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Watkins J, Vromen O, Sirotkin T, Elad R. Young Man With Shortness of Breath. Am Fam Physician 2024; 109:181-183. [PMID: 38393807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
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Elwood P, Morgan G, Watkins J, Protty M, Mason M, Adams R, Dolwani S, Pickering J, Delon C, Longley M. Aspirin and cancer treatment: systematic reviews and meta-analyses of evidence: for and against. Br J Cancer 2024; 130:3-8. [PMID: 38030748 PMCID: PMC10782022 DOI: 10.1038/s41416-023-02506-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Aspirin as a possible treatment of cancer has been of increasing interest for over 50 years, but the balance of the risks and benefits remains a point of contention. We summarise the valid published evidence 'for' and 'against' the use of aspirin as a cancer treatment and we present what we believe are relevant ethical implications. Reasons for aspirin include the benefits of aspirin taken by patients with cancer upon relevant biological cancer mechanisms. These explain the observed reductions in metastatic cancer and vascular complications in cancer patients. Meta-analyses of 118 observational studies of mortality in cancer patients give evidence consistent with reductions of about 20% in mortality associated with aspirin use. Reasons against aspirin use include increased risk of a gastrointestinal bleed though there appears to be no valid evidence that aspirin is responsible for fatal gastrointestinal bleeding. Few trials have been reported and there are inconsistencies in the results. In conclusion, given the relative safety and the favourable effects of aspirin, its use in cancer seems justified, and ethical implications of this imply that cancer patients should be informed of the present evidence and encouraged to raise the topic with their healthcare team.
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Affiliation(s)
- Peter Elwood
- Population Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Gareth Morgan
- Population Medicine, Cardiff University, Cardiff, CF14 4XN, UK.
| | - John Watkins
- Population Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Majd Protty
- Systems Immunity Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - Malcolm Mason
- School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Richard Adams
- Population Medicine, Cardiff University, Cardiff, CF14 4XN, UK
- Wales Cancer Bank, University Hospital of Wales, Cardiff, CF14 4XN, UK
| | - Sunil Dolwani
- School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - Janet Pickering
- Population Medicine, Cardiff University, Cardiff, CF14 4XN, UK
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3
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Wehbe H, Obaitan I, Al-Haddad MA, Tong Y, Mahendraker N, DeWitt JM, Bick B, Fogel E, Zyromski N, Gutta A, Sherman S, Watkins J, Gromski M, Saleem N, Easler JJ. Profile of and risk factors for early unplanned readmissions in patients with acute necrotizing pancreatitis. Pancreatology 2023; 23:465-472. [PMID: 37330391 DOI: 10.1016/j.pan.2023.05.014] [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: 01/18/2023] [Revised: 05/04/2023] [Accepted: 05/28/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Acute necrotizing pancreatitis (ANP) complicates up to 15% of acute pancreatitis cases. ANP has historically been associated with a significant risk for readmission, but there are currently no studies exploring factors that associate with risk for unplanned, early (<30-day) readmissions in this patient population. METHODS We performed a retrospective review of all consecutive patients presenting to hospitals in the Indiana University (IU) Health system with pancreatic necrosis between December 2016 and June 2020. Patients younger than 18 years of age, without confirmed pancreatic necrosis and those that suffered in-hospital mortality were excluded. Logistic regression was performed to identify potential predictors of early readmission in this group of patients. RESULTS One hundred and sixty-two patients met study criteria. 27.7% of the cohort was readmitted within 30-days of index discharge. The median time to readmission was 10 days (IQR 5-17 days). The most frequent reason for readmission was abdominal pain (75.6%), followed by nausea and vomiting in (35.6%). Discharge to home was associated with 93% lower odds of readmission. We found no additional clinical factors that predicted early readmission. CONCLUSION Patients with ANP have a significant risk for early (<30 days) readmission. Direct discharge to home, rather than short or long-term rehabilitation facilities, is associated with lower odds of early readmission. Analysis was otherwise negative for independent, clinical predictors of early unplanned readmissions in ANP.
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Affiliation(s)
- H Wehbe
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - I Obaitan
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M A Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Y Tong
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Mahendraker
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J M DeWitt
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - B Bick
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - E Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A Gutta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S Sherman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J Watkins
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N Saleem
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - J J Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Linnerooth S, Penley B, Sauvageau G, Ha J, Beal A, Craven J, Feeney E, Taddei-Allen P, Thomas N, Watkins J, Hydery T. Methodology for conducting a comprehensive product review in managed care. J Manag Care Spec Pharm 2023; 29:237-243. [PMID: 36840955 PMCID: PMC10388012 DOI: 10.18553/jmcp.2023.29.3.237] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The high degree of complexity of the product-review process and differences in procedures between organizations have resulted in a need for best practices and an overall product-review process to create efficiencies for health care decision makers. In an effort to streamline product-review concepts, this article outlines the different components of the review process, including clinical and economic review, formulary placement determination, and evaluation of alternatives within a drug class. The article also details opportunities for the near future, as technology continues to advance and alignment between medical and pharmacy benefits is desired. DISCLOSURES: Drs Linnerooth, Penley, Ha, and Craven report employment with Xcenda, which provided funding for the manuscript. Drs Sauvageau and Hydery report employment Xcenda, which provided funding for the manuscript, and stock holdings with AmerisourceBergen. Dr Feeney reports support for attending meetings and/or travel provided by Highmark, Inc. Dr Thomas reports receipt of consulting fees from ActiveRADAR, board member roles with ActiveRADAR and RoundtableRx, an adjunct professor role with the University of Minnesota, and stock options and pensions with Eli Lilly and Aetna/CVS. Dr Watkins reports payment or honoraria from ISPOR and for articles written for Value and Outcomes Spotlight, and support for attending meetings and/or travel by AMCP.
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Affiliation(s)
| | | | | | | | | | - Jennifer Craven
- MedImpact, San Diego, CA, now with UC Davis Health, Sacramento
| | | | - Patty Taddei-Allen
- WellDyneRx, Lakeland, FL, now with School of Pharmacy, Lake Erie College of Osteopathic Medicine, Bradenton, FL
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5
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Funingana I, Trotman J, Ambrose J, Roberts T, Watkins J, Ridley M, Gilson B, Freeman S, Jimenez-Linan M, Sosinsky A, Tadross J, Tarpey P, Brenton J. 7P Integration of whole genome sequencing (WGS) into NHS pathways for high-grade ovarian cancer (HGOC): A single-centre prospective experience. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100861] [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: 02/27/2023] Open
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Abstract
Evidence on aspirin and cancer comes from two main sources: (1) the effect of aspirin upon biological mechanisms in cancer, and (2) clinical studies of patients with cancer, some of whom take aspirin. A series of systematic literature searches identified published reports relevant to these two sources. The effects of aspirin upon biological mechanisms involved in cancer initiation and growth appear to generate reasonable expectations of effects upon the progress and mortality of cancer. Clinical evidence on aspirin appears overall to be favourable to the use of aspirin, but evidence from randomized trials is limited, and inconsistent. The main body of evidence comes from meta-analyses of observational studies of patients with a wide range of cancers, about 25% of whom were taking aspirin. Heterogeneity is large but, overall, aspirin is associated with increases in survival and reductions in metastatic spread and vascular complications of different cancers. It is important that evaluations of aspirin used as an adjunct cancer treatment are based upon all the available relevant evidence, and there appears to be a marked harmony between the effects of aspirin upon biological mechanisms and upon the clinical progress of cancer.
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Affiliation(s)
- Peter Elwood
- Division of Population Medicine, University of Cardiff, Cardiff, Wales CF10 3AT, UK
| | - Majd Protty
- Department of Cardiology, Cardiff Lipidomic Group, University of Cardiff, Cardiff, Wales, UK
| | | | - Janet Pickering
- Division of Population Medicine, University of Cardiff, Cardiff, Wales CF10 3AT, UK
| | | | - John Watkins
- Division of Population Medicine, University of Cardiff, Cardiff, Wales CF10 3AT, UK
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Drummond MF, Augustovski F, Bhattacharyya D, Campbell J, Chaiyakanapruk N, Chen Y, Galindo-Suarez RM, Guerino J, Mejía A, Mujoomdar M, Ollendorf D, Ronquest N, Torbica A, Tsiao E, Watkins J, Yeung K. Challenges of Health Technology Assessment in Pluralistic Healthcare Systems: An ISPOR Council Report. Value Health 2022; 25:1257-1267. [PMID: 35931428 DOI: 10.1016/j.jval.2022.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
Health technology assessment (HTA) has been growing in use over the past 40 years, especially in its impact on decisions regarding the reimbursement, adoption, and use of new drugs, devices, and procedures. In countries or jurisdictions with "pluralistic" healthcare systems, there are multiple payers or sectors, each of which could potentially benefit from HTA. Nevertheless, a single HTA, conducted centrally, may not meet the needs of these different actors, who may have different budgets, current standards of care, populations to serve, or decision-making processes. This article reports on the research conducted by an ISPOR Health Technology Assessment Council Working Group established to examine the specific challenges of conducting and using HTA in countries with pluralistic healthcare systems. The Group used its own knowledge and expertise, supplemented by a narrative literature review and survey of US payers, to identify existing challenges and any initiatives taken to address them. We recommend that countries with pluralistic healthcare systems establish a national focus for HTA, develop a uniform set of HTA methods guidelines, ensure that HTAs are produced in a timely fashion, facilitate the use of HTA in the local setting, and develop a framework to encourage transparency in HTA. These efforts can be enhanced by the development of good practice guidance from ISPOR or similar groups and increased training to facilitate local use of HTA.
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Affiliation(s)
| | | | | | | | - Nathorn Chaiyakanapruk
- University of Utah, Salt Lake City, UT, USA; Monash University, Selangor, Malaysia; IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | | | | | | | | | - Michelle Mujoomdar
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada
| | | | | | | | - Emily Tsiao
- Premera Blue Cross, Mountlake Terrace, WA, USA
| | | | - Kai Yeung
- Kaiser Permanente Washington Health Research Centre, Seattle, WA, USA
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de Fougerolles TR, Damm O, Ansaldi F, Chironna M, Crépey P, de Lusignan S, Gray I, Guillen JM, Kassianos G, Mosnier A, de Lejarazu RO, Pariani E, Puig-Barbera J, Schelling J, Trippi F, Vanhems P, Wahle K, Watkins J, Rasuli A, Vitoux O, Bricout H. National influenza surveillance systems in five European countries: a qualitative comparative framework based on WHO guidance. BMC Public Health 2022; 22:1151. [PMID: 35681199 PMCID: PMC9178537 DOI: 10.1186/s12889-022-13433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Influenza surveillance systems vary widely between countries and there is no framework to evaluate national surveillance systems in terms of data generation and dissemination. This study aimed to develop and test a comparative framework for European influenza surveillance. Methods Surveillance systems were evaluated qualitatively in five European countries (France, Germany, Italy, Spain, and the United Kingdom) by a panel of influenza experts and researchers from each country. Seven surveillance sub-systems were defined: non-medically attended community surveillance, virological surveillance, community surveillance, outbreak surveillance, primary care surveillance, hospital surveillance, mortality surveillance). These covered a total of 19 comparable outcomes of increasing severity, ranging from non-medically attended cases to deaths, which were evaluated using 5 comparison criteria based on WHO guidance (granularity, timing, representativeness, sampling strategy, communication) to produce a framework to compare the five countries. Results France and the United Kingdom showed the widest range of surveillance sub-systems, particularly for hospital surveillance, followed by Germany, Spain, and Italy. In all countries, virological, primary care and hospital surveillance were well developed, but non-medically attended events, influenza cases in the community, outbreaks in closed settings and mortality estimates were not consistently reported or published. The framework also allowed the comparison of variations in data granularity, timing, representativeness, sampling strategy, and communication between countries. For data granularity, breakdown per risk condition were available in France and Spain, but not in the United Kingdom, Germany and Italy. For data communication, there were disparities in the timeliness and accessibility of surveillance data. Conclusions This new framework can be used to compare influenza surveillance systems qualitatively between countries to allow the identification of structural differences as well as to evaluate adherence to WHO guidance. The framework may be adapted for other infectious respiratory diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13433-0.
