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Antonik M, Sankar S, Shepherd J, Hassan S. The economic and resource burden of e-scooter-related orthopaedic injuries: A district general hospital's experience. Injury 2024:111493. [PMID: 38508983 DOI: 10.1016/j.injury.2024.111493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Electric scooters (e-scooters) are an increasingly popular method of transportation worldwide. However, there are concerns regarding their safety, specifically with regards to orthopaedic injuries. We aimed to investigate the overall burden and financial impact on orthopaedic services as a result of e-scooter-related orthopaedic injuries. METHODS We retrospectively identified all e-scooter-related injuries requiring orthopaedic admission or surgical intervention in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Injuries sustained, surgical management, inpatient stay and resources used were calculated. RESULTS Seventy-nine patients presented with orthopaedic injuries as a result of e-scooter transportation with a mean age of 30.1 years (SD 11.6), of which 62 were males and 17 were females. A total of 86 individual orthopaedic injuries were sustained, with fractures being the most common type of injury. Of these, 23 patients required 28 individual surgical procedures. The combined theatre and recovery time of these procedures was 5500 min, while isolated operating time was 2088 min. The total cost of theatre running time for these patients was estimated at £77,000. A total of 17 patients required hospital admission under Trauma and Orthopaedics, which accounted for total combined stay of 99 days with a mean length of stay of 5.8 days. CONCLUSION While there are potential environmental benefits to e-scooters, we demonstrate the risks of injury associated with their use and the associated increased burden to the healthcare system through additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.
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Affiliation(s)
- M Antonik
- Trauma & Orthopaedic Surgery Department, Northampton General Hospital, UK
| | - S Sankar
- Trauma & Orthopaedic Surgery Department, Northampton General Hospital, UK
| | - J Shepherd
- Trauma & Orthopaedic Surgery Department, Leicester Royal Infirmary, UK; University of Leicester, Leicester, UK; National Institute for Health and Care Research, Academic Clinical Fellowship Integrated Clinical Academic Training Pathway, UK.
| | - S Hassan
- Trauma & Orthopaedic Surgery Department, Northampton General Hospital, UK
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Matthews K, Heravi S, Morgan P, Page N, Shepherd J, Sivarajasingam V. Alcohol prices, the April effect, and the environment, in violence-related injury in England and Wales. Eur J Health Econ 2024; 25:237-255. [PMID: 36988743 PMCID: PMC10052256 DOI: 10.1007/s10198-023-01583-w] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
Violent injury varies widely across England and Wales as does the price of alcohol. While the links between alcohol consumption and violence are well established in the medical and epidemiological literature, a causal link is questionable. This paper cuts through the causative argument by reporting a link between the general price of alcohol and violence-related injury across the economic regions of England and Wales. It examines the influence of the real price of alcohol and identifies an 'April effect' that coincides with the annual uprating of alcohol prices for excise duties, on violence-related injuries recorded at Emergency Department attendance. The data are monthly frequency of violent injury rates covering the period 2005-2014 across the economic regions. The principal finding is that a one-way relationship between the real price of alcohol and violent injury is established, and tax policy can be used to reduce the incidence of violent injury and the associated health costs.
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Affiliation(s)
- Kent Matthews
- Cardiff Business School, Cardiff University, Colum Drive, Cardiff, CF10 3EU, UK.
- Nottingham University Business School China, University of Nottingham Ningbo China, 199 Taikang East Road, Ningbo, 315100, China.
| | - Saeed Heravi
- Cardiff Business School, Cardiff University, Colum Drive, Cardiff, CF10 3EU, UK
| | - Peter Morgan
- Cardiff Business School, Cardiff University, Colum Drive, Cardiff, CF10 3EU, UK
| | - Nicholas Page
- School of Social Sciences, Cardiff University, Spark, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Jonathan Shepherd
- School of Dentistry, Cardiff University, University Hospital Wales, Heath Park, Cardiff, CF14 4XY, UK
| | - Vaseekaran Sivarajasingam
- School of Dentistry, Cardiff University, University Hospital Wales, Heath Park, Cardiff, CF14 4XY, UK
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3
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Nilsson W, Schmidt M, Turner L, Shepherd J. Comparing Postoperative Pain With Laparoscopic Versus Robotic Sacrocolpopexy. J Minim Invasive Gynecol 2024; 31:200-204. [PMID: 38013160 DOI: 10.1016/j.jmig.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
STUDY OBJECTIVE To compare postoperative pain and pain-related outcomes after laparoscopic (LS-MISC) vs robotic minimally invasive sacrocolpopexy (R-MISC). DESIGN A secondary analysis of an original placebo-controlled randomized controlled trial (RCT) examining preoperative intravenous (IV) acetaminophen on postoperative pain after MISC. SETTING Planned secondary analysis of multicenter RCT. PATIENTS Women undergoing MISC. INTERVENTIONS Coprimary outcomes at 24 hours were total opioid use in morphine milligram equivalents (MMEs) and visual analog scale (VAS) pain scores comparing LS-MISC and R-MISC. The secondary outcome was pain scores using a pain diary through 7 days after the procedure. MEASUREMENTS AND MAIN RESULTS The original study was a double-blind, multicenter, RCT comparing IV acetaminophen with placebo that took place between 2014 and 2017. Given that the original trial was unable to show an impact from the use of IV acetaminophen, our analysis focused on the impact of surgical modality. We included 90 subjects undergoing MISC: 65 LS-MISC and 25 R-MISC. Most were Caucasian (97.8%) and postmenopausal (88.9%) with mean age of 61.2 ± 7.2 years and body mass index of 27.6 ± 4.4 kg/m2. IV acetaminophen did not affect pain in the original study and was not different between LS-MISC and R-MISC. Concomitant hysterectomy was performed in 67% (LS-MISC) vs 60% (R-MISC, p = .49). LS-MISC underwent more perineorrhaphies (15.4% vs 0%, p = .04) and posterior repairs (18.5% vs 0%, p = .02). Operative time was longer with LS-MISC (208.5 ± 57.3 vs 143.6 ± 21.0 minutes, p <.01). Length of stay was longer with LS-MISC (0.9 ± 0.4 vs 0.7 ± 0.4 days, p = .02). Women undergoing LS-MISC consumed more opioid MMEs through 24 hours when including intraoperative opioids (48.5 ± 25.5 vs 35.1 ± 14.6 MME, p <.01). Using linear regression correcting for operative time and concomitant vaginal repairs, this difference disappeared. Likewise, when intraoperative opioids were excluded, there was no difference. There were no differences in 24-hour postoperative VAS scores, opioid use in the first week, or quality of life (Patient-Reported Outcomes Measurement Information System - Pain Interference Short Form, all p <.05). CONCLUSION When comparing VAS pain scores, MME opioid usage, and quality of life between LS-MISC and R-MISC, either there was no difference or differences disappeared after adjusting for confounders. Overall, opioid use, pain scores, and opioid side effects were low.
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Affiliation(s)
- Wesley Nilsson
- Division of Minimally Invasive Gynecological Surgery, Department of Obstetrics and Gynecology, UConn Health - John Dempsy Hospital, Farmington, Connecticut (Drs. Nilsson and Shepherd).
| | - Megan Schmidt
- Department of Obstetrics/Gynecology, Trinity Health of New England, Hartford, Connecticut (Dr. Schmidt)
| | - Lindsay Turner
- Division of Urogynecology, Department of Obstetrics and Gynecology, Allegheny Health Network, and the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania (Drs. Turner and Shepherd)
| | - Jonathan Shepherd
- Division of Minimally Invasive Gynecological Surgery, Department of Obstetrics and Gynecology, UConn Health - John Dempsy Hospital, Farmington, Connecticut (Drs. Nilsson and Shepherd); Division of Urogynecology, Department of Obstetrics and Gynecology, Allegheny Health Network, and the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania (Drs. Turner and Shepherd)
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Hernandez-Meier J, Xu Z, Kohlbeck SA, Levas M, Shepherd J, Hargarten S. Linking emergency care and police department data to strengthen timely information on violence-related paediatric injuries. Emerg Med J 2023; 40:653-659. [PMID: 37611955 DOI: 10.1136/emermed-2023-213370] [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: 05/18/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Combined ED and police department (PD) data have improved violence surveillance in the UK, enabling significantly improved prevention. We sought to determine if the addition of emergency medical service (EMS) data to ED data would contribute meaningful information on violence-related paediatric injuries beyond PD record data in a US city. METHODS Cross-sectional data on self-reported violence-related injuries of youth treated in the ED between January 2015 and September 2016 were combined with incidents classified by EMS as intentional interpersonal violence and incidents in which the PD responded to a youth injury from a simple or aggravated assault, robbery or sexual offence. Nearest neighbour hierarchical spatial clustering detected areas in which 10 or more incidents occurred during this period (hotspots), with the radii of the area being 1000, 1500, 2000 and 3000 ft. Overlap of PD incidents within ED&EMS hotspots (and vice versa) was calculated and Spearman's r tested statistical associations between the data sets, or ED&EMS contribution to PD violence information. RESULTS There were 935 unique ED&EMS records (ED=381; EMS=554). Of these, 877 (94%) were not in PD records. In large hotspots >2000 ft, ED&EMS records identified one additional incident for every three in the PD database. ED and EMS provided significant numbers of incidents not reported to PD. Significant correlations of ED&EMS incidents in PD hotspots imply that the ED&EMS incidents are as pervasive across the city as that reported by PD. In addition, ED and EMS provided unique violence information, as ED&EMS hotspots never included a majority (>50%) of PD records. Most (676/877; 77%) incidents unique to ED&EMS records were within 1000 ft of a school or park. CONCLUSIONS Many violence locations in ED and EMS data were not present in PD records. A combined PD, ED and EMS database resulted in new knowledge of the geospatial distribution of violence-related paediatric injuries and can be used for data-informed and targeted prevention of violence in which children are injured-especially in and around schools and parks.
