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Chanchlani N, Lin S, Bewshea C, Hamilton B, Thomas A, Smith R, Roberts C, Bishara M, Nice R, Lees CW, Sebastian S, Irving PM, Russell RK, McDonald TJ, Goodhand JR, Ahmad T, Kennedy NA. Mechanisms and management of loss of response to anti-TNF therapy for patients with Crohn's disease: 3-year data from the prospective, multicentre PANTS cohort study. Lancet Gastroenterol Hepatol 2024; 9:521-538. [PMID: 38640937 DOI: 10.1016/s2468-1253(24)00044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND We sought to report the effectiveness of infliximab and adalimumab over the first 3 years of treatment and to define the factors that predict anti-TNF treatment failure and the strategies that prevent or mitigate loss of response. METHODS Personalised Anti-TNF therapy in Crohn's disease (PANTS) is a UK-wide, multicentre, prospective observational cohort study reporting the rates of effectiveness of infliximab and adalimumab in anti-TNF-naive patients with active luminal Crohn's disease aged 6 years and older. At the end of the first year, sites were invited to enrol participants still receiving study drug into the 2-year PANTS-extension study. We estimated rates of remission across the whole cohort at the end of years 1, 2, and 3 of the study using a modified survival technique with permutation testing. Multivariable regression and survival analyses were used to identify factors associated with loss of response in patients who had initially responded to anti-TNF therapy and with immunogenicity. Loss of response was defined in patients who initially responded to anti-TNF therapy at the end of induction and who subsequently developed symptomatic activity that warranted an escalation of steroid, immunomodulatory, or anti-TNF therapy, resectional surgery, or exit from study due to treatment failure. This study was registered with ClinicalTrials.gov, NCT03088449, and is now complete. FINDINGS Between March 19, 2014, and Sept 21, 2017, 389 (41%) of 955 patients treated with infliximab and 209 (32%) of 655 treated with adalimumab in the PANTS study entered the PANTS-extension study (median age 32·5 years [IQR 22·1-46·8], 307 [51%] of 598 were female, and 291 [49%] were male). The estimated proportion of patients in remission at the end of years 1, 2, and 3 were, for infliximab 40·2% (95% CI 36·7-43·7), 34·4% (29·9-39·0), and 34·7% (29·8-39·5), and for adalimumab 35·9% (95% CI 31·2-40·5), 32·9% (26·8-39·2), and 28·9% (21·9-36·3), respectively. Optimal drug concentrations at week 14 to predict remission at any later timepoints were 6·1-10·0 mg/L for infliximab and 10·1-12·0 mg/L for adalimumab. After excluding patients who had primary non-response, the estimated proportions of patients who had loss of response by years 1, 2, and 3 were, for infliximab 34·4% (95% CI 30·4-38·2), 54·5% (49·4-59·0), and 60·0% (54·1-65·2), and for adalimumab 32·1% (26·7-37·1), 47·2% (40·2-53·4), and 68·4% (50·9-79·7), respectively. In multivariable analysis, loss of response at year 2 and 3 for patients treated with infliximab and adalimumab was predicted by low anti-TNF drug concentrations at week 14 (infliximab: hazard ratio [HR] for each ten-fold increase in drug concentration 0·45 [95% CI 0·30-0·67], adalimumab: 0·39 [0·22-0·70]). For patients treated with infliximab, loss of response was also associated with female sex (vs male sex; HR 1·47 [95% CI 1·11-1·95]), obesity (vs not obese 1·62 [1·08-2·42]), baseline white cell count (1·06 [1·02-1·11) per 1 × 109 increase in cells per L), and thiopurine dose quartile. Among patients treated with adalimumab, carriage of the HLA-DQA1*05 risk variant was associated with loss of response (HR 1·95 [95% CI 1·17-3·25]). By the end of year 3, the estimated proportion of patients who developed anti-drug antibodies associated with undetectable drug concentrations was 44·0% (95% CI 38·1-49·4) among patients treated with infliximab and 20·3% (13·8-26·2) among those treated with adalimumab. The development of anti-drug antibodies associated with undetectable drug concentrations was significantly associated with treatment without concomitant immunomodulator use for both groups (HR for immunomodulator use: infliximab 0·40 [95% CI 0·31-0·52], adalimumab 0·42 [95% CI 0·24-0·75]), and with carriage of HLA-DQA1*05 risk variant for infliximab (HR for carriage of risk variant: infliximab 1·46 [1·13-1·88]) but not for adalimumab (HR 1·60 [0·92-2·77]). Concomitant use of an immunomodulator before or on the day of starting infliximab was associated with increased time without the development of anti-drug antibodies associated with undetectable drug concentrations compared with use of infliximab alone (HR 2·87 [95% CI 2·20-3·74]) or introduction of an immunomodulator after anti-TNF initiation (1·70 [1·11-2·59]). In years 2 and 3, 16 (4%) of 389 patients treated with infliximab and 11 (5%) of 209 treated with adalimumab had adverse events leading to treatment withdrawal. Nine (2%) patients treated with infliximab and two (1%) of those treated with adalimumab had serious infections in years 2 and 3. INTERPRETATION Only around a third of patients with active luminal Crohn's disease treated with an anti-TNF drug were in remission at the end of 3 years of treatment. Low drug concentrations at the end of the induction period predict loss of response by year 3 of treatment, suggesting higher drug concentrations during the first year of treatment, particularly during induction, might lead to better long-term outcomes. Anti-drug antibodies associated with undetectable drug concentrations of infliximab, but not adalimumab, can be predicted by carriage of HLA-DQA1*05 and mitigated by concomitant immunomodulator use for both drugs. FUNDING Guts UK, Crohn's and Colitis UK, Cure Crohn's Colitis, AbbVie, Merck Sharp and Dohme, Napp Pharmaceuticals, Pfizer, and Celltrion Healthcare.
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Affiliation(s)
- Neil Chanchlani
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Simeng Lin
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Claire Bewshea
- Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Benjamin Hamilton
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Amanda Thomas
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Rebecca Smith
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Christopher Roberts
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Maria Bishara
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Rachel Nice
- Department of Blood Science, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Charlie W Lees
- Department of Gastroenterology, Edinburgh IBD Unit, Western General Hospital, NHS Lothian, Edinburgh, UK; Institute of Genetic and Cancer, University of Edinburgh, Edinburgh, UK
| | - Shaji Sebastian
- Gastroenterology and Hepatology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK; Hull York Medical School, University of Hull, Hull, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Richard K Russell
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children & Young People, Edinburgh, UK; Child Life and Health, University of Edinburgh, Royal Hospital for Children & Young People, Edinburgh, UK
| | - Timothy J McDonald
- Department of Blood Science, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - James R Goodhand
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter IBD and Pharmacogenetics Research Group, University of Exeter, Exeter, UK.
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Williams JL, Roberts C, Harley R, Gruffydd-Jones TJ, Murray JK. Prevalence and risk factors for gingivitis in a cohort of UK companion cats aged up to 6 years. J Small Anim Pract 2024. [PMID: 38736278 DOI: 10.1111/jsap.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Prospectively collected data were used to estimate the prevalence of gingivitis in a cohort of companion cats aged up to 6 years and to investigate factors associated with the risk of gingivitis in cats aged 3 to 4 years. MATERIALS AND METHODS Data were obtained from a longitudinal study of domestic cats (the Bristol Cats Study), using owner-completed questionnaires and veterinary surgeon-completed oral health scores. Prevalence estimates of veterinary-reported gingivitis for cats aged up to 6 years old (n = 1534) were calculated for different age groups. Cat signalment, diet and dental care were assessed for association with gingivitis in cats aged 3 to 4 years (n = 317) using univariable and multiple logistic regression. RESULTS The prevalence of gingivitis increased with age and ranged from 24.5% (<12 months old) to 56.3% (5 to 6 years old). Odds of gingivitis in cats aged 3 to 4 years were higher in cats fed a wet only or mixed wet/dry diet compared to dry only (odds ratio: 2.7; 95% confidence interval: 1.4 to 5.1), cats not reported to hunt compared to reported hunters (odds ratio: 2.1; 95% confidence interval: 1.0 to 4.2), cats reported to dribble whilst being stroked at age 6 months compared to reported non-dribblers (odds ratio: 3.2; 95% confidence interval: 1.3 to 8.4) and cats with orange variants in their coat colour compared to non-orange cats (odds ratio: 2.3; 95% confidence interval: 1.0 to 5.3). CLINICAL SIGNIFICANCE These results will help veterinary surgeons identify cats that may be at a greater risk of gingivitis and provide an evidence base to inform dietary and oral healthcare recommendations aimed at promoting gingival health in cats.
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Affiliation(s)
- J L Williams
- Bristol Vet School, University of Bristol, Bristol, UK
| | - C Roberts
- Bristol Vet School, University of Bristol, Bristol, UK
| | - R Harley
- Bristol Vet School, University of Bristol, Bristol, UK
| | | | - J K Murray
- Bristol Vet School, University of Bristol, Bristol, UK
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Paterson C, Roberts C, Blackburn J, Jojo N, Northam HL, Wallis E, Hind A, Caulfield R, Barratt M, Toohey K, Kavanagh PS, Bacon R, Wilson RL. Understanding the needs and preferences for cancer care among First Nations people: An integrative review. J Adv Nurs 2024; 80:1776-1812. [PMID: 38018290 DOI: 10.1111/jan.15968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
AIM This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people. DESIGN Integrative review. DATA SOURCES An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted. RESULTS Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs. CONCLUSION Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs. PATIENT OR PUBLIC CONTRIBUTION Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work. IMPLICATIONS FOR NURSING PRACTICE Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, Aberdeen, UK
| | - C Roberts
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - J Blackburn
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - N Jojo
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - H L Northam
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - E Wallis
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - A Hind
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - R Caulfield
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - M Barratt
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - K Toohey
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | - P S Kavanagh
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Justice and Society, University of South Australia, Magill, South Australia, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - R L Wilson
- School of Nursing and Midwifery, University of Newcastle, Gosford, New South Wales, Australia
- School of Nursing, Massey University, Palmerston North, New Zealand
- Descendent of the Wiradjuri Nation (First Nations Person), New South Wales, Australia
- Department of Nursing, RMIT University, Melbourne, Victoria, Australia
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Young PF, Roberts C, Shi GG, Heckman MG, White L, Clendenen S, Wilke B. Total Knee Arthroplasty With and Without Schedule II Opioids: A Randomized, Double-Blinded, Placebo-Controlled Trial. Cureus 2024; 16:e56150. [PMID: 38618342 PMCID: PMC11015880 DOI: 10.7759/cureus.56150] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Orthopedic surgeons are the third highest prescribers of narcotics. Previous work demonstrated that surgeons prescribe three times the narcotics required, and most patients do not properly dispose of leftover medication following surgery. This has prompted the creation of multimodal pain regimens to reduce reliance on narcotics. It is unknown if these pathways can effectively eliminate opioids following total knee arthroplasty (TKA). Our purpose was to evaluate a multimodal regimen without schedule II narcotics following TKA, in a randomized, blinded fashion. We hypothesized that there would be no difference in pain scores between groups. METHODS A total of 43 narcotic-naïve patients participated in a randomized, double-blinded, placebo-controlled trial. Postoperative protocols were identical between cohorts, except for the study medication. The narcotic group received an encapsulated 5 mg oxycodone, whereas the control group received an encapsulated placebo. Perioperative outcomes were compared with routine statistical analysis. RESULTS Four patients withdrew early secondary to pain: three in the placebo group and one in the narcotic group (p=1.00). We found no difference in hospital length of stay (p=0.09) or pain scores at all time points between cohorts (all p>0.05). There was a higher proportion of patients using a narcotic in the opioid treatment arm at day 30 (40% vs. 21.4%, p=0.29) and day 60 (20% vs. 7.1%, p=0.32), although this was not statistically significant. CONCLUSION A multimodal regimen without schedule II narcotics demonstrates equivalent pain scores and may reduce the risk of long-term opioid dependence following TKA.
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Affiliation(s)
- Porter F Young
- Orthopedic Surgery, University of Florida, Jacksonville, USA
| | | | | | | | | | - Steven Clendenen
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, USA
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Paterson C, Davis D, Roberts C, Bail K, Wallis E, Northam HL, Frost J, Jojo N, McGrory C, Dombkins A, Kavanagh PS. Sense of coherence moderates job demand-resources and impact on burnout among nurses and midwives in the context of the COVID-19 pandemic: A cross-sectional survey. J Adv Nurs 2024. [PMID: 38426656 DOI: 10.1111/jan.16125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/04/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
AIM This study aimed to test the propositions using the job demands-resources (JD-R) model for main/moderation/mediation effects of a sense of coherence and practice environment support on mental well-being (anxiety, depression and burnout) outcomes in nurses and midwives in Australia during the COVID-19 pandemic. DESIGN Cross-sectional quantitative survey. DATA SOURCES The study was a cross-sectional design using self-report questionnaires reported as per the Reporting of Observational Studies in Epidemiology Guidelines. Following human research ethics approval (2020.ETH.00121) participants were recruited to take part in an online anonymous survey using self-report instruments to test the JD-R model in Australia. RESULTS 156 participant nurses and midwives experienced anxiety, depression and emotional burnout during COVID-19. While a considerable proportion of participants indicated high levels of emotional exhaustion, their responses showed low levels of depersonalization (detached response to other people) and high levels of personal accomplishment (high levels of work performance and competence). A sense of coherence was a significant protective factor for mental health well-being for the participants, which is to say, high levels of sense of coherence were predictive of lower levels of anxiety, depression and burnout in this study sample. CONCLUSION It is evident that both nursing and midwifery professions require psychosocial support to preserve their health both in the short and long term. Ensuring individualized tailored support will require a layered response within organizations aimed at individual self-care and collegial peer support. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution in this study, as the focus was on nurses and midwives.