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Affiliation(s)
| | - Oliver Damm
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | | | - Maria Chironna
- Department of Interdisciplinary Medicine - Hygiene Section, University of Bari, Bari, Italy
| | - Pascal Crépey
- Université de Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U 1309, Rennes, France
| | - Simon de Lusignan
- University of Oxford, Oxford, UK.,Royal College of General Practitioners, London, UK
| | | | | | | | | | | | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | | | | | - Philippe Vanhems
- CIRI, Centre International de Recherche en Infectiologie, (Team (PHE3ID), Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France.,Hospices Civils de Lyon and Hospices Civils de Lyon (HCL), Lyon, France
| | - Klaus Wahle
- Westfälische Wilhelms-Universität, Munich, Germany
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Tso CHM, Monteith D, Scott T, Watson H, Dodd B, Pereira MG, Henrys P, Hollaway M, Rennie S, Lowther A, Watkins J, Killick R, Blair G. The evolving role of weather types on rainfall chemistry under large reductions in pollutant emissions. Environ Pollut 2022; 299:118905. [PMID: 35091021 DOI: 10.1016/j.envpol.2022.118905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Long-term change and shorter-term variability in the atmospheric deposition of pollutants and marine salts can have major effects on the biogeochemistry and ecology of soils and surface water ecosystems. In the 1980s, at the time of peak acid deposition in the UK, deposition loads were highly dependent on prevailing weather types, and it was postulated that future pollution recovery trajectories would be partly dependent on any climate change-driven shifts in weather systems. Following three decades of substantial acidic emission reductions, we used monitoring data collected between 1992 and 2015 from four UK Environmental Change Network (ECN) sites in contrasting parts of Great Britain to examine the trends in precipitation chemistry in relation to prevailing weather conditions. Weather systems were classified on the basis of Lamb weather type (LWT) groupings, while emissions inventories and clustering of air mass trajectories were used to interpret the observed patterns. Concentrations of ions showed clear differences between cyclonic-westerly-dominated periods and others, reflecting higher marine and lower anthropogenic contributions in Atlantic air masses. Westerlies were associated with higher rainfall, higher sea salt concentrations, and lower pollutant concentrations at all sites, while air mass paths exerted additional controls. Westerlies therefore have continued to favour higher sea salt fluxes, whereas emission reductions are increasingly leading to positive correlations between westerlies and pollutant fluxes. Our results also suggest a shift from the influence of anthropogenic emissions to natural emissions (e.g., sea salt) and climate forcing as they are transported under relatively cleaner conditions to the UK. Westerlies have been relatively frequent over the ECN monitoring period, but longer-term cyclicity in these weather types suggests that current contributions to precipitation may not be sustained over coming years.
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Affiliation(s)
- Chak-Hau Michael Tso
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK; Centre of Excellence for Environmental Data Science, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK.
| | - Don Monteith
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - Tony Scott
- Rothamsted Research, Harpenden, Hertfordshire, AL5 2JQ, UK
| | - Helen Watson
- James Hutton Institute, Craigiebuckler, Aberdeen, AB15 8QH, UK
| | - Beverley Dodd
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - M Glória Pereira
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - Peter Henrys
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK; Centre of Excellence for Environmental Data Science, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - Michael Hollaway
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK; Centre of Excellence for Environmental Data Science, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - Susannah Rennie
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK; Centre of Excellence for Environmental Data Science, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - Aaron Lowther
- Department of Maths and Statistics, Fylde College, Lancaster University, Lancaster, LA1 4YF, UK
| | - John Watkins
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK; Centre of Excellence for Environmental Data Science, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - Rebecca Killick
- Department of Maths and Statistics, Fylde College, Lancaster University, Lancaster, LA1 4YF, UK; Centre of Excellence for Environmental Data Science, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - Gordon Blair
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK; School of Computing and Communications, InfoLab21, Lancaster University, Lancaster, LA1 4WA, UK; Centre of Excellence for Environmental Data Science, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
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Al Kharusi S, Anton G, Badhrees I, Barbeau P, Beck D, Belov V, Bhatta T, Breidenbach M, Brunner T, Cao G, Cen W, Chambers C, Cleveland B, Coon M, Craycraft A, Daniels T, Darroch L, Daugherty S, Davis J, Delaquis S, Der Mesrobian-Kabakian A, DeVoe R, Dilling J, Dolgolenko A, Dolinski M, Echevers J, Fairbank W, Fairbank D, Farine J, Feyzbakhsh S, Fierlinger P, Fudenberg D, Gautam P, Gornea R, Gratta G, Hall C, Hansen E, Hoessl J, Hufschmidt P, Hughes M, Iverson A, Jamil A, Jessiman C, Jewell M, Johnson A, Karelin A, Kaufman L, Koffas T, Krücken R, Kuchenkov A, Kumar K, Lan Y, Larson A, Lenardo B, Leonard D, Li G, Li S, Li Z, Licciardi C, Lin Y, MacLellan R, McElroy T, Michel T, Mong B, Moore D, Murray K, Njoya O, Nusair O, Odian A, Ostrovskiy I, Perna A, Piepke A, Pocar A, Retière F, Robinson A, Rowson P, Ruddell D, Runge J, Schmidt S, Sinclair D, Skarpaas K, Soma A, Stekhanov V, Tarka M, Thibado S, Todd J, Tolba T, Totev T, Tsang R, Veenstra B, Veeraraghavan V, Vogel P, Vuilleumier JL, Wagenpfeil M, Watkins J, Weber M, Wen L, Wichoski U, Wrede G, Wu S, Xia Q, Yahne D, Yang L, Yen YR, Zeldovich O, Ziegler T. Search for Majoron-emitting modes of
Xe136
double beta decay with the complete EXO-200 dataset. Int J Clin Exp Med 2021. [DOI: 10.1103/physrevd.104.112002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Rigoine de Fougerolles T, Puig-Barbera J, Kassianos G, Vanhems P, Schelling J, Crepey P, de Lejarazu RO, Ansaldi F, Fruhwein M, Galli C, Mosnier A, Pariani E, Rasuli A, Vitoux O, Watkins J, Weinke T, Bricout H. A comparison of coronavirus disease 2019 and seasonal influenza surveillance in five European countries: France, Germany, Italy, Spain and the United Kingdom. Influenza Other Respir Viruses 2021; 16:417-428. [PMID: 34866344 PMCID: PMC8983920 DOI: 10.1111/irv.12941] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background In response to the coronavirus disease (COVID‐19) outbreak that unfolded across Europe in 2020, the World Health Organisation (WHO) called for repurposing existing influenza surveillance systems to monitor COVID‐19. This analysis aimed to compare descriptively the extent to which influenza surveillance systems were adapted and enhanced and how COVID‐19 surveillance could ultimately benefit or disrupt routine influenza surveillance. Methods We used a previously developed framework in France, Germany, Italy, Spain and the United Kingdom to describe COVID‐19 surveillance and its impact on influenza surveillance. The framework divides surveillance systems into seven subsystems and 20 comparable outcomes of interest and uses five evaluation criteria based on WHO guidance. Information on influenza and COVID‐19 surveillance systems were collected from publicly available resources shared by European and national public health agencies. Results Overall, non‐medically attended, virological, primary care and mortality surveillance were adapted in most countries to monitor COVID‐19, although community, outbreak and hospital surveillance were reinforced in all countries. Data granularity improved, with more detailed demographic and medical information recorded. A shift to systematic notification for cases and deaths enhanced both geographic and population representativeness, although the sampling strategy benefited from the roll out of widespread molecular testing. Data communication was greatly enhanced, contributing to improved public awareness. Conclusions Well‐established influenza surveillance systems are a key component of pandemic preparedness, and their upgrade allowed European countries to respond to the COVID‐19 pandemic. However, uncertainties remain on how both influenza and COVID‐19 surveillance can be jointly and durably implemented.
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Affiliation(s)
| | | | - George Kassianos
- Royal College of General Practitioners, UK and British Global & Travel Health Association, London, UK
| | - Philippe Vanhems
- Department of Hygiene and Epidemiology, Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID) - Inserm - U1111 - UCBL, Lyon University Hospital and Centre International de Recherche en Infectiologie (CIRI), Lyon, France
| | - Jorg Schelling
- Medical Faculty, Ludwig-Maximilians-University, Munich, Germany
| | - Pascal Crepey
- School of Advanced Studies in Public Health, University of Rennes, Rennes, France
| | | | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Markus Fruhwein
- Dr. Fruehwein & Partners, Practise for General Medicine, Travel Medicine and Tropical Diseases, Munich, Germany
| | - Cristina Galli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anvar Rasuli
- Medical Department, Sanofi Pasteur, Lyon, France
| | | | - John Watkins
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Thomas Weinke
- Klinikum Ernst von Bergmann, Medizinische Klinik, Gastroenterologie, Infektiologie, Pneumologie, Potsdam, Germany
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12
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Elwood PC, Morgan G, Delon C, Protty M, Galante J, Pickering J, Watkins J, Weightman A, Morris D. Aspirin and cancer survival: a systematic review and meta-analyses of 118 observational studies of aspirin and 18 cancers. Ecancermedicalscience 2021; 15:1258. [PMID: 34567243 PMCID: PMC8426031 DOI: 10.3332/ecancer.2021.1258] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 10/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite the accumulation of research papers on aspirin and cancer, there is doubt as to whether or not aspirin is an acceptable and effective adjunct treatment of cancer. The results of several randomised trials are awaited, and these should give clear evidence on three common cancers: colon, breast and prostate. The biological effects of aspirin appear likely however to be of relevance to cancer generally, and to metastatic spread, rather than just to one or a few cancers, and there is already a lot of evidence, mainly from observational studies, on the association between aspirin and survival in a wide range of cancers. AIMS In order to test the hypothesis that aspirin taking is associated with an increase in the survival of patients with cancer, we conducted a series of systematic literature searches to identify clinical studies of patients with cancer, some of whom took aspirin after having received a diagnosis of cancer. RESULTS Three literature searches identified 118 published observational studies in patients with 18 different cancers. Eighty-one studies report on aspirin and cancer mortality and 63 studies report on all-cause mortality. Within a total of about a quarter of a million patients with cancer who reported taking aspirin, representing 20%-25% of the total cohort, we found aspirin to be associated with a reduction of about 20% in cancer deaths (pooled hazard ratio (HR): 0.79; 95% confidence intervals: 0.73, 0.84 in 70 reports and a pooled odds ratio (OR): 0.67; 0.45, 1.00 in 11 reports) with similar reductions in all-cause mortality (HR: 0.80; 0.74, 0.86 in 56 studies and OR: 0.57; 0.36, 0.89 in seven studies). The relative safety of aspirin taking was examined in the studies and the corresponding author of every paper was written to asking for additional information on bleeding. As expected, the frequency of bleeding increased in the patients taking aspirin, but fatal bleeding was rare and no author reported a significant excess in fatal bleeds associated with aspirin. No author mentioned cerebral bleeding in the patients they had followed. CONCLUSIONS There is a considerable body of evidence suggestive of about a 20% reduction in mortality in patients with cancer who take aspirin, and the benefit appears not to be restricted to one or a few cancers. Aspirin, therefore, appears to deserve serious consideration as an adjuvant treatment of cancer, and patients with cancer, and their carers, have a right to be informed of the available evidence.