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Affiliation(s)
| | - Zengwang Xu
- Geography, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Sara A Kohlbeck
- Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Levas
- Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jonathan Shepherd
- Crime and Intelligence Innovation Institute, Cardiff University, Cardiff, UK
| | - Stephen Hargarten
- Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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5
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Falkner A, Kolodinsky J, Mark T, Snell W, Hill R, Luke A, Shepherd J, Lacasse H. The reintroduction of hemp in the USA: a content analysis of state and tribal hemp production plans. J Cannabis Res 2023; 5:17. [PMID: 37280709 DOI: 10.1186/s42238-023-00181-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/23/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The reintroduction of Cannabis sativa L. in the form of hemp (< 0.3% THC by dry weight) into the US agricultural sector has been complex and remains confounded by its association with cannabis (> 0.3% THC by dry weight). This has been further exacerbated by inconsistent hemp regulations in the US since the 2014 Farm Bill's reintroduction. METHODS A content analysis was performed to analyze the terms and definitions presented by state and tribal hemp production plans, the USDA Hemp producer license, and the 2014 state pilot plans. A total of 69 hemp production plans were analyzed. RESULTS Results suggest significant discrepancies between hemp production plans, which have been exacerbated by extending the 2014 Farm Bill language into the 2018 Farm Bill timeframe. CONCLUSIONS Findings from this study point to areas in need of uniformity and consistency as the regulatory framework is modified and provides a starting point for change for federal policymakers. The results may also be useful to companies attempting to market products across state boundaries. Suggestions for how to mitigate these inconsistencies are provided based on the content analysis findings.
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Affiliation(s)
- Amanda Falkner
- Department of Community Development and Applied Economics, University of Vermont, 146 University Place, Morrill Hall Room 205, Burlington, VT, 05405-1016, USA.
| | - Jane Kolodinsky
- Department of Community Development and Applied Economics, University of Vermont, 146 University Place, Morrill Hall Room 205, Burlington, VT, 05405-1016, USA
| | | | | | | | - Amelia Luke
- Department of Community Development and Applied Economics, University of Vermont, 146 University Place, Morrill Hall Room 205, Burlington, VT, 05405-1016, USA
| | | | - Hannah Lacasse
- Department of Community Development and Applied Economics, University of Vermont, 146 University Place, Morrill Hall Room 205, Burlington, VT, 05405-1016, USA
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Baker T, Taylor N, Kloot K, Miller P, Egerton‐Warburton D, Shepherd J. Using the Cardiff model to reduce late-night alcohol-related presentations in regional Australia. Aust J Rural Health 2023; 31:532-539. [PMID: 37078513 PMCID: PMC10947014 DOI: 10.1111/ajr.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION The Cardiff model is a data sharing approach that aims to reduce the volume of intoxicated patients in emergency departments (EDs). This approach has not been tested in a rural setting. OBJECTIVE This study assessed whether this approach would reduce the number of alcohol-associated presentations during high-alcohol hours (HAH) in a regional ED. DESIGN From July 2017, people over the age of 18 attending the ED were asked by the triage nurse (1) whether they had consumed alcohol in the past 12 h, (2) their typical alcohol consumption level, (3) the location where most alcohol was purchased and (4) the location of the last drink. From April 2018, quarterly letters were sent to the top five venues reported within the ED. Deidentified, aggregated data were shared with local police, licensing authorities and local government, identifying the top five venues reported in the ED and providing a summary of alcohol-related attendances to the ED. Interrupted time series analyses were used to estimate the influence of the intervention on monthly injury and alcohol-related ED presentations. FINDINGS ITS models found that there was a significant gradual decrease in the monthly rate of injury attendances during HAH (Coefficient = -0.004, p = 0.044). No other significant results were found. DISCUSSION Our study found that sharing last drinks data collected in the ED with a local violence prevention committee was associated with a small, but significant reduction in the rate of injury presentations compared with all ED presentations. CONCLUSION This intervention continues to have promise for reducing alcohol-related harm.
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Affiliation(s)
- Tim Baker
- Centre for Rural Emergency Medicine, Faculty of HealthDeakin UniversityWarrnamboolVictoriaAustralia
- South West HealthcareWarrnamboolVictoriaAustralia
| | - Nicholas Taylor
- School of Psychology, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
- National Drug Research InstituteCurtin UniversityPerthVictoriaAustralia
| | - Kate Kloot
- South West HealthcareWarrnamboolVictoriaAustralia
- School of MedicineDeakin UniversityWarrnamboolVictoriaAustralia
| | - Peter Miller
- School of Psychology, Faculty of HealthDeakin UniversityGeelongVictoriaAustralia
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Kohut K, Morton K, Turner L, Shepherd J, Fenerty V, Woods L, Grimmett C, Eccles DM, Foster C. Patient decision support resources inform decisions about cancer susceptibility genetic testing and risk management: a systematic review of patient impact and experience. Front Health Serv 2023; 3:1092816. [PMID: 37395995 PMCID: PMC10311450 DOI: 10.3389/frhs.2023.1092816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Abstract
Background Patients with genetic cancer susceptibility are presented with complex management options involving difficult decisions, for example about genetic testing, treatment, screening and risk-reducing surgery/medications. This review sought to explore the experience of patients using decision support resources in this context, and the impact on decision-making outcomes. Methods Systematic review of quantitative, qualitative and mixed-methods studies involving adults with or without cancer who used a decision support resource pre- or post-genetic test for any cancer susceptibility. To gather a broad view of existing resources and gaps for development, digital or paper-based patient resources were included and not limited to decision aids. Narrative synthesis was used to summarise patient impact and experience. Results Thirty-six publications describing 27 resources were included. Heterogeneity of resources and outcome measurements highlighted the multiple modes of resource delivery and personal tailoring acceptable to and valued by patients. Impact on cognitive, emotional, and behavioural outcomes was mixed, but mainly positive. Findings suggested clear potential for quality patient-facing resources to be acceptable and useful. Conclusions Decision support resources about genetic cancer susceptibility are likely useful to support decision-making, but should be co-designed with patients according to evidence-based frameworks. More research is needed to study impact and outcomes, particularly in terms of longer term follow-up to identify whether patients follow through on decisions and whether any increased distress is transient. Innovative, streamlined resources are needed to scale up delivery of genetic cancer susceptibility testing for patients with cancer in mainstream oncology clinics. Tailored patient-facing decision aids should also be made available to patients identified as carriers of a pathogenic gene variant that increases future cancer risks, to complement traditional genetic counselling. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020220460, identifier: CRD42020220460.
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Affiliation(s)
- Kelly Kohut
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kate Morton
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lesley Turner
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, United Kingdom
| | - Vicky Fenerty
- Engagement Services, University of Southampton Library, University of Southampton, Southampton, United Kingdom
| | - Lois Woods
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, United Kingdom
| | - Chloe Grimmett
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana M. Eccles
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
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8
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McClure MB, Kogure Y, Ansari-Pour N, Saito Y, Chao HH, Shepherd J, Tabata M, Olopade OI, Wedge DC, Hoadley KA, Perou CM, Kataoka K. Landscape of Genetic Alterations Underlying Hallmark Signature Changes in Cancer Reveals TP53 Aneuploidy-driven Metabolic Reprogramming. Cancer Res Commun 2023; 3:281-296. [PMID: 36860655 PMCID: PMC9973382 DOI: 10.1158/2767-9764.crc-22-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 10/08/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
The hallmark signatures based on gene expression capture core cancer processes. Through a pan-cancer analysis, we describe the overview of hallmark signatures across tumor types/subtypes and reveal significant relationships between these signatures and genetic alterations. TP53 mutation exerts diverse changes, including increased proliferation and glycolysis, which are closely mimicked by widespread copy-number alterations. Hallmark signature and copy-number clustering identify a cluster of squamous tumors and basal-like breast and bladder cancers with elevated proliferation signatures, frequent TP53 mutation, and high aneuploidy. In these basal-like/squamous TP53-mutated tumors, a specific and consistent spectrum of copy-number alterations is preferentially selected prior to whole-genome duplication. Within Trp53-null breast cancer mouse models, these copy-number alterations spontaneously occur and recapitulate the hallmark signature changes observed in the human condition. Together, our analysis reveals intertumor and intratumor heterogeneity of the hallmark signatures, uncovering an oncogenic program induced by TP53 mutation and select aneuploidy events to drive a worsened prognosis. Significance Our data demonstrate that TP53 mutation and a resultant selected pattern of aneuploidies cause an aggressive transcriptional program including upregulation of glycolysis signature with prognostic implications. Importantly, basal-like breast cancer demonstrates genetic and/or phenotypic changes closely related to squamous tumors including 5q deletion that reveal alterations that could offer therapeutic options across tumor types regardless of tissue of origin.