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Affiliation(s)
- C Paterson
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Robert Gordon University, Aberdeen, Scotland, UK
| | - D Davis
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- ACT Health Directorate, Canberra, Australian Capital Territory, Australia
| | - C Roberts
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - K Bail
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- ACT Health Directorate, Canberra, Australian Capital Territory, Australia
| | - E Wallis
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - H L Northam
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - J Frost
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Western Sydney University, Penrith South, New South Wales, Australia
| | - N Jojo
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - C McGrory
- ACT Health Directorate, Canberra, Australian Capital Territory, Australia
| | - A Dombkins
- ACT Health Directorate, Canberra, Australian Capital Territory, Australia
| | - P S Kavanagh
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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Yu N, Sriranganathan D, Walker GJ, Sazonovs A, Wilding H, Roberts C, Kennedy NA, Ahmad T, Boyapati RK, Ding NS, Segal JP. Prevalence of NUDT15 Genetic Variants and Incidence of Thiopurine-induced Leukopenia in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2023; 17:1920-1930. [PMID: 37346013 DOI: 10.1093/ecco-jcc/jjad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS Nudix hydrolase 15 [NUDT15] genetic variants confer an increased risk of thiopurine-induced leukopenia [TIL]; however, their global prevalence in inflammatory bowel disease [IBD] patients is unknown. We aimed to evaluate the global prevalence of NUDT15 variants in IBD patients and incidence of TIL in these patients. METHODS Six databases were searched from inception until July 2022. Studies reporting the frequency of any NUDT15 variant and/or frequency of leukopenia in adult IBD patients with these variants were included. A random effects model was performed to estimate the pooled prevalence of variants, incidence of early [≤8 weeks] and late [>8 weeks] leukopenia, and relative risk of developing leukopenia. RESULTS Twenty studies comprising 5232 patients were included. The pooled prevalence of the *1/*3 c.415C > T C/T diplotype was 13% (95% confidence interval [CI]: 10-18%), *3/*3 c.415C > T T/T diplotype was 2% [95% CI: 1-2%], *1/*5 c.52G > A G/A diplotype was 2% [95% CI: 1-3%], and *1/*6 c.36_37insGGAGTC ins/- diplotype was 7% [95% CI: 4-12%]. The pooled prevalence of *1/*3 was high in Japanese [20%, 95% CI: 16-24%] and Chinese patients [18%, 95% CI: 12-27%]. The incidence of early leukopenia was 20% [95% CI: 16-26%] in *1/*3 patients, 99% [95% CI: 7-100%] in *3/*3 patients, and 49% [95% CI: 29-69%] in *1/*6 patients. The incidence of late leukopenia was 36% [95% CI: 26-49%] in *1/*3 patients. CONCLUSIONS NUDT15 variants are common and strongly predict TIL in IBD patients. Pre-treatment NUDT15 genotyping should be considered particularly in Asian populations, to guide thiopurine dosing and prevent myelotoxicity.
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Affiliation(s)
- Natalie Yu
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Danujan Sriranganathan
- Department of Gastroenterology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Gareth J Walker
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital Brisbane, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Gut Health Research Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Aleksejs Sazonovs
- Genomics of Inflammation and Immunity Group, Wellcome Sanger Institute, Hinxton, UK
| | - Helen Wilding
- Library Service, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Christopher Roberts
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
- Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
- Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
- Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Ray K Boyapati
- Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Nik S Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan P Segal
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Peake L, Inns T, Jarvis C, King G, Rabie H, Henderson J, Wensley A, Jarratt R, Roberts C, Williams C, Orife O, Browning L, Neilson M, McCarthy C, Millar P, Love N, Elwin K, Robinson G, Mannes T, Young N, Chalmers R, Elson R, Vivancos R. Preliminary investigation of a significant national Cryptosporidium exceedance in the United Kingdom, August 2023 and ongoing. Euro Surveill 2023; 28:2300538. [PMID: 37883039 PMCID: PMC10604540 DOI: 10.2807/1560-7917.es.2023.28.43.2300538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 10/27/2023] Open
Abstract
Routine laboratory surveillance has identified an unprecedented and ongoing exceedance of Cryptosporidium spp. across the United Kingdom, notably driven by C. hominis transmission, since 14 August 2023. Information from 477 reported cases in England and Wales, followed up with a standardised exposure questionnaire as of 25 September 2023, identified foreign travel in 250 (54%) of 463 respondents and swimming in 234 (66%) of 353 cases. A significant, common exposure has not yet been identified in first analyses.
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Affiliation(s)
- Lewis Peake
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Thomas Inns
- United Kingdom Health Security Agency, London, the United Kingdom
| | | | - Grace King
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Hussein Rabie
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Joan Henderson
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Adrian Wensley
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Reece Jarratt
- United Kingdom Health Security Agency, London, the United Kingdom
| | | | | | | | | | | | | | - Paul Millar
- Health and Safety Committee (HSC) Public Health Agency, Belfast, Northern Ireland, the United Kingdom
| | - Nicola Love
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
| | - Kristin Elwin
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Guy Robinson
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Trish Mannes
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Nick Young
- United Kingdom Health Security Agency, London, the United Kingdom
| | - Rachel Chalmers
- Cryptosporidium Reference Unit, Public Health Wales, Swansea, the United Kingdom
| | - Richard Elson
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, the United Kingdom
| | - Roberto Vivancos
- United Kingdom Health Security Agency, London, the United Kingdom
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, Liverpool, the United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, the United Kingdom
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Keener DJ, de Oliveira Ruellas AC, Aliaga-Del Castillo A, Arriola-Guillén LE, Bianchi J, Oh H, Gurgel ML, Benavides E, Soki F, Rodríguez-Cárdenas YA, Ruíz-Mora GA, Barkley M, Gebeck T, Hannapel E, McClatchey LM, Pinzon M, Roberts C, Cevidanes L. Three-dimensional decision support system for treatment of canine impaction. Am J Orthod Dentofacial Orthop 2023; 164:491-504. [PMID: 37037759 DOI: 10.1016/j.ajodo.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION This study aimed to develop a 3-dimensional (3D) characterization of the severity of maxillary impacted canines and to test the clinical performance of this characterization as a treatment decision support tool. METHODS Cone-beam computed tomography images obtained from 83 patients with 120 impacted maxillary canines were included. Quantitative information on the canine 3D position and qualitative assessment of root damage of adjacent teeth were evaluated. A severity index was constructed on the basis of the quantitative findings. Clinical applicability was tested by comparing clinical diagnosis and treatment planning for conventional records vs the 3D characterization via a 2-part survey. RESULTS The average quantitative assessments of impacted maxillary canine position were 6.4 ± 3.6 mm from the midsagittal plane, 11.6 ± 3.1 mm in height relative to the occlusal plane, 31.5° ± 18° of roll, and 48.8° ± 14.3° of pitch. The severity index ranged from 0-13 with a mean score of 4.5 ± 2.2. Overlap with adjacent teeth was the greatest contributor (33%) to the index. Bicortically impacted canines caused the most severe root damage. Cone-beam computed tomography was preferred for assessing root damage and overall severity, whereas conventional imaging was sufficient for height and angulation assessment. The 3D report was very important or important for evaluating root damage, canine position, overall severity, and overlap. The 3D report changed most of the decisions relating to biomechanics, patient education, and treatment time estimate. The decision of exposure and traction vs extraction was changed 22% of the time after the presentation of the 3D report. CONCLUSIONS The overlap with adjacent teeth frequently contributes the most to the severity index. The 3D report provided relevant clinical information regarding the canine position, damage to adjacent teeth, and the severity index, with a profound impact on the decisions of the clinicians regarding biomechanics, patient education, and treatment time estimate.
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Affiliation(s)
| | | | - Aron Aliaga-Del Castillo
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Luis Ernesto Arriola-Guillén
- Division of Orthodontics and Division of Oral and Maxillofacial Radiology, School of Dentistry, Universidad Científica del Sur, Lima, Perú
| | - Jonas Bianchi
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | - Heesoo Oh
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, Calif
| | - Marcela Lima Gurgel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Erika Benavides
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Fabiana Soki
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | | | | | - Mary Barkley
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Thomas Gebeck
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Eric Hannapel
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Laurie McNamara McClatchey
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Maria Pinzon
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Christopher Roberts
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, Mich
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Chanchlani N, Lin S, Smith R, Roberts C, Nice R, McDonald TJ, Hamilton B, Bishara M, Bewshea C, Kennedy NA, Goodhand JR, Ahmad T. Pretreatment Vitamin D Concentrations Do Not Predict Therapeutic Outcome to Anti-TNF Therapies in Biologic-Naïve Patients With Active Luminal Crohn's Disease. Crohns Colitis 360 2023; 5:otad026. [PMID: 37265586 PMCID: PMC10231451 DOI: 10.1093/crocol/otad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Indexed: 06/03/2023] Open
Abstract
Background and Aims Vitamin D has a regulatory role in innate and adaptive immune processes. Previous studies have reported that low pretreatment vitamin D concentrations are associated with primary non-response (PNR) and non-remission to anti-TNF therapy. This study aimed to assess whether pretreatment 25-hydroxyvitamin D concentrations predicted PNR and non-remission to infliximab and adalimumab in patients with active luminal Crohn's disease. Methods 25-Hydroxyvitamin D concentrations were measured in stored baseline samples from 659 infliximab- and 448 adalimumab-treated patients in the Personalised Anti-TNF Therapy in Crohn's disease (PANTS) study. Cut-offs for vitamin D were deficiency <25 nmol/L, insufficiency 25-50 nmol/L, and adequacy/sufficiency >50 nmol/L. Results About 17.1% (189/1107; 95% CI, 15.0-19.4) and 47.7% (528/1107; 95% CI, 44.8-50.6) of patients had vitamin D deficiency and insufficiency, respectively. 22.2% (246/1107) of patients were receiving vitamin D supplementation. Multivariable analysis confirmed that sampling during non-summer months, South Asian ethnicity, lower serum albumin concentrations, and non-treatment with vitamin D supplementation were independently associated with lower vitamin D concentrations. Pretreatment vitamin D status did not predict response or remission to anti-TNF therapy at week 14 (infliximab Ppnr = .89, adalimumab Ppnr = .18) or non-remission at week 54 (infliximab P = .13, adalimumab P = .58). Vitamin D deficiency was, however, associated with a longer time to immunogenicity in patients treated with infliximab, but not adalimumab. Conclusions Vitamin D deficiency is common in patients with active Crohn's disease. Unlike previous studies, pretreatment vitamin D concentration did not predict PNR to anti-TNF treatment at week 14 or nonremission at week 54.
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Affiliation(s)
| | | | - Rebecca Smith
- Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Christopher Roberts
- Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Rachel Nice
- Biochemistry, Exeter Clinical Laboratory International, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Timothy J McDonald
- Biochemistry, Exeter Clinical Laboratory International, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Benjamin Hamilton
- Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Maria Bishara
- Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Claire Bewshea
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Nicholas A Kennedy
- Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | | | - Tariq Ahmad
- Address correspondence to: Tariq Ahmad, DPhil, Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, RILD building, Barrack Road, Exeter EX2 5DW, UK ()
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Paterson C, Roberts C, Li J, Chapman M, Strickland K, Johnston N, Law E, Bacon R, Turner M, Mohanty I, Pranavan G, Toohey K. What are the experiences of supportive care in people affected by brain cancer and their informal caregivers: A qualitative systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01401-5. [PMID: 37256499 DOI: 10.1007/s11764-023-01401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE To critically synthesise qualitative research to understand experiences of supportive care in people affected by brain cancer and their informal caregivers. METHODS A qualitative systematic review was conducted according to the Joanna Briggs methodology and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. Electronic databases were searched by an expert systematic review librarian for all qualitative studies irrespective of research design. All publications were double screened by two reviewers using a pre-determined exclusion and inclusion criteria. The review was managed using Covidence systematic review software. Methodological quality assessment and data extraction were performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories, which created the overall synthesised findings. RESULTS A total of 33 studies were included which represented a total sample of 671 participants inclusive of 303 patients and 368 informal caregivers. There was a total of 220 individual findings included in this review, which were synthesised into two findings (1) caregivers and patients perceived supports which would have been helpful and (2) caregiver and patient experiences of unmet supportive care needs. CONCLUSION This review highlighted the suffering and distress caused by brain cancer and associated treatments. Both patients and their informal caregivers experienced disconnect from themselves in renegotiating roles, and a profound sense of loneliness as the physical deterioration of the disease progressed. Both patients and informal caregivers reported similar unmet needs within the current service provision for brain cancer. However, what is apparent is that current cancer services are provided solely for patients, with little or no consideration to the support needs of both the patient and their informal caregiver. Service re-design is needed to improve care coordination with individualised informational support, implementation of holistic needs assessments for both the patients and their caregivers, better community support provision, improved opportunities for emotional care with early referral for palliative care services. IMPLICATIONS FOR CANCER SURVIVORS It is recommended that members of the multidisciplinary brain cancer team reflect on these findings to target holistic needs assessments and develop shared self-management care plans for both the patient and the informal caregiver.
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Affiliation(s)
- C Paterson
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia.
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia.
- Canberra Health Services and ACT Health, Garran, Canberra, Australia.
