponikowski P, Lok DJ, Estol C, Anker SD, Pullicino PM, Buchsbaum R, Levin B, Thompson JL, Homma S, Ye S. Heart Failure Severity and Quality of Warfarin Anticoagulation Control (From the WARCEF Trial). Am J Cardiol 2018; 122:821-827. [PMID: 30037426 DOI: 10.1016/j.amjcard.2018.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 01/06/2023]
Abstract
Previous studies in patients with atrial fibrillation showed that a history of heart failure (HF) could negatively impact anticoagulation quality, as measured by the average time in therapeutic range (TTR). Whether additional markers of HF severity are associated with TTR has not been investigated thoroughly. We aimed to examine the potential role of HF severity in the quality of warfarin control in patients with HF with reduced ejection fraction. Data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction Trial were used to investigate the association between TTR and HF severity. Multivariable logistic regression models were used to examine the association of markers of HF severity, including New York Heart Association (NYHA) class, Minnesota Living with HF (MLWHF) score, and frequency of HF hospitalization, with TTR ≥70% (high TTR). We included 1,067 participants (high TTR, N = 413; low TTR, N = 654) in the analysis. In unadjusted analysis, patients with a high TTR were older and less likely to have had strokes or receive other antiplatelet agents. Those patients also had lower NYHA class, better MLWHF scores, greater 6-minute walk distance, and lower frequency of HF hospitalizations. Multivariable analysis showed that NYHA class III and/or IV (Odds ratio [OR] 0.68 [95% confidence intervals [CIs] 0.49 to 0.94]), each 10-point increase in MLWHF score (i.e., worse health-related quality of life) (OR 0.92 [0.86 to 0.99]), and higher number of HF hospitalization per year (OR0.45 [0.30 to 0.67]) were associated with decreased likelihood of having high TTR. In HF patients with systolic dysfunction, NYHA class III and/or IV, poor health-related quality of life, and a higher rate of HF hospitalization were independently associated with suboptimal quality of warfarin anticoagulation control. These results affirm the need to assess the new approaches, such as direct oral anticoagulants, to prevent thromboembolism in this patient population.
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28
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Robertson MM, Waldron L, Robbins RS, Chamberlin S, Penrose K, Levin B, Kulkarni S, Braunstein SL, Irvine MK, Nash D. Using Registry Data to Construct a Comparison Group for Programmatic Effectiveness Evaluation: The New York City HIV Care Coordination Program. Am J Epidemiol 2018; 187:1980-1989. [PMID: 29788080 DOI: 10.1093/aje/kwy103] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 05/02/2018] [Indexed: 12/25/2022] Open
Abstract
Many nonrandomized interventions rely upon a pre-post design to evaluate effectiveness. Such designs cannot account for events external to the intervention that may produce the outcome. We describe a method to construct a surveillance registry-based comparison group, which allows for estimating the effectiveness of the intervention while controlling for secular trends in the outcome of interest. Using data from the population-based, human immunodeficiency virus Surveillance Registry in New York City, we created a contemporaneous comparison group for persons enrolled in the New York City human immunodeficiency virus Care Coordination Program (CCP) from December 2009 to March 2013. Inclusion in the Registry-based (non-CCP) comparison group required meeting CCP eligibility criteria. To control for secular trends in the outcome, we randomly assigned persons in the non-CCP, Registry-based comparison group a pseudoenrollment date such that the distribution of pseudoenrollment dates matched the distribution of enrollment dates among CCP enrollees. We then matched CCP to non-CCP persons on propensity for enrollment in the CCP, enrollment dates, and baseline viral load. Registry-based comparison group estimates were attenuated relative to pre-post estimates of program effectiveness. These methods have broad applicability for observational intervention effectiveness studies and programmatic evaluations for conditions with surveillance registries.
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Affiliation(s)
- McKaylee M Robertson
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Levi Waldron
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Rebekkah S Robbins
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Stephanie Chamberlin
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Kate Penrose
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Sarah Kulkarni
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Sarah L Braunstein
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Mary K Irvine
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
| | - Denis Nash
- Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, New York
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Di Tullio MR, Qian M, Thompson JLP, Labovitz AJ, Mann DL, Sacco RL, Pullicino PM, Freudenberger RS, Teerlink JR, Graham S, Lip GYH, Levin B, Mohr JP, Buchsbaum R, Estol CJ, Lok DJ, Ponikowski P, Anker SD, Homma S. Left atrial volume and cardiovascular outcomes in systolic heart failure: effect of antithrombotic treatment. ESC Heart Fail 2018; 5:800-808. [PMID: 30015405 PMCID: PMC6165930 DOI: 10.1002/ehf2.12331] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 12/27/2017] [Revised: 05/24/2018] [Accepted: 06/14/2018] [Indexed: 01/20/2023] Open
Abstract
AIMS Left atrium (LA) dilation is associated with adverse cardiovascular (CV) outcomes. Blood stasis, thrombus formation and atrial fibrillation may occur, especially in heart failure (HF) patients. It is not known whether preventive antithrombotic treatment may decrease the incidence of CV events in HF patients with LA enlargement. We investigated the relationship between LA enlargement and CV outcomes in HF patients and the effect of different antithrombotic treatments. METHODS AND RESULTS Two-dimensional echocardiography with LA volume index (LAVi) measurement was performed in 1148 patients with systolic HF from the Warfarin versus Aspirin in Reduced Ejection Fraction (WARCEF) trial. Patients were randomized to warfarin or aspirin and followed for 3.4 ± 1.7 years. While the primary aim of the trial was a composite of ischaemic stroke, death, and intracerebral haemorrhage, the present report focuses on the individual CV events, whose incidence was compared across different LAVi and treatment subgroups. After adjustment for demographics and clinical covariates, moderate or severe LA enlargement was significantly associated with total death (hazard ratio 1.6 and 2.7, respectively), CV death (HR 1.7 and 3.3), and HF hospitalization (HR 2.3 and 2.6) but not myocardial infarction (HR 1.0 and 1.4) or ischaemic stroke (1.1 and 1.5). The increased risk was observed in both patients treated with warfarin or aspirin. In warfarin-treated patients, a time in therapeutic range >60% was associated with lower event rates, and an interaction between LAVi and time in therapeutic range was observed for death (P = 0.034). CONCLUSIONS In patients with systolic HF, moderate or severe LA enlargement is associated with death and HF hospitalization despite treatment with antithrombotic medications. The possibility that achieving a more consistent therapeutic level of anticoagulation may decrease the risk of death requires further investigation.