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Affiliation(s)
- Marni B. McClure
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yasunori Kogure
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
| | - Naser Ansari-Pour
- MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Yuki Saito
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Department of Gastroenterology, Keio University School of Medicine, Tokyo, Japan
| | - Hann-Hsiang Chao
- Department of Radiation Oncology, Richmond VA Medical Center, Richmond, Virginia
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Jonathan Shepherd
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mariko Tabata
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Olufunmilayo I. Olopade
- Center for Clinical Cancer Genetics & Global Health, University of Chicago School of Medicine, The University of Chicago, Chicago, Illinois
| | - David C. Wedge
- Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
| | - Katherine A. Hoadley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles M. Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Keisuke Kataoka
- Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Reeves G, Shepherd J. Preliminary findings from a risk stratification, quality of life and burden of illness in pulmonary arterial hypertension pilot study. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.084] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Australia and New Zealand (Janssen-Cilag Pty Ltd)
Pulmonary Arterial Hypertension (PAH) management strategies focus on lowering mortality risk, extending the patient’s life span through the control and alleviation of disease symptoms, improving Quality of Life (QoL) and decreasing the burden of illness.
This paper describes preliminary results of an Investigator Initiated pilot study exploring the relationship between PRO measures (PAH-SYMPACT, EQ5D5L); Burden of Illness assessment; and the ESC/ERS Risk Stratification.
Findings
Measures of PAH risk and QoL were assessed in 42 patients presenting to the IPAH clinic for management; mean age 69.2 [range 39, 84]; females 35 (83.3%), males 7 (16.7%). Tools analysed and compared included: PAH-SYMPACT and EQ-5D-5L as PRO and QoL measures; and ESC-ERS PAH risk stratification criteria to assess mortality risk. Health utility scores were derived from existing value sets: there was a 20% median reduction in QALYs for our patient population, with detrimental effects being more marked in those patients with greater impairment of EQ-5D-5L physical and cognitive-emotional domains (respectively: r = -0.92, p<0.001; and r = -0.85, p<0.001), PAH-SYMPACT physical domain reduction (r = -0.59, p<0.01), and PAH-SYMPACT cardiovascular symptoms (r = 0.64), p<0.01) and cardiorespiratory (r = 0.64, p<0.01) involvement. Physical domain scores were highly correlated for the two PROs studied (r = 0.74, p<0.001), but an unexpected poor correlation was seen in the cognitive/emotional domain (non-significant negative correlation) which requires further exploration. Unsurprisingly, EQ-5D-5L Visual Analogue Score for well-being was inversely correlated with physical domain impairment (r = -0.59, p<0.01), although it was noted that this did not apply for the cognitive/emotional domain. The agreement between tools was variable, with highest concordance seen for assessment of the physical domain (r = 0.74, p<0.001), and this raises the need to further define the merits of disease-specific (PAH-SYMPACT) vs generic (EQ-5D-5L) PRO analytic approaches. Tools examined in this study were well-correlated with symptomatic impairment, but neither PRO tool correlated with established risk markers as characterized in compound prognostic guides such as ESC-ERS criteria.
Conclusions
The fact that PRO indices showed little correlation with established risk stratification markers implies that the information provided by PROs is not redundant, and it is yet be assessed whether the incorporation of PRO’s may add further to the precision of risk assessment, a little-studied area which this group is further exploring. There should be more widespread and uniform use of PRO measures as part of standard PAH management.
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Affiliation(s)
- G Reeves
- John Hunter Hospital , Newcastle , Australia
| | - J Shepherd
- John Hunter Hospital , Newcastle , Australia
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10
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Theuring S, Lewally A, Shepherd J, Williamson Taylor R. Implementing an eHealth tool to improve referral services for obstetric emergencies in Sierra Leone. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Maternal health remains a major issue of concern in Sierra Leone. In the main referral maternity institution, Princess Christian Maternity Hospital (PCMH), up to 25% of maternal deaths occur during or shortly after transit from another health facility. There is an urgent need to improve referral systems between peripheral health units (PHUs) and PCMH. Our aim was to pilot and evaluate an eHealth tool facilitating referral of obstetric emergency cases through effective teleconsultation between PHUs and PCMH.
Methods
A web application was designed to capture unclear or complicated delivery cases at PHUs and request respective telemedical counselling from the referral institution PCMH. The eHealth tool was piloted at 10 PHUs in Western area urban and rural in August 2021. Necessary devices were provided and delivery staff was trained to use the app. In December 2021, we conducted focus group discussion with 3-6 delivery staff at five PHUs and at PCMH to evaluate utilization and outcomes of the tool.
Results
All participants perceived the eHealth tool as an improvement of referral procedures. Response time from PCMH after a request for counselling from a PHU was mostly <30 minutes. The main perceived advantage of the tool was the systematic documentation of obstetric complications and procedures. This relieved staff from fear of wrong treatment accusations, and recorded communication with PCMH made processes and responsibilities transparent. Another important benefit was PCMH staff being already prepared to receive a specific emergency case after use of the app, thus reducing the ‘third delay’ within the referral facility. As a major obstacle to smooth referral despite the eHealth tool, a lacking ambulance system was mentioned as a critical gap.
Conclusions
Exceedingly positive user experiences with this simple tool seem to make an expansion to more PHUs worthwhile. Benefits of using the app in more remote districts in Sierra Leone should be further investigated.
Key messages
• Delivery staff in Sierra Leone was capable of using a web app for telemedical counselling in a useful and effective manner.
• The eHealth tool was perceived as very helpful in systematically and transparently documenting emergency delivery cases and treatment procedures.
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Affiliation(s)
- S Theuring
- Institute of Tropical Medicine and International Health, Charité- Universitätsmedizin , Berlin, Germany
| | - A Lewally
- National School of Midwifery, Ministry of Health and Sanitation , Freetown, Sierra Leone
| | - J Shepherd
- National School of Midwifery, Ministry of Health and Sanitation , Freetown, Sierra Leone
| | - R Williamson Taylor
- Princess Christian Maternity Hospital, Ministry of Health and Sanitation , Freetown, Sierra Leone
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11
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Miller P, Vakidis T, Taylor N, Baker T, Stella J, Egerton-Warburton D, Hyder S, Staiger P, Bowe SJ, Shepherd J, Zordan R, Walby A, Jones ML, Caldicott D, Barker D, Hall M, Doran CM, Ezard N, Preisz P, Havard A, Shakeshaft A, Akhlaghi H, Kloot K, Lowry N, Bumpstead S. Most common principal diagnoses assigned to Australian emergency department presentations involving alcohol use: a multi-centre study. Aust N Z J Public Health 2022; 46:903-909. [PMID: 36121276 DOI: 10.1111/1753-6405.13303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/01/2022] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Alcohol is the most widely consumed psychoactive substance in Australia and the consequences of alcohol consumption have enormous personal and social impacts. This study aimed to describe the principal diagnoses of emergency department (ED) presentations involving alcohol use in the previous 12 hours at eight hospitals in Victoria and the Australian Capital Territory, Australia. METHODS Twelve months' data (1 July 2018 - 30 June 2019) were collected from eight EDs, including demographics, ICD-10 codes, hospital location and self-reported drinking in the preceding 12 hours. The ten most common ICD-10 discharge codes were analysed based on age, sex and hospital geographic area. RESULTS ICD codes pertaining to mental and behavioural disorders due to alcohol use accounted for the highest proportion in most EDs. Suicide ideation/attempt was in the five highest ICD codes for all but one hospital. It was the second most common alcohol-related presentation for both males and females. CONCLUSIONS Alcohol plays a major role in a range of presentations, especially in relation to mental health and suicide. IMPLICATIONS FOR PUBLIC HEALTH The collection of alcohol involvement in ED presentations represents a major step forward in informing the community about the burden of alcohol on their health resources.