- Robert Gordon University, Aberdeen, Scotland, UK.
| | - C Roberts
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - J Li
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - M Chapman
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- Department of Palliative Care, Canberra Health Services, Garran, Canberra, Australia
- School of Medicine and Psychology, Australian National University, Canberra, Australia
| | - K Strickland
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, WA, Australia
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, AUT, Auckland, New Zealand
| | - N Johnston
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - E Law
- Icon Cancer Centre, Canberra, Australia
| | - R Bacon
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
| | - I Mohanty
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
| | - G Pranavan
- Canberra Health Services and ACT Health, Garran, Canberra, Australia
| | - K Toohey
- Faculty of Health, University of Canberra, Bruce, Canberra, ACT, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, Canberra, ACT, Australia
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Lane C, Hogg E, Karwatowska LA, French L, Ranieri VF, Jesnick LGD, Roberts C, Scott S, Senior R, Skinner GC, Kennedy EMM. Personalised interventions for subgroups of children with conduct problems. Cochrane Database Syst Rev 2023; 4:CD012746. [PMID: 37115724 PMCID: PMC10144971 DOI: 10.1002/14651858.cd012746.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Conduct problems are a range of disruptive behaviours in childhood that are associated with long-term adverse outcomes in adolescence and adulthood, including antisocial behaviour, substance misuse, and poor academic achievement. Children with conduct problems can vary according to age of onset, comorbidities, and environmental factors, and it has been suggested that certain groups of children may have different treatment outcomes. Therefore, it is important to assess the extent to which personalised interventions for different groups of children with conduct problems may affect outcomes. To our knowledge, this is the first review to systematically identify and appraise the effectiveness of personalised interventions, adapted, or developed, for prespecified subgroups of children with conduct problems. OBJECTIVES To assess whether personalised interventions, adapted or developed for subgroups of children with conduct problems are effective in improving outcomes. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search was 1 February 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs), in any setting, in children (aged two to 12 years) with conduct problems and within a prespecified subgroup, comparing a personalised intervention with a non-personalised intervention, waitlist control, or treatment as usual. Personalised interventions included adaptations to standard practice, such as parent-training programmes; other recommended interventions for children with conduct problems; or interventions developed specifically to target subgroups of children with conduct problems. We excluded non-personalised and non-psychological interventions (e.g. pharmacological or dietary intervention). Prespecified subgroups of children with conduct problems, however defined, were eligible for inclusion. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. child conduct problems or disruptive behaviour and 2. ADVERSE EVENTS Our secondary outcomes were 3. personalised treatment outcomes relevant to each subgroup, 4. parenting skills and knowledge, 5. family functioning, engagement and decreased dropout, and 6. educational outcomes. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We identified 13 RCTs (858 participants). Seven studies were conducted in the USA, five in Australia, and one in Germany. Eleven studies reported their source of funding, with five studies receiving grants from the National Institute of Mental Health. In total, 15 different funders supported the studies included in the review. We separated subgroups of children with conduct problems into three broad categories: children with co-occurring conditions (e.g. emotional difficulties), parent characteristics (e.g. conflict between parents), or familial/environmental circumstances (e.g. rural families). All studies delivered a personalised intervention that was adapted or developed for a prespecified subgroup of children with conduct problems. We rated all trials at unclear or high risk of bias in most domains. Below, we report the results of improvement in child conduct problems and disruptive behaviour, personalised treatment outcomes, and parenting skills and knowledge for our main comparison: personalised versus non-personalised interventions. Improvement in child conduct problems and disruptive behaviour Compared with a non-personalised intervention, a personalised intervention may result in a slight improvement in child conduct problems or disruptive behaviour measured using the Eyberg Child Behavior Inventory (ECBI) Problem subscale in the short term (mean difference (MD) -3.04, 95% confidence interval (CI) -6.06 to -0.02; 6 studies, 278 participants; P = 0.05), but may have little to no effect on improving child conduct problems or disruptive behaviour measured by the ECBI Intensity subscale (MD -6.25, 95% CI -16.66 to 4.15; 6 studies, 278 participants; P = 0.24), or the Externalising subscale of the Child Behaviour Checklist (CBCL) (MD -2.19, 95% CI -6.97 to 2.59; 3 studies, 189 participants, P = 0.37) in the short term. We graded the certainty of evidence as very low for all three outcomes, meaning any estimate of effect is very uncertain. Personalised treatment outcomes, relevant to each subgroup Although six studies reported personalised treatment outcomes, relevant to each subgroup, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Parenting skills and knowledge Although seven studies reported parenting skills and knowledge, we were unable to pool the data due to differences between the measures used in the studies and the heterogeneity this would produce in analysis. The results for this outcome were inconclusive. Adverse events None of the trials reported monitoring adverse events. Summary of results In summary, there is limited evidence that personalised intervention improves child conduct problems, personalised treatment outcomes, relevant to each subgroup, or parenting skills and knowledge compared with a non-personalised intervention. AUTHORS' CONCLUSIONS There is limited evidence for the effectiveness of personalised interventions for subgroups of children with conduct problems. The certainty of evidence for all outcomes was very low, meaning that we have very little confidence in the estimated effects and the true effects may be different to our findings, which will limit the relevance of our findings to clinical decisions. To overcome the limitations of the evidence, large-scale RCTs are needed to determine whether personalised interventions, adapted or developed, for subgroups of children with conduct problems are effective in improving outcomes. Consensus on the most appropriate measures to use in these studies is needed in order to facilitate cross-study comparisons. Persistent conduct problems predict a range of adverse long-term outcomes, so future research should investigate the medium- and long-term effects of personalised treatments. Studies are needed in low- and middle-income countries as well as studies recruiting children aged between nine and 12 years, as they were under-represented in the studies.
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Affiliation(s)
- Chloe Lane
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Elizabeth Hogg
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Lucy A Karwatowska
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Lorna French
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Veronica F Ranieri
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Leah G D Jesnick
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Senior
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Guy Cm Skinner
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eilis M M Kennedy
- Tavistock Research Unit, Tavistock and Portman NHS Foundation Trust, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Roberts C, Hussein M, Poole E, Kolimarala V, Erlewyn-Lajeunesse M, Beattie RM, Sundrum F, Afzal N. Factors Affecting Delayed Gastric Emptying and Long-Term Outcomes of Children With Gastric Emptying. J Pediatr Gastroenterol Nutr 2023; 76:428-433. [PMID: 36727898 DOI: 10.1097/mpg.0000000000003708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Our study attempted to identify what factors best predict for delayed gastric emptying (DGE) and whether children respond to treatment. METHODS Children aged between 0 and 18 were included who had a gastric emptying scintigraphy (GES) study performed between 2009 and 2018. Baseline clinical details were recorded from clinic visit records regarding symptoms, medication, and past medical history. Results were analyzed using multivariate regression analysis and coefficient analysis. Children were followed up at 2 years to assess their symptoms and medication usage. RESULTS Two hundred and eighty-five children were included in the study of which 174 demonstrated DGE. All children had symptoms prior to GES, the most common symptom being that of vomiting and reflux symptoms which were present in over 90% of patients; other common symptoms like abdominal pain and nausea were seen commonly in around 30%. A genetic disorder and prior surgery were more common in children with DGE but there was no difference in presenting symptoms between normal and DGE groups. Regression analysis showed prior surgery and particularly prior abdominal surgery predicted for DGE and additionally predicted for those with highly DGE. Improvement in symptoms and reduction in medication usage was seen after 2 years. CONCLUSIONS This study provides one of the largest data sets looking at DGE in children. Prior surgery was found to be a key factor in predicting for highly DGE. Symptoms and medication usage did significantly reduce substantially after 2 years.
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Affiliation(s)
- Christopher Roberts
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Maryam Hussein
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
- University of Southampton, Southampton, UK
| | - Esme Poole
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
- University of Southampton, Southampton, UK
| | - Vinod Kolimarala
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | | | - R Mark Beattie
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
| | - Francis Sundrum
- the Department of Nuclear Medicine, University Hospital Southampton, Southampton, UK
| | - Nadeem Afzal
- From the Department of Paediatric Gastroenterology, Southampton Children's Hospital, Southampton, UK
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13
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Roberts C, Albusoda A, Farmer AD, Aziz Q. Factors influencing rectal hypersensitivity in irritable bowel syndrome: A systematic review and meta-analysis. Neurogastroenterol Motil 2023; 35:e14515. [PMID: 36573039 DOI: 10.1111/nmo.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/28/2022] [Accepted: 11/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND A frequent, although not universal, feature of irritable bowel syndrome (IBS) is heightened sensitivity to mechanical stimulation of the rectum, termed rectal hypersensitivity (RH). Differences in RH-based on sex, IBS subtype, IBS diagnostic criteria and age of population studied are incompletely understood. We aimed to determine whether IBS population had lower pain thresholds than healthy controls. METHODS We searched MEDLINE and EMBASE databases (1970-2021). Prospective studies that compared pain/discomfort thresholds to mechanical rectal stimuli in IBS and healthy controls were included. Data were pooled for meta-analyses and effect sizes were calculated with 95% confidence interval (CIs). RESULTS Our search strategy identified 809 studies of which 32 studies met the inclusion criteria. Reduced rectal pain thresholds was more common in IBS patients compared to healthy controls with an effect size of 1.00 95% CIs (0.77-1.24) (p < 0.0001) (I2 = 78.6%). The pediatric IBS population had lower pain thresholds than adult IBS populations (p = 0.05) but no difference based on IBS diagnostic criteria, subtype or sex. CONCLUSION & INFERENCES The results suggest that reduced rectal pain threshold to experimental stimulation is far more common in IBS patients than healthy controls. Further research is required to understand the pathophysiological and therapeutic implications of rectal sensitivity such as its role in measuring response to treatment and prognosis in IBS.
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Affiliation(s)
- Christopher Roberts
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Paediatric Gastroenterology, University Hospital Southampton, Southampton, UK
| | - Ahmed Albusoda
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Adam D Farmer
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
- Institute of Applied Clinical Sciences, University of Keele, Keele, UK
- Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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14
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Patel R, Stokes WA, Roberts C, Chung J, Fancy T, Wen S, Gao S. Preoperative low-molecular weight heparin chemoprophylaxis in head and neck free flap reconstruction. Am J Otolaryngol 2023; 44:103722. [PMID: 36527816 DOI: 10.1016/j.amjoto.2022.103722] [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: 09/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The safety of presurgical thromboprophylaxis using low molecular weight heparin (LMWH) has not been well described in head and neck oncologic surgery with free tissue transfer (HNS-FTT). METHODS Retrospective chart review of HNS-FTT patients receiving versus not receiving presurgical subcutaneous enoxaparin (Px-LMWH) was performed. Outcomes included estimated blood loss (EBL), hematoma, flap compromise, DVT or pulmonary embolus (PE). Fisher's exact test and Wilcoxon Rank Sum test were performed to compare groups. Odds ratios and associated 95 % confidence intervals were provided as appropriate. RESULTS 43 of 128 patients (34 %) received Px-LMWH. There was no significant difference in EBL, hematoma, or flap complications between groups. Patients without Px-LMWH had higher rates of DVT and PE, although the difference did not reach statistical significance (p = 1.00, 0.095, respectively). CONCLUSION Presurgical Px-LMWH can be used in major head and neck reconstructive surgery without increased intraoperative blood loss or postoperative complications. Larger studies will need to be done to determine the impact of Px-LMWH on DVT and PE in this patient population. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Rusha Patel
- University of Oklahoma Health Sciences Center, United States of America.
| | | | | | | | - Tanya Fancy
- West Virginia University, United States of America
| | - Sijin Wen
- West Virginia University, United States of America
| | - Si Gao
- West Virginia University, United States of America
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15
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Rotjan RD, Ray NE, Cole I, Castro KG, Kennedy BRC, Barbasch T, Lesneski KC, Lord KS, Bhardwaj A, Edens M, Karageorge I, Klawon C, Kruh-Needleman H, McCarthy G, Perez R, Roberts C, Trumble IF, Volk A, Torres J, Morey J. Shifts in predator behaviour following climate induced disturbance on coral reefs. Proc Biol Sci 2022; 289:20221431. [PMID: 36541169 PMCID: PMC9768634 DOI: 10.1098/rspb.2022.1431] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Coral reefs are increasingly ecologically destabilized across the globe due to climate change. Behavioural plasticity in corallivore behaviour and short-term trophic ecology in response to bleaching events may influence the extent and severity of coral bleaching and subsequent recovery potential, yet our understanding of these interactions in situ remains unclear. Here, we investigated interactions between corallivory and coral bleaching during a severe high thermal event (10.3-degree heating weeks) in Belize. We found that parrotfish changed their grazing behaviour in response to bleaching by selectively avoiding bleached Orbicella spp. colonies regardless of bleaching severity or coral size. For bleached corals, we hypothesize that this short-term respite from corallivory may temporarily buffer coral energy budgets by not redirecting energetic resources to wound healing, and may therefore enable compensatory nutrient acquisition. However, colonies that had previously been heavily grazed were also more susceptible to bleaching, which is likely to increase mortality risk. Thus, short-term respite from corallivory during bleaching may not be sufficient to functionally rescue corals during prolonged bleaching. Such pairwise interactions and behavioural shifts in response to disturbance may appear small scale and short term, but have the potential to fundamentally alter ecological outcomes, especially in already-degraded ecosystems that are vulnerable and sensitive to change.
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Affiliation(s)
- Randi D. Rotjan
- Department of Biology, Boston University, 5 Cummington Mall, Boston, MA 02215, USA,Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Nicholas E. Ray
- Department of Biology, Boston University, 5 Cummington Mall, Boston, MA 02215, USA,Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA,Department of Ecology and Evolutionary Biology, Cornell University, Ithaca, NY 14853, USA
| | - Ingrid Cole
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Kurt G. Castro
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Brian R. C. Kennedy
- Department of Biology, Boston University, 5 Cummington Mall, Boston, MA 02215, USA,Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Tina Barbasch
- Department of Biology, Boston University, 5 Cummington Mall, Boston, MA 02215, USA,Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Kathryn C. Lesneski
- Department of Biology, Boston University, 5 Cummington Mall, Boston, MA 02215, USA,Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Karina Scavo Lord
- Department of Biology, Boston University, 5 Cummington Mall, Boston, MA 02215, USA,Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Anjali Bhardwaj
- Department of Biology, Boston University, 5 Cummington Mall, Boston, MA 02215, USA,Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Madeleine Edens
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Ioanna Karageorge
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Caitlynn Klawon
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Hallie Kruh-Needleman
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Gretchen McCarthy
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Raziel Perez
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Christopher Roberts
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Isabela F. Trumble
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
| | - Aryanna Volk
- Boston University Marine Program, Boston University, 5 Cummington Mall, Boston, MA 02215, USA
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16
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Stewart S, Briggs KB, Fraser JA, Osuchukwu OO, Roberts C, Oyetunji TA, Alemayehu H. Testicular torsion disparities in the pediatric population. J Natl Med Assoc 2022; 114:558-563. [PMID: 36229235 DOI: 10.1016/j.jnma.2022.09.009] [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: 08/09/2022] [Revised: 09/07/2022] [Accepted: 09/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are disparate findings in the literature on the impact of race and insurance status on gonadal loss in testicular torsion. We sought to determine if race or levels of social vulnerability influence the rate of torsion or gonadal loss. METHODS Retrospective cross-sectional review between December 2017 and September 2019. Social vulnerability index was dichotomized using the 75th percentile. Primary outcome was the diagnosis of testicular torsion. RESULTS 515 patients were included. There was no difference in median age, torsion diagnosis, and orchiectomy rate between the two institutions. Black/African American patients were >3 times more likely than Caucasian patients to be diagnosed with TT when controlled for dichotomized SVI, insurance, and age (OR 3.39, 95% CI 1.74 - 6.61, p < 0.01). CONCLUSION Black/African American children have an increased risk of testicular torsion. Despite these patients having higher levels of social vulnerability, it was not associated.