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Affiliation(s)
- Marco R Di Tullio
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | | | | | | | | | | | | | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA, USA
| | - Susan Graham
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Jay P Mohr
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Conrado J Estol
- Centro Neurológico de Tratamiento y Rehabilitación, Buenos Aires, Argentina
| | - Dirk J Lok
- Deventer Hospital, Deventer, The Netherlands
| | | | - Stefan D Anker
- Department of Innovative Clinical Trials, University Medicine Göttingen (UMG), Göttingen, Germany
| | - Shunichi Homma
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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Ravindranath TM, Gomez A, Harwayne-Gidansky I, Connors TJ, Neill N, Levin B, Howell JD, Saiman L, Baird JS. Pediatric acute respiratory distress syndrome associated with human metapneumovirus and respiratory syncytial virus. Pediatr Pulmonol 2018; 53:929-935. [PMID: 29737017 DOI: 10.1002/ppul.24044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/20/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To study the incidence, risk factors, clinical course, and outcome of ARDS in children with HMP and RSV. WORKING HYPOTHESIS We hypothesized that ARDS in children with HMP was similar in incidence, risk factors, clinical course, and outcomes to ARDS in children with RSV. STUDY DESIGN Retrospective, observational study over 2 years. PATIENT-SUBJECT SELECTION Patients included were <18 years old with HMP or RSV detected from nasopharyngeal specimens by commercial reverse transcriptase polymerase chain reaction assay admitted to a study site. METHODOLOGY We described the incidence of ARDS within 1 week following the detection of HMP or RSV using recently developed Pediatric ARDS (PARDS) criteria. We also assessed risk factors, clinical course, and outcomes of children in the PICU with HMP or RSV and PARDS or non-PARDS. RESULTS We identified 57 patients with HMP and 161 patients with RSV: the proportions of patients with either virus who developed PARDS (HMP: 23%, RSV: 20%) and severe PARDS (HMP: 9%, RSV: 7%) were similar, as were the proportions of patients with acute (or acute-on-chronic) respiratory failure who developed PARDS (HMP: 41%, RSV: 31%). In a logistic regression model, risk factors associated with PARDS included neurologic comorbidity and PIM 3 probability of mortality, but not virus type. The risk factors, clinical course, and outcomes were similar for patients with PARDS associated with HMP and RSV. CONCLUSIONS About 1/3 of children with HMP or RSV and acute (or acute-on-chronic) respiratory failure developed PARDS. Children with either virus and a neurologic comorbidity or an increased PIM 3 probability of mortality were at increased risk for PARDS.
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Affiliation(s)
- Thyyar M Ravindranath
- Department of Pediatrics, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Amanda Gomez
- Department of Pediatrics, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Ilana Harwayne-Gidansky
- Department of Pediatrics, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Thomas J Connors
- Department of Pediatrics, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Nathan Neill
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Bruce Levin
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Joy D Howell
- Department of Pediatrics, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
| | - Lisa Saiman
- Department of Pediatrics, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York.,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
| | - John S Baird
- Department of Pediatrics, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, New York
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31
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Teerlink JR, Qian M, Bello NA, Freudenberger RS, Levin B, Di Tullio MR, Graham S, Mann DL, Sacco RL, Mohr JP, Lip GYH, Labovitz AJ, Lee SC, Ponikowski P, Lok DJ, Anker SD, Thompson JLP, Homma S. Aspirin Does Not Increase Heart Failure Events in Heart Failure Patients: From the WARCEF Trial. JACC Heart Fail 2018; 5:603-610. [PMID: 28774396 DOI: 10.1016/j.jchf.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/13/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of this study was to determine whether aspirin increases heart failure (HF) hospitalization or death in patients with HF with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). BACKGROUND Because of its cyclooxygenase inhibiting properties, aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs. However, no large randomized trial has addressed the clinical relevance of this issue. METHODS We compared aspirin and warfarin for HF events (hospitalization, death, or both) in the 2,305 patients enrolled in the WARCEF (Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction) trial (98.6% on ACE inhibitor or ARB treatment), using conventional Cox models for time to first event (489 events). In addition, to examine multiple HF hospitalizations, we used 2 extended Cox models, a conditional model and a total time marginal model, in time to recurrent event analyses (1,078 events). RESULTS After adjustment for baseline covariates, aspirin- and warfarin-treated patients did not differ in time to first HF event (adjusted hazard ratio: 0.87; 95% confidence interval: 0.72 to 1.04; p = 0.117) or first hospitalization alone (adjusted hazard ratio: 0.88; 95% confidence interval: 0.73 to 1.06; p = 0.168). The extended Cox models also found no significant differences in all HF events or in HF hospitalizations alone after adjustment for covariates. CONCLUSIONS Among patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF]; NCT00041938).