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Affiliation(s)
- Peter Miller
- School of Psychology, Deakin University, Victoria
| | - Thea Vakidis
- School of Psychology, Deakin University, Victoria
| | - Nicholas Taylor
- School of Psychology, Deakin University, Victoria.,National Drug Research Institute, Curtin University, Victoria
| | - Tim Baker
- Centre for Rural Emergency Medicine, Faculty of Health, Deakin University, Victoria.,South West Healthcare, Victoria
| | | | | | | | | | | | - Jonathan Shepherd
- Crime and Security Research Institute, Cardiff University, Wales, UK
| | - Rachel Zordan
- St Vincent's Hospital Melbourne, Victoria.,Melbourne Medical School, University of Melbourne, Victoria
| | | | - Martyn Lloyd Jones
- VMO Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria.,Alfred Addiction and Mental Health, the Alfred Hospital, Victoria
| | | | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, New South Wales
| | | | - Christopher M Doran
- Cluster for Resilience and Well-being, Appleton Institute, Central Queensland University, Queensland
| | - Nadine Ezard
- St Vincent's Hospital Sydney, National Centre for Clinical Research on Emerging Drugs, New South Wales.,National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales
| | - Paul Preisz
- St Vincent's Hospital Darlinghurst, New South Wales.,Faculty of Medicine & Health, UNSW Sydney, New South Wales.,School of Medicine, University Notre Dame, New South Wales
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, New South Wales.,Centre for Big Data Research in Health, UNSW Sydney, New South Wales
| | | | - Hamed Akhlaghi
- St Vincent's Hospital Melbourne, Victoria.,Melbourne Medical School, University of Melbourne, Victoria
| | - Kate Kloot
- School of Medicine, Deakin University, Victoria
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12
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Kailasam A, Harvey C, Jenusaitis L, White K, Wakefield D, Shepherd J, Hansen K. Appropriate guideline directed HPV testing during routine pap smears via electronic medical record change: A quality improvement initiative (454). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01676-6] [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: 11/04/2022]
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13
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Hapca S, Shepherd J, Messeder S. 145 Best Medical Therapy for Patients with Peripheral Arterial Disease: A Quality Improvement Project in Vascular Surgery, Aberdeen Royal Infirmary. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Peripheral arterial disease (PAD) is the leading cause of limb amputation and cardiovascular morbidity. The National Institute for Health and Care Excellence (NICE) advocates best medical therapy (BMT) with high-dose statin (atorvastatin 80mg) and antiplatelets (clopidogrel or aspirin) for secondary prevention in patients with PAD. We assessed compliance to BMT prescribing in our vascular department.
Method
Retrospective data were collected for all patients admitted with symptomatic PAD in our vascular department over a 2-week period. Criteria for BMT were as per NICE guidelines with a standard set to 100%. Following cycle 1, a new admission document prompting antiplatelet and statin review was designed and departmental teaching on BMT delivered. Standard compliance was re-audited after 3 months.
Results
Twenty-five patients were admitted with PAD during cycle 1 with 28% of patients (n = 7) on BMT on admission. This increased to 40% (n = 10) on discharge with 100% (n = 25) on an antiplatelet and 28% (n = 7) on high-dose statin. Overall, there were twenty patients in cycle 2 with 25% of patients (n = 5) on BMT on admission. This increased to 80% (n = 16) on discharge with 100% (n = 20) on an antiplatelet and 80% (n = 16) on high-dose statin.
Conclusions
Our data demonstrated poor implementation of BMT for patients with PAD managed in primary care suggesting a need for primary care education. Adaption of our admission proforma to prompt BMT prescribing as well as departmental teaching was associated with drastic improvement of BMT prescription on discharge and standard adherence.
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Affiliation(s)
- S. Hapca
- Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, United Kingdom
| | - J. Shepherd
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S.J. Messeder
- Leicester Vascular Institute, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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14
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Chakraborty B, Byemerwa J, Shepherd J, Haines CN, Baldi R, Gong W, Liu W, Mukherjee D, Artham S, Lim F, Bae Y, Brueckner O, Tavares K, Wardell SE, Hanks BA, Perou CM, Chang CY, McDonnell DP. Inhibition of estrogen signaling in myeloid cells increases tumor immunity in melanoma. J Clin Invest 2021; 131:151347. [PMID: 34637400 DOI: 10.1172/jci151347] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022] Open
Abstract
Immune checkpoint blockade (ICB) therapies have significantly prolonged patient survival across multiple tumor types, particularly in melanoma. Interestingly, sex-specific differences in response to ICB have been observed, with males receiving a greater benefit from ICB than females, although the mechanism or mechanisms underlying this difference are unknown. Mining published transcriptomic data sets, we determined that the response to ICBs is influenced by the functionality of intratumoral macrophages. This puts into context our observation that estrogens (E2) working through the estrogen receptor α (ERα) stimulated melanoma growth in murine models by skewing macrophage polarization toward an immune-suppressive state that promoted CD8+ T cell dysfunction and exhaustion and ICB resistance. This activity was not evident in mice harboring macrophage-specific depletion of ERα, confirming a direct role for estrogen signaling within myeloid cells in establishing an immunosuppressed state. Inhibition of ERα using fulvestrant, a selective estrogen receptor downregulator (SERD), decreased tumor growth, stimulated adaptive immunity, and increased the antitumor efficacy of ICBs. Further, a gene signature that determines ER activity in macrophages predicted survival in patients with melanoma treated with ICB. These results highlight the importance of E2/ER signaling as a regulator of intratumoral macrophage polarization, an activity that can be therapeutically targeted to reverse immune suppression and increase ICB efficacy.
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Affiliation(s)
- Binita Chakraborty
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jovita Byemerwa
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan Shepherd
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Corinne N Haines
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert Baldi
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Weida Gong
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wen Liu
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Debarati Mukherjee
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sandeep Artham
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Felicia Lim
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yeeun Bae
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Olivia Brueckner
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kendall Tavares
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Suzanne E Wardell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brent A Hanks
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ching-Yi Chang
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Donald P McDonnell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
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15
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Pattem J, Swift T, Rimmer S, Holmes T, MacNeil S, Shepherd J. Development of a novel micro-bead force spectroscopy approach to measure the ability of a thermo-active polymer to remove bacteria from a corneal model. Sci Rep 2021; 11:13697. [PMID: 34211063 PMCID: PMC8249514 DOI: 10.1038/s41598-021-93172-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023] Open
Abstract
Microbial keratitis occurs from the infection of the cornea by fungi and or bacteria. It remains one of the most common global causes of irreversible blindness accounting for 3.5% (36 million) of blind people as of 2015. This paper looks at the use of a bacteria binding polymer designed to bind Staphylococcus aureus and remove it from the corneal surface. Mechanical unbinding measurements were used to probe the interactions of a thermo-active bacteria-binding polymer, highly-branched poly(N-isopropyl acrylamide), functionalised with modified vancomycin end groups (HB-PNIPAM-Van) to bacteria placed on rabbit corneal surfaces studied ex-vivo. This was conducted during sequential temperature phase transitions of HB-PNIPAM-Van-S. aureus below, above and below the lower critical solution temperature (LCST) in 3 stages, in-vitro, using a novel micro-bead force spectroscopy (MBFS) approach via atomic force microscopy (AFM). The effect of temperature on the functionality of HB-PNIPAM-Van-S. aureus showed that the polymer-bacteria complex reduced the work done in removing bacterial aggregates at T > LCST (p < 0.05), exhibiting reversibility at T < LCST (p < 0.05). At T < LCST, the breaking force, number of unbinding events, percentage fitted segments in the short and long range, and the percentage of unbinding events occurring in the long range (> 2.5 µm) increased (p < 0.05). Furthermore, the LCST phase transition temperature showed 100 × more unbinding events in the long-range z-length (> 2.5 µm) compared to S. aureus aggregates only. Here, we present the first study using AFM to assess the reversible mechanical impact of a thermo-active polymer-binding bacteria on a natural corneal surface.
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Affiliation(s)
- J Pattem
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK. .,National Centre for Molecular Hydrodynamics, and, Soft Matter Biomaterials and Bio-Interfaces, University of Nottingham, The Limes Building, Sutton Bonington Campus, Sutton Bonington, Leicestershire, LE12 5RD, UK.