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Affiliation(s)
- Shai Stewart
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
| | - Kayla B Briggs
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - James A Fraser
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Obiyo O Osuchukwu
- Department of Surgery and Pediatrics, Children's and Women's Hospital, 1601 Center St, Ste 1E Mobile, AL 36604, USA
| | - Christopher Roberts
- College of Medicine, University of South Alabama, 5795 USA Drive North, CSAB 170 Mobile, AL 36688, USA
| | - Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA
| | - Hanna Alemayehu
- Department of Surgery and Pediatrics, Children's and Women's Hospital, 1601 Center St, Ste 1E Mobile, AL 36604, USA
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17
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Budd K, Kwon CH, Kasper LH, Roberts C, Roach J, Ocasio-Adorno J, Larson JD, Baker SJ. Abstract IA007: Transforming chromatin: Oncohistone mutations in pediatric high-grade glioma. Cancer Res 2022. [DOI: 10.1158/1538-7445.cancepi22-ia007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Abstract
Pediatric diffuse high-grade gliomas (HGGs) are a heterogeneous spectrum of disease with abysmal survival rates. Approximately half of diffuse high-grade gliomas in children arise in midline structures predominantly the brainstem, but also thalamus, cerebellum and spinal cord. Approximately 80% of these tumors harbor H3 K27M mutations, which result in dramatic depletion of the post-translational modification H3K27me3. Alternative mutations in diffuse midline gliomas can result in similar reduction of H3K27me3, leading to a redefined classification of this collection of tumors as diffuse midline glioma, H3 K27-altered. In contrast, distinct histone H3 mutations, H3.3 G34R/V, are found in approximately 30% of diffuse gliomas arising in the cerebral hemispheres of older adolescents and young adults, defining the tumor subgroup of diffuse hemispheric glioma, H3 G34-mutant. The striking spatiotemporal pattern of these histone mutations, termed oncohistones, indicates an intimate association between epigenetic dysregulation, brain development, and tumorigenesis. We will discuss use of genetically engineered and patient-derived models to investigate the contribution of oncohistone mutations to disrupted development, epigenetic dysregulation and gliomagenesis.
Citation Format: Kaitlin Budd, Chang-Hyuk Kwon, Lawryn H. Kasper, Christopher Roberts, Jordan Roach, Jennifer Ocasio-Adorno, Jon D. Larson, Suzanne J. Baker. Transforming chromatin: Oncohistone mutations in pediatric high-grade glioma. [abstract]. In: Proceedings of the AACR Special Conference: Cancer Epigenomics; 2022 Oct 6-8; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2022;82(23 Suppl_2):Abstract nr IA007.
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Affiliation(s)
- Kaitlin Budd
- 1St. Jude Children's Research Hospital, Memphis, TN,
| | | | | | | | - Jordan Roach
- 1St. Jude Children's Research Hospital, Memphis, TN,
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18
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Vidal Yucha SE, Quackenbush D, Chu T, Lo F, Sutherland JJ, Kuzu G, Roberts C, Luna F, Barnes SW, Walker J, Kuss P. "3D, human renal proximal tubule (RPTEC-TERT1) organoids 'tubuloids' for translatable evaluation of nephrotoxins in high-throughput". PLoS One 2022; 17:e0277937. [PMID: 36409750 PMCID: PMC9678317 DOI: 10.1371/journal.pone.0277937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
The importance of human cell-based in vitro tools to drug development that are robust, accurate, and predictive cannot be understated. There has been significant effort in recent years to develop such platforms, with increased interest in 3D models that can recapitulate key aspects of biology that 2D models might not be able to deliver. We describe the development of a 3D human cell-based in vitro assay for the investigation of nephrotoxicity, using RPTEC-TERT1 cells. These RPTEC-TERT1 proximal tubule organoids 'tubuloids' demonstrate marked differences in physiologically relevant morphology compared to 2D monolayer cells, increased sensitivity to nephrotoxins observable via secreted protein, and with a higher degree of similarity to native human kidney tissue. Finally, tubuloids incubated with nephrotoxins demonstrate altered Na+/K+-ATPase signal intensity, a potential avenue for a high-throughput, translatable nephrotoxicity assay.
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Affiliation(s)
- Sarah E. Vidal Yucha
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
- * E-mail:
| | - Doug Quackenbush
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
| | - Tiffany Chu
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
| | - Frederick Lo
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
| | - Jeffrey J. Sutherland
- Novartis Institutes for BioMedical Research-Cambridge, Cambridge, MA, United States of America
| | - Guray Kuzu
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
| | - Christopher Roberts
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
| | - Fabio Luna
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
| | - S. Whitney Barnes
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
| | - John Walker
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
| | - Pia Kuss
- Novartis Institutes for BioMedical Research-San Diego, La Jolla, CA, United States of America
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19
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Pacchiarini N, Sawyer C, Williams C, Sutton D, Roberts C, Simkin F, King G, McClure V, Cottrell S, Clayton H, Beazer A, Williams C, Rey SM, Connor TR, Moore C. Epidemiological analysis of the first 1000 cases of SARS-CoV-2 lineage BA.1 (B.1.1.529, Omicron) compared with co-circulating Delta in Wales, UK. Influenza Other Respir Viruses 2022; 16:986-993. [PMID: 35822273 PMCID: PMC9350272 DOI: 10.1111/irv.13021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background The Omicron (lineage B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) was first reported in Wales, UK, on 3 December 2021. The aim of the study was to describe the first 1000 cases of the Omicron variant by demographic, vaccination status, travel and severe outcome status and compare this to contemporaneous cases of the Delta variant. Methods Testing, typing and contact tracing data were collected by Public Health Wales and analysis undertaken by the Communicable Disease Surveillance Centre (CDSC). Risk ratios for demographic factors and symptoms were calculated comparing Omicron cases to Delta cases identified over the same time period. Results By 14 December 2021, 1000 cases of the Omicron variant had been identified in Wales. Of the first 1000, just 3% of cases had a prior history of travel revealing rapid community transmission. A higher proportion of Omicron cases were identified in individuals aged 20–39, and most cases were double vaccinated (65.9%) or boosted (15.7%). Age‐adjusted analysis also revealed that Omicron cases were less likely to be hospitalised (0.4%) or report symptoms (60.8%). Specifically a significant reduction was observed in the proportion of Omicron cases reporting anosmia (8.9%). Conclusion Key findings include a lower risk of anosmia and a reduced risk of hospitalisation in the first 1000 Omicron cases compared with co‐circulating Delta cases. We also identify that existing measures for travel restrictions to control importations of new variants identified outside the United Kingdom did not prevent the rapid ingress of Omicron within Wales.
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Affiliation(s)
- Nicole Pacchiarini
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Clare Sawyer
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Christopher Williams
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Daryn Sutton
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Christopher Roberts
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Felicity Simkin
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Grace King
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Victoria McClure
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Simon Cottrell
- Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Cardiff, Wales, UK
| | - Helen Clayton
- Informatics Division, Operations and Finance Directorate, Public Health Wales, Cardiff, Wales, UK
| | - Andrew Beazer
- Pathogen Genomics Unit, Public Health Wales, Cardiff, Wales, UK
| | - Catie Williams
- Pathogen Genomics Unit, Public Health Wales, Cardiff, Wales, UK
| | - Sara M Rey
- Pathogen Genomics Unit, Public Health Wales, Cardiff, Wales, UK
| | - Thomas R Connor
- Pathogen Genomics Unit, Public Health Wales, Cardiff, Wales, UK.,Cardiff University School of Biosciences, Cardiff University, Cardiff, Wales, UK
| | - Catherine Moore
- Wales Specialist Virology Centre, Microbiology, Public Health Wales, Cardiff, Wales, UK
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20
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Ishiyama N, O'Connor M, Salomatov A, Romashko D, Thakur S, Mentes A, Hopkins JF, Frampton GM, Albacker LA, Kohlmann A, Roberts C, Buck E. Computational and Functional Analyses of HER2 Mutations Reveal Allosteric Activation Mechanisms and Altered Pharmacologic Effects. Cancer Res 2022; 83:1531-1542. [PMID: 35503682 PMCID: PMC10152233 DOI: 10.1158/0008-5472.can-21-0940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 09/07/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
Amplification of HER2 can drive the proliferation of cancer cells, and several inhibitors of HER2 have been successfully developed. Recent advances in next-generation sequencing now reveal that HER2 is subject to mutation, with over 2000 unique variants observed in human cancers. Several examples of oncogenic HER2 mutations have been described, and these primarily occur at allosteric sites outside the ATP-binding site. To identify the full spectrum of oncogenic HER2 driver mutations aside from a few well-studied mutations, we developed mutation-allostery-pharmacology (MAP), an in silico prediction algorithm based on machine learning. By applying this computational approach to 820 single-nucleotide variants, a list of 222 known and potential driver mutations was produced. Of these 222 mutations, 111 were screened by Ba/F3-retrovirus proliferation assays; 37 HER2 mutations were experimentally determined to be driver mutations, comprising 15 previously characterized and 22 newly identified oncogenic mutations. These oncogenic mutations mostly affected allosteric sites in the extracellular domain (ECD), transmembrane domain, and kinase domain of HER2, with only a single mutation in the HER2 orthosteric ATP site. Covalent homodimerization was established as a common mechanism of activation among HER2 ECD allosteric mutations, including the most prevalent HER2 mutation, S310F. Furthermore, HER2 allosteric mutants with enhanced covalent homodimerization were characterized by altered pharmacology that reduces the activity of existing anti-HER2 agents, including the monoclonal antibody trastuzumab and the tyrosine kinase inhibitor lapatinib. Overall, the MAP-scoring and functional validation analyses provided new insights into the oncogenic activity and therapeutic targeting of HER2 mutations in cancer.
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Affiliation(s)
| | | | | | - Darlene Romashko
- Black Diamond Therapeutics Inc, Stony Brook, New York, United States
| | | | - Ahmet Mentes
- Black Diamond Therapeutics, Inc., New York, United States
| | | | | | | | | | | | - Elizabeth Buck
- Black Diamond Therapeutics Inc, New York, NY, United States
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21
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Wright A, Amodie DM, Cernicchiaro N, Lascelles BDX, Pavlock AM, Roberts C, Bartram DJ. Identification of canine osteoarthritis using an owner-reported questionnaire and treatment monitoring using functional mobility tests. J Small Anim Pract 2022; 63:609-618. [PMID: 35385129 PMCID: PMC9543207 DOI: 10.1111/jsap.13500] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/10/2022] [Accepted: 03/11/2022] [Indexed: 12/14/2022]
Abstract
Objectives To investigate the diagnostic value of an owner‐completed canine osteoarthritis screening checklist to help identify previously undiagnosed osteoarthritis cases, and assess their response to carprofen treatment by monitoring pain and functional mobility. Materials and Methods Dogs (n=500) whose owners reported ≥1 positive response to the osteoarthritis checklist were examined to identify dogs with previously undiagnosed osteoarthritis. Eligible dogs (n=133) were evaluated for pain and video mobility analysis by Helsinki Chronic Pain Index and visual analogue scale scores, respectively, following carprofen treatment, administered for 30 days (n=95) or up to 120 days (n=38). Dogs were filmed at clinics performing activities (walking, jogging, sitting/lying, walking up and down stairs), and scored at days 0, 30 and 120 using visual analogue scale by an independent blinded expert. Results A diagnosis of osteoarthritis was confirmed by a veterinarian in 38% (188 of 500) of dogs. Balance of sensitivity and specificity across the original group of nine screening questions was optimised to approximately 88 and 71%, respectively, after elimination of three questions. Pain measured by Helsinki Chronic Pain Index and functional mobility improved over time in response to treatment with carprofen. Mean ability scores for activities significantly improved between days 0 and 30 for walking, jogging, sitting/lying and walking down stairs, and days 0 and 120 for sitting/lying and walking up stairs. Clinical Significance More osteoarthritis cases were identified in study dogs than previous prevalence estimates, indicating the screening checklist's potential to help identify for further evaluation cases that could otherwise remain undiagnosed. Improvements in function were demonstrated after carprofen treatment.
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Affiliation(s)
- A Wright
- Outcomes Research, Zoetis Inc., Parsippany, New Jersey, 07054, USA
| | - D M Amodie
- Outcomes Research, Zoetis Inc., Parsippany, New Jersey, 07054, USA
| | - N Cernicchiaro
- Center for Outcomes Research and Epidemiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, 66506, USA
| | - B D X Lascelles
- Comparative Pain Research and Education Centre & Translational Research in Pain Program, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, 27606, USA
| | - A M Pavlock
- AMP Research Solutions, Parker Ford, Pennsylvania, 19457, USA
| | - C Roberts
- vHive, School of Veterinary Medicine, University of Surrey, Guildford, GU2 7AL, UK
| | - D J Bartram
- Outcomes Research, Zoetis Inc., Parsippany, New Jersey, 07054, USA
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22
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Pouillot R, Smith M, Van Doren JM, Catford A, Holtzman J, Calci KR, Edwards R, Goblick G, Roberts C, Stobo J, White J, Woods J, DePaola A, Buenaventura E, Burkhardt W. Risk Assessment of Norovirus Illness from Consumption of Raw Oysters in the United States and in Canada. Risk Anal 2022; 42:344-369. [PMID: 34121216 PMCID: PMC9291475 DOI: 10.1111/risa.13755] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 05/30/2023]
Abstract
Human norovirus (NoV) is the leading cause of foodborne illness in the United States and Canada. Bivalve molluscan shellfish is one commodity commonly identified as being a vector of NoV. Bivalve molluscan shellfish are grown in waters that may be affected by contamination events, tend to bioaccumulate viruses, and are frequently eaten raw. In an effort to better assess the elements that contribute to potential risk of NoV infection and illness from consumption of bivalve molluscan shellfish, the U.S. Department of Health and Human Services/Food and Drug Administration (FDA), Health Canada (HC), the Canadian Food Inspection Agency (CFIA), and Environment and Climate Change Canada (ECCC) collaborated to conduct a quantitative risk assessment for NoV in bivalve molluscan shellfish, notably oysters. This study describes the model and scenarios developed and results obtained to assess the risk of NoV infection and illness from consumption of raw oysters harvested from a quasi-steady-state situation. Among the many factors that influence the risk of NoV illness for raw oyster consumers, the concentrations of NoV in the influent (raw, untreated) and effluent (treated) of wastewater treatment plants (WWTP) were identified to be the most important. Thus, mitigation and control strategies that limit the influence from human waste (WWTP outfalls) in oyster growing areas have a major influence on the risk of illness from consumption of those oysters.