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Affiliation(s)
- John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California
| | - Min Qian
- Columbia University Medical Center, New York, New York
| | | | | | - Bruce Levin
- Columbia University Medical Center, New York, New York
| | | | - Susan Graham
- State University of New York at Buffalo, Buffalo, New York
| | | | | | - J P Mohr
- Columbia University Medical Center, New York, New York
| | - Gregory Y H Lip
- Institute of Birmingham Centre for Cardiovascular Sciences, Birmingham, England, United Kingdom
| | | | - Seitetz C Lee
- Columbia University Medical Center, New York, New York
| | | | - Dirk J Lok
- Deventer Hospital, Deventer, the Netherlands
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
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Garone C, Taylor RW, Nascimento A, Poulton J, Fratter C, Domínguez-González C, Evans JC, Loos M, Isohanni P, Suomalainen A, Ram D, Hughes MI, McFarland R, Barca E, Lopez Gomez C, Jayawant S, Thomas ND, Manzur AY, Kleinsteuber K, Martin MA, Kerr T, Gorman GS, Sommerville EW, Chinnery PF, Hofer M, Karch C, Ralph J, Cámara Y, Madruga-Garrido M, Domínguez-Carral J, Ortez C, Emperador S, Montoya J, Chakrapani A, Kriger JF, Schoenaker R, Levin B, Thompson JLP, Long Y, Rahman S, Donati MA, DiMauro S, Hirano M. Retrospective natural history of thymidine kinase 2 deficiency. J Med Genet 2018; 55:515-521. [PMID: 29602790 PMCID: PMC6073909 DOI: 10.1136/jmedgenet-2017-105012] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [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: 10/03/2017] [Revised: 03/02/2018] [Accepted: 03/11/2018] [Indexed: 12/21/2022]
Abstract
Background Thymine kinase 2 (TK2) is a mitochondrial matrix protein encoded in nuclear DNA and phosphorylates the pyrimidine nucleosides: thymidine and deoxycytidine. Autosomal recessive TK2 mutations cause a spectrum of disease from infantile onset to adult onset manifesting primarily as myopathy. Objective To perform a retrospective natural history study of a large cohort of patients with TK2 deficiency. Methods The study was conducted by 42 investigators across 31 academic medical centres. Results We identified 92 patients with genetically confirmed diagnoses of TK2 deficiency: 67 from literature review and 25 unreported cases. Based on clinical and molecular genetics findings, we recognised three phenotypes with divergent survival: (1) infantile-onset myopathy (42.4%) with severe mitochondrial DNA (mtDNA) depletion, frequent neurological involvement and rapid progression to early mortality (median post-onset survival (POS) 1.00, CI 0.58 to 2.33 years); (2) childhood-onset myopathy (40.2%) with mtDNA depletion, moderate-to-severe progression of generalised weakness and median POS at least 13 years; and (3) late-onset myopathy (17.4%) with mild limb weakness at onset and slow progression to respiratory insufficiency with median POS of 23 years. Ophthalmoparesis and facial weakness are frequent in adults. Muscle biopsies show multiple mtDNA deletions often with mtDNA depletion. Conclusions In TK2 deficiency, age at onset, rate of weakness progression and POS are important variables that define three clinical subtypes. Nervous system involvement often complicates the clinical course of the infantile-onset form while extraocular muscle and facial involvement are characteristic of the late-onset form. Our observations provide essential information for planning future clinical trials in this disorder.