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Affiliation(s)
- Peter C Elwood
- Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - Gareth Morgan
- Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | | | - Majd Protty
- Cardiff Lipidomics Group, Cardiff University, UK
| | - Julieta Galante
- University of Cambridge, Cambridge, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration East of England, Cambridge, UK
| | - Janet Pickering
- Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK
| | - John Watkins
- Division of Population Medicine, Cardiff University, Cardiff CF14 4XN, UK
- Public Health Wales, Cardiff, UK
| | - Alison Weightman
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Delyth Morris
- University Library Service, Cardiff University, Cardiff, UK
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13
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Williams O, Williams C, Turner D, Bull M, Watkins J, Hurt L. An epidemiological investigation of COVID-19 outbreaks in a group of care homes in Wales, UK: a retrospective cohort study. J Public Health (Oxf) 2021; 44:606-613. [PMID: 33993283 PMCID: PMC8194567 DOI: 10.1093/pubmed/fdab150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background This study describes the epidemiology of COVID-19 outbreaks in four care homes in terms of spread, severity, presentation and interventions. Methods Participants were 100 residents and 102 staff from four co-located care homes in Wales. Data were collected from the homes and Public Health Wales, including demographics, presentations, test status and results, hospital admissions and deaths. Genomic sequencing of confirmed case samples was completed, where possible. Epi-curves, crude attack rates, a Kaplan-Meier survival curve and adjusted hazard ratios were calculated using R. Results About 14 confirmed and 43 possible resident cases, 23 confirmed and 47 possible staff cases occurred. Crude attack rates of possible and confirmed cases were 57% (residents) and 69% (staff). Genomic sequencing for 10 confirmed case PCR samples identified at least 5 different UK lineages of COVID-19.42 (42%) residents died, 23 (55%) with COVID-19 or suspected COVID-19 recorded on the death certificate. The hazard ratio for death amongst resident possible and confirmed cases compared to null cases, adjusting for age and sex, was 13.26 (95% CI 5.61–31.34). Conclusions There were extensive outbreaks of COVID-19 in these homes with high crude attack rates and deaths. Universal testing and early isolation of residents are recommended.
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Affiliation(s)
- O Williams
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - C Williams
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - D Turner
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - M Bull
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - J Watkins
- Public Health Wales, Cardiff CF10 4BZ, UK
| | - L Hurt
- Cardiff University, Cardiff CF14 4YS, UK
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14
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Course CW, Watkins J, Muller C, Odd D, Kotecha S, Chakraborty M. Volatile organic compounds as disease predictors in newborn infants: a systematic review. J Breath Res 2021; 15. [PMID: 33530065 DOI: 10.1088/1752-7163/abe283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
Volatile organic compounds (VOC) detected in human breath, urine, stool, sweat, saliva, and blood result from metabolic processes in the body during health or disease. Using sophisticated measurement systems, small amounts of these compounds can be detected in the above bodily fluids. Multiple studies in adults and children have shown the potential of these compounds to differentiate between healthy individuals and patients by detecting profiles of compounds in non-invasively collected samples. However, the detection of biomarkers in VOCs from neonates is particularly attractive due to the non-invasive nature of its approach, and its ability to track disease progress by longitudinal sampling. In this work we have reviewed the literature on the use of VOCs in neonates and identified areas for future work.
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Affiliation(s)
- Christopher William Course
- University Hospital of Wales, University Hospital of Wales, Cardiff, Cardiff, CF14 4XW, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - John Watkins
- Cardiff University, Cardiff University, Cardiff, CF14 4YS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Carsten Muller
- Cardiff University, Cardiff University, Cardiff, CF14 4YS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - David Odd
- Cardiff University, Cardiff University, Cardiff, CF14 4YS, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Sailesh Kotecha
- Cardiff University, University Hospital of Wales, Cardiff, CF14 4XW, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Mallinath Chakraborty
- Cardiff University, University Hospital of Wales, Cardiff, CF10 3AT, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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15
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Fogelson N, Watkins J. Liver Mobilization for Right Diaphragm Surgery in Diaphragmatic Endometriosis. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.029] [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: 10/23/2022]
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16
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Hollaway MJ, Dean G, Blair GS, Brown M, Henrys PA, Watkins J. Tackling the Challenges of 21 st-Century Open Science and Beyond: A Data Science Lab Approach. Patterns (N Y) 2020; 1:100103. [PMID: 33205137 PMCID: PMC7660442 DOI: 10.1016/j.patter.2020.100103] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/09/2020] [Accepted: 08/24/2020] [Indexed: 11/10/2022]
Abstract
In recent years, there has been a drive toward more open, cross-disciplinary science taking center stage. This has presented a number of challenges, including providing research platforms for collaborating scientists to explore big data, develop methods, and disseminate their results to stakeholders and decision makers. We present our vision of a "data science lab" as a collaborative space where scientists (from different disciplines), stakeholders, and policy makers can create data-driven solutions to environmental science's grand challenges. We set out a clear and defined research roadmap to serve as a focal point for an international research community progressing toward a more data-driven and transparent approach to environmental data science, centered on data science labs. This includes ongoing case studies of good practice, with the infrastructural and methodological developments required to enable data science labs to support significant increase in our cross- and trans-disciplinary science capabilities.
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Affiliation(s)
- Michael J. Hollaway
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Lancaster, UK
| | - Graham Dean
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Lancaster, UK
| | - Gordon S. Blair
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Lancaster, UK
- School of Computing and Communications, Lancaster University, Lancaster, UK
| | - Mike Brown
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Lancaster, UK
| | - Peter A. Henrys
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Lancaster, UK
| | - John Watkins
- UK Centre for Ecology and Hydrology, Lancaster Environment Centre, Lancaster, UK
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17
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Elwood PC, Longley M, Greene G, Morgan G, Watkins J, Pickering J, Watkins A, Protty M, Bayer A, Gallacher J. Better than any pill—and no side effects! Healthy lifestyles, statins, and aspirin. Lifestyle Medicine 2020. [DOI: 10.1002/lim2.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Peter C. Elwood
- Division of Population Medicine Cardiff University Cardiff UK
| | | | - Giles Greene
- Division of Population Medicine Cardiff University Cardiff UK
| | - Gareth Morgan
- Division of Population Medicine Cardiff University Cardiff UK
| | | | - Janet Pickering
- Division of Population Medicine Cardiff University Cardiff UK
| | - Angela Watkins
- Division of Population Medicine Cardiff University Cardiff UK
| | - Majd Protty
- Division of Population Medicine Cardiff University Cardiff UK
| | - Antony Bayer
- Division of Population Medicine Cardiff University Cardiff UK
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18
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Hart A, Ng SC, Watkins J, Paridaens K, Edwards JO, Fullarton JR, Sonderegger YLY, Ghatnekar O, Ghosh S. The use of 5-aminosalicylates in Crohn's disease: a retrospective study using the UK Clinical Practice Research Datalink. Ann Gastroenterol 2020; 33:500-507. [PMID: 32879597 PMCID: PMC7406809 DOI: 10.20524/aog.2020.0521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background There are few recent studies on the use of 5-aminosalicylates (5-ASA) as therapy for Crohn's disease (CD) in routine clinical practice. The aim of this database investigation was to provide real-world evidence on 5-ASA use in CD. Methods Patients with CD, aged ≥18 years when first prescribed 5-ASA (index date) and having received 5-ASA at any time between 01 January 2006 and 07 May 2018, were included for analysis. Outcomes included treatment patterns and resource use. Results Of 21,456 patients with CD, 9492 (44.2%) had been prescribed 5-ASA, with the majority (5606; 59.1%) starting on oral 5-ASA as monotherapy. 58.3% (5537) of patients on 5-ASA did not require dose change, 67.6% (6416) did not require supplementary treatment (e.g., corticosteroids, immunosuppressants, etc.), and 4.6% (436) required a switch to another treatment. Resource use was significantly decreased in the year after vs. year before 5-ASA initiation (including: specialist referrals, hospitalizations and hospital days; all P<0.001). Patients remained on 5-ASA for a median of 4.7 years (interquartile range 1.2-10.1). 25.3% (2406) of patients were still on 5-ASA at 10 years. There was a significant correlation between earlier use of 5-ASA following diagnosis and longer 5-ASA retention (P<0.001). Conclusions 5-ASA is widely used as a long-term treatment for CD, as evidenced by continuation rates extending beyond 10 years in a quarter of patients. CD-related healthcare resource use decreased significantly in the year following 5-ASA initiation. Earlier use was associated with longer retention.
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Affiliation(s)
- Ailsa Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, Harrow, Middlesex, UK (Ailsa Hart)
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong (Siew C. Ng)
| | - John Watkins
- Public Health Wales, Cardiff, UK (John Watkins).,School of Medicine, Cardiff University, Cardiff, UK (John Watkins)
| | - Kristine Paridaens
- Ferring International Center, St-Prex, Switzerland (Kristine Paridaens, Yum Lina Yip Sonderegger)
| | - James O Edwards
- Strategen Limited, Winchester, UK (James O. Edwards, John R. Fullarton)
| | - John R Fullarton
- Strategen Limited, Winchester, UK (James O. Edwards, John R. Fullarton)
| | - Yum Lina Yip Sonderegger
- Ferring International Center, St-Prex, Switzerland (Kristine Paridaens, Yum Lina Yip Sonderegger)
| | - Ola Ghatnekar
- Ferring International PharmaScience Center, Copenhagen, Denmark (Ola Ghatnekar)
| | - Subrata Ghosh
- Institute of Immunology and Immunotherapy, University of Birmingham, UK (Subrata Ghosh)
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19
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Meier GC, Watkins J, McEwan P, Pockett RD. Resource use and direct medical costs of acute respiratory illness in the UK based on linked primary and secondary care records from 2001 to 2009. PLoS One 2020; 15:e0236472. [PMID: 32760071 PMCID: PMC7410242 DOI: 10.1371/journal.pone.0236472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have shown that influenza is associated with a substantial healthcare burden in the United Kingdom (UK), but more studies are needed to evaluate the resource use and direct medical costs of influenza in primary care and secondary care. Methods A retrospective observational database study in the UK to describe the primary care and directly-associated secondary care resource use, and direct medical costs of acute respiratory illness (ARI), according to age, and risk status (NCT Number: 01521416). Patients with influenza, ARI or influenza-related respiratory infections during 9 consecutive pre-pandemic influenza peak seasons were identified by READ codes in the linked Clinical Practice Research Datalink (CPRD) and Hospital Episodes Statistics (HES) dataset. The study period was from 21st January 2001 to 31st March 2009. Results A total of 156,193 patients had ≥1 general practitioner (GP) episode of ARI, and a total of 82,204 patients received ≥1 GP prescription, at a mean of 2.5 (standard deviation [SD]: 3.0) prescriptions per patient. The total cost of GP consultations and prescriptions equated to £462,827 per year per 100,000 patients. The yearly cost of prescribed medication for ARI was £319,732, at an estimated cost of £11,596,350 per year extrapolated to the UK, with 40% attributable to antibiotics. The mean cost of hospital admissions equated to a yearly cost of £981,808 per 100,000 patients. The total mean direct medical cost of ARI over 9 influenza seasons was £21,343,445 (SD: £10,441,364), at £136.65 (SD: £66.85) per case. Conclusions Extrapolating to the UK population, for pre-pandemic influenza seasons from 2001 to 2009, the direct medical cost of ARI equated to £86 million each year. More studies are needed to assess the costs of influenza disease to help guide public health decision-making for seasonal influenza in the UK.