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Affiliation(s)
- Régis Pouillot
- U.S. Food and Drug Administration5001 Campus DriveCollege ParkMD20740USA
| | - Mark Smith
- Health Canada251 Sir Frederick Banting Driveway Tunney's Pasture, Mail Stop 2204EOttawaONK1A 0K9Canada
| | - Jane M. Van Doren
- U.S. Food and Drug Administration5001 Campus DriveCollege ParkMD20740USA
| | - Angela Catford
- Health Canada251 Sir Frederick Banting Driveway Tunney's Pasture, Mail Stop 2204EOttawaONK1A 0K9Canada
| | - Jennifer Holtzman
- Health Canada251 Sir Frederick Banting Driveway Tunney's Pasture, Mail Stop 2204EOttawaONK1A 0K9Canada
| | - Kevin R. Calci
- U.S. Food and Drug AdministrationGulf Coast Seafood LaboratoryDauphin IslandAL36528USA
| | - Robyn Edwards
- Canadian Food Inspection Agency1400 Merivale RoadOttawaONK1A 0Y9Canada
| | - Gregory Goblick
- U.S. Food and Drug AdministrationGulf Coast Seafood LaboratoryDauphin IslandAL36528USA
| | - Christopher Roberts
- Environment and Climate Change Canada45 Alderney Dr, 7th FloorDartmouthNSB2Y 2N6Canada
| | - Jeffrey Stobo
- Environment and Climate Change Canada45 Alderney Dr, 7th FloorDartmouthNSB2Y 2N6Canada
| | - John White
- Canadian Food Inspection Agency57 Central St., Suite 204SummersidePEC1N 3K9Canada
| | - Jacquelina Woods
- U.S. Food and Drug AdministrationGulf Coast Seafood LaboratoryDauphin IslandAL36528USA
| | - Angelo DePaola
- U.S. Food and Drug AdministrationGulf Coast Seafood LaboratoryDauphin IslandAL36528USA
| | - Enrico Buenaventura
- Health Canada251 Sir Frederick Banting Driveway Tunney's Pasture, Mail Stop 2204EOttawaONK1A 0K9Canada
| | - William Burkhardt
- U.S. Food and Drug AdministrationGulf Coast Seafood LaboratoryDauphin IslandAL36528USA
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23
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Hunjan MK, Roberts C, Karim S, Hague J. Pityriasis rubra pilaris-like eruption following administration of the BNT163b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine. Clin Exp Dermatol 2022; 47:188-190. [PMID: 34379821 PMCID: PMC8444918 DOI: 10.1111/ced.14878] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
We describe a case of a pityriasis rubra pilaris (PRP)-like eruption occurring following administration of the Pfizer-Biontech mRNA COVID-19 vaccine, with worsening of the condition following the second dose. To our knowledge, this is the first reported case of a PRP-like eruption as a cutaneous adverse event of the Pfizer-Biontech mRNA COVID-19 vaccine.
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Affiliation(s)
- M. K. Hunjan
- Department of DermatologySolihull HospitalUniversity Hospitals Birmingham Foundation NHS TrustBirminghamUK
| | - C. Roberts
- Department of HistopathologySolihull HospitalUniversity Hospitals Birmingham Foundation NHS TrustBirminghamUK
| | - S. Karim
- Department of HistopathologySolihull HospitalUniversity Hospitals Birmingham Foundation NHS TrustBirminghamUK
| | - J. Hague
- Department of DermatologySolihull HospitalUniversity Hospitals Birmingham Foundation NHS TrustBirminghamUK
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24
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Roberts C, Castaño J, Ozolek J, Smith MC, Kiefer A, Ramadan HH, Makary CA. Endoscopic-Assisted Resection of a Novel Nasopharyngeal Hairy Polyp and Odontoma in an Infant. Ear Nose Throat J 2021:1455613211065516. [PMID: 34894791 DOI: 10.1177/01455613211065516] [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: 11/17/2022] Open
Affiliation(s)
- Christopher Roberts
- Department of Otolaryngology, 5631West Virginia University, Morgantown, WV, USA
| | - Johnathan Castaño
- Department of Otolaryngology, 5631West Virginia University, Morgantown, WV, USA
| | - John Ozolek
- Department of Pathology, 5631West Virginia University, Morgantown, WV, USA
| | - Mark Cody Smith
- Department of Pediatrics, 5631West Virginia University, Morgantown, WV, USA
| | - Autumn Kiefer
- Department of Pediatrics, 5631West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology, 5631West Virginia University, Morgantown, WV, USA
| | - Chadi A Makary
- Department of Otolaryngology, 5631West Virginia University, Morgantown, WV, USA
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Dardenne E, Padilla F, Rasmussen S, Yang SN, Mentes A, Ogawa LS, Trombino A, Romashko D, Chevtsova M, Thakur S, Buck E, Roberts C, Lucas M, Lin TA. Abstract P246: Discovery and characterization of selective, FGFR1 sparing, inhibitors of FGFR2/3 oncogenic mutations for the treatment of cancers. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Targeting FGFR genetic alterations using small molecule inhibitors is a validated therapeutic strategy for urothelial carcinoma and cholangiocarcinoma. However, the current FDA-approved pan-FGFR inhibitors, erdafitinib and pemigatinib, are subject to FGFR1-mediated dose-limiting toxicities (e.g., hyperphosphatemia). These treatments necessitate a high rate of dose reductions, interruptions, and discontinuations, thereby potentially limiting efficacy. In addition, drug-resistant mutations (e.g., gatekeeper) in FGFR2 and FGFR3 genes rapidly emerge in patients treated with these drugs. Our research goals are to reveal the full spectrum of oncogenic FGFR2 and FGFR3 mutations that drive tumor growth and to discover an inhibitor that selectively targets these mutations together with FGFR2 and FGFR3 gene fusion and drug-resistance mutations, while minimizing FGFR1 activity and associated toxicities. We hypothesize that this will deliver an FGFR precision medicine with enhanced anti-tumor activity, an improved drug resistance profile, and broader mutational coverage. Methods: Applying the Mutation-Allostery-Pharmacology (MAP) platform technology developed by Black Diamond Therapeutics, we defined a spectrum of 34 allosteric FGFR2/3 oncogenic mutations, including over 28 previously uncharacterized mutations that we now show to be oncogenic. The MAP platform allowed us to further classify those mutations into functional clusters or families of mutations that can be targeted using a single compound. While located throughout the extracellular and kinase domains, we demonstrated how these functional clusters activate FGFR2 or FGFR3. Among the mechanisms identified, a functional cluster of mutations is activated due to disulfide-bond mediated dimerization. Results: Herein, we report the discovery of a series of orally available, selective FGFR2/3 inhibitors that 1) shows antiproliferative potency across all 34 mutations; 2) spares FGFR1-wild-type; 3) is active against gatekeeper mutations and 4) shows favorable selectivity versus a subset of closely related kinases in the human kinome. In addition to being potent against FGFR2 and FGFR3 primary mutations, we demonstrated that our FGFR1 sparing inhibitors retain potency against the most prevalent FGFR2 resistant mutations. When dosed orally, one example was well tolerated and exhibited dose-dependent PK/PD and anti-tumor efficacy and regression in several FGFR2 and FGFR3 driven xenograft models in mice. In addition, when dosed at efficacious doses, no FGFR1-mediated hyperphosphatemia was observed in these animals instead of the animals that were treated with pan FGFR inhibitors. Conclusion: Our data support the development of rationally designed selective inhibitors targeting a spectrum of FGFR2/3 mutations while sparing dose limiting FGFR1 activity.
Citation Format: Etienne Dardenne, Fernando Padilla, Sara Rasmussen, Shao Ning Yang, Ahmet Mentes, Luisa Shin Ogawa, Anthony Trombino, Darlene Romashko, Maria Chevtsova, Shalabh Thakur, Elisabeth Buck, Christopher Roberts, Matthew Lucas, Tai-An Lin. Discovery and characterization of selective, FGFR1 sparing, inhibitors of FGFR2/3 oncogenic mutations for the treatment of cancers [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P246.
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Han YC, Ng PY, Schulz R, Yang SN, Lelo A, Shin L, O'Connor M, Jewett I, Ishiyama N, Romashko D, Thakur S, Salomatov A, Smith S, Buck E, Roberts C, Lucas M, Lin TA. Abstract P229: Pre-clinical evaluation of next-generation inhibitor targeting a wide spectrum of oncogenic BRAF dimers. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The canonical BRAF V600E (Class I) mutation is a potent oncogene uniquely active as a RAS-independent monomer, successfully targeted by several FDA-approved inhibitors. However, these first-generation BRAF inhibitors are not active against non-canonical BRAF oncogenic mutations, including BRAF-fusions, that drive RAS-independent (Class II) or RAS-dependent (Class III) dimers. As such, developing inhibitors directed against dimeric BRAF oncogenic mutations that avoid paradoxical activation is a major unmet clinical need. We applied proprietary Mutation-Allostery-Pharmacology (MAP) platform technology developed by Black Diamond Therapeutics to identify and validate a group of previously uncharacterized non-canonical oncogenic Class II and Class III BRAF mutation clusters. We further demonstrate that this ensemble of novel and previously validated non-canonical oncogenic BRAF mutants can form the basis of a differentiated drug discovery program aimed at identifying small molecules that potently and selectively target this family of dimeric BRAF mutations. Herein, we describe a small molecule inhibitor, BDTX BRAF-A, with potent anti-proliferative activity directed against tumor cells expressing a wide spectrum of non-canonical Class II/III mutations. This broad activity (“MasterKey” profile) of BDTX BRAF-A is further demonstrated in cell lines that harbor endogenous oncogenic dimer-inducing BRAF mutations and in various solid tumor patient-derived xenograft (PDX) models ex vivo. Importantly, BDTX BRAF-A did not induce paradoxical RAF activation characteristic of Class I BRAF inhibitors. Finally, BDTX BRAF-A achieves robust anti-tumor efficacy and target engagement of dimeric BRAF oncogenes in mouse models. These data support the continued development of rationally designed molecules targeting a broad range of non-canonical BRAF dimer-promoting mutations to extend the prospect of precision medicine in patients.
Citation Format: Yoon-Chi Han, Pui Yee Ng, Ryan Schulz, Shao Ning Yang, Alana Lelo, Luisa Shin, Matthew O'Connor, Ivan Jewett, Noboru Ishiyama, Darlene Romashko, Shalabh Thakur, Andrei Salomatov, Sherri Smith, Elizabeth Buck, Christopher Roberts, Matthew Lucas, Tai-An Lin. Pre-clinical evaluation of next-generation inhibitor targeting a wide spectrum of oncogenic BRAF dimers [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P229.
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Affiliation(s)
| | - Pui Yee Ng
- 2Black Diamond Therapeutics, Cambridge, MA,
| | | | | | - Alana Lelo
- 1Black Diamond Therapeutics, New York, NY,
| | - Luisa Shin
- 2Black Diamond Therapeutics, Cambridge, MA,
| | | | | | | | | | | | | | | | | | | | | | - Tai-An Lin
- 1Black Diamond Therapeutics, New York, NY,
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Lucas MC, Merchant MS, O'Connor M, Cook C, Smith S, Trombino A, Zhang WY, Visiers I, Tith K, Foroughi R, Waters N, Wrona I, Pickard M, Eathiraj S, Witt K, Roberts C, Humphrey R, Buck E. Abstract P02-04: BDTX-1535, a CNS penetrant MasterKey inhibitor of common, uncommon and resistant EGFR mutations, demonstrates in vivo efficacy and has potential to treat osimertinib-resistant NSCLC with or without brain metastases. Mol Cancer Ther 2021. [DOI: 10.1158/1535-7163.targ-21-p02-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
NSCLC accounts for approximately 85% of lung cancer cases worldwide. NSCLC harboring EGFR mutations constitutes 10-20% of all lung cancer cases in Europe and North America, and up to 50% of those in Asia. The majority (80-90%) of these mutations are either Exon19del or L858R. Uncommon EGFR mutations, of which G719X, S768I and L861Q are amongst the most frequent, account for 10-20% of EGFR mutations in NSCLC. Additionally, secondary EGFR mutations such as C797S that emerge during treatment with osimertinib occur in ~10% of patients. Current generation EGFR inhibitors with efficacy against common, uncommon and/or resistance mutations are either poorly brain penetrant or do not have broad spectrum activity against multiple mutations. BDTX-1535 is an irreversible, spectrum selective MasterKey inhibitor of common, uncommon and resistance EGFR mutations such as G719X and C797S that occur in NSCLC (IC50<10nM). BDTX-1535 is differentiated from many EGFR inhibitors by its CNS-penetrating properties. BDTX-1535 has a Kpuu, defined as the ratio of the unbound brain tissue concentration over the unbound plasma concentration, of 0.8 in rat. In studies of EGFR Exon19del+C797S, BDTX-1535 achieved pEGFR suppression exceeding 24 hours in vitro and following a single dose in vivo. BDTX-1535 has demonstrated robust tumor growth inhibition and regressions in multiple pre-clinical models, including PDX intracranial models. Thus, BDTX-1535 has potential to treat patients with NSCLC harboring a broad range of mutations, both common and uncommon, as well as those associated with resistance to the current standard of care TKIs. The CNS penetrating properties may help to treat CNS metastases or to prevent them from occurring. BDTX-1535 is currently being evaluated in IND-enabling studies.
Citation Format: Matthew C. Lucas, Melinda S. Merchant, Matthew O'Connor, Carl Cook, Sherri Smith, Anthony Trombino, Wu-Yan Zhang, Irache Visiers, Kate Tith, Reza Foroughi, Nigel Waters, Iwona Wrona, Michael Pickard, Sudharshan Eathiraj, Karsten Witt, Christopher Roberts, Rachel Humphrey, Elizabeth Buck. BDTX-1535, a CNS penetrant MasterKey inhibitor of common, uncommon and resistant EGFR mutations, demonstrates in vivo efficacy and has potential to treat osimertinib-resistant NSCLC with or without brain metastases [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P02-04.