| | - T Swift
- Polymer and Biomaterials Chemistry Laboratories, School of Chemistry and Biosciences, University of Bradford, Bradford, UK
| | - S Rimmer
- Polymer and Biomaterials Chemistry Laboratories, School of Chemistry and Biosciences, University of Bradford, Bradford, UK
| | - T Holmes
- Department of Oncology and Metabolism, School of Medicine, University of Sheffield, Sheffield, UK
| | - S MacNeil
- Department of Materials Science and Engineering, Faculty of Engineering, University of Sheffield, Sheffield, UK
| | - J Shepherd
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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16
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Stitterich N, Shepherd J, Koroma MM, Theuring S. Risk factors for preeclampsia and eclampsia at a main referral maternity hospital in Freetown, Sierra Leone: a case-control study. BMC Pregnancy Childbirth 2021; 21:413. [PMID: 34078312 PMCID: PMC8173903 DOI: 10.1186/s12884-021-03874-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the African region, 5.6% of pregnancies are estimated to be complicated by preeclampsia and 2.9% by eclampsia, with almost one in ten maternal deaths being associated with hypertensive disorders. In Sierra Leone, representing one of the countries with the highest maternal mortality rates in the world, 16% of maternal deaths were caused by pregnancy-induced hypertension in 2016. In the light of the high burden of preeclampsia and eclampsia (PrE/E) in Sierra Leone, we aimed at assessing population-based risk factors for PrE/E to offer improved management for women at risk. METHODS A facility-based, unmatched observational case-control study was conducted in Princess Christian Maternity Hospital (PCMH). PCMH is situated in Freetown and is the only health care facility providing 'Comprehensive Emergency Obstetric and Neonatal Care services' throughout the entire country. Cases were defined as pregnant or postpartum women diagnosed with PrE/E, and controls as normotensive postpartum women. Data collection was performed with a questionnaire assessing a wide spectrum of factors influencing pregnant women's health. Statistical analysis was performed by estimating a binary logistic regression model. RESULTS We analyzed data of 672 women, 214 cases and 458 controls. The analysis yielded several independent predictors for PrE/E, including family predisposition for PrE/E (AOR = 2.72, 95% CI: 1.46-5.07), preexisting hypertension (AOR = 3.64, 95% CI: 1.32-10.06), a high mid-upper arm circumflex (AOR = 3.09, 95% CI: 1.83-5.22), presence of urinary tract infection during pregnancy (AOR = 2.02, 95% CI: 1.28-3.19), presence of prolonged diarrhoea during pregnancy (AOR = 2.81, 95% CI: 1.63-4.86), low maternal assets (AOR = 2.56, 95% CI: 1.63-4.02), inadequate fruit intake (AOR = 2.58, 95% CI: 1.64-4.06), well or borehole water as the main source of drinking water (AOR = 2.05, 95% CI: 1.31-3.23) and living close to a waste deposit (AOR = 1.94, 95% CI: 1.15-3.25). CONCLUSION Our findings suggest that systematic assessment of identified PrE/E risk factors, including a family predisposition for PrE/E, preexisting hypertension, or obesity, should be performed early on in ANC, followed by continued close monitoring of first signs and symptoms of PrE/E. Additionally, counseling on nutrition, exercise, and water safety is needed throughout pregnancy as well as education on improved hygiene behavior. Further research on sources of environmental pollution in Freetown is urgently required.
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Affiliation(s)
- N Stitterich
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - J Shepherd
- National School of Midwifery, Freetown, Sierra Leone
| | - M M Koroma
- Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - S Theuring
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353 Berlin, Germany
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17
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Ablatt S, Wang X, Sahil S, Cheng A, Kirchhoff-Rowald A, Shepherd J, Sutkin G. 50 Reoperation rates of stress incontinence surgery in rural versus urban hospitals. Am J Obstet Gynecol 2021. [DOI: 10.1016/j.ajog.2021.04.075] [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: 11/16/2022]
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18
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Moore SC, Orpen B, Smith J, Sarkar C, Li C, Shepherd J, Bauermeister S. Alcohol affordability: implications for alcohol price policies. A cross-sectional analysis in middle and older adults from UK Biobank. J Public Health (Oxf) 2021; 44:e192-e202. [PMID: 33837430 PMCID: PMC9234508 DOI: 10.1093/pubmed/fdab095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/27/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Increasing the price of alcohol reduces alcohol consumption and harm. The role of food complementarity, transaction costs and inflation on alcohol demand are determined and discussed in relation to alcohol price policies. Methods UK Biobank (N = 502,628) was linked by region to retail price quotes for the years 2007 to 2010. The log residual food and alcohol prices, and alcohol availability were regressed onto log daily alcohol consumption. Model standard errors were adjusted for clustering by region. Results Associations with alcohol consumption were found for alcohol price (β = −0.56, 95% CI, −0.92 to −0.20) and availability (β = 0.06, 95% CI, 0.04 to 0.07). Introducing, food price reduced the alcohol price consumption association (β = −0.26, 95% CI, −0.50 to −0.03). Alcohol (B = 0.001, 95% CI, 0.0004 to 0.001) and food (B = 0.001, 95% CI, 0.0005 to 0.0006) price increased with time and were associated (ρ = 0.57, P < 0.001). Conclusion Alcohol and food are complements, and the price elasticity of alcohol reduces when the effect of food price is accounted for. Transaction costs did not affect the alcohol price consumption relationship. Fixed alcohol price policies are susceptible to inflation.
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Affiliation(s)
- Simon C Moore
- Violence Research Group, School of Dentistry, Cardiff CF14 4XY, UK.,Crime and Security Research Institute, Cardiff University, Cardiff CF10 3AE, UK
| | - Bella Orpen
- Crime and Security Research Institute, Cardiff University, Cardiff CF10 3AE, UK
| | - Jesse Smith
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff CF10 3BD, UK
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong
| | | | - Jonathan Shepherd
- Violence Research Group, School of Dentistry, Cardiff CF14 4XY, UK.,Crime and Security Research Institute, Cardiff University, Cardiff CF10 3AE, UK
| | - Sarah Bauermeister
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
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19
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Shepherd J. Optimizing public services after COVID. Nature 2021; 589:19. [PMID: 33402713 DOI: 10.1038/d41586-020-03644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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21
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Schmidt M, Newmark A, Lamonica R, Shepherd J, Luciano D. Preparing OB/GYN Residents for the Fundamentals of Laparoscopic Surgery Exam. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.265] [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: 11/27/2022]
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22
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Fernandez-Martinez A, Krop IE, Hillman DW, Polley MY, Parker JS, Huebner L, Hoadley KA, Shepherd J, Tolaney S, Henry NL, Dang C, Harris L, Berry D, Hahn O, Hudis C, Winer E, Partridge A, Perou CM, Carey LA. Survival, Pathologic Response, and Genomics in CALGB 40601 (Alliance), a Neoadjuvant Phase III Trial of Paclitaxel-Trastuzumab With or Without Lapatinib in HER2-Positive Breast Cancer. J Clin Oncol 2020; 38:4184-4193. [PMID: 33095682 DOI: 10.1200/jco.20.01276] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE CALGB 40601 assessed whether dual versus single human epidermal growth factor receptor 2 (HER2) -targeting drugs added to neoadjuvant chemotherapy increased pathologic complete response (pCR). Here, we report relapse-free survival (RFS), overall survival (OS), and gene expression signatures that predict pCR and survival. PATIENTS AND METHODS Three hundred five women with untreated stage II and III HER2-positive breast cancer were randomly assigned to receive weekly paclitaxel combined with trastuzumab plus lapatinib (THL), trastuzumab (TH), or lapatinib (TL). The primary end point was pCR, and secondary end points included RFS, OS, and gene expression analyses. mRNA sequencing was performed on 264 pretreatment samples. RESULTS One hundred eighteen patients were randomly allocated to THL, 120 to TH, and 67 to TL. At more than 7 years of follow-up, THL had significantly better RFS and OS than did TH (RFS hazard ratio, 0.32; 95% CI, 0.14 to 0.71; P = .005; OS hazard ratio, 0.34; 95% CI, 0.12 to 0.94; P = .037), with no difference between TH and TL. Of 688 previously described gene expression signatures, significant associations were found in 215 with pCR, 45 with RFS, and only 22 with both pCR and RFS (3.2%). Specifically, eight immune signatures were significantly correlated with a higher pCR rate and better RFS. Among patients with residual disease, the immunoglobulin G signature was an independent, good prognostic factor, whereas the HER2-enriched signature, which was associated with a higher pCR rate, showed a significantly shorter RFS. CONCLUSION In CALGB 40601, dual HER2-targeting resulted in significant RFS and OS benefits. Integration of intrinsic subtype and immune signatures allowed for the prediction of pCR and RFS, both overall and within the residual disease group. These approaches may provide means for rational escalation and de-escalation treatment strategies in HER2-positive breast cancer.
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Affiliation(s)
- Aranzazu Fernandez-Martinez
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Ian E Krop
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - David W Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Mei-Yin Polley
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Joel S Parker
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Lucas Huebner
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Katherine A Hoadley
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Jonathan Shepherd
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Sara Tolaney
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - N Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Chau Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lyndsay Harris
- National Cancer Institute, Cancer Diagnostics Program, Bethesda, MD
| | - Donald Berry
- Division of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Olwen Hahn
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | | | - Eric Winer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Charles M Perou
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Lisa A Carey
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Division of Hematology-Oncology, University of North Carolina, Chapel Hill, NC
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23
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Olivia Mullen C, Shepherd J, Campbell B, Feinn R. Opioid Prescription Practices in the Postpartum Period. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.297] [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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24
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Crosby EJ, Acharya C, Rabiola C, Muller WJ, Chodosh LA, Broadwater G, Shepherd J, Hollern D, He X, Perou CM, Ashby BK, Vincent BG, Morse MA, Lyerly HK, Hartman ZC. Abstract 904: Stimulation and expansion of oncogene-reactive tumor infiltrating T cells through combined Ad-HER2Δ16 vaccination and anti-PD1 enable anti-tumor responses against established HER2 BC. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-904] [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
Despite promising advances, overcoming immune suppression and driving productive immune responses in the tumor microenvironment remains a significant challenge. Using a spontaneous breast cancer model, we found that vaccination targeting HER2d16, a highly expressed driver of oncogenicity and HER2-therapeutic resistance, elicited significant anti-tumor responses. In contrast, vaccines targeting a non-driver tumor-specific antigen (GFP) or unique non-driver tumor neoepitopes had no impact on tumor occurrence or progression. While vaccine-induced HER2-specific CD8+ T cells were essential for responses, tumors treated therapeutically with a vaccine alone ultimately progressed. However, long-term tumor control and complete tumor regression was only achieved when vaccine was combined with immune-checkpoint blockade (anti-PD1). Single cell RNAsequencing of tumor-infiltrating T cells (TILs) revealed that while vaccination expanded CD8 T cells within the tumor, only the combination of vaccine with anti-PD1 therapy induced a tumor rejection activation signature that was identified in the expanded T cell clones. We go on to use the single cell data to clone and reexpress the TCRs from expanded TILs from vaccinated mice and show that they are HER2-reactive. This data conclusively demonstrates the efficacy of this vaccination strategy in expanding tumor rejection T cells and supports its further evaluation in an ongoing Phase II trial (NCT03632941). The workflow used to identify and clone expanded, tumor specific T cells has broad potential applications across tumor types and treatment platforms.