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Affiliation(s)
- Caterina Garone
- Department of Neurology, Columbia University Medical Center, New York City, New York, USA.,MRC Mitochondrial Biology Unit, Cambridge Biomedical Campus, Cambridge, UK
| | - Robert W Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Andrés Nascimento
- Neuromuscular Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Joanna Poulton
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Carl Fratter
- Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Cristina Domínguez-González
- Neuromuscular Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Julie C Evans
- Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mariana Loos
- Neurology Department, Hospital de Pediatría 'Prof. Dr JP Garrahan', Buenos Aires, Argentina
| | - Pirjo Isohanni
- Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.,Department of Child Neurology, Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Anu Suomalainen
- Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.,Neuroscience Center, University of Helsinki, Helsinki, Finland.,Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Dipak Ram
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Manchester, UK
| | - M Imelda Hughes
- Department of Paediatric Neurology, Royal Manchester Children's Hospital, Manchester, UK
| | - Robert McFarland
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Emanuele Barca
- Department of Neurology, Columbia University Medical Center, New York City, New York, USA.,UOC Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carlos Lopez Gomez
- Department of Neurology, Columbia University Medical Center, New York City, New York, USA
| | - Sandeep Jayawant
- Paediatric Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Neil D Thomas
- Paediatric Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adnan Y Manzur
- Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Karin Kleinsteuber
- Pediatric Neurology, Faculty of Medicine, Universidad de Chile, Clínica Las Condes, Santiago, Chile
| | - Miguel A Martin
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Investigación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Timothy Kerr
- Paediatric Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Grainne S Gorman
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Ewen W Sommerville
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Patrick F Chinnery
- MRC Mitochondrial Biology Unit, Cambridge Biomedical Campus, Cambridge, UK.,Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Monika Hofer
- Department of Neuropathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christoph Karch
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey Ralph
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Yolanda Cámara
- Research Group on Neuromuscular and Mitochondrial Disorders, Vall d'Hebron Institut de Recerca, Barcelona, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Marcos Madruga-Garrido
- Sección de Neuropediatría, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla, Seville, Spain
| | - Jana Domínguez-Carral
- Neuromuscular Unit, Department of Neurology, Hospital Sant Joan de Déu, CIBERER, ISCIII, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Ortez
- Neuromuscular Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Sonia Emperador
- Department of Biochemistry and Molecular Biology, University of Zaragoza-CIBERER-Instituto de investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - Julio Montoya
- Department of Biochemistry and Molecular Biology, University of Zaragoza-CIBERER-Instituto de investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - Anupam Chakrapani
- Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Joshua F Kriger
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York City, New York, USA
| | - Robert Schoenaker
- Department of Neurology, Columbia University Medical Center, New York City, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York City, New York, USA
| | - John L P Thompson
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York City, New York, USA
| | - Yuelin Long
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York City, New York, USA
| | - Shamima Rahman
- Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Mitochondrial Research Group, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Salvatore DiMauro
- Department of Neurology, Columbia University Medical Center, New York City, New York, USA
| | - Michio Hirano
- Department of Neurology, Columbia University Medical Center, New York City, New York, USA
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33
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Spivack J, Cheng B, Levin B. Limb-Leaf designs for adaptive exploration of the dose-response curve. Contemp Clin Trials 2017; 64:210-218. [PMID: 28988992 DOI: 10.1016/j.cct.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/27/2017] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
We propose a two-stage strategy, called the Limb-Leaf method, to explore the dose-response curve using dose promotion and addition in the context of adaptive seamless Phase II/III trials. Strong control of the overall type 1 familywise error rate of the proposed method is enforced by the closed testing principle. The design constants are determined to minimize the risk-adjusted expected total sample size while maintaining a target power. In the case of a nonmonotonic dose response curve where more doses are required to adequately explore the curve, substantial savings in sample size are achieved compared with a traditional strategy which offers only selection and promotion from among initial first stage doses.
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Affiliation(s)
- John Spivack
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA.
| | - Bin Cheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York 10032, USA
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34
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Affiliation(s)
- Cheng-Shiun Leu
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Bruce Levin
- Department of Biostatistics, Columbia University, New York, New York, USA
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35
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Abstract
From its beginning, there have been attempts by physicists to formulate quantum mechanics without requiring the use of wave functions. An interesting recent approach takes the point of view that quantum effects arise solely from the interaction of finitely many classical "worlds." The wave function is then recovered (as a secondary object) from observations of particles in these worlds, without knowing the world from which any particular observation originates. Hall, Deckert and Wiseman [Physical Review X 4 (2014) 041013] have introduced an explicit many-interacting-worlds harmonic oscillator model to provide support for this approach. In this note we provide a proof of their claim that the particle configuration is asymptotically Gaussian, thus matching the stationary ground-state solution of Schrödinger's equation when the number of worlds goes to infinity. We also construct a Markov chain based on resampling from the particle configuration and show that it converges to an Ornstein-Uhlenbeck process, matching the time-dependent solution as well.
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Affiliation(s)
| | - Bruce Levin
- Department of Biostatistics, Columbia University
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36
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Williamson H, Perkins E, Lulinski A, Armstrong M, Baldwin J, Levin B, Massey O. Medicaid Managed Care and Adults With Intellectual or Developmental Disabilities and Their Family Caregivers. Am J Occup Ther 2017. [DOI: 10.5014/ajot.2017.71s1-rp401a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/1/2017
States are reforming their Medicaid programs to a managed care approach. Opportunities exist for the field of occupational therapy to help inform current and future managed care reform efforts. Occupational therapists can contribute to encouraging stakeholder engagement and informing family caregiver support efforts.