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Affiliation(s)
| | | | | | - Carl Cook
- 1Black Diamond Therapeutics, Cambridge, MA,
| | | | | | | | | | - Kate Tith
- 1Black Diamond Therapeutics, Cambridge, MA,
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van Mourik MSM, van Rooden SM, Abbas M, Aspevall O, Astagneau P, Bonten MJM, Carrara E, Gomila-Grange A, de Greeff SC, Gubbels S, Harrison W, Humphreys H, Johansson A, Koek MBG, Kristensen B, Lepape A, Lucet JC, Mookerjee S, Naucler P, Palacios-Baena ZR, Presterl E, Pujol M, Reilly J, Roberts C, Tacconelli E, Teixeira D, Tängdén T, Valik JK, Behnke M, Gastmeier P. PRAISE: providing a roadmap for automated infection surveillance in Europe. Clin Microbiol Infect 2021; 27 Suppl 1:S3-S19. [PMID: 34217466 DOI: 10.1016/j.cmi.2021.02.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/17/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Healthcare-associated infections (HAI) are among the most common adverse events of medical care. Surveillance of HAI is a key component of successful infection prevention programmes. Conventional surveillance - manual chart review - is resource intensive and limited by concerns regarding interrater reliability. This has led to the development and use of automated surveillance (AS). Many AS systems are the product of in-house development efforts and heterogeneous in their design and methods. With this roadmap, the PRAISE network aims to provide guidance on how to move AS from the research setting to large-scale implementation, and how to ensure the delivery of surveillance data that are uniform and useful for improvement of quality of care. METHODS The PRAISE network brings together 30 experts from ten European countries. This roadmap is based on the outcome of two workshops, teleconference meetings and review by an independent panel of international experts. RESULTS This roadmap focuses on the surveillance of HAI within networks of healthcare facilities for the purpose of comparison, prevention and quality improvement initiatives. The roadmap does the following: discusses the selection of surveillance targets, different organizational and methodologic approaches and their advantages, disadvantages and risks; defines key performance requirements of AS systems and suggestions for their design; provides guidance on successful implementation and maintenance; and discusses areas of future research and training requirements for the infection prevention and related disciplines. The roadmap is supported by accompanying documents regarding the governance and information technology aspects of implementing AS. CONCLUSIONS Large-scale implementation of AS requires guidance and coordination within and across surveillance networks. Transitions to large-scale AS entail redevelopment of surveillance methods and their interpretation, intensive dialogue with stakeholders and the investment of considerable resources. This roadmap can be used to guide future steps towards implementation, including designing solutions for AS and practical guidance checklists.
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Affiliation(s)
- Maaike S M van Mourik
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, the Netherlands.
| | - Stephanie M van Rooden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Centre for Infectious Disease Epidemiology and Surveillance National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mohamed Abbas
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - Olov Aspevall
- Unit for Surveillance and Coordination, Public Health Agency of Sweden, Solna, Sweden
| | - Pascal Astagneau
- Centre for Prevention of Healthcare-Associated Infections, Assistance Publique - Hôpitaux de Paris & Faculty of Medicine, Sorbonne University, Paris, France
| | - Marc J M Bonten
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Aina Gomila-Grange
- Infectious Diseases Unit, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Barcelona, Infectious Diseases Unit, Consorci Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Sabine C de Greeff
- Centre for Infectious Disease Epidemiology and Surveillance National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sophie Gubbels
- Data Integration and Analysis Secretariat, Statens Serum Institut, Copenhagen, Denmark
| | - Wendy Harrison
- Healthcare Associated Infections, Antimicrobial Resistance and Prescribing Programme (HARP), Public Health Wales, UK
| | - Hilary Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | | | - Mayke B G Koek
- Centre for Infectious Disease Epidemiology and Surveillance National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Brian Kristensen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Alain Lepape
- Clinical Research Unit, Department of Intensive Care, Centre Hospitalier Universitaire Lyon Sud 69495, Pierre-Bénite, France
| | - Jean-Christophe Lucet
- Infection Control Unit, Hôpital Bichat-Claude Bernard Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Siddharth Mookerjee
- Infection Prevention and Control Department, Imperial College Healthcare NHS Trust, UK
| | - Pontus Naucler
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Zaira R Palacios-Baena
- Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Institute of Biomedicine of Seville (I. BIS), Sevilla, Spain
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Austria
| | - Miquel Pujol
- Infectious Diseases Unit, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Barcelona, Infectious Diseases Unit, Consorci Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Jacqui Reilly
- Safeguarding Health Through Infection Prevention Research Group, Institute for Applied Health Research, Glasgow Caledonian University, Scotland, UK
| | - Christopher Roberts
- Healthcare Associated Infections, Antimicrobial Resistance and Prescribing Programme (HARP), Public Health Wales, UK
| | - Evelina Tacconelli
- Infectious Diseases, Research Clinical Unit, DZIF Center, University Hospital Tübingen, Germany; Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Daniel Teixeira
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Tängdén
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - John Karlsson Valik
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Behnke
- National Reference Center for Surveillance of nosocomial Infections, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Petra Gastmeier
- National Reference Center for Surveillance of nosocomial Infections, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
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Roberts C, Albusoda A, Farmer AD, Aziz Q. Rectal Hypersensitivity in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Crohns Colitis 360 2021; 3:otab041. [PMID: 36776657 PMCID: PMC9802320 DOI: 10.1093/crocol/otab041] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Indexed: 11/14/2022] Open
Abstract
Abdominal pain is a key symptom of inflammatory bowel disease (IBD), particularly in active IBD, but also occurs in patients with quiescent disease suggesting that mechanisms other than active inflammation may be responsible. Putative hypothesis to explain chronic abdominal pain in patients with quiescent IBD includes crossover with irritable bowel syndrome where rectal hypersensitivity is common and has pathophysiological implications. In contrast, in IBD, the role of rectal hypersensitivity has not been established. We aimed to determine if rectal hypersensitivity was more common in IBD compared to a healthy control population. We searched MEDLINE and EMBASE databases (1970-2018). Prospective studies that measured pain/discomfort thresholds to mechanical rectal stimuli in IBD and healthy controls were included. Data were pooled for meta-analysis and effect sizes were calculated with 95% confidence intervals (CIs). Our search strategy identified 222 citations of which 8 met the inclusion criteria, covering 133 individuals with IBD (67 men), aged between 10 and 77 compared to 99 healthy controls (55 men), aged between 10 and 67. The prevalence of rectal hypersensitivity in IBD compared to healthy controls was similar with an effect size of 0.59 (95% CIs: -0.27 to 1.44, P = .16, I 2 = 87.3%). Subgroup analysis did show a significant effect size for patients compared to healthy controls with active disease (1.32) but not for quiescent disease (-0.02). These results suggest that reduced rectal pain thresholds to experimental stimulation are not seen in IBD populations except during active flares of the disease. Further research is required to understand the pathophysiology of chronic abdominal pain in quiescent IBD populations with and without chronic abdominal pain to identify appropriate management strategies.
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Affiliation(s)
- Christopher Roberts
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK,University Hospital Southampton, Southampton, UK
| | - Ahmed Albusoda
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adam D Farmer
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK,Mech-Sense, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark,Institute of Applied Clinical Sciences, University of Keele, Keele, UK,Department of Gastroenterology, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK,Address correspondence to: Qasim Aziz, PhD, FRCP, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, 26 Ashfield Street, Whitechapel, London E1 2AJ, UK ()
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Ladi E, Papalois ZA, Shin JH, Roberts C, Jones K. P089. Fertility preservation in newly diagnosed breast cancer patients: Compliance with national standards. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Reeves N, Cuff S, Boyce K, Harries R, Roberts C, Harrison W, Torkington J. Diagnosis of colorectal and emergency surgical site infections in the era of enhanced recovery: an all-Wales prospective study. Colorectal Dis 2021; 23:1239-1247. [PMID: 33544977 DOI: 10.1111/codi.15569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/19/2020] [Revised: 11/26/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022]
Abstract
AIM Surgical site infections (SSIs) are associated with increased morbidity, hospital stay and cost. The literature reports that 25% of patients who undergo colorectal surgical procedures develop a SSI. Due to the enhanced recovery programme, patients are being discharged earlier with some SSIs presenting in primary care, making accurate recording of SSIs difficult. The aim of this study was to accurately record the 30-day SSI rate after surgery performed by colorectal surgeons nationally within Wales. METHOD During March 2019, a national prospective snapshot study of all patients undergoing elective or emergency colorectal and general surgical procedures under the care of a colorectal consultant at 12 Welsh hospitals was completed. There was a multimodal 30-day follow-up using electronic records, clinic visits and/or telephone calls. Diagnosis of SSI was based on Centers for Disease Control and Prevention diagnostic criteria. RESULTS Within Wales, of the 545 patients included, 13% developed a SSI within 30 days, with SSI rates of 14.3% for elective surgery and 11.7% for emergency surgery. Of these SSIs, 49.3% were diagnosed in primary care, with 28.2% of patients being managed exclusively in the community. There were two peaks of diagnosis at days 5-7 and days 22-28. SSI rates between laparoscopic (8.6%) and open (16.2%) surgeries were significantly different (p = 0.028), and there was also a significantly different rate of SSI between procedure groups (p = 0.001), with high SSI rates for colon (22%) and rectal (18.9%) surgery compared with general surgical procedures. CONCLUSION This first all-Wales prospective study demonstrated an overall SSI rate of 13%. By incorporating accurate primary care follow-up it was found that 49.3% of these SSIs were diagnosed in primary care.
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Affiliation(s)
- Nicola Reeves
- Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Simone Cuff
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Kathryn Boyce
- Colorectal Surgery, University Hospital of Wales, Cardiff, UK
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Azeez N, Roberts C, Bradbury H. Stakeholders (trainees & tutors) views on the introduction of a workplace-based assessment tool within the pre-registration pharmacy training programme in a large teaching hospital: A qualitative triangulation study. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab015.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Pre-registration pharmacy training in the UK is a competency-based programme1. Workplace-based assessment (WBA) tools are valid and reliable tools in assessing competency in the workplace,2 however no recognised WBA tools are used within pre-registration pharmacy training. Historically WBA have been used within healthcare training, including postgraduate pharmacy. A WBA tool was designed by amalgamating three recognised tools from postgraduate pharmacy training (case-based discussion, mini clinical examination and direct observed patient consultation), then piloted within the 2018/19 pre-registration pharmacy training year in a large teaching hospital.
Aim
To gather the views of pre-registration pharmacist trainees and tutors of their experiences of using the WBA tool in practice. From the views, to determine if the purposes of the tool had been met: allowing tutors to work directly with their trainee in the workplace and meet the GPhC performance standards1 that are more easily met through observation.
Methods
This research was carried out in a large teaching hospital in the North of England. The WBA tool which included a six-point Likert scale and comments boxes for feedback, was introduced to the stakeholders at the start of the 2018/19 training year in a training session. Data was collected 6 months after using the tool in practice. A triangulation method was used; a semi-structured interview with the pre-registration pharmacist manager and two focus groups were conducted, one with trainees (n=7) and one with tutors (n=5). Participants were recruited through an invitation email sent via a gatekeeper. The focus groups moderator set ground rules to ensure a safe space for discussion to reduce conflict. They also reduced possible bias by ensuring they were not a current tutor. Responses from the interview were used to support the design of the topic guide for the focus groups. Data was transcribed and thematic analysis was undertaken.
Results
Following thematic analysis, three global themes emerged: clarity of purpose of the tool, feedback to trainees and the WBA tool as an assessment. Overall, trainees found the WBA tool was the most valuable part of their training owing to the benefit of instant feedback. Tutors agreed the tool was valuable when directly observing their trainee in practice, supporting the initial aim of the tool. There were conflicting views on why the tool was introduced, therefore highlighting the importance of a good implementation strategy when making changes. Interestingly, the WBA tool was not perceived as an assessment by the majority of trainees, and the inclusion of the Likert scale on the tool was questioned, leading to possible changes being made for future use.
Conclusion
This is the first study that gathers stakeholders’ experiences of using a WBA tool within pre-registration pharmacy training within the UK. Overall, the WBA tool received positive responses from both trainees and tutors. With upcoming changes in foundation pharmacy training proposed, this study supports the use of a WBA tool as it allows for focused feedback which trainees’ value. Limitations include a small sample size and the WBA tool being piloted in one hospital.
References
1. GPhC. 2020. Pre-registration trainee. [Online]. Available from: https://www.pharmacyregulation.org/i-am-pre-registration-trainee
2. Norcini, J. and Burch, V. 2007. Workplace-based assessment as an educational tool: AMEE Guide No.31. Medical Teacher.29, pp. 855–871.
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Affiliation(s)
- N Azeez
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, UK
| | - C Roberts
- Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust, UK
| | - H Bradbury
- School of Healthcare, University of Leeds, UK
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Cain MT, Smith NJ, Barash M, Simpson P, Durham LA, Makker H, Roberts C, Falcucci O, Wang D, Walker R, Ahmed G, Brown SA, Nanchal RS, Joyce DL. Extracorporeal Membrane Oxygenation with Right Ventricular Assist Device for COVID-19 ARDS. J Surg Res 2021; 264:81-89. [PMID: 33789179 PMCID: PMC7969863 DOI: 10.1016/j.jss.2021.03.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 12/14/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 01/08/2023]
Abstract
Background: Right ventricular failure is an underrecognized consequence of COVID-19 pneumonia. Those with severe disease are treated with extracorporeal membrane oxygenation (ECMO) but with poor outcomes. Concomitant right ventricular assist device (RVAD) may be beneficial. Methods: A retrospective analysis of intensive care unit patients admitted with COVID-19 ARDS (Acute Respiratory Distress Syndrome) was performed. Nonintubated patients, those with acute kidney injury, and age > 75 were excluded. Patients who underwent RVAD/ECMO support were compared with those managed via invasive mechanical ventilation (IMV) alone. The primary outcome was in-hospital mortality. Secondary outcomes included 30-d mortality, acute kidney injury, length of ICU stay, and duration of mechanical ventilation. Results: A total of 145 patients were admitted to the ICU with COVID-19. Thirty-nine patients met inclusion criteria. Of these, 21 received IMV, and 18 received RVAD/ECMO. In-hospital (52.4 versus 11.1%, P = 0.008) and 30-d mortality (42.9 versus 5.6%, P= 0.011) were significantly lower in patients treated with RVAD/ECMO. Acute kidney injury occurred in 15 (71.4%) patients in the IMV group and zero RVAD/ECMO patients (P< 0.001). ICU (11.5 versus 21 d, P= 0.067) and hospital (14 versus 25.5 d, P = 0.054) length of stay were not significantly different. There were no RVAD/ECMO device complications. The duration of mechanical ventilation was not significantly different (10 versus 5 d, P = 0.44). Conclusions: RVAD support at the time of ECMO initiation resulted in the no secondary end-organ damage and higher in-hospital and 30-d survival versus IMV in specially selected patients with severe COVID-19 ARDS. Management of severe COVID-19 ARDS should prioritize right ventricular support.