Citation Format: Erika J. Crosby, Chaitanya Acharya, Christopher Rabiola, William J. Muller, Lewis A. Chodosh, Gloria Broadwater, Jonathan Shepherd, Daniel Hollern, Xiaping He, Charles M. Perou, Benjamin K. Ashby, Benjamin G. Vincent, Michael A. Morse, Herbert K. Lyerly, Zachary C. Hartman. Stimulation and expansion of oncogene-reactive tumor infiltrating T cells through combined Ad-HER2Δ16 vaccination and anti-PD1 enable anti-tumor responses against established HER2 BC [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 904.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaping He
- 4University of North Carolina, Chapel Hill, NC
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Ma Y, Shepherd J, Zhao D, Bollu LR, Tahaney WM, Hill J, Zhang Y, Mazumdar A, Brown PH. SOX9 Is Essential for Triple-Negative Breast Cancer Cell Survival and Metastasis. Mol Cancer Res 2020; 18:1825-1838. [PMID: 32661114 DOI: 10.1158/1541-7786.mcr-19-0311] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/21/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
Triple-negative breast cancer (TNBC) has the worst prognosis of all breast cancers, and lacks effective targeted treatment strategies. Previously, we identified 33 transcription factors highly expressed in TNBC. Here, we focused on six sex determining region Y-related HMG-box (SOX) transcription factors (SOX4, 6, 8, 9, 10, and 11) highly expressed in TNBCs. Our siRNA screening assay demonstrated that SOX9 knockdown suppressed TNBC cell growth and invasion in vitro. Thus, we hypothesized that SOX9 is an important regulator of breast cancer survival and metastasis, and demonstrated that knockout of SOX9 reduced breast tumor growth and lung metastasis in vivo. In addition, we found that loss of SOX9 induced profound apoptosis, with only a slight impairment of G1 to S progression within the cell cycle, and that SOX9 directly regulates genes controlling apoptosis. On the basis of published CHIP-seq data, we demonstrated that SOX9 binds to the promoter of apoptosis-regulating genes (tnfrsf1b, fadd, tnfrsf10a, tnfrsf10b, and ripk1), and represses their expression. SOX9 knockdown upregulates these genes, consistent with the induction of apoptosis. Analysis of available CHIP-seq data showed that SOX9 binds to the promoters of several epithelial-mesenchymal transition (EMT)- and metastasis-regulating genes. Using CHIP assays, we demonstrated that SOX9 directly binds the promoters of genes involved in EMT (vim, cldn1, ctnnb1, and zeb1) and that SOX9 knockdown suppresses the expression of these genes. IMPLICATIONS: Our studies identified the SOX9 protein as a "master regulator" of breast cancer cell survival and metastasis, and provide preclinical rationale to develop SOX9 inhibitors for the treatment of women with metastatic triple-negative breast cancer.
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Affiliation(s)
- Yanxia Ma
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jonathan Shepherd
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Dekuang Zhao
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Lakshmi Reddy Bollu
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - William M Tahaney
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Jamal Hill
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Yun Zhang
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Abhijit Mazumdar
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Powel H Brown
- Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. .,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas.,Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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Frampton GK, Shepherd J, Pickett K, Griffiths G, Wyatt JC. Digital tools for the recruitment and retention of participants in randomised controlled trials: a systematic map. Trials 2020; 21:478. [PMID: 32498690 PMCID: PMC7273688 DOI: 10.1186/s13063-020-04358-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 04/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Recruiting and retaining participants in randomised controlled trials (RCTs) is challenging. Digital tools, such as social media, data mining, email or text-messaging, could improve recruitment or retention, but an overview of this research area is lacking. We aimed to systematically map the characteristics of digital recruitment and retention tools for RCTs, and the features of the comparative studies that have evaluated the effectiveness of these tools during the past 10 years. METHODS We searched Medline, Embase, other databases, the Internet, and relevant web sites in July 2018 to identify comparative studies of digital tools for recruiting and/or retaining participants in health RCTs. Two reviewers independently screened references against protocol-specified eligibility criteria. Included studies were coded by one reviewer with 20% checked by a second reviewer, using pre-defined keywords to describe characteristics of the studies, populations and digital tools evaluated. RESULTS We identified 9163 potentially relevant references, of which 104 articles reporting 105 comparative studies were included in the systematic map. The number of published studies on digital tools has doubled in the past decade, but most studies evaluated digital tools for recruitment rather than retention. The key health areas investigated were health promotion, cancers, circulatory system diseases and mental health. Few studies focussed on minority or under-served populations, and most studies were observational. The most frequently-studied digital tools were social media, Internet sites, email and tv/radio for recruitment; and email and text-messaging for retention. One quarter of the studies measured efficiency (cost per recruited or retained participant) but few studies have evaluated people's attitudes towards the use of digital tools. CONCLUSIONS This systematic map highlights a number of evidence gaps and may help stakeholders to identify and prioritise further research needs. In particular, there is a need for rigorous research on the efficiency of the digital tools and their impact on RCT participants and investigators, perhaps as studies-within-a-trial (SWAT) research. There is also a need for research into how digital tools may improve participant retention in RCTs which is currently underrepresented relative to recruitment research. REGISTRATION Not registered; based on a pre-specified protocol, peer-reviewed by the project's Advisory Board.
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Affiliation(s)
- Geoff K. Frampton
- Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
- Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
- Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
| | - Karen Pickett
- Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
- Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and Southampton University Hospital NHS Foundation Trust, Southampton General Hospital, Southampton, SO16 6YD UK
| | - Jeremy C. Wyatt
- Wessex Institute, Faculty of Medicine, University of Southampton, Alpha House, Southampton Science Park, Southampton, SO16 7NS UK
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Dermont MA, Field P, Shepherd J, Rushton R. Evidence into action: implementing alcohol screening and brief interventions in the UK Armed Forces. BMJ Mil Health 2020; 166:187-192. [DOI: 10.1136/jramc-2019-001313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 11/04/2022]
Abstract
IntroductionAlcohol-related harm continues to represent a major public health problem and previous evidence suggests that alcohol misuse within the UK Armed Forces is higher than in the general population. The aim was to introduce a population-level primary care intervention with an existing evidence base to identify and support Service Personnel whose drinking places them at greater risk of harm.ImplementationFollowing successful piloting, the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) brief screening tool was introduced as part of routine dental inspections by Defence Primary Healthcare (DPHC) dentists. Alcohol brief intervention (ABI) advice and signposting to support services was offered to personnel identified as being at increased risk and recorded in the patient’s electronic health record.Achievements to datePatients attending DPHC Dental Centres are now routinely offered AUDIT-C with 74% (109 459) personnel screened in the first 12 months rising to over 276 000 at 24 months, representing the single largest use of AUDIT-C and ABIs in a military population to date.DiscussionIntroduction of AUDIT-C has seen Defence successfully deliver a whole population alcohol initiative, overcoming implementation barriers to demonstrate the flexibility of a dental workforce to deliver a public health intervention at scale and contributing towards promoting positive attitudes towards alcohol use. The initiative represents a first step towards the goal of a standardised alcohol screening and treatment pathway across DPHC while recognising that the Defence Medical Services are only one aspect of the broader public health approach required to tackle alcohol-related harm in Service Personnel.