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Affiliation(s)
| | - John Watkins
- Public Health Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Phil McEwan
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, United Kingdom
| | - Rhys D. Pockett
- Swansea Centre for Health Economics, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
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20
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Al Kharusi S, Anton G, Badhrees I, Barbeau PS, Beck D, Belov V, Bhatta T, Breidenbach M, Brunner T, Cao GF, Cen WR, Chambers C, Cleveland B, Coon M, Craycraft A, Daniels T, Darroch L, Daugherty SJ, Davis J, Delaquis S, Der Mesrobian-Kabakian A, DeVoe R, Dilling J, Dolgolenko A, Dolinski MJ, Echevers J, Fairbank W, Fairbank D, Farine J, Feyzbakhsh S, Fierlinger P, Fudenberg D, Gautam P, Gornea R, Gratta G, Hall C, Hansen EV, Hoessl J, Hufschmidt P, Hughes M, Iverson A, Jamil A, Jessiman C, Jewell MJ, Johnson A, Karelin A, Kaufman LJ, Koffas T, Kostensalo J, Krücken R, Kuchenkov A, Kumar KS, Lan Y, Larson A, Lenardo BG, Leonard DS, Li GS, Li S, Li Z, Licciardi C, Lin YH, MacLellan R, McElroy T, Michel T, Mong B, Moore DC, Murray K, Nakarmi P, Njoya O, Nusair O, Odian A, Ostrovskiy I, Piepke A, Pocar A, Retière F, Robinson AL, Rowson PC, Ruddell D, Runge J, Schmidt S, Sinclair D, Skarpaas K, Soma AK, Stekhanov V, Suhonen J, Tarka M, Thibado S, Todd J, Tolba T, Totev TI, Tsang R, Veenstra B, Veeraraghavan V, Vogel P, Vuilleumier JL, Wagenpfeil M, Watkins J, Weber M, Wen LJ, Wichoski U, Wrede G, Wu SX, Xia Q, Yahne DR, Yang L, Yen YR, Zeldovich OY, Ziegler T. Measurement of the Spectral Shape of the β-Decay of ^{137}Xe to the Ground State of ^{137}Cs in EXO-200 and Comparison with Theory. Phys Rev Lett 2020; 124:232502. [PMID: 32603173 DOI: 10.1103/physrevlett.124.232502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
We report on a comparison between the theoretically predicted and experimentally measured spectra of the first-forbidden nonunique β-decay transition ^{137}Xe(7/2^{-})→^{137}Cs(7/2^{+}). The experimental data were acquired by the EXO-200 experiment during a deployment of an AmBe neutron source. The ultralow background environment of EXO-200, together with dedicated source deployment and analysis procedures, allowed for collection of a pure sample of the decays, with an estimated signal to background ratio of more than 99 to 1 in the energy range from 1075 to 4175 keV. In addition to providing a rare and accurate measurement of the first-forbidden nonunique β-decay shape, this work constitutes a novel test of the calculated electron spectral shapes in the context of the reactor antineutrino anomaly and spectral bump.
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Affiliation(s)
- S Al Kharusi
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - G Anton
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - I Badhrees
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - P S Barbeau
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - D Beck
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - V Belov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - T Bhatta
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Breidenbach
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Brunner
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G F Cao
- Institute of High Energy Physics, Beijing 100049, China
| | - W R Cen
- Institute of High Energy Physics, Beijing 100049, China
| | - C Chambers
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - B Cleveland
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - M Coon
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - A Craycraft
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Daniels
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - L Darroch
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - S J Daugherty
- Physics Department and CEEM, Indiana University, Bloomington, Indiana 47405, USA
| | - J Davis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S Delaquis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | | | - R DeVoe
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - J Dilling
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Dolgolenko
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - M J Dolinski
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Echevers
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - W Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - D Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - J Farine
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - S Feyzbakhsh
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - P Fierlinger
- Technische Universität München, Physikdepartment and Excellence Cluster Universe, Garching 80805, Germany
| | - D Fudenberg
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - P Gautam
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R Gornea
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G Gratta
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - C Hall
- Physics Department, University of Maryland, College Park, Maryland 20742, USA
| | - E V Hansen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Hoessl
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - P Hufschmidt
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - M Hughes
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Iverson
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - A Jamil
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Jessiman
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M J Jewell
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - A Johnson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - A Karelin
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - L J Kaufman
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Koffas
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - J Kostensalo
- University of Jyväskylä, Department of Physics, P.O. Box 35 (YFL), Jyväskylä FI-40014, Finland
| | - R Krücken
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Kuchenkov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - K S Kumar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - Y Lan
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Larson
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - B G Lenardo
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - D S Leonard
- IBS Center for Underground Physics, Daejeon 34126, Korea
| | - G S Li
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - S Li
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - Z Li
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Licciardi
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - Y H Lin
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R MacLellan
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - T McElroy
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - T Michel
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - B Mong
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D C Moore
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - K Murray
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - P Nakarmi
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - O Njoya
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794, USA
| | - O Nusair
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Odian
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - I Ostrovskiy
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Piepke
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Pocar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - F Retière
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A L Robinson
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - P C Rowson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D Ruddell
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - J Runge
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory (TUNL), Durham, North Carolina 27708, USA
| | - S Schmidt
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - D Sinclair
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - K Skarpaas
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - A K Soma
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - V Stekhanov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - J Suhonen
- University of Jyväskylä, Department of Physics, P.O. Box 35 (YFL), Jyväskylä FI-40014, Finland
| | - M Tarka
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - S Thibado
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - J Todd
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Tolba
- Institute of High Energy Physics, Beijing 100049, China
| | - T I Totev
- Physics Department, McGill University, Montreal, Quebec H3A 2T8, Canada
| | - R Tsang
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - B Veenstra
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - V Veeraraghavan
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - P Vogel
- Kellogg Lab, Caltech, Pasadena, California 91125, USA
| | - J-L Vuilleumier
- LHEP, Albert Einstein Center, University of Bern, Bern CH-3012, Switzerland
| | - M Wagenpfeil
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - J Watkins
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M Weber
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - L J Wen
- Institute of High Energy Physics, Beijing 100049, China
| | - U Wichoski
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - G Wrede
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - S X Wu
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - Q Xia
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - D R Yahne
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - L Yang
- Department of Physics, University of California San Diego, La Jolla, California 92093, USA
| | - Y-R Yen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - O Ya Zeldovich
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Centre "Kurchatov Institute", Moscow 117218, Russia
| | - T Ziegler
- Erlangen Centre for Astroparticle Physics (ECAP), Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91058, Germany
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Watkins J, Maruthappu M. Public health and economic responses to COVID-19: finding the tipping point. Public Health 2020; 191:21-22. [PMID: 33476938 PMCID: PMC7245272 DOI: 10.1016/j.puhe.2020.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J Watkins
- PILAR Research and Education, London, UK.
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Faulkner E, Holtorf AP, Walton S, Liu CY, Lin H, Biltaj E, Brixner D, Barr C, Oberg J, Shandhu G, Siebert U, Snyder SR, Tiwana S, Watkins J, IJzerman MJ, Payne K. Being Precise About Precision Medicine: What Should Value Frameworks Incorporate to Address Precision Medicine? A Report of the Personalized Precision Medicine Special Interest Group. Value Health 2020; 23:529-539. [PMID: 32389217 DOI: 10.1016/j.jval.2019.11.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 07/18/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 06/11/2023]
Abstract
Precision medicine is a dynamic area embracing a diverse and increasing type of approaches that allow the targeting of new medicines, screening programs or preventive healthcare strategies, which include the use of biologic markers or complex tests driven by algorithms also potentially taking account of patient preferences. The International Society for Pharmacoeconomics and Outcome Research expanded its current work around precision medicine to (1) describe the evolving paradigm of precision medicine with examples of current and evolving applications, (2) describe key stakeholders perspectives on the value of precision medicine in their respective domains, and (3) define the core factors that should be considered in a value assessment framework for precision medicine. With the ultimate goal of improving health of well-defined patient groups, precision medicine will affect all stakeholders in the healthcare system at multiple levels spanning the individual perspective to the societal perspective. For an efficient, timely and practical precision medicine value assessment framework, it will be important to address these multiple perspectives through building consensus among the stakeholders for robust procedures and measures of value aspects, including performance of precision mechanism; aligned reimbursement processes of precision mechanism and subsequent treatment; transparent expectations for evidence requirements and study designs adequately matched to the intended use of the precision mechanism and to the smaller target patient populations; recognizing the potential range of value-generation such as ruling-in and ruling-out decisions.
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Affiliation(s)
- Eric Faulkner
- Evidera, Bethesda, MD, USA; University of North Carolina at Chapel Hill, Chapel Hill, NC; National Association of Managed Care Physicians, Glen Allen, VA, USA.
| | | | - Surrey Walton
- University of Illinois at Chicago, Chicago, IL, USA; Second City Outcomes Research, LLC, Chicago, IL, USA
| | | | - Hwee Lin
- National University of Singapore, Singapore
| | | | | | | | | | | | - Uwe Siebert
- University for Health Sciences, Medical Informatics, and Technology, Hall in Tirol, Austria; Harvard School of Public Health and Harvard Medical School, Boston, MA, USA; ONCOTYROL Center for Personalized Cancer Medicine, Innsbruck, Austria
| | | | | | | | - Maarten J IJzerman
- University of Melbourne Centre for Cancer Research, Parkville, Australia
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Hart MR, Garrison LP, Doyle DL, Jarvik GP, Watkins J, Devine B. Projected Cost-Effectiveness for 2 Gene-Drug Pairs Using a Multigene Panel for Patients Undergoing Percutaneous Coronary Intervention. Value Health 2019; 22:1231-1239. [PMID: 31708059 DOI: 10.1016/j.jval.2019.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/09/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND For patients undergoing percutaneous coronary intervention, gene-drug associations exist relevant to first-line treatment options-antiplatelet agent, clopidogrel, and pain medication, tramadol. Knowledge of genotype information may allow for avoidance of adverse drug events during critical clinical windows. OBJECTIVE This evaluation estimated cost-effectiveness associated with a multi-gene panel pre-emptively testing two genes providing CYP2C19 genotype-guided strategy for antiplatelet therapy, with CYP2D6 genotype-guided pain management, compared to single gene test for CYP2C19 with random assignment for pain treatment, and to no testing (empiric clopidogrel with random assignment for pain treatment). METHODS Decision analysis modeling was used to project costs from a payer perspective and patient quality-adjusted life years (QALYs) from the three strategies. The model captured composite risks of major adverse cardiovascular events and pain therapy-related adverse drug events and associated utility estimates. We conducted sensitivity analyses to assess influential input parameters. RESULTS Over 15 months, multi-gene testing was least costly and yielded more QALYs compared to both single gene and no testing; total incremental costs were $1646 lower with incremental gains of 0.04 QALYs for multi-gene compared with single gene and $11 368 lower with 0.17 QALY gains compared to no test. Base case analyses revealed multi gene was dominant compared to both single gene and no test, as it demonstrated cost savings with increased QALYs. CONCLUSIONS For these patients, a multi-gene-guided strategy yields a favorable incremental cost-effectiveness ratio compared to the other two treatment strategies. Pre-emptively ascertaining additional gene-drug pair information can inform clinical and economic decision-making at the point of care.