Primary Author and Speaker: Heather Williamson
Contributing Authors: Elizabeth Perkins, Amie Lulinski, Mary Armstrong, Julie Baldwin, Bruce Levin, Oliver Massey
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37
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Connors TJ, Ravindranath TM, Bickham KL, Gordon CL, Zhang F, Levin B, Baird JS, Farber DL. Airway CD8(+) T Cells Are Associated with Lung Injury during Infant Viral Respiratory Tract Infection. Am J Respir Cell Mol Biol 2017; 54:822-30. [PMID: 26618559 DOI: 10.1165/rcmb.2015-0297oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 11/24/2022] Open
Abstract
Infants and young children are disproportionately susceptible to severe complications from respiratory viruses, although the underlying mechanisms remain unknown. Recent studies show that the T cell response in the lung is important for protective responses to respiratory infections, although details on the infant/pediatric respiratory immune response remain sparse. The objectives of the present study were to characterize the local versus systemic immune response in infants and young children with respiratory failure from viral respiratory tract infections and its association to disease severity. Daily airway secretions were sampled from infants and children 4 years of age and younger receiving mechanical ventilation owing to respiratory failure from viral infection or noninfectious causes. Samples were examined for immune cell composition and markers of T cell activation. These parameters were then correlated with clinical disease severity. Innate immune cells and total CD3(+) T cells were present in similar proportions in airway aspirates derived from infected and uninfected groups; however, the CD8:CD4 T cell ratio was markedly increased in the airways of patients with viral infection compared with uninfected patients, and specifically in infected infants with acute lung injury. T cells in the airways were phenotypically and functionally distinct from those in blood with activated/memory phenotypes and increased cytotoxic capacity. We identified a significant increase in airway cytotoxic CD8(+) T cells in infants with lung injury from viral respiratory tract infection that was distinct from the T cell profile in circulation and associated with increasing disease severity. Airway sampling could therefore be diagnostically informative for assessing immune responses and lung damage.
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Affiliation(s)
- Thomas J Connors
- 1 Department of Pediatrics and.,2 Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | | | - Kara L Bickham
- 2 Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Claire L Gordon
- 2 Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Feifan Zhang
- 3 Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York; and Departments of
| | - Bruce Levin
- 3 Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York; and Departments of
| | | | - Donna L Farber
- 2 Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York.,4 Surgery and.,5 Microbiology and Immunology, Columbia University Medical Center, New York, New York
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38
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Shao X, Levin B, Nemenman I. Single variant bottleneck in the early dynamics ofH. influenzaebacteremia in neonatal rats questions the theory of independent action. Phys Biol 2017; 14:045004. [DOI: 10.1088/1478-3975/aa731b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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39
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Nakanishi K, Di Tullio MR, Qian M, Thompson JLP, Labovitz AJ, Mann DL, Sacco RL, Pullicino PM, Freudenberger RS, Teerlink JR, Graham S, Lip GYH, Levin B, Mohr JP, Buchsbaum R, Estol CJ, Lok DJ, Ponikowski P, Anker SD, Homma S. Resting Heart Rate and Ischemic Stroke in Patients with Heart Failure. Cerebrovasc Dis 2017; 44:43-50. [PMID: 28419982 DOI: 10.1159/000474958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/29/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Although high resting heart rate (RHR) is known to be associated with an increased risk of mortality and hospital admission in patients with heart failure, the relationship between RHR and ischemic stroke remains unclear. This study is aimed at investigating the relationship between RHR and ischemic stroke in patients with heart failure in sinus rhythm. METHODS We examined 2,060 patients with systolic heart failure in sinus rhythm from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. RHR was determined from baseline electrocardiogram, and was examined as both a continuous variable and a categorical variable using quartiles. Ischemic strokes were identified during follow-up and adjudicated by physician review. RESULTS During 3.5 ± 1.8 years of follow-up, 77 patients (5.3% from Kaplan-Meier [KM] curve) experienced an ischemic stroke. The highest incidence of ischemic stroke (21/503 [KM 6.9%]) was observed in the lowest RHR quartile (RHR <64 beats/min) compared to other groups; 22/573 (KM 5.3%) in 64-70 beats/min, 13/465 (KM 3.5%) in 71-79 beats/min, and 21/519 (KM 5.4%) in RHR >79 beats/min (p = 0.693). Multivariable Cox proportional hazards analysis revealed that RHR was significantly associated with ischemic stroke (hazard ratio per unit decrease: 1.07, 95% CI 1.02-1.13, when RHR <64/beats/min; p = 0.038), along with a history of stroke or transient ischemic attack and left ventricular ejection fraction. CONCLUSIONS In contrast to its beneficial effect on mortality and hospital re-admissions, lower RHR may increase the risk of ischemic stroke in patients with systolic heart failure in sinus rhythm.
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Affiliation(s)
- Koki Nakanishi
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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40
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Patel AN, Lee S, Andrews HF, Pelton GH, Schultz SK, Sultzer DL, Mintzer J, de la Pena D, Gupta S, Colon S, Schimming C, Levin B, Devanand D. Prediction of Relapse After Discontinuation of Antipsychotic Treatment in Alzheimer's Disease: The Role of Hallucinations. Am J Psychiatry 2017; 174:362-369. [PMID: 27855483 PMCID: PMC5378647 DOI: 10.1176/appi.ajp.2016.16020226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In Alzheimer's disease, antipsychotic medications are often used for a period, with relief of symptoms, and then discontinued, after which relapse may occur. The authors sought to determine which neuropsychiatric symptoms predict relapse. METHOD In the Antipsychotic Discontinuation in Alzheimer's Disease trial, 180 patients with Alzheimer's disease and symptoms of agitation or psychosis were treated with risperidone for 16 weeks, after which patients who responded (N=110) were randomly assigned to continue risperidone for 32 weeks, to continue risperidone for 16 weeks followed by switch to placebo for 16 weeks, or to receive placebo for 32 weeks. As reported previously, discontinuation of risperidone was associated with a two- to fourfold increased risk of relapse over 16-32 weeks. In planned post hoc analyses, the authors examined associations between the 12 symptom domains in the Neuropsychiatric Inventory (NPI) and relapse in the first 16-week phase after randomization. RESULTS Compared with patients with mild hallucinations or no hallucinations, patients with severe hallucinations as a presenting symptom at baseline had a higher likelihood of relapse (hazard ratio=2.96, 95% CI=1.52, 5.76). This effect was present for the subgroup with auditory hallucinations, but not the subgroup with visual hallucinations. Among patients with baseline hallucinations, 13 of 17 (76.5%) who discontinued risperidone relapsed, compared with 10 of 26 (38.5%) who continued risperidone (p<0.02). This group difference remained significant for severe (77.8%) compared with mild (36%) hallucinations. NPI domain scores after the initial open-treatment phase were not associated with relapse. CONCLUSIONS Patients with severe baseline hallucinations were more likely to relapse after randomization, and the presence of baseline hallucinations was associated with a higher risk of relapse after discontinuation of risperidone compared with continued risperidone treatment. For patients with hallucinations, particularly auditory hallucinations, antipsychotic discontinuation should be approached cautiously because of high relapse risk.