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Schmidt MF, Turner L, Bradley M, Shepherd J. 2738 Comparing Postoperative Pain with Laparoscopic Versus Robotic Sacrocolpopexy. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anstee S, Shepherd J, Graham CA, Stone N, Brown K, Newby K, Ingham R. Evidence for behavioural interventions addressing condom use fit and feel issues to improve condom use: a systematic review. Sex Health 2019; 16:539-547. [PMID: 31665616 DOI: 10.1071/sh19001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 06/21/2019] [Indexed: 11/23/2022]
Abstract
Continuing high rates of sexually transmissible infections (STIs) in many countries highlight the need to identify effective behavioural interventions. Consistent and correct use of male condoms is a key strategy for the prevention of STIs. However, some men report problems with condom fit (e.g. the size and shape of the condom) and feel (e.g. tightness, irritation, sensitivity), which inhibits their use. We conducted a systematic review to identify existing interventions addressing condom use fit and feel problems. We searched electronic databases for peer-reviewed articles and searched reference lists of retrieved studies. Five studies met the inclusion criteria. These were generally small-scale pilot studies evaluating behavioural interventions to promote safer sex with men aged under 30 years, addressing, among other things, barriers to condom use relating to fit and feel. There were significant increases in the reported use of condoms, including condom use with no errors and problems. Improvements in some condom use mediators were reported, such as condom use self-efficacy, knowledge, intentions and condom use experience. There were mixed findings in terms of the ability of interventions to reduce STI acquisition. Behavioural interventions addressing condom fit and feel are promising in terms of effectiveness but require further evaluation.
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Affiliation(s)
- Sydney Anstee
- Centre for Sexual Health Research, Department of Psychology, Faculty of Environmental and Life Sciences, Shackleton Building (B44) Room 3073, University of Southampton, Southampton, Hampshire SO17 1BJ, UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), Alpha House, Wessex Institute, Enterprise Road, University of Southampton Science Park, Southampton, Hampshire SO16 7NS, UK
| | - Cynthia A Graham
- Centre for Sexual Health Research, Department of Psychology, Faculty of Environmental and Life Sciences, Shackleton Building (B44) Room 3073, University of Southampton, Southampton, Hampshire SO17 1BJ, UK; and Corresponding author.
| | - Nicole Stone
- Centre for Sexual Health Research, Department of Psychology, Faculty of Environmental and Life Sciences, Shackleton Building (B44) Room 3073, University of Southampton, Southampton, Hampshire SO17 1BJ, UK
| | - Katherine Brown
- Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences, Richard Crossman Building (4th Floor), Coventry University, Priory Street, Coventry CV1 5FB, UK
| | - Katie Newby
- Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences, Richard Crossman Building (4th Floor), Coventry University, Priory Street, Coventry CV1 5FB, UK
| | - Roger Ingham
- Centre for Sexual Health Research, Department of Psychology, Faculty of Environmental and Life Sciences, Shackleton Building (B44) Room 3073, University of Southampton, Southampton, Hampshire SO17 1BJ, UK
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Affiliation(s)
- David K Humphreys
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
| | | | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Jonathan Shepherd
- Crime and Security Research Institute, Cardiff University, Cardiff, UK
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Grimmett C, Corbett T, Brunet J, Shepherd J, Pinto BM, May CR, Foster C. Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors. Int J Behav Nutr Phys Act 2019; 16:37. [PMID: 31029140 PMCID: PMC6486962 DOI: 10.1186/s12966-019-0787-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [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: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 01/05/2023] Open
Abstract
Background Physical activity can improve health and wellbeing after cancer and may reduce cancer recurrence and mortality. To achieve such long-term benefits cancer survivors must be habitually active. This review evaluates the effectiveness of interventions in supporting maintenance of physical activity behaviour change among adults diagnosed with cancer and explores which intervention components and contextual features are associated with effectiveness. Methods Relevant randomised controlled trials (RCTs) were identified by a search of Ovid Medline, Ovid Embase and PsychINFO. Trials including adults diagnosed with cancer, assessed an intervention targeting physical activity and reported physical activity behaviour at baseline and ≥ 3 months post-intervention were included. The behaviour change technique (BCT) taxonomy was used to identify intervention components and the Template for Intervention Description and Replication to capture contextual features. Random effect meta-analysis explored between and within group differences in physical activity behaviour. Standardised mean differences (SMD) describe effect size. Results Twenty seven RCTs were included, 19 were pooled in meta-analyses. Interventions were effective at changing long-term behaviour; SMD in moderate to vigorous physical activity (MVPA) between groups 0.25; 95% CI = 0.16–0.35. Within-group pre-post intervention analysis yielded a mean increase of 27.48 (95% CI = 11.48-43.49) mins/wk. of MVPA in control groups and 65.30 (95% CI = 45.59–85.01) mins/wk. of MVPA in intervention groups. Ineffective interventions tended to include older populations with existing physical limitations, had fewer contacts with participants, were less likely to include a supervised element or the BCTs of ‘action planning’, ‘graded tasks’ and ‘social support (unspecified)’. Included studies were biased towards inclusion of younger, female, well-educated and white populations who were already engaging in some physical activity. Conclusions Existing interventions are effective in achieving modest increases in physical activity at least 3 months post-intervention completion. Small improvements were also evident in control groups suggesting low-intensity interventions may be sufficient in promoting small changes in behaviour that last beyond intervention completion. However, study samples are not representative of typical cancer populations. Interventions should consider a stepped-care approach, providing more intensive support for older people with physical limitations and others less likely to engage in these interventions. Electronic supplementary material The online version of this article (10.1186/s12966-019-0787-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, UK.
| | - Teresa Corbett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jennifer Brunet
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | | | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Claire Foster
- School of Health Sciences, University of Southampton, Southampton, UK
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Miller P, Droste N, Egerton‐Warburton D, Caldicott D, Fulde G, Ezard N, Preisz P, Walby A, Lloyd‐Jones M, Stella J, Sheridan M, Baker T, Hall M, Shakeshaft A, Havard A, Bowe S, Staiger PK, D'Este C, Doran C, Coomber K, Hyder S, Barker D, Shepherd J. Driving change: A partnership study protocol using shared emergency department data to reduce alcohol‐related harm. Emerg Med Australas 2019; 31:942-947. [DOI: 10.1111/1742-6723.13266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/16/2019] [Accepted: 02/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Miller
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Nicolas Droste
- School of PsychologyDeakin University Geelong Victoria Australia
| | | | - David Caldicott
- Calvary Health Care Canberra Australian Capital Territory Australia
| | - Gordian Fulde
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Nadine Ezard
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Paul Preisz
- St Vincent's Hospital Sydney Sydney New South Wales Australia
| | - Andrew Walby
- St Vincent's Hospital Melbourne Melbourne Victoria Australia
| | | | | | | | - Tim Baker
- Southwest Health Care Warrnambool Victoria Australia
| | - Michael Hall
- The Canberra Hospital and Health Service Canberra Australian Capital Territory Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, The University of New South Wales Sydney New South Wales Australia
| | - Alys Havard
- Centre for Big Data Research in HealthThe University of New South Wales Sydney New South Wales Australia
| | - Steve Bowe
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Petra K Staiger
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Catherine D'Este
- National Centre for Epidemiology and Population HealthThe Australian National University Canberra Australian Capital Territory Australia
- The University of Newcastle Newcastle New South Wales Australia
| | - Chris Doran
- Central Queensland University Rockhampton Queensland Australia
| | - Kerri Coomber
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Shannon Hyder
- School of PsychologyDeakin University Geelong Victoria Australia
| | - Daniel Barker
- Central Queensland University Rockhampton Queensland Australia
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Attwood D, D’Arcy N, Shepherd J, Griffiths A. 9THERE AND BACK AGAIN: THE DEVELOPMENT OF AN AMBULATORY CARE PATHWAY FOR OLDER PEOPLE LIVING WITH FRAILTY THAT BEGINS AND ENDS IN THE PATIENT’S OWN HOME. PART 2: RESULTS OF A FOUR DAY PILOT. Age Ageing 2019. [DOI: 10.1093/ageing/afy211.09] [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: 11/14/2022] Open
Affiliation(s)
| | - N D’Arcy
- Newton Abbot Locality, South Devon