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Affiliation(s)
- M Ragan Hart
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA; Institute for Public Health Genetics, University of Washington, Seattle, WA, USA.
| | - Louis P Garrison
- Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Debra L Doyle
- Institute for Public Health Genetics, University of Washington, Seattle, WA, USA; Washington State Department of Health, Kent, WA, USA
| | - Gail P Jarvik
- University of Washington Department of Medicine (Medical Genetics), Seattle, WA, USA
| | - John Watkins
- Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA; Premera Blue Cross, Mountlake Terrace, WA, USA
| | - Beth Devine
- Institute for Public Health Genetics, University of Washington, Seattle, WA, USA; Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
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25
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Anton G, Badhrees I, Barbeau PS, Beck D, Belov V, Bhatta T, Breidenbach M, Brunner T, Cao GF, Cen WR, Chambers C, Cleveland B, Coon M, Craycraft A, Daniels T, Danilov M, Darroch L, Daugherty SJ, Davis J, Delaquis S, Der Mesrobian-Kabakian A, DeVoe R, Dilling J, Dolgolenko A, Dolinski MJ, Echevers J, Fairbank W, Fairbank D, Farine J, Feyzbakhsh S, Fierlinger P, Fudenberg D, Gautam P, Gornea R, Gratta G, Hall C, Hansen EV, Hoessl J, Hufschmidt P, Hughes M, Iverson A, Jamil A, Jessiman C, Jewell MJ, Johnson A, Karelin A, Kaufman LJ, Koffas T, Krücken R, Kuchenkov A, Kumar KS, Lan Y, Larson A, Lenardo BG, Leonard DS, Li GS, Li S, Li Z, Licciardi C, Lin YH, MacLellan R, McElroy T, Michel T, Mong B, Moore DC, Murray K, Njoya O, Nusair O, Odian A, Ostrovskiy I, Piepke A, Pocar A, Retière F, Robinson AL, Rowson PC, Ruddell D, Runge J, Schmidt S, Sinclair D, Soma AK, Stekhanov V, Tarka M, Todd J, Tolba T, Totev TI, Veenstra B, Veeraraghavan V, Vogel P, Vuilleumier JL, Wagenpfeil M, Watkins J, Weber M, Wen LJ, Wichoski U, Wrede G, Wu SX, Xia Q, Yahne DR, Yang L, Yen YR, Zeldovich OY, Ziegler T. Search for Neutrinoless Double-β Decay with the Complete EXO-200 Dataset. Phys Rev Lett 2019; 123:161802. [PMID: 31702371 DOI: 10.1103/physrevlett.123.161802] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/30/2019] [Indexed: 06/10/2023]
Abstract
A search for neutrinoless double-β decay (0νββ) in ^{136}Xe is performed with the full EXO-200 dataset using a deep neural network to discriminate between 0νββ and background events. Relative to previous analyses, the signal detection efficiency has been raised from 80.8% to 96.4±3.0%, and the energy resolution of the detector at the Q value of ^{136}Xe 0νββ has been improved from σ/E=1.23% to 1.15±0.02% with the upgraded detector. Accounting for the new data, the median 90% confidence level 0νββ half-life sensitivity for this analysis is 5.0×10^{25} yr with a total ^{136}Xe exposure of 234.1 kg yr. No statistically significant evidence for 0νββ is observed, leading to a lower limit on the 0νββ half-life of 3.5×10^{25} yr at the 90% confidence level.
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Affiliation(s)
- G Anton
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - I Badhrees
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - P S Barbeau
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - D Beck
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - V Belov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - T Bhatta
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - M Breidenbach
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Brunner
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G F Cao
- Institute of High Energy Physics, Beijing 100049, China
| | - W R Cen
- Institute of High Energy Physics, Beijing 100049, China
| | - C Chambers
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - B Cleveland
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - M Coon
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - A Craycraft
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Daniels
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - M Danilov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - L Darroch
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
| | - S J Daugherty
- Physics Department and CEEM, Indiana University, Bloomington, Indiana 47405, USA
| | - J Davis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S Delaquis
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | | | - R DeVoe
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - J Dilling
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Dolgolenko
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - M J Dolinski
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Echevers
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - W Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - D Fairbank
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - J Farine
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - S Feyzbakhsh
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - P Fierlinger
- Physik Department and Excellence Cluster Universe, Technische Universität München, Garching 80805, Germany
| | - D Fudenberg
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - P Gautam
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R Gornea
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - G Gratta
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - C Hall
- Physics Department, University of Maryland, College Park, Maryland 20742, USA
| | - E V Hansen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - J Hoessl
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - P Hufschmidt
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - M Hughes
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Iverson
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - A Jamil
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Jessiman
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M J Jewell
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - A Johnson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - A Karelin
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - L J Kaufman
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T Koffas
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - R Krücken
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Kuchenkov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - K S Kumar
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794, USA
| | - Y Lan
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A Larson
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - B G Lenardo
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - D S Leonard
- IBS Center for Underground Physics, Daejeon 34126, Korea
| | - G S Li
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - S Li
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - Z Li
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - C Licciardi
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - Y H Lin
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - R MacLellan
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - T McElroy
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
| | - T Michel
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - B Mong
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D C Moore
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - K Murray
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
| | - O Njoya
- Department of Physics and Astronomy, Stony Brook University, SUNY, Stony Brook, New York 11794, USA
| | - O Nusair
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Odian
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - I Ostrovskiy
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Piepke
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - A Pocar
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - F Retière
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A L Robinson
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - P C Rowson
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - D Ruddell
- Department of Physics and Physical Oceanography, University of North Carolina at Wilmington, Wilmington, North Carolina 28403, USA
| | - J Runge
- Department of Physics, Duke University, and Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - S Schmidt
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - D Sinclair
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
- TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - A K Soma
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - V Stekhanov
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - M Tarka
- Amherst Center for Fundamental Interactions and Physics Department, University of Massachusetts, Amherst, Massachusetts 01003, USA
| | - J Todd
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - T Tolba
- Institute of High Energy Physics, Beijing 100049, China
| | - T I Totev
- Physics Department, McGill University, Montreal H3A 2T8, Quebec, Canada
| | - B Veenstra
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - V Veeraraghavan
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - P Vogel
- Kellogg Lab, Caltech, Pasadena, California 91125, USA
| | - J-L Vuilleumier
- LHEP, Albert Einstein Center, University of Bern, Bern CH-3012, Switzerland
| | - M Wagenpfeil
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - J Watkins
- Physics Department, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - M Weber
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - L J Wen
- Institute of High Energy Physics, Beijing 100049, China
| | - U Wichoski
- Department of Physics, Laurentian University, Sudbury, Ontario P3E 2C6, Canada
| | - G Wrede
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
| | - S X Wu
- Physics Department, Stanford University, Stanford, California 94305, USA
| | - Q Xia
- Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06511, USA
| | - D R Yahne
- Physics Department, Colorado State University, Fort Collins, Colorado 80523, USA
| | - L Yang
- Physics Department, University of Illinois, Urbana-Champaign, Illinois 61801, USA
| | - Y-R Yen
- Department of Physics, Drexel University, Philadelphia, Pennsylvania 19104, USA
| | - O Ya Zeldovich
- Institute for Theoretical and Experimental Physics named by A.I. Alikhanov of National Research Center "Kurchatov Institute," 117218 Moscow, Russia
| | - T Ziegler
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen 91058, Germany
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Coburn J, Unterberg E, Barton J, Rudakov D, Bykov I, Parish C, Wilcox R, Lasnier C, Abrams T, Watkins J, Hillis D, Bourham M. Erosion characterization of SiC and Ti3SiC2 on DIII-D using focused ion beam micro-trenches. Nuclear Materials and Energy 2019. [DOI: 10.1016/j.nme.2019.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khilfeh I, Guyette E, Watkins J, Danielson D, Gross D, Yeung K. Adherence, Persistence, and Expenditures for High-Cost Anti-Inflammatory Drugs in Rheumatoid Arthritis: An Exploratory Study. J Manag Care Spec Pharm 2019; 25:461-467. [PMID: 30917076 PMCID: PMC10398092 DOI: 10.18553/jmcp.2019.25.4.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Drugs for inflammatory conditions are one of the highest expenditure therapeutic classes for health plans. Published literature for adherence, persistence, nonadherence risk factors, and health care costs are incomplete for newer biologic agents. OBJECTIVES To (a) examine differences in adherence, persistence, switch patterns, and health care costs among high-cost specialty anti-inflammatory medications and (b) suggest risk factors for nonadherence in rheumatoid arthritis. METHODS In this exploratory retrospective cohort study, we used medical and pharmacy claims from 1.2 million enrollees in commercial health plans administrated by Premera Blue Cross, the largest not-for-profit health plan in the Pacific Northwest. We included members with rheumatoid arthritis who used the following high-cost disease-modifying antirheumatic drugs: abatacept, adalimumab, anakinra, apremilast, certolizumab, etanercept, golimumab, infliximab, rituximab, sekukinumab, tocilizumab, tofacitinib, and ustekinumab. Adherence was calculated via medication possession ratio. Persistence was calculated as the amount of days between the initial fill and final fill plus days supply. Switch rates for adalimumab and etanercept were calculated as the percentage of members who switched to another target drug during the observation period. Direct medical costs (total health care costs) and health care costs excluding specialty agents were calculated using the net allowable amount per claim for the duration of each therapy. Adherence, persistence, and costs of care were also examined for concurrent methotrexate use for the most used target drugs. RESULTS The most commonly used drugs were abatacept (n = 47), adalimumab (n = 226), and etanercept (n = 252). Nonadherence in certain subgroups was associated with higher mean monthly health care costs, excluding specialty agents (etanercept cohort: +$1,063 for nonmethotrexate users; +$492 for nonadherent methotrexate users), but adherence was associated with higher total health care costs (+$883 for etanercept). Relative to specialty pharmacies, retail was associated with 9% higher nonadherence. Concurrent methotrexate use was associated with higher persistence (+307 and +192 days with adalimumab and etanercept). The most commonly switched-to drug after adalimumab/etanercept was abatacept (n = 39). CONCLUSIONS This exploratory study raises signals suggesting that retail pharmacies may be associated with higher nonadherence; nonadherence may be associated with increased health care costs, excluding specialty agents; adherence may increase total health care costs; and methotrexate use may be associated with increased persistence. Future research should confirm these findings. DISCLOSURES This research was part of an internship awarded to Khilfeh by the AMCP Foundation/Pfizer Summer Internship Program and funded by Pfizer. Gross is an employee of Pfizer. The other authors have nothing to disclose. A portion of this research was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting as a continuing education session entitled "The Evolving Role of Real-World Data in Health Care Decision Making" on March 29, 2017, in Denver, CO, and at AMCP Nexus 2016 as a poster on October 3-6, 2016, in National Harbor, MD.
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Affiliation(s)
| | - Eric Guyette
- Premera Blue Cross, Mountlake Terrace, Washington
| | - John Watkins
- University of Washington School of Pharmacy, Seattle, and Premera Blue Cross, Mountlake Terrace, Washington
| | | | | | - Kai Yeung
- Kaiser Permanente Washington Health Research Institute, Seattle
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Lytras T, Kogevinas M, Kromhout H, Carsin AE, Antó JM, Bentouhami H, Weyler J, Heinrich J, Nowak D, Urrutia I, Martínez-Moratalla J, Gullón JA, Vega AP, Raherison Semjen C, Pin I, Demoly P, Leynaert B, Villani S, Gíslason T, Svanes Ø, Holm M, Forsberg B, Norbäck D, Mehta AJ, Probst-Hensch N, Benke G, Jogi R, Torén K, Sigsgaard T, Schlünssen V, Olivieri M, Blanc PD, Watkins J, Bono R, Buist AS, Vermeulen R, Jarvis D, Zock JP. Occupational exposures and incidence of chronic bronchitis and related symptoms over two decades: the European Community Respiratory Health Survey. Occup Environ Med 2019; 76:222-229. [PMID: 30700596 DOI: 10.1136/oemed-2018-105274] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey. METHODS Population samples aged 20-44 were randomly selected in 1991-1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations. RESULTS 8794 participants fulfilled the inclusion criteria, contributing 13 185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95% CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95% CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides. CONCLUSIONS Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation.