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Affiliation(s)
- Anjali N. Patel
- Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University and the Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York
| | - Seonjoo Lee
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - Howard F. Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - Gregory H. Pelton
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York
| | - Susan K. Schultz
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - David L. Sultzer
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jacobo Mintzer
- Division of Translational Research, Department of Neuroscience, Medical University of South Carolina and the Ralph H. Johnson VA Medical Center, Charleston, South Carolina,Clinical Biotechnology Research Institute, Roper St. Francis Healthcare, Charleston, South Carolina
| | | | - Sanjay Gupta
- Department of Psychiatry State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Sylvia Colon
- Department of Psychiatry, VA Medical Center, Tuscaloosa, Alabama
| | - Corbett Schimming
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University
| | - D.P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York,Gertrude H. Sergievsky Center and the Department of Neurology, College of Physicians and Surgeons, Columbia University and the Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia University, New York
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41
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See SB, Clerkin KJ, Kennel PJ, Zhang F, Weber MP, Rogers KJ, Chatterjee D, Vasilescu ER, Vlad G, Naka Y, Restaino SW, Farr MA, Topkara VK, Colombo PC, Mancini DM, Schulze PC, Levin B, Zorn E. Ventricular assist device elicits serum natural IgG that correlates with the development of primary graft dysfunction following heart transplantation. J Heart Lung Transplant 2017; 36:862-870. [PMID: 28431981 DOI: 10.1016/j.healun.2017.03.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 11/30/2016] [Revised: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pre-transplant sensitization is a limiting factor in solid-organ transplantation. In heart transplants, ventricular assist device (VAD) implantation has been associated with sensitization to human leukocyte antigens (HLA). The effect of VAD on non-HLA antibodies is unclear. We have previously shown that polyreactive natural antibodies (Nabs) contribute to pre-sensitization in kidney allograft recipients. Here we assessed generation of Nabs after VAD implantation in pre-transplant sera and examined their contribution to cardiac allograft outcome. METHODS IgM and IgG Nabs were tested in pre-transplant serum samples collected from 206 orthotopic heart transplant recipients, including 128 patients with VAD (VAD patients) and 78 patients without VAD (no-VAD patients). Nabs were assessed by testing serum reactivity to apoptotic cells by flow cytometry and to the generic oxidized epitope, malondialdehyde, by enzyme-linked immunosorbent assay. RESULTS No difference was observed in serum levels of IgM Nabs between VAD and no-VAD patients. However, serum IgG Nabs levels were significantly increased in VAD compared with no-VAD patients. This increase was likely due to the presence of the VAD, as revealed by lower serum IgG Nabs levels before implantation. Elevated pre-transplant IgG Nabs level was associated with development of primary graft dysfunction (PGD). CONCLUSIONS Our study demonstrates that VAD support elicits IgG Nabs reactive to apoptotic cells and oxidized epitopes. These findings further support broad and non-specific B-cell activation by VAD, resulting in IgG sensitization. Moreover, the association of serum IgG Nabs levels with development of PGD suggests a possible role for these antibodies in the inflammatory reaction accompanying this complication.
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Affiliation(s)
- Sarah B See
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Kevin J Clerkin
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Peter J Kennel
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Feifan Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Matthew P Weber
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Kortney J Rogers
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Debanjana Chatterjee
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York
| | - Elena R Vasilescu
- Department of Pathology and Cell Biology, Department of Surgery, Columbia University Medical Center, New York, New York
| | - George Vlad
- Department of Pathology and Cell Biology, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Susan W Restaino
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Veli K Topkara
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Donna M Mancini
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - P Christian Schulze
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Bruce Levin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Emmanuel Zorn
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, New York.