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Affiliation(s)
- Michael T Cain
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathan J Smith
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Mark Barash
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pippa Simpson
- Department of Pediatrics, Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lucian A Durham
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hemanckur Makker
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher Roberts
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Octavio Falcucci
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dong Wang
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebekah Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gulrayz Ahmed
- Department of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sherry-Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rahul S Nanchal
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David L Joyce
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Merola JF, Wang W, Wager CG, Hamann S, Zhang X, Thai A, Roberts C, Lam C, Musselli C, Marsh G, Rabah D, Barbey C, Franchimont N, Reynolds TL. RNA tape sampling in cutaneous lupus erythematosus discriminates affected from unaffected and healthy volunteer skin. Lupus Sci Med 2021; 8:8/1/e000428. [PMID: 33658303 PMCID: PMC7931768 DOI: 10.1136/lupus-2020-000428] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/20/2020] [Accepted: 01/17/2021] [Indexed: 12/13/2022]
Abstract
Objective Punch biopsy, a standard diagnostic procedure for patients with cutaneous lupus erythematosus (CLE) carries an infection risk, is invasive, uncomfortable and potentially scarring, and impedes patient recruitment in clinical trials. Non-invasive tape sampling is an alternative that could enable serial evaluation of specific lesions. This cross-sectional pilot research study evaluated the use of a non-invasive adhesive tape device to collect messenger RNA (mRNA) from the skin surface of participants with CLE and healthy volunteers (HVs) and investigated its feasibility to detect biologically meaningful differences between samples collected from participants with CLE and samples from HVs. Methods Affected and unaffected skin tape samples and simultaneous punch biopsies were collected from 10 participants with CLE. Unaffected skin tape and punch biopsies were collected from 10 HVs. Paired samples were tested using quantitative PCR for a candidate immune gene panel and semi-quantitative immunohistochemistry for hallmark CLE proteins. Results mRNA collected using the tape device was of sufficient quality for amplification of 94 candidate immune genes. Among these, we found an interferon (IFN)-dominant gene cluster that differentiated CLE-affected from HV (23-fold change; p<0.001) and CLE-unaffected skin (sevenfold change; p=0.002), respectively. We found a CLE-associated gene cluster that differentiated CLE-affected from HV (fourfold change; p=0.005) and CLE-unaffected skin (fourfold change; p=0.012), respectively. Spearman’s correlation between per cent area myxovirus 1 protein immunoreactivity and IFN-dominant mRNA gene cluster expression was highly significant (dermis, rho=0.86, p<0.001). In total, skin tape-derived RNA expression comprising both IFN-dominant and CLE-associated gene clusters correlated with per cent area immunoreactivity of some hallmark CLE-associated proteins in punch biopsies from the same lesions. Conclusions A non-invasive tape RNA collection technique is a potential tool for repeated skin biomarker measures throughout a clinical trial.
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Affiliation(s)
- Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Alice Thai
- Biogen Inc, Cambridge, Massachusetts, USA
| | | | - Christina Lam
- Dermatology, Boston University, Boston, Massachusetts, USA
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Dardenne E, Padilla F, Rasmussen S, Yang S, Mentes A, Ogawa L, Fiorenza R, Trombino A, Smith S, Romashko D, Ishiyama N, Chevtsova M, Thakur S, Rosfjord E, Buck E, Roberts C, Lucas M, Lin TA. 35MO Discovery and characterization of selective, FGFR1-sparing, inhibitors of FGFR2/3 oncogenic mutations for the treatment of cancers. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Roberts C, Wheatley-Price P, Asmis T, Barton G, Greene T. P39.03 Developing A Collaborative Northern Roadmap for Lung Cancer Care. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Han YC, Ng P, Schulz R, Yang S, Lelo A, Ogawa L, O'Connor M, Ishiyama N, Jewett I, Romashko D, Salomatov A, Thakur S, Smith S, Buck E, Roberts C, Lucas M, Lin TA. 43P Pre-clinical evaluation of potent and orally bioavailable next-generation inhibitors targeting the family of mutants that drive oncogenic BRAF dimer formation. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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38
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Roberts C, Kaplow J, Giroux M, Krause S, Kanekiyo M. Amyloid and APOE Status of Screened Subjects in the Elenbecestat MissionAD Phase 3 Program. J Prev Alzheimers Dis 2021; 8:218-223. [PMID: 33569570 DOI: 10.14283/jpad.2021.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/OBJECTIVES Elenbecestat, an oral BACE-1 inhibitor that has been shown to reduce Aβ levels in cerebrospinal fluid, was investigated in two global phase 3 studies in early AD. Here we report on differences observed in characteristics of APOE ε4 and amyloid positive subjects in the large screening cohort. DESIGN Screening was performed in 5 sequential tiers over a maximum of 80 days, as part of placebo controlled, double blind phase 3 studies. SETTING Subjects were evaluated at sites in 7 regions (29 countries). PARTICIPANTS Overall, 9758 subjects were screened. INTERVENTION All screened subjects that were eligible received either placebo or 50 mg QID elenbecestat post randomisation. MEASUREMENTS Gender, disease staging, APOE ε4 status, amyloid status, amyloid positron emission tomography (PET) standard uptake value ratio (SUVr) and amyloid PET Centiloid (CL) values were determined for screened subjects; by country and region. RESULTS In this program, 44% of subjects were APOE ε4 positive. Frequency of females was similar in both APOE ε4 positive and negative groups. However, early mild AD subjects were slightly higher in the APOE ε4 positive group compared with the APOE ε4 negative group. 56% of subjects were amyloid positive. The mean age in the amyloid positive group was slightly higher than the amyloid negative group. The gender distribution was similar between amyloid groups. A lower number of mild cognitive impairment was observed in the amyloid positive group along with a higher number of early mild AD. APOE ε4 positive subjects were higher in amyloid positive group compared to the amyloid negative group. China had the lowest APOE ε4 and amyloid positivity rates with Western Europe and Oceania performing best. Subjects received florbetapir, florbetaben or flutemetamol amyloid PET tracer. Amyloid negative and positive subjects CL values were normally distributed around their respective means of 1.5 CL and 83 CL. However, there was an appreciable overlap in the 20-40 CL range. CONCLUSIONS In this large cohort of cognitively impaired subjects, subject demographics characteristics were comparable regardless of APOE genotype or amyloid positivity. APOE ε4 positivity and amyloid positivity varied by country and by geographical region.
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Affiliation(s)
- C Roberts
- Claire Roberts, Eisai Ltd., Hatfield, UK, , Phone: +44 8456 761 590
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Lane AS, Roberts C. Developing open disclosure strategies to medical error using simulation in final-year medical students: linking mindset and experiential learning to lifelong reflective practice. BMJ Simul Technol Enhanc Learn 2020; 7:345-351. [PMID: 35515741 PMCID: PMC8936528 DOI: 10.1136/bmjstel-2020-000659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/04/2022]
Abstract
Introduction and objectives Open disclosure is a policy outlining how healthcare practitioners should apologise for mistakes, discussing them with the harmed parties. Simulation is a training and feedback method in which learners practise tasks and processes in lifelike circumstances. We explore how final-year medical students experience the learning of open disclosure. Methods A qualitative study of final-year medical students who had been involved a high-fidelity simulation session based on open disclosure after medication error was conducted. Students were selected using purposive sampling. Focus groups illuminated their experiences and interpretation of simulated open disclosure experiences. The data were analysed using interpretative phenomenological analysis and supported two superordinate themes: (1) identifying learning needs; and (2) learning to say sorry Results The medical students constructed their learning in three different ways: negotiating environmental relationships; embracing challenge and stress; and achieving learning outcomes. The data reinforced the need for psychological safety, emphasised the need for emotional arousal and demonstrated the need for both individual and collective reflective learning. Our data linked the benefits of experiential learning to the development of growth mindset and Jarvis’s theory. Conclusions The lived experience of the final-year medical student participants in this study reinforced the notions of continuous psychological safety and the need for emotional arousal during learning. Our data also demonstrated the variety of participant experiences when preparing to give open disclosure, reinforcing the need for facilitators to optimise learning for the whole group as well as the individuals, given that participants are at different parts of their learning cycle.
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Affiliation(s)
- Andrew Stuart Lane
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Intensive Care Medicine, Nepean Hospital, Penrith, New South Wales, Australia
| | - Christopher Roberts
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Lane AS, Roberts C, Khanna P. Do We Know Who the Person With the Borderline Score is, in Standard-Setting and Decision-Making. Health Professions Education 2020. [DOI: 10.1016/j.hpe.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Callaghan CT, Poore AGB, Mesaglio T, Moles AT, Nakagawa S, Roberts C, Rowley JJL, VergÉs A, Wilshire JH, Cornwell WK. Three Frontiers for the Future of Biodiversity Research Using Citizen Science Data. Bioscience 2020. [DOI: 10.1093/biosci/biaa131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AbstractCitizen science is fundamentally shifting the future of biodiversity research. But although citizen science observations are contributing an increasingly large proportion of biodiversity data, they only feature in a relatively small percentage of research papers on biodiversity. We provide our perspective on three frontiers of citizen science research, areas that we feel to date have had minimal scientific exploration but that we believe deserve greater attention as they present substantial opportunities for the future of biodiversity research: sampling the undersampled, capitalizing on citizen science's unique ability to sample poorly sampled taxa and regions of the world, reducing taxonomic and spatial biases in global biodiversity data sets; estimating abundance and density in space and time, develop techniques to derive taxon-specific densities from presence or absence and presence-only data; and capitalizing on secondary data collection, moving beyond data on the occurrence of single species and gain further understanding of ecological interactions among species or habitats. The contribution of citizen science to understanding the important biodiversity questions of our time should be more fully realized.
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Affiliation(s)
- Corey T Callaghan
- Centre for Ecosystem Science, School of Biological, Earth, and Environmental Sciences, University of New South Wales
- Ecology and Evolution Research Centre, School of Biological, Earth, and Environmental Sciences, also at the University of New South Wales
| | - Alistair G B Poore
- Ecology and Evolution Research Centre, School of Biological, Earth, and Environmental Sciences, also at the University of New South Wales
| | - Thomas Mesaglio
- Centre for Ecosystem Science, School of Biological, Earth, and Environmental Sciences, University of New South Wales
| | - Angela T Moles
- Ecology and Evolution Research Centre, School of Biological, Earth, and Environmental Sciences, also at the University of New South Wales
| | - Shinichi Nakagawa
- Ecology and Evolution Research Centre, School of Biological, Earth, and Environmental Sciences, also at the University of New South Wales
| | - Christopher Roberts
- Centre for Ecosystem Science, School of Biological, Earth, and Environmental Sciences, University of New South Wales
| | - Jodi J L Rowley
- Australian Museum Research Institute, part of the Australian Museum, Sydney, New South Wales, Australia
| | - Adriana VergÉs
- Ecology and Evolution Research Centre, School of Biological, Earth, and Environmental Sciences, also at the University of New South Wales
| | - John H Wilshire
- Centre for Ecosystem Science, School of Biological, Earth, and Environmental Sciences, University of New South Wales
| | - William K Cornwell
- Centre for Ecosystem Science, School of Biological, Earth, and Environmental Sciences, University of New South Wales
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O’Connor M, Lucas M, Romashko D, Rasmussen S, Fiorenza R, Lin TA, Waters N, Trainor G, Flohr A, Ottaviani G, Roberts C, Buck E, Nicolaides T, Raleigh D, Ozawa T, Arista L. EXTH-59. POTENT, SELECTIVE, AND BRAIN PENETRANT INHIBITORS OF EXTRACELLULAR DOMAIN EGFR ONCOGENIC MUTANTS EXPRESSED IN GBM DEMONSTRATE EFFICACY IN AN INTRACRANIAL PATIENT DERIVED XENOGRAFT MODEL. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
EGFR mutations identified in glioblastomas (GBM) occur nearly exclusively at the allosteric extracellular domain (ECD) and constitutively activate oncogenic signaling. Despite wide success in treating tumors expressing EGFR catalytic site mutants, no drug has demonstrated clinical utility against tumors expressing the extracellular domain EGFR mutants. We demonstrate that the family of ECD mutations are not only co-expressed in GBM, but that they all activate the oncogene through a similar disulfide bond-mediated receptor dimerization mechanism. This dimerization occurs independent of ligands and renders the Locked-dimer (LoDi)-EGFR insensitive to agents that target the EGFR kinase domain mutants in NSCLC. The kinase conformation induced by these ECD mutations seen in glioblastomas is both oncogenic and altered from kinase domain mutations, thus necessitating a new approach to targeting. By screening against cells expressing LoDi-EGFR mutants, we have identified the first inhibitors that potently and selectively target LoDi-EGFR mutants versus both canonical active site oncogenic mutants and wild type EGFR. Through an optimization effort, we have identified a novel family of potent and selective LoDi-EGFR mutant inhibitors that effectively penetrate the blood brain barrier (BBB) following oral dosing in preclinical studies. A leading exemplar, BDTX-GBM-001, inhibits the 5 major LoDi-EGFR mutants expressed in GBM with antiproliferative potency of ~10 nM while showing favorable selectivity versus the human kinome. When dosed orally in the intracranial GBM6 patient derived xenograft model at 50, 30, and 15 mg/kg, a dose responsive decrease in tumor growth, as well as a statistically significant increase in survival, were observed. These data support the continued evaluation of rationally designed BBB penetrant inhibitors selectively targeting the common LoDi-EGFR mutants and enable the first chance to fully test the clinical hypothesis of EGFR driver mutants in GBM.