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Affiliation(s)
- Theodore Lytras
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Manolis Kogevinas
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Hans Kromhout
- IRAS, University of Utrecht, Utrecht, The Netherlands
| | - Anne-Elie Carsin
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Josep Maria Antó
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Hayat Bentouhami
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Joost Weyler
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre, German Centre for Lung Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre, German Centre for Lung Research, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Isabel Urrutia
- Pulmonology Department, Galdakao Hospital, Galdakao, Spain
| | - Jesús Martínez-Moratalla
- Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.,Facultad de Medicina Albacete, University of Castilla-La Mancha, Ciudad Real, Spain
| | | | - Antonio Pereira Vega
- Pulmonology and Allergy Clinical Unit, University Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Chantal Raherison Semjen
- Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Université de Bordeaux, Bordeaux, France
| | - Isabelle Pin
- Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France.,U1209, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, INSERM, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, Paris, France
| | - Bénédicte Leynaert
- Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France
| | - Simona Villani
- Section of Epidemiology and Medical Statistics, Department of Health Sciences, University of Pavia, Pavia, Italy
| | - Thorarinn Gíslason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Øistein Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Mathias Holm
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bertil Forsberg
- Occupational and Environmental Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amar J Mehta
- Office of Research and Evaluation, Boston Public Health Commission, Boston, Massachusetts, USA
| | - Nicole Probst-Hensch
- Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Geza Benke
- Monash Centre for Occupation and Environmental Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Europe
| | - Kjell Torén
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Torben Sigsgaard
- Section for Environment, Occupation and Health, Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark
| | - Vivi Schlünssen
- Section for Environment, Occupation and Health, Department of Public Health, Danish Ramazzini Center, Aarhus University, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Mario Olivieri
- Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy
| | - Paul D Blanc
- San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, California, USA
| | - John Watkins
- School of Medicine, Cardiff University, Cardiff, Wales, UK.,Public Health Wales, Cardiff, Wales, UK
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - A Sonia Buist
- Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Deborah Jarvis
- School of Medicine, Cardiff University, Cardiff, Wales, UK.,Public Health Wales, Cardiff, Wales, UK.,Department of Public Health and Pediatrics, University of Turin, Turin, Italy.,Population Health and Occupational Disease, National Heart and Lung Institute, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Jan-Paul Zock
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Wyer MD, Kay D, Morgan H, Naylor S, Clark S, Watkins J, Davies CM, Francis C, Osborn H, Bennett S. Within-day variability in microbial concentrations at a UK designated bathing water: Implications for regulatory monitoring and the application of predictive modelling based on historical compliance data. Water Res X 2018; 1:100006. [PMID: 31193990 PMCID: PMC6549935 DOI: 10.1016/j.wroa.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 06/09/2023]
Abstract
Prediction of bathing water quality is recommended by the World Health Organization (WHO), the European Union (EU) and the United States Environmental Protection Agency (USEPA) and is an established element in bathing water management designed to protect public health. Most commonly, historical regulatory compliance data are used for model calibration and provide the dependent variable for modelling. Independent (or predictor) variables (e.g. rainfall, river flow and received irradiance) measured over some antecedent period are used to deliver prediction of the faecal indicator concentration measured on the day of the regulatory sample collection. The implied linked assumptions of this approach are, therefore, that; (i) the independent variables accurately predict the bathing-day water quality; which is (ii) accurately characterized by the single regulatory sample. Assumption (ii) will not be the case where significant within-day variability in water quality is evident. This study built a detailed record of water quality change through 60 days at a UK coastal bathing water in 2011 using half-hourly samples each subjected to triplicate filtration designed to enhance enumeration precision. On average, the mean daily variation in FIO concentrations exceeded 1 log10 order, with the largest daily variations exceeding 2 log10 orders. Significant diurnality was observed at this bathing water, which would determine its EU Directive compliance category if the regulatory samples were collected at the same time each day. A sampling programme of this intensity has not been reported elsewhere to date and, if this pattern is proven to be characteristic of other bathing waters world-wide, it has significance for: (a) the design of regulatory sampling programmes; (b) the use of historical data to assess compliance, which often comprises a single sample taken at the compliance point on a regular, often weekly, basis; and (c) the use of regulatory compliance data to build predictive models of water quality.
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Affiliation(s)
- Mark D. Wyer
- Department of Geography and Earth Sciences, Llandinam Building, Aberystwyth University, SY23 3DB, UK
| | - David Kay
- Department of Geography and Earth Sciences, Llandinam Building, Aberystwyth University, SY23 3DB, UK
| | - Huw Morgan
- Place, Housing and Public Protection Services, Pollution Control, Swansea Council, The Guildhall, Swansea, SA1 4PE, UK
| | - Sam Naylor
- Place, Housing and Public Protection Services, Pollution Control, Swansea Council, The Guildhall, Swansea, SA1 4PE, UK
| | - Simon Clark
- Place, Housing and Public Protection Services, Pollution Control, Swansea Council, The Guildhall, Swansea, SA1 4PE, UK
| | - John Watkins
- Department of Geography and Earth Sciences, Llandinam Building, Aberystwyth University, SY23 3DB, UK
| | - Cheryl M. Davies
- Department of Geography and Earth Sciences, Llandinam Building, Aberystwyth University, SY23 3DB, UK
| | - Carol Francis
- Department of Geography and Earth Sciences, Llandinam Building, Aberystwyth University, SY23 3DB, UK
| | - Hamish Osborn
- Natural Resources Wales, Area Office, Maes Newydd, Llandarcy, SA10 6JQ, UK
| | - Sarah Bennett
- Natural Resources Wales, Area Office, Maes Newydd, Llandarcy, SA10 6JQ, UK
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30
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Ren J, Donovan D, Watkins J, Wang HQ, Rudakov D, Murphy C, McLean A, Lasnier C, Unterberg E, Thomas D, Boivin R. The surface eroding thermocouple for fast heat flux measurement in DIII-D. Rev Sci Instrum 2018; 89:10J122. [PMID: 30399945 DOI: 10.1063/1.5038677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
A novel type of surface eroding thermocouple (SETC) has been tested and demonstrated in the small angle slot (SAS) divertor of DIII-D for fast local heat flux measurements. The thermojunction of the SETC is formed between two thin (10 μm) ribbons, which are filed over to create microfiber junctions. These thermocouples are able to be exposed directly to the plasma at surface temperatures exceeding 2000 °C and are capable of sub-10 ms time resolution. Before installation in SAS, the SETCs were exposed in the lower DIII-D divertor during L-mode and H-mode discharges, from which results are presented. In preliminary tests, SETCs proved to be a qualified diagnostic to accurately measure both the intra-edge localized mode (ELM) and inter-ELM heat flux during H-mode shots with high frequency ELMs (hundreds of Hz) and to resolve heat flux profiles during strike point sweeps. The heat fluxes measured by using SETCs are consistent with the heat fluxes measured by using IR cameras and Langmuir probes. These new diagnostic capabilities will complement the existing IR camera measurements and will be of particularly significant value to measure surface heat flux in the SAS divertor or other regions where the IR camera lacks line of sight.
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Affiliation(s)
- J Ren
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996-1410, USA
| | - D Donovan
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996-1410, USA
| | - J Watkins
- Sandia National Laboratories, Livermore, California 94551, USA
| | - H Q Wang
- Oak Ridge Associated Universities, Oak Ridge, Tennessee 37830, USA
| | - D Rudakov
- University of California San Diego, San Diego, California 92093, USA
| | - C Murphy
- General Atomics, San Diego, California 92186-5608, USA
| | - A McLean
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C Lasnier
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Unterberg
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - D Thomas
- General Atomics, San Diego, California 92186-5608, USA
| | - R Boivin
- General Atomics, San Diego, California 92186-5608, USA
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31
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Trosman JR, Weldon CB, Gradishar WJ, Benson AB, Cristofanilli M, Kurian AW, Ford JM, Balch A, Watkins J, Phillips KA. From the Past to the Present: Insurer Coverage Frameworks for Next-Generation Tumor Sequencing. Value Health 2018; 21:1062-1068. [PMID: 30224110 PMCID: PMC6374027 DOI: 10.1016/j.jval.2018.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/11/2018] [Indexed: 05/16/2023]
Abstract
Next-generation sequencing promises major advancements in precision medicine but faces considerable challenges with insurance coverage. These challenges are especially important to address in oncology in which next-generation tumor sequencing (NGTS) holds a particular promise, guiding the use of life-saving or life-prolonging therapies. Payers' coverage decision making on NGTS is challenging because this revolutionary technology pushes the very boundaries of the underlying framework used in coverage decisions. Some experts have called for the adaptation of the coverage framework to make it better equipped for assessing NGTS. Medicare's recent decision to cover NGTS makes this topic particularly urgent to examine. In this article, we discussed the previously proposed approaches for adaptation of the NGTS coverage framework, highlighted their innovations, and outlined remaining gaps in their ability to assess the features of NGTS. We then compared the three approaches with Medicare's national coverage determination for NGTS and discussed its implications for US private payers as well as for other technologies and clinical areas. We focused on US payers because analyses of coverage approaches and policies in the large and complex US health care system may inform similar efforts in other countries. We concluded that further adaptation of the coverage framework will facilitate a better suited assessment of NGTS and future genomics innovations.
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Affiliation(s)
- Julia R Trosman
- Center for Business Models in Healthcare, Glencoe, IL, USA; Department of Clinical Pharmacy, UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, CA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Christine B Weldon
- Center for Business Models in Healthcare, Glencoe, IL, USA; Department of Clinical Pharmacy, UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, CA, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Al B Benson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - James M Ford
- Stanford University School of Medicine, Stanford, CA, USA
| | - Alan Balch
- Patient Advocate Foundation, Hampton, VA, USA
| | | | - Kathryn A Phillips
- Department of Clinical Pharmacy, UCSF Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California San Francisco, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
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32
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Seyedin SN, Mott SL, Snow AN, Russo JK, Watkins J. The impact of prostate cancer (PC) margin extent (ME) at radical prostatectomy (RP) on biochemical relapse-free survival (bRFS). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
83 Background: Surgical margin involvement (M+) by PC at RP is associated with suboptimal bRFS; however, the interaction of M+ with coincident high-risk clinicopathologic and treatment factors obscures accurate estimation of recurrence risk. The objective of this study is to determine whether ME permits risk stratification. Methods: Retrospective analysis of clinicopathologic factor association with bRFS. Eligible patients underwent RP alone for clinically localized PC. Patients with metastatic disease, PSA > 30 at diagnosis, pathologic involvement of seminal vesicles or lymph nodes at RP, insufficient follow-up, or receipt of pre-RP or adjuvant therapy were excluded. Slides from RP specimens with close or positive margins were re-reviewed by study pathologists blinded to outcome. Results: From 2002-2010, 667 patients were eligible for analysis. The median age was 61 yrs (range, 43-76), and all had cT1-2 disease (83% T1c), with median PSA 5.6 (0.9-28.0; 85% ≤10). Robot-assisted RP was employed in 141 cases (21%). Two hundred ten patients (31%) had M+, with single maximal ME 3mm (0.1-23), and cumulative ME 4mm (0.1-34). At median follow-up of 102 months (13-184), 149 patients (22%) had recurrence, with estimated 8-year bRFS rates of 85%/56% for M-/+ patients (p < 0.01). Multivariable analysis identified PSA, Gleason score (GS), extraprostatic extension, and M+ as associated with bRFS. Specific to patients with involved margins, the combination of ME and GS permitted recurrence risk stratification, with a low-risk subset identified (GS≤6 and ME < 3mm; Table). Conclusions: The current investigation suggests that GS6 patients with maximal or cumulative ME < 3mm appear to have favorable early 8-year bRFS following RP. GS6 patients with wider ME and GS ≥7 with any extent M+ appear to have suboptimal bRFS. RP pathology reports should include ME details, in order to more precisely estimate risk of subsequent disease recurrence. [Table: see text]
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Affiliation(s)
| | - Sarah L Mott
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
| | | | | | - John Watkins
- University of Iowa Hospitals and Clinics, Iowa City, IA
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Anwar S, Tampubolon G, Hutajulu S, Watkins J, Wulaningsih W. Determinants of cancer screening awareness and participation among Indonesian women: A nationwide study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx729.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Jarvis D, Newson R, Janson C, Corsico A, Heinrich J, Anto JM, Abramson MJ, Kirsten AM, Zock JP, Bono R, Demoly P, Leynaert B, Raherison C, Pin I, Gislason T, Jogi R, Schlunssen V, Svanes C, Watkins J, Weyler J, Pereira-Vega A, Urrutia I, Gullón JA, Forsberg B, Probst-Hensch N, Boezen HM, Martinez-Moratalla Rovira J, Accordini S, de Marco R, Burney P. Prevalence of asthma-like symptoms with ageing. Thorax 2017; 73:37-48. [PMID: 28974648 PMCID: PMC5738606 DOI: 10.1136/thoraxjnl-2016-209596] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 11/24/2022]
Abstract
Background Change in the prevalence of asthma-like symptoms in populations of ageing adults is likely to be influenced by smoking, asthma treatment and atopy. Methods The European Community Respiratory Health Survey collected information on prevalent asthma-like symptoms from representative samples of adults aged 20–44 years (29 centres in 13 European countries and Australia) at baseline and 10 and 20 years later (n=7844). Net changes in symptom prevalence were determined using generalised estimating equations (accounting for non-response through inverse probability weighting), followed by meta-analysis of centre level estimates. Findings Over 20 years the prevalence of ‘wheeze’ and ‘wheeze in the absence of a cold’ decreased (−2.4%, 95% CI −3.5 to −1.3%; −1.5%, 95% CI −2.4 to −0.6%, respectively) but the prevalence of asthma attacks, use of asthma medication and hay fever/nasal allergies increased (0.6%, 95% CI 0.1 to 1.11; 3.6%, 95% CI 3.0 to 4.2; 2.7%, 95% CI 1.7 to 3.7). Changes were similar in the first 10 years compared with the second 10 years, except for hay fever/nasal allergies (increase seen in the first 10 years only). Decreases in these wheeze-related symptoms were largely seen in the group who gave up smoking, and were seen in those who reported hay fever/nasal allergies at baseline. Interpretation European adults born between 1946 and 1970 have, over the last 20 years, experienced less wheeze, although they were more likely to report asthma attacks, use of asthma medication and hay fever. Decrease in wheeze is largely attributable to smoking cessation, rather than improved treatment of asthma. It may also be influenced by reductions in atopy with ageing.