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Tsze DS, Ieni M, Fenster DB, Babineau J, Kriger J, Levin B, Dayan PS. Optimal Volume of Administration of Intranasal Midazolam in Children: A Randomized Clinical Trial. Ann Emerg Med 2016; 69:600-609. [PMID: 27823876 DOI: 10.1016/j.annemergmed.2016.08.450] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 08/13/2016] [Accepted: 08/22/2016] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE The optimal intranasal volume of administration for achieving timely and effective sedation in children is unclear. We aimed to compare clinical outcomes relevant to procedural sedation associated with using escalating volumes of administration to administer intranasal midazolam. METHODS We conducted a randomized, single-blinded, 3-arm, superiority clinical trial. Children aged 1 to 7 years and undergoing laceration repair requiring 0.5 mg/kg intranasal midazolam (5 mg/mL) were block-randomized to receive midazolam using 1 of 3 volumes of administration: 0.2, 0.5, or 1 mL. Procedures were videotaped, with outcome assessors blinded to volume of administration. Primary outcome was time to onset of minimal sedation (ie, score of 1 on the University of Michigan Sedation Scale). Secondary outcomes included procedural distress, time to procedure start, deepest level of sedation achieved, adverse events, and clinician and caregiver satisfaction. RESULTS Ninety-nine children were enrolled; 96 were analyzed for the primary outcome and secondary outcomes, except for the outcome of procedural distress, for which only 90 were analyzed. Time to onset of minimal sedation for each escalating volume of administration was 4.7 minutes (95% confidence interval [CI] 3.8 to 5.4 minutes), 4.3 minutes (95% CI 3.9 to 4.9 minutes), and 5.2 minutes (95% CI 4.6 to 7.0 minutes), respectively. There were no differences in secondary outcomes except for clinician satisfaction with ease of administration: fewer clinicians were satisfied when using a volume of administration of 0.2 mL. CONCLUSION There was a slightly shorter time to onset of minimal sedation when a volume of administration of 0.5 mL was used compared with 1 mL, but all 3 volumes of administration produced comparable clinical outcomes. Fewer clinicians were satisfied with ease of administration with a volume of administration of 0.2 mL.
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Affiliation(s)
- Daniel S Tsze
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
| | - Maria Ieni
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Daniel B Fenster
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - John Babineau
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Joshua Kriger
- Department of Biostatistics, Columbia University Medical Center, New York, NY
| | - Bruce Levin
- Department of Biostatistics, Columbia University Medical Center, New York, NY
| | - Peter S Dayan
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
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Hoffman S, Exner TM, Lince-Deroche N, Leu CS, Phillip JL, Kelvin EA, Gandhi AD, Levin B, Singh D, Mantell JE, Blanchard K, Ramjee G. Immediate Blood Draw for CD4+ Cell Count Is Associated with Linkage to Care in Durban, South Africa: Findings from Pathways to Engagement in HIV Care. PLoS One 2016; 11:e0162085. [PMID: 27706150 PMCID: PMC5051894 DOI: 10.1371/journal.pone.0162085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Timely linkage to care by newly-diagnosed HIV+ individuals remains a significant challenge to achieving UNAIDS 90-90-90 goals. Current World Health Organization (WHO) guidelines recommend initiating anti-retroviral treatment (ART) regardless of CD4+ count, with priority given to those with CD4+ <350 cells/μl. We evaluated the impact of not having a day-of-diagnosis CD4+ count blood draw, as recommended by South African guidelines, on time to linkage, using data from a prospective cohort study. METHODS Individuals (N = 2773) were interviewed prior to HIV counseling and testing at three public sector primary care clinics in the greater Durban area; 785 were newly-diagnosed and eligible for the cohort study; 459 (58.5%) joined and were followed for eight months with three structured assessments. Linkage to care, defined as returning to clinic for CD4+ count results, and day-of-diagnosis blood draw were self-reported. RESULTS Overall, 72.5% did not have a day-of-diagnosis CD4+ count blood draw, and 19.2% of these never returned. Compared with a day-of-diagnosis blood draw, the adjusted hazard ratio of linkage (AHRlinkage) associated with not having day-of-diagnosis blood draw was 0.66 (95%CI: 0.51, 0.85). By 4 months, 54.8% of those without day-of-diagnosis blood draw vs. 75.2% with one were linked to care (chi-squared p = 0.004). Of those who deferred blood draw, 48.3% cited clinic-related and 51.7% cited personal reasons. AHRlinkage was 0.60 (95%CI: 0.44, 0.82) for clinic-related and 0.53 (95%CI: 0.38, 0.75) for personal reasons relative to having day-of-diagnosis blood draw. CONCLUSIONS Newly-diagnosed HIV+ individuals who did not undergo CD4+ count blood draw on the day they were diagnosed-regardless of the reason for deferring-had delayed linkage to care relative to those with same-day blood draw. To enhance prompt linkage to care even when test and treat protocols are implemented, all diagnostic testing required before ART initiation should be performed on the same day as HIV testing/diagnosis. This may require modifying clinic procedures to enable overnight blood storage if same-day draws cannot be performed, and providing additional counseling to encourage newly-diagnosed individuals to complete day-of-diagnosis testing. Tracking HIV+ individuals via clinic registries should commence immediately from diagnosis to reduce these early losses to care.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Theresa M. Exner
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
| | | | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Jessica L. Phillip
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Elizabeth A. Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America
| | - Anisha D. Gandhi
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
| | - Bruce Levin
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Dinesh Singh
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Joanne E. Mantell
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, New York, United States of America
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, Massachusetts, United States of America
| | - Gita Ramjee
- South African Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
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Abstract
Background Clinical trials undertaken by industrialized nations in undeveloped nations pose several critical ethical dilemmas. One key potential problem concerns misunderstandings of the consent process by participants. Though other reports have begun to explore this area, needs remain to identify specific areas of misunderstanding. Purpose To identify deficits in comprehension during consent processes in Mali, West Africa. Methods After obtaining informed consent for participation for a malaria vaccine trial being conducted in two West African villages, we administered to participants a nine-item questionnaire testing their understanding of information relevant for their consent. After testing their ability to understand a multiple choice format, 78 of 100 subjects were administered the questionnaire in one village and 85 of 100 in the other. Results Participants had difficulty comprehending several concepts relevant to informed consent: 90% of respondents did not understand withdrawal criterion, 93% did not understand the existence of study side effects, and 74% did not understand that they were enrolled in an investigation as opposed to receiving therapy. The response rate and percentage of correct answers was generally much higher in the village nearer an urban center than the more rural village. The percent of correct answers exceeded 50% for five questions in the urban village and for only two question in the more rural setting. Limitations Potential limitations of this study are relating to translation, cultural differences in the notion of informed consent, staff differences between each village, the proportion who could not understand the survey instrument and the fact that the study explored participants' understanding of the consent process but did not observe the process itself. Conclusions This study illustrates potential areas of miscomprehension in the consent process in a developing country. The degree of miscomprehension found in this study appeared to be more than that found in similar studies conducted in industrialized nations. Despite efforts to obtain truly informed consent, several factors make it more challenging in the developing world. This research highlights the need for more comprehensive studies of consent in developing countries. Such studies may eventually aid investigators in identifying, targeting and addressing specific areas of miscomprehension and thereby improve the informed consent process in the developing world.