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Affiliation(s)
| | - Matt Lucas
- Black Diamond Therapeutics, Cambridge, MA, USA
| | | | | | | | - Tai-An Lin
- Black Diamond Therapeutics, New York City, NY, USA
| | | | | | | | | | | | | | - Theodore Nicolaides
- Division of Pediatric Neuro-Oncology, Department of Pediatrics, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - David Raleigh
- University of California, San Francisco, San Francisco, CA, USA
| | - Tomoko Ozawa
- University of California, San Francisco, San Francisco, CA, USA
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43
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Triant DA, Le Tourneau JJ, Diesh CM, Unni DR, Shamimuzzaman M, Walsh AT, Gardiner J, Goldkamp AK, Li Y, Nguyen HN, Roberts C, Zhao Z, Alexander LJ, Decker JE, Schnabel RD, Schroeder SG, Sonstegard TS, Taylor JF, Rivera RM, Hagen DE, Elsik CG. Using online tools at the Bovine Genome Database to manually annotate genes in the new reference genome. Anim Genet 2020; 51:675-682. [PMID: 32537769 PMCID: PMC7540445 DOI: 10.1111/age.12962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/16/2022]
Abstract
With the availability of a new highly contiguous Bos taurus reference genome assembly (ARS-UCD1.2), it is the opportune time to upgrade the bovine gene set by seeking input from researchers. Furthermore, advances in graphical genome annotation tools now make it possible for researchers to leverage sequence data generated with the latest technologies to collaboratively curate genes. For many years the Bovine Genome Database (BGD) has provided tools such as the Apollo genome annotation editor to support manual bovine gene curation. The goal of this paper is to explain the reasoning behind the decisions made in the manual gene curation process while providing examples using the existing BGD tools. We will describe the sources of gene annotation evidence provided at the BGD, including RNA-seq and Iso-Seq data. We will also explain how to interpret various data visualizations when curating gene models, and will demonstrate the value of manual gene annotation. The process described here can be applied to manual gene curation for other species with similar tools. With a better understanding of manual gene annotation, researchers will be encouraged to edit gene models and contribute to the enhancement of livestock gene sets.
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Affiliation(s)
- D. A. Triant
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
| | | | - C. M. Diesh
- Department of BioengineeringUniversity of California, BerkeleyBerkeleyCA94720USA
| | - D. R. Unni
- Division of Environmental Genomics and Systems BiologyLawrence Berkeley National LaboratoryBerkeleyCA94608USA
| | - M. Shamimuzzaman
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
| | - A. T. Walsh
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
| | - J. Gardiner
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
| | - A. K. Goldkamp
- Department of Animal and Food SciencesOklahoma State UniversityStillwaterOK74078USA
| | - Y. Li
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
| | - H. N. Nguyen
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
- MU Institute for Data Science and InformaticsUniversity of MissouriColumbiaMO65211USA
| | - C. Roberts
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
| | - Z. Zhao
- Division of Plant SciencesUniversity of MissouriColumbiaMO65211USA
| | - L. J. Alexander
- USDA‐ARS‐PA‐Livestock & Range Research LabMiles CityMT59301USA
| | - J. E. Decker
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
- MU Institute for Data Science and InformaticsUniversity of MissouriColumbiaMO65211USA
| | - R. D. Schnabel
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
- MU Institute for Data Science and InformaticsUniversity of MissouriColumbiaMO65211USA
| | - S. G. Schroeder
- USDA‐ARS Animal Genomics and Improvement LabBeltsvilleMD20705USA
| | | | - J. F. Taylor
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
| | - R. M. Rivera
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
| | - D. E. Hagen
- Department of Animal and Food SciencesOklahoma State UniversityStillwaterOK74078USA
| | - C. G. Elsik
- Division of Animal SciencesUniversity of MissouriColumbiaMO65211USA
- MU Institute for Data Science and InformaticsUniversity of MissouriColumbiaMO65211USA
- Division of Plant SciencesUniversity of MissouriColumbiaMO65211USA
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Middleton RM, Pearson OR, Ingram G, Craig EM, Rodgers WJ, Downing-Wood H, Hill J, Tuite-Dalton K, Roberts C, Watson L, Ford DV, Nicholas R. A Rapid Electronic Cognitive Assessment Measure for Multiple Sclerosis: Validation of Cognitive Reaction, an Electronic Version of the Symbol Digit Modalities Test. J Med Internet Res 2020; 22:e18234. [PMID: 32965240 PMCID: PMC7542403 DOI: 10.2196/18234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/06/2020] [Accepted: 08/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients’ own devices. Objective This paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT. Methods We carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers. Results SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls. Conclusions This study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS.
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Affiliation(s)
- Rod M Middleton
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Owen R Pearson
- Department of Neurology, Morriston Hospital, Swansea Bay National Health Service Trust, Swansea, United Kingdom
| | - Gillian Ingram
- Department of Neurology, Morriston Hospital, Swansea Bay National Health Service Trust, Swansea, United Kingdom
| | - Elaine M Craig
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - William J Rodgers
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Hannah Downing-Wood
- Department of Neurology, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Joseph Hill
- Department of Neurology, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Katherine Tuite-Dalton
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Christopher Roberts
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Lynne Watson
- Department of Neurology, Morriston Hospital, Swansea Bay National Health Service Trust, Swansea, United Kingdom
| | - David V Ford
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Richard Nicholas
- Department of Neurology, Charing Cross Hospital, Imperial College London, London, United Kingdom
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Paterson C, Roberts C, Toohey K, McKie A. Prostate Cancer Prehabilitation and the Importance of Multimodal Interventions for Person-centred Care and Recovery. Semin Oncol Nurs 2020; 36:151048. [PMID: 32709485 DOI: 10.1016/j.soncn.2020.151048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prostate cancer is the second most commonly diagnosed cancer globally. Cancer prehabilitation is defined as a process on the continuum of care that occurs between the time of a cancer diagnosis and the beginning of acute treatment. This article will discuss the importance of prostate cancer prehabilitation interventions in optimising physical and psychological recovery to enhance person-centred care. DATA SOURCES Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, professional websites, and grey literature were searched using Google Scholar. CONCLUSION Prehabilitation in cancer care aims to enhance perioperative care and recovery. An emerging field of research suggests that the preoperative period may be physically and psychologically salient to introduce modifiable self-management behaviours to optimise overall recovery. IMPLICATIONS FOR NURSING PRACTICE Prostate cancer specialist nurses provide the hub of person-centred care across the entire cancer care continuum embedded within the multidisciplinary team. Individually tailored interventions such as exercise and pelvic floor muscle training programmes, nutritional advice, anxiety and depression reduction, and sexual well-being interventions should be considered in the prehabilitation phase of the cancer care continuum.
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Affiliation(s)
- C Paterson
- School of Nursing, Midwifery, and Public Health, University of Canberra, Canberra, ACT, Australia; ACT Health and the Canberra Health Services, Canberra ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia.
| | - C Roberts
- School of Nursing, Midwifery, and Public Health, University of Canberra, Canberra, ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia
| | - K Toohey
- ACT Health and the Canberra Health Services, Canberra ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - A McKie
- School of Nursing, Midwifery, and Public Health, University of Canberra, Canberra, ACT, Australia; School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
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Paterson C, Kozlovskaia M, Turner M, Strickland K, Roberts C, Ogilvie R, Pranavan G, Craft P. Identifying the supportive care needs of men and women affected by chemotherapy-induced alopecia? A systematic review. J Cancer Surviv 2020; 15:14-28. [PMID: 32683651 DOI: 10.1007/s11764-020-00907-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To systematically evaluate evidence regarding the unmet supportive care needs of men and women affected by chemotherapy-induced alopecia (CIA) to inform clinical practice guidelines. METHODS We performed a review of CINAHL, MEDLINE, PsychINFO, Scopus, the Cochrane Library (CCRT and CDSR) controlled trial databases and clinicaltrials.gov from January 1990 to June 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Twenty-seven publications were selected for inclusion in this analysis. RESULTS Included reports used qualitative (ten) and quantitative (17) studies. Across these studies men and women reported the major impact that CIA had on their psychological well-being, quality of life and body image. Hair loss had a negative impact irrespective of gender, which resulted in feelings of vulnerability and visibility of being a "cancer patient". Men and women described negative feelings, often similar, related to CIA with a range of unmet supportive care needs. CONCLUSIONS Some patients are not well-prepared for alopecia due to a lack of information and resources to reduce the psychological burden associated with CIA. Hair loss will affect each patient and their family differently, therefore, intervention and support must be tailored at an individual level of need to optimise psychological and physical well-being and recovery. IMPLICATIONS FOR CANCER SURVIVORS People affected by CIA may experience a range of unmet supportive care needs, and oncology doctors and nurses are urged to use these findings in their everyday consultations to ensure effective, person-centred care and timely intervention to minimise the sequalae associated with CIA.
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Affiliation(s)
- C Paterson
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia.
- Australian Capital Territory (ACT) Health & Canberra Health Services, Canberra, Australia.
- SYNERGY Nursing & Midwifery, Research Centre, ACT Health Directorate, Canberra Hospital, Canberra, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra, ACT, Australia.
- Robert Gordon University, Aberdeen, Scotland.
| | - M Kozlovskaia
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
- SYNERGY Nursing & Midwifery, Research Centre, ACT Health Directorate, Canberra Hospital, Canberra, Australia
| | - M Turner
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
| | - K Strickland
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
- SYNERGY Nursing & Midwifery, Research Centre, ACT Health Directorate, Canberra Hospital, Canberra, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra, ACT, Australia
| | - C Roberts
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra, ACT, Australia
| | - R Ogilvie
- Faculty of Health, School of Nursing, Midwifery & Public Health, University of Canberra ACT, Canberra, 2601, Australia
- Australian Capital Territory (ACT) Health & Canberra Health Services, Canberra, Australia
- SYNERGY Nursing & Midwifery, Research Centre, ACT Health Directorate, Canberra Hospital, Canberra, Australia
| | - G Pranavan
- Australian Capital Territory (ACT) Health & Canberra Health Services, Canberra, Australia
- Australian National University, Canberra, Australia
| | - P Craft
- Australian Capital Territory (ACT) Health & Canberra Health Services, Canberra, Australia
- Australian National University, Canberra, Australia
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Roberts C, Paterson C. An Exploration of the Rs of Radiobiology in Prostate Cancer. Semin Oncol Nurs 2020; 36:151054. [PMID: 32669231 DOI: 10.1016/j.soncn.2020.151054] [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: 11/29/2022]
Abstract
OBJECTIVES To explore the four Rs of radiobiology (Repair, Reoxygenation, Reassortment, and Repopulation) as a means to understand the effects of ionising radiation on biological tissue and subsequently as the basis for conventional fractionated treatment schedules. These radiobiological principles will form a rationale for combined regimens in prostate cancer treatment involving androgen deprivation therapy and radiation therapy and the associated toxicities of this approach will be discussed. DATA SOURCES Electronic databases including CINAHL, MEDLINE, Scopus, professional websites, books and grey literature were searched using Google Scholar. CONCLUSION It is important for nurses to understand the four Rs of radiobiology to grasp the effects of ionising radiation on biological tissue as the basis for conventional fractionated treatment schedules in prostate cancer. Men can experience a sequalae of physical and psychological side effects of treatment that can negatively impact quality of life. IMPLICATIONS FOR NURSING PRACTICE Men can experience a range of unmet supportive care needs particularly related to informational, sexual, and psychological needs. For men affected by prostate cancer opting for radiation therapy (+/-) androgen deprivation therapy, nurses should ask targeted questions based on the Common Terminology Criteria for Adverse Events related to urinary and bowel function, potency and fatigue, and sexual health. We also recommend the use of holistic needs assessments to tailor self-management care plans. Evidence-based self-management advice should be provided in response to each man's unique needs.
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Affiliation(s)
- C Roberts
- Faculty of Health, University of Canberra, Canberra ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia; School of Nursing, Midwifery and Public Health, University of Canberra, ACT, Australia.
| | - C Paterson
- Faculty of Health, University of Canberra, Canberra ACT, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research group, University of Canberra, Canberra ACT, Australia; School of Nursing, Midwifery and Public Health, University of Canberra, ACT, Australia; ACT Synergy Nursing and Midwifery Research Centre, Canberra Hospital, ACT, Australia
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Haught E, Roberts C, McChesney J. Cryptococcal Anterior Glottic Web from Disseminated Infection Presenting as Confusion: A Case Report. Ann Otol Rhinol Laryngol 2020; 130:211-214. [PMID: 32627566 DOI: 10.1177/0003489420937036] [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: 11/17/2022]
Abstract
OBJECTIVES To educate healthcare providers on Cryptococcus neoformans as a novel cause of glottic webs especially in an immunocompromised patient and discuss recurrence of the glottic web. This case also emphasizes the importance of a comprehensive patient evaluation in cases such as this, as laryngeal involvement in this case was only a portion of the patient's disease burden. METHODS An extensive review of the patient's clinical course was assessed including patient presentation, diagnostic techniques, medical and surgical treatment, and complications. RESULTS Prolonged Fluconazole therapy and two excisions of the glottic web, the second with keel placement, was an effective treatment course for our patient. CONCLUSION Cryptococcal glottic webs are rare, and this case report demonstrates successful treatment in one such case with operative intervention following medical management of disseminated disease.
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Affiliation(s)
- Erica Haught
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Christopher Roberts
- West Virginia University Department of Otolaryngology, Head and Neck Surgery, Morgantown, WV, USA
| | - Jason McChesney
- West Virginia University Department of Otolaryngology, Head and Neck Surgery, Morgantown, WV, USA
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Lu M, Samblanet K, Roberts C. Myocarditis: A Heart on Fire. Curr Sports Med Rep 2020; 19:110-112. [PMID: 32141905 DOI: 10.1249/jsr.0000000000000698] [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: 11/21/2022]
Affiliation(s)
- Myro Lu
- Tripler Army Medical Center, Primary Care Sports and Family Medicine, Honolulu, HI
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Leung K, Trevena L, Roberts C, Waters D. Validation of the SYdney Shared and Evidence-based decision-Making test (SYStEM) among healthcare professionals. Health Professions Education 2019. [DOI: 10.1016/j.hpe.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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