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Affiliation(s)
- Debbie Jarvis
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Roger Newson
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Angelo Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center, Ludwig Maximilian University, Comprehensive Pneumology Centre Munich, German Centre for Lung Research, Muenchen, Germany
| | - Josep M Anto
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut Municipal d'Investigació Mèdica (IMIM), Barcelona, Spain
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne-Marie Kirsten
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, Grosshansdorf, Germany
| | - Jan Paul Zock
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Sorbonne Universités, Paris, France
| | - Bénédicte Leynaert
- Inserm UMR 1152-Equipe Epidémiologie, Université Paris Diderot, Paris, France
| | - Chantal Raherison
- Inserm-U1219 Bordeaux Population Health Research Center, Bordeaux University, Bordeaux, France
| | - Isabelle Pin
- INSERM, IAB, Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Grenoble, France.,Department of Pédiatrie, CHU de Grenoble Alpes, Grenoble, France
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Rain Jogi
- Tartu University Hospital, Lung Clinic, Estonia, Europe
| | - Vivi Schlunssen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - John Watkins
- Public Health Wales, Cardiff, Wales.,University of Cardiff, Cardiff, Wales
| | - Joost Weyler
- Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, StatUA Statistics Centre, University of Antwerp, Antwerp, Belgium
| | - Antonio Pereira-Vega
- Respiratory and Allergy Clinical Unit, Universitary Hospitalary Complex, Huelva, Spain
| | - Isabel Urrutia
- Department of Respiratory, Galdakao Hospital, Galdakao, Spain
| | - Jose A Gullón
- Servicio Neumología, Hospital Universitario San Agustín, Avilés, Spain
| | - Bertil Forsberg
- Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umea, Umea, Sweden
| | - Nicole Probst-Hensch
- Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - H Marike Boezen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jesús Martinez-Moratalla Rovira
- Servicio de Neumología, Complejo Hospitalario Universitario, Albacete, Spain.,Facultad de Medicina Albacete, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Peter Burney
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
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Berger ML, Sox H, Willke RJ, Brixner DL, Eichler HG, Goettsch W, Madigan D, Makady A, Schneeweiss S, Tarricone R, Wang SV, Watkins J, Mullins CD. Good Practices for Real-World Data Studies of Treatment and/or Comparative Effectiveness: Recommendations from the Joint ISPOR-ISPE Special Task Force on Real-World Evidence in Health Care Decision Making. Value Health 2017; 20:1003-1008. [PMID: 28964430 DOI: 10.1016/j.jval.2017.08.3019] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. METHODS The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. RESULTS The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. CONCLUSION The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders.
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Affiliation(s)
| | - Harold Sox
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Richard J Willke
- International Society for Pharmacoeconomics and Outcomes Research, Lawrenceville, NJ, USA
| | | | | | - Wim Goettsch
- Zorginstituut Nederland and University of Utrecht, Utrecht, The Netherlands
| | | | - Amr Makady
- Zorginstituut Nederland and University of Utrecht, Utrecht, The Netherlands
| | | | | | - Shirley V Wang
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Berger ML, Sox H, Willke RJ, Brixner DL, Eichler H, Goettsch W, Madigan D, Makady A, Schneeweiss S, Tarricone R, Wang SV, Watkins J, Daniel Mullins C. Good practices for real-world data studies of treatment and/or comparative effectiveness: Recommendations from the joint ISPOR-ISPE Special Task Force on real-world evidence in health care decision making. Pharmacoepidemiol Drug Saf 2017; 26:1033-1039. [PMID: 28913966 PMCID: PMC5639372 DOI: 10.1002/pds.4297] [Citation(s) in RCA: 217] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 07/26/2017] [Accepted: 07/28/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Real-world evidence (RWE) includes data from retrospective or prospective observational studies and observational registries and provides insights beyond those addressed by randomized controlled trials. RWE studies aim to improve health care decision making. METHODS The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the International Society for Pharmacoepidemiology (ISPE) created a task force to make recommendations regarding good procedural practices that would enhance decision makers' confidence in evidence derived from RWD studies. Peer review by ISPOR/ISPE members and task force participants provided a consensus-building iterative process for the topics and framing of recommendations. RESULTS The ISPOR/ISPE Task Force recommendations cover seven topics such as study registration, replicability, and stakeholder involvement in RWE studies. These recommendations, in concert with earlier recommendations about study methodology, provide a trustworthy foundation for the expanded use of RWE in health care decision making. CONCLUSION The focus of these recommendations is good procedural practices for studies that test a specific hypothesis in a specific population. We recognize that some of the recommendations in this report may not be widely adopted without appropriate incentives from decision makers, journal editors, and other key stakeholders.
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Affiliation(s)
| | - Harold Sox
- Patient‐Centered Outcomes Research InstituteWashingtonDCUSA
| | - Richard J. Willke
- International Society for Pharmacoeconomics and Outcomes ResearchLawrencevilleNJUSA
| | | | | | - Wim Goettsch
- Zorginstituut Nederland and University of UtrechtUtrechtThe Netherlands
| | | | - Amr Makady
- Zorginstituut Nederland and University of UtrechtUtrechtThe Netherlands
| | | | | | - Shirley V. Wang
- Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
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Chandran S, Watkins J, Abdul-Aziz A, Calvert P, Bowles K, Flather M, Rushworth S, Ryding A. P1779Differential cytokine expression between the coronary and peripheral circulation in patients with ruptured and intact fibrous caps presenting with ST segment myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1779] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nitecki R, Davis M, Watkins J, Wu Y, Muto M, Horowitz N, Berkowitz R, Feltmate C. Extramammary Paget's disease of the vulva: Management, recurrence and malignant transformation. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.486] [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: 11/26/2022]
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Finken KH, Reiter D, Denner T, Dippel KH, Hobirk J, Mank G, Kever H, Wolf GH, Noda N, Miyahara A, Shoji T, Sato KN, Akaishi K, Boedo JA, Brooks JN, Conn RW, Corbett WJ, Doerner RP, Goebel D, Gray DS, Hillis DL, Hogan J, Mcgrath RT, Matsunaga M, Moyer R, Nygren RE, Watkins J. The Toroidal Pump Limiter ALT-II in TEXTOR. Fusion Science and Technology 2017. [DOI: 10.13182/fst05-a694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- K. H. Finken
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - D. Reiter
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - T. Denner
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - K. H. Dippel
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - J. Hobirk
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - G. Mank
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - H. Kever
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - G. H. Wolf
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - N. Noda
- Institut für Plasmaphysik, Forschungszentrum Jülich GmbH, EURATOM Association, Trilateral Euregio Cluster, D-52425 Jülich, Germany
| | - A. Miyahara
- National Institute for Fusion Science, Orochi-Cho, Toki, Gifu, Japan
| | - T. Shoji
- Nagoya University, Department of Energy Engineering and Science, 464-8603 Nagoya, Japan
| | - K. N. Sato
- National Institute for Fusion Science, Orochi-Cho, Toki, Gifu, Japan
| | - K. Akaishi
- National Institute for Fusion Science, Orochi-Cho, Toki, Gifu, Japan
| | - J. A. Boedo
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | | | - R. W. Conn
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - W. J. Corbett
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - R. P. Doerner
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - D. Goebel
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - D. S. Gray
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - D. L. Hillis
- Oak Ridge National Laboratory, Building 9201-2, MS-8072, Oak Ridge, Tennessee
| | - J. Hogan
- Oak Ridge National Laboratory, Building 9201-2, MS-8072, Oak Ridge, Tennessee
| | - R. T. Mcgrath
- Sandia National Laboratories, Albuquerque, New Mexico
| | - M. Matsunaga
- Toyama University, Hydrogen Isotope Research Center, Gofuku 3190, Toyama 930-8555, Japan
| | - R. Moyer
- University of California, San Diego, Department of Applied Mechanics and Engineering Sciences San Diego, California
| | - R. E. Nygren
- Sandia National Laboratories, Albuquerque, New Mexico
| | - J. Watkins
- Sandia National Laboratories, Albuquerque, New Mexico
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Mohd Noor A, Maguire S, Watkins J, Quist J, Mirza H, Tutt A, Gillett C, Natrajan R, Grigoriadis A. Abstract P1-05-14: Copy number aberration-induced gene breakage analysis identifies recurrent FOXP1 fusions in breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-14] [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: Genomic instability is a critical feature of breast cancers, which manifests in genome-wide copy number aberrations (CNA), often causing “gene breakage” and the generation of fusion genes. We aimed to identify aborted transcripts with underlying CNAs and to investigate the molecular landscape of breast cancers harbouring such events.
Methods: A walking student's t-test algorithm was applied to Affymetrix Exon 1.0ST array data of 123 breast cancers to identify regions of aborted transcription and overlaid with DNA breakpoints derived from matched Affymetrix SNP6 ASCAT-segmented copy number. Aborted transcripts were investigated as potential fusion gene partners through RNA-seq analysis of 151 breast cancer samples (TCGA) and 51 breast cancer cell lines (BCCL) using ChimeraScan. Clinical correlates were established for clinicopathological features, genomic instability measures, and gene expression-based molecular classifiers including PAM50, TNBCtype, IntClust subtypes and immune signatures.