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Affiliation(s)
- Michael T Krosin
- San Francisco Orthopedic Program at St. Mary's Medical Center, San Francisco, CA, USA.
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Russell A, Levin B, France NE, Wilmers M. The Webbing Syndrome (Ullrich-Turner) with and without Gonadal Agenesis. Chromosomal Sex Typing by Skin Cell or Leucocyte Examination in Diagnosis. Proc R Soc Med 2016. [DOI: 10.1177/003591575504800413] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Affiliation(s)
| | | | - N M Jacoby
- Queen Elizabeth Hospital for Children, Hackney Road, London E2 8PS
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Affiliation(s)
- B Levin
- Queen Elizabeth Hospital for Children, Hackney, London
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Affiliation(s)
- B Levin
- Queen Elizabeth Hospitalfor Children, Hackney, London
| | - R H Dobbs
- Queen Elizabeth Hospitalfor Children, Hackney, London
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Ye S, Qian M, Zhao B, Buchsbaum R, Sacco RL, Levin B, Di Tullio MR, Mann DL, Pullicino PM, Freudenberger RS, Teerlink JR, Mohr JP, Graham S, Labovitz AJ, Estol CJ, Lok DJ, Ponikowski P, Anker SD, Lip GYH, Thompson JLP, Homma S. CHA 2 DS 2 -VASc score and adverse outcomes in patients with heart failure with reduced ejection fraction and sinus rhythm. Eur J Heart Fail 2016; 18:1261-1266. [PMID: 27444219 DOI: 10.1002/ejhf.613] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 03/21/2016] [Revised: 05/25/2016] [Accepted: 06/16/2016] [Indexed: 01/06/2023] Open
Abstract
AIMS The aim of this study was to determine whether the CHA2 DS2 -VASc score can predict adverse outcomes such as death, ischaemic stroke, and major haemorrhage, in patients with systolic heart failure in sinus rhythm. METHODS AND RESULTS CHA2 DS2 -VASc scores were calculated for 1101 patients randomized to warfarin and 1123 patients randomized to aspirin. Adverse outcomes were defined as death or ischaemic stroke, death alone, ischaemic stroke alone, and major haemorrhage. Using proportional hazards models, we found that each 1-point increase in the CHA2 DS2 -VASc score was associated with increased hazard of death or ischaemic stroke events [hazard ratio (HR) for the warfarin arm = 1.21, 95% confidence interval (CI) 1.13-1.30, P < 0.001; for aspirin, HR = 1.20, 95% CI 1.11-1.29, P < 0.001]. Similar increased hazards for higher CHA2 DS2 -VASc scores were observed for death alone, ischaemic stroke alone, and major haemorrhage. Overall performance of the CHA2 DS2 -VASc score was assessed using c-statistics for full models containing the risk score, treatment assignment, and score-treatment interaction, with the c-statistics for the full models ranging from 0.57 for death to 0.68 for major haemorrhage. CONCLUSIONS The CHA2 DS2 -VASc score predicted adverse outcomes in patients with systolic heart failure in sinus rhythm, with modest prediction accuracy.
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Affiliation(s)
- Siqin Ye
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Bo Zhao
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Richard Buchsbaum
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bruce Levin
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Marco R Di Tullio
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Douglas L Mann
- Department of Medicine, Washington University, St. Louis, MO, USA
| | - Patrick M Pullicino
- Kent Institute of Medicine and Health Sciences, University of Kent, Canterbury, UK
| | - Ronald S Freudenberger
- Division of Cardiology, Department of Medicine, Lehigh Valley Hospital, Allentown, PA, USA
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - J P Mohr
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Susan Graham
- Division of Cardiology, Department of Medicine, SUNY Upstate Medical University, Buffalo, NY, USA
| | - Arthur J Labovitz
- Department of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Conrado J Estol
- Centro Neurológico de Tratamiento y Rehabilitación, Buenos Aires, Argentina
| | - Dirk J Lok
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Military Hospital, Wroclaw, Poland
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Centre Göttingen, Göttingen, Germany
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - John L P Thompson
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Shunichi Homma
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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