Results: One hundred and six genes with recurrent CNA-induced aborted transcription were identified. Aborted transcription showed hormone receptor subtype-specificity for 7 genes (nTNBC=1, nNon-TNBC=6) and was less prevalent in samples of IntClust 2 and IntClust 4 subtypes (p: 0.0043, 0.0011). Aborted transcripts were more frequently observed in samples with greater copy-neutral loss of heterozygosity (p=0.012), while aborted transcription of 54/106 genes significantly affected enrichment of 27 tumor-infiltrating lymphocyte subpopulations.14 aborted transcripts were found as a fusion gene with one partner in RNA-seq of TCGA and BCCL, while 19 were involved in multiple fusion events (range=1-6, median=2). Nine of 106 genes displayed gene breakage and fusion events exclusively in samples with an enriched tandem duplication phenotype. Notably, FOXP1, localised to a tumour suppressor locus at 3p14.1, reported the highest number of fusion configurations (n=6) with concurrent aborted transcription across all RNA-seq datasets (nPRADA=9, nTCGA=38, nBCCL=6).
Conclusion: CNA-induced gene breakage affects the molecular landscape of breast cancers and is linked with many genomic configurations of interest including copy-neutral loss of heterozygosity and tandem duplications. In particular, the role of recurrent gene fusions of the tumour suppressor, FOXP1, in tumourigenesis warrants further investigation.
Citation Format: Mohd Noor A, Maguire S, Watkins J, Quist J, Mirza H, Tutt A, Gillett C, Natrajan R, Grigoriadis A. Copy number aberration-induced gene breakage analysis identifies recurrent FOXP1 fusions in breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-14.
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Affiliation(s)
- A Mohd Noor
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - S Maguire
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - J Watkins
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - J Quist
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - H Mirza
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - A Tutt
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - C Gillett
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - R Natrajan
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
| | - A Grigoriadis
- Cancer Bioinformatics, Guy's Hospital, King's College London, London, United Kingdom; Breast Cancer Now Research Centre, Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom; King's College London, London, United Kingdom
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Wulaningsih W, Astuti Y, Matsuguchi T, Anggriyadanny P, Watkins J. 54P Circulating prostate-specific antigen and telomere length in a nationally representative sample of men without history of prostate cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw574.027] [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: 11/13/2022] Open
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Affiliation(s)
- A J Swannell
- Department of Rheumatology and Rehabilitation, City Hospital, Nottingham, NG5 1PD
| | - J Watkins
- Protein Reference Unit, Department of Immunology, Hallamshire Hospital, Sheffield S10 2RX
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Noor AM, Maguire S, Watkins J, Quist J, Mirza H, Ougham K, Tutt A, Gillett C, Natrajan R, Grigoriadis A. The characterisation of potential fusion genes in breast cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61097-3] [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: 11/26/2022]
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Furqan M, Saqlain MU, Mott SL, Patel R, Laux DE, Zhang J, Abushahin LI, Anderson CM, Watkins J, Snow AN, Sun W, Clamon GH. Retrospective comparison between high-dose cisplatin and less-intensive weekly cisplatin/paclitaxel concurrently with radiation for locally advanced head and neck cancer (LAHNC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17535] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Sarah L Mott
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
| | - Ravi Patel
- University of Iowa Hospsital and Clinics, Iowa City, IA
| | | | - Jun Zhang
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | - John Watkins
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Wenqing Sun
- University of Iowa Hospitals and Clinics, Iowa City, IA
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Marsh K, IJzerman M, Thokala P, Baltussen R, Boysen M, Kaló Z, Lönngren T, Mussen F, Peacock S, Watkins J, Devlin N. Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force. Value Health 2016; 19:125-137. [PMID: 27021745 DOI: 10.1016/j.jval.2015.12.016] [Citation(s) in RCA: 271] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions.
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Affiliation(s)
| | - Maarten IJzerman
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
| | | | - Rob Baltussen
- Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Meindert Boysen
- National Institute for Health and Care Excellence, Manchester, UK
| | - Zoltán Kaló
- Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary; Syreon Research Institute, Budapest, Hungary
| | | | - Filip Mussen
- Janssen Pharmaceutical Companies of Johnson & Johnson, Antwerp, Belgium
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Agency, Vancouver, BC, Canada; Leslie Diamond Chair in Cancer Survivorship, Simon Fraser University, Vancouver, Canada
| | - John Watkins
- Premera Blue Cross, Bothell, WA, USA; University of Washington, Seattle, WA, USA
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Chang T, Bhatia S, Berg DJ, Buatti JM, Watkins J. Disease control and survival outcomes for rectal adenocarcinoma (RA) managed with neoadjuvant chemoradiotherapy (nCRT): Performance of serum CEA changes as a biomarker. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.552] [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: 11/20/2022] Open
Abstract
552 Background: nCRT is commonly employed in advanced or distal RA, with validated associations between tumor response and disease control; however, the identification of patients likely to respond remains elusive. The present investigation seeks to determine whether absolute CEA levels and changes during treatment are associated with pathologic complete response (pCR), freedom from failure (FFF), disease specific survival (DSS), and overall survival (OS). Methods: Retrospective analysis of clinicopathologic and treatment factor association with outcomes. Eligible patients underwent nCRT followed by mesorectal resection; patients with pre-nCRT evidence of metastasis or who did not undergo resection were excluded. CEA levels were recorded at 3 times: pre-nCRT (C1), post-nCRT/pre-op (C2), and post-op (C3; < 45 days of surgery, or < 225 days if post-op C given). Univariate analysis was performed to identify clinicopathologic factor association with pCR, FFF, DSS, and OS. The absolute and relative changes in interval CEA levels were computed and included as factors in the analysis. Results: From 2003-11, 71 patients were eligible. At median follow-up of 57 months (range, 5-124), 20 patients had RA recurrence and 25 had died (19 recurrent). nCRT resulted in pCR for 19 patients (27%), which was associated with DSS (p = 0.04). The estimated 5-year FFF, DSS, and OS for the entire population were 69%, 77%, and 72%, respectively. Clinical and pathologic N-stage, nodal ratio, ypTNM stage, and stage migration post-CRT were significantly associated with FFF, DSS, and OS. The relative change from C1 to C2 was significantly associated with pCR (exp(b); p = 0.031). Absolute C3 was associated with FFF (1.091; 0.001), DSS (1.183; 0.018), and OS (1.092; 0.002); however, absolute and relative changes at C2 and C3 as compared with C1 did not demonstrate associations with disease control or survival endpoints. Conclusions: Within the present study, changes in CEA levels following CRT were associated with pCR. Additionally, initial post-op CEA demonstrated associations with disease control and survival endpoints.
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Affiliation(s)
- Tangel Chang
- University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | | | | | - John Watkins
- University of Iowa Hospitals and Clinics, Iowa City, IA
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Thokala P, Devlin N, Marsh K, Baltussen R, Boysen M, Kalo Z, Longrenn T, Mussen F, Peacock S, Watkins J, Ijzerman M. Multiple Criteria Decision Analysis for Health Care Decision Making--An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force. Value Health 2016; 19:1-13. [PMID: 26797229 DOI: 10.1016/j.jval.2015.12.003] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [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: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 05/23/2023]
Abstract
Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making.
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Affiliation(s)
- Praveen Thokala
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
| | | | | | - Rob Baltussen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Meindert Boysen
- National Institute for Health and Clinical Excellence (NICE), Manchester, UK
| | - Zoltan Kalo
- Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE); Syreon Research Institute, Budapest, Hungary
| | | | - Filip Mussen
- Regional Regulatory Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Antwerp, Belgium
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), British Columbia Cancer Agency, Vancouver, WA, USA; Leslie Diamond Chair in Cancer Survivorship, Simon Fraser University, Vancouver, WA, USA
| | - John Watkins
- Formulary Development, Premera Blue Cross, Bothell, WA, USA; University of Washington, Seattle, WA, USA
| | - Maarten Ijzerman
- Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands
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Watkins J. Sylvia Madeleine Watkins. Assoc Med J 2015. [DOI: 10.1136/bmj.h5031] [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: 11/03/2022]
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Pockett RD, Watkins J, McEwan P, Meier G. Burden of Illness in UK Subjects with Reported Respiratory Infections Vaccinated or Unvaccinated against Influenza: A Retrospective Observational Study. PLoS One 2015; 10:e0134928. [PMID: 26287532 PMCID: PMC4546056 DOI: 10.1371/journal.pone.0134928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 07/15/2015] [Indexed: 11/19/2022] Open
Abstract
Objective Detailed data are lacking on influenza burden in the United Kingdom (UK). The objective of this study was to estimate the disease burden associated with influenza-like illness (ILI) in the United Kingdom stratified by age, risk and influenza vaccination status. Methods This retrospective, cross-sectional, exploratory, observational study used linked data from the General Practice Research Database and the Hospital Episode Statistics databases to estimate resource use and cost associated with ILI in the UK. Results Data were included from 156,193 patients with ≥1 general practitioner visit with ILI. There were 21,518 high-risk patients, of whom 12,514 (58.2%) were vaccinated and 9,004 (41.8%) were not vaccinated, and 134,675 low-risk patients, of whom 17,482 (13.0%) were vaccinated and 117,193 (87.0%) were not vaccinated. High-risk vaccinated patients were older (p<0.001) and had more risk conditions (p<0.001). High-risk (odds ratio [OR] 2.16) or vaccinated (OR 1.19) patients had a higher probability of >1 general practitioner visit compared with low-risk and unvaccinated patients. Patients who were high-risk and vaccinated had a reduced risk of >1 general practitioner visit (OR 0.82; p<0.001). High-risk individuals who were also vaccinated had a lower probability of ILI-related hospitalisation than individuals who were high-risk or vaccinated alone (OR 0.59). In people aged ≥65 years, the mortality rate was lower in vaccinated than unvaccinated individuals (OR 0.75). The cost of ILI-related GP visits and hospital admissions in the UK over the study period in low-risk vaccinated patients was £27,391,142 and £141,932,471, respectively. In low-risk unvaccinated patients the corresponding values were £168,318,709 and £112,534,130, respectively. Conclusions Although vaccination rates in target groups have increased, many people are still not receiving influenza vaccination, and the burden of ILI in the United Kingdom remains substantial. Improving influenza vaccination uptake may have the potential to reduce this burden.
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Affiliation(s)
- Rhys D. Pockett
- Swansea Center for Health Economics, Swansea University, SA2 8PP, Wales, United Kingdom
| | - John Watkins
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4YS, Wales, United Kingdom
| | - Phil McEwan
- Swansea Center for Health Economics, Swansea University, SA2 8PP, Wales, United Kingdom
| | - Genevieve Meier
- Health Economics, GSK Vaccines, 1300, Wavre, Belgium
- * E-mail:
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Goodman AL, Murray CD, Watkins J, Griffiths PD, Webster DP. CMV in the gut: a critical review of CMV detection in the immunocompetent host with colitis. Eur J Clin Microbiol Infect Dis 2015; 34:13-18. [PMID: 25097085 PMCID: PMC4281362 DOI: 10.1007/s10096-014-2212-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/14/2014] [Indexed: 12/18/2022]
Abstract
As scientific techniques for the detection of cytomegalovirus (CMV) improve, we are able to detect small amounts of CMV in the mucosal wall. As clinicians, we are unsure how to interpret the results of this novel test. There is controversy in the literature as to the significance of the detection of CMV in the gut. Whilst the importance of CMV and reactivation of the virus is clear in those patients such as allograft recipients with established immune compromise, the role is less clear in patients with less damaged immune systems. We explore whether the detection of CMV in such cases influences outcome and how it should be optimally managed. We discuss the optimal management of such cases, according to current guidelines, with a review of the literature.
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Affiliation(s)
- A L Goodman
- Department of Infection and Immunity, University College London, Cruciform Building, Gower Street, London, WC1E 6BT, UK.
| | - C D Murray
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK
| | - J Watkins
- Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK
| | - P D Griffiths
- Centre for Virology, University College London Medical School, Rowland Hill Street, London, NW3 2PF, UK
| | - D P Webster
- Centre for Virology, University College London Medical School, Rowland Hill Street, London, NW3 2PF, UK
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