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Picot J, Rose M, Cooper K, Pickett K, Lord J, Harris P, Whyte S, Böhning D, Shepherd J. Virtual chromoendoscopy for the real-time assessment of colorectal polyps in vivo: a systematic review and economic evaluation. Health Technol Assess 2019; 21:1-308. [PMID: 29271339 DOI: 10.3310/hta21790] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Current clinical practice is to remove a colorectal polyp detected during colonoscopy and determine whether it is an adenoma or hyperplastic by histopathology. Identifying adenomas is important because they may eventually become cancerous if untreated, whereas hyperplastic polyps do not usually develop into cancer, and a surveillance interval is set based on the number and size of adenomas found. Virtual chromoendoscopy (VCE) (an electronic endoscopic imaging technique) could be used by the endoscopist under strictly controlled conditions for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of the VCE technologies narrow-band imaging (NBI), flexible spectral imaging colour enhancement (FICE) and i-scan for the characterisation and management of diminutive (≤ 5 mm) colorectal polyps using high-definition (HD) systems without magnification. DESIGN Systematic review and economic analysis. PARTICIPANTS People undergoing colonoscopy for screening or surveillance or to investigate symptoms suggestive of colorectal cancer. INTERVENTIONS NBI, FICE and i-scan. MAIN OUTCOME MEASURES Diagnostic accuracy, recommended surveillance intervals, health-related quality of life (HRQoL), adverse effects, incidence of colorectal cancer, mortality and cost-effectiveness of VCE compared with histopathology. DATA SOURCES Electronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and Database of Abstracts of Reviews of Effects were searched for published English-language studies from inception to June 2016. Bibliographies of related papers, systematic reviews and company information were screened and experts were contacted to identify additional evidence. REVIEW METHODS Systematic reviews of test accuracy and economic evaluations were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Meta-analyses were conducted, where possible, to inform the independent economic model. A cost-utility decision-analytic model was developed to estimate the cost-effectiveness of VCE compared with histopathology. The model used a decision tree for patients undergoing endoscopy, combined with estimates of long-term outcomes (e.g. incidence of colorectal cancer and subsequent morbidity and mortality) derived from University of Sheffield School of Health and Related Research's bowel cancer screening model. The model took a NHS perspective, with costs and benefits discounted at 3.5% over a lifetime horizon. There were limitations in the data on the distribution of adenomas across risk categories and recurrence rates post polypectomy. RESULTS Thirty test accuracy studies were included: 24 for NBI, five for i-scan and three for FICE (two studies assessed two interventions). Polyp assessments made with high confidence were associated with higher sensitivity and endoscopists experienced in VCE achieved better results than those without experience. Two economic evaluations were included. NBI, i-scan and FICE are cost-saving strategies compared with histopathology and the number of quality-adjusted life-years gained was similar for histopathology and VCE. The correct surveillance interval would be given to 95% of patients with NBI, 94% of patients with FICE and 97% of patients with i-scan. LIMITATIONS Limited evidence was available for i-scan and FICE and there was heterogeneity among the NBI studies. There is a lack of data on longer-term health outcomes of patients undergoing VCE for assessment of diminutive colorectal polyps. CONCLUSIONS VCE technologies, using HD systems without magnification, could potentially be used for the real-time assessment of diminutive colorectal polyps, if endoscopists have adequate experience and training. FUTURE WORK Future research priorities include head-to-head randomised controlled trials of all three VCE technologies; more research on the diagnostic accuracy of FICE and i-scan (when used without magnification); further studies evaluating the impact of endoscopist experience and training on outcomes; studies measuring adverse effects, HRQoL and anxiety; and longitudinal data on colorectal cancer incidence, HRQoL and mortality. STUDY REGISTRATION This study is registered as PROSPERO CRD42016037767. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Joanna Picot
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Micah Rose
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Karen Pickett
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Petra Harris
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Sophie Whyte
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute (S3RI), Mathematical Sciences, University of Southampton, Southampton, UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Shepherd J, Perou C. Abstract B185: Epithelial cancer cell-expressed genes contribute to clinically relevant immune-based classifications of breast cancer. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-b185] [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
Introduction: With the development of immunotherapies for breast cancer therapy, reliable methods to evaluate the extent and type of immune involvement present in tumors and investigation of its effect on patient prognosis and treatment are needed. Identifying tumor-specific features that affect immune involvement will be a key to understand tumor-immune involvement. Therefore, we evaluated expression of immune-related mRNA signatures in TCGA breast cancer data to identify distinct immune-related tumor subsets and asociated prognostic values. We also evaluated immune cell features, including B cell and T-cell receptor richness and diversity, as well as epithelial tumor cell-specific features, including somatic mutations, copy number alterations and differential RNA expression between identified groups. Methods: More than 130 published immune related gene signatures were evaluated in 1095 breast tumors and 97 normal mammary samples. Groups were identified by consensus based hierarchical clustering of the immune signatures, using the proportion of ambiguous clustering to select the optimal number of groups. An ElasticNet model trained on TCGA data was applied to two other breast tumor datasets to predict immune group classification. RNA-sequencing (RNAseq) data from 70 breast cancer cell lines and from human tumor xenografts passaged in immune-compromised mice and processed through a human specific sequencing pipeline provided in vitro and in vivo sources of epithelial cancer cell expression with limited stromal content that was used to filter TCGA bulk RNAseq data for epithelial expressed genes. Results: We identified three distinct immune groups present in breast cancer: immune-low, immune-normal, and immune-high. The immune-high group is characterized by high T-cell scores, including both cytotoxic and regulatory T-cell signatures, and increased B cell and macrophage signatures. The immune-normal set shows signs of normal epithelia and low proliferation. The immune-low group has very low immune cell signatures. Intrinsic breast cancer subtypes (Basal, luminal A, Luminal B, Her2 and Normal-like) are present in each of the immune groups; however, enrichment of basal tumors in immune-high, luminal tumors in the immune-low, and normal mammary, normal-like tumors and luminal A tumors in the immune-normal group demonstrate an interaction between intrinsic tumor type and immune involvement. Immune groups are prognostic in TCGA, with the immune-high group having improved recurrence-free survival. Two more breast tumor datasets confirmed improved survival for basal tumors in the immune-high group relative to the immune-low tumors. Total mutation burden, unique somatic mutations, and copy number alterations did not show significant changes between immune-low and –high groups, whereas RNA expression differs between groups. Selecting for genes with evidence of expression by epithelial breast cancer cells identified over 8,000 genes differentially expressed between the immune-low and –high groups, with CCL5, ACAP1, PVRIG, SLA2, LCK and CD8A being among the most significant. Conclusion: Breast cancer can be divided into three clinically relevant immune-related groups. Immune-high has high immune involvement, showing of markers for cytotoxicity and immune suppression and exhaustion. These patients have improved survival, but may still benefit from immune checkpoint inhibition. Immune-normal is reflective of a normal mammary immune state, suggesting a microenvironment that has not been strongly altered by the tumor. Immune-low appears to demonstrate exclusion of immune cells from the tumor, even though tumors contain predicted neoantigens. These patients have poor survival and novel therapeutic strategies to activate immune involvement need to be developed. Epithelial cancer cell expressed many immune-related genes, including CCL5, LCK and CD8A, which may be critical determinants of immune cell attraction.
Citation Format: Jonathan Shepherd, Charles Perou. Epithelial cancer cell-expressed genes contribute to clinically relevant immune-based classifications of breast cancer [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr B185.
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Affiliation(s)
| | - Charles Perou
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Affiliation(s)
- C. A. Sykes
- Queen Elizabeth University Hospital, Glasgow, Scotland
| | - J. Shepherd
- Medical Research Council University of Glasgow Centre for Virus Research, Glasgow, Scotland
| | - C. McGoldrick
- University Hospital Monklands, Airdrie, Scotland, UK
| | - N. Kennedy
- University Hospital Monklands, Airdrie, Scotland, UK
| | - A. Raafat
- University Hospital Monklands, Airdrie, Scotland, UK
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Gil-Nagel A, Sanchez-Carpintero R, San Antonio V, Mistry A, Barker G, Shepherd J, Gil A. Ascertaining the epidemiology, patient flow and disease management for Dravet syndrome in Spain. Rev Neurol 2019; 68:75-81. [PMID: 30638257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Dravet syndrome (DS) is a rare, drug resistant epilepsy that starts very early in life with febrile seizures followed by cognitive impairment and diverse seizure types. AIM To generate evidence on the epidemiology of DS, its diagnosis, patient-flow, treatment and unmet needs from the perspective of Spanish experts. DEVELOPMENT A two-round Delphi study involving 19 physicians was conducted. Questionnaires were based on literature review and validated by clinical experts. Consensus was reached when topics were subject to routine clinical practice and individual experience, or the coefficient of variation among answers was <= 0.3. The estimated number of new DS patients is 73 per year. Prevalence is estimated to be between 348-540 patients. DS is mostly diagnosed in children. Survival varies from 5 to 60 years. There is no standardised follow-up of patients beyond the age of 18 and mortality rates are uncertain. No standard guidelines exist for diagnosing or treating DS. It takes 9 to 15 months to confirm the diagnosis and genetic testing is unevenly available. Valproic acid, clobazam, stiripentol and topiramate are commonly used. Poor efficacy and safety are the main reasons for treatment switch. CONCLUSIONS The epidemiology of DS in Spain is not well known and several areas of unmet needs still exist. Experts' views offer a starting point for further research into the reality of DS in Spain. Epidemiological studies, consensus criteria, easy access to genetic testing, treatment options, training and research into quality of life aspects are highly needed.
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Affiliation(s)
- A Gil-Nagel
- Hospital Ruber Internacional, 28034 Madrid, Espana
| | | | - V San Antonio
- Hospital Universitari Sant Joan de Deu, Esplugues de Llobregat, Espana
| | - A Mistry
- Zogenix International Limited, Berkshire, England
| | - G Barker
- Zogenix International Limited, Berkshire, England
| | | | - A Gil
- Omakase Consulting, Barcelona, Espana
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Rose M, Shepherd J, Harris P, Pickett K, Lord J. Etelcalcetide for Treating Secondary Hyperparathyroidism: An Evidence Review Group Evaluation of a NICE Single Technology Appraisal. Pharmacoeconomics 2018; 36:1299-1308. [PMID: 29691773 DOI: 10.1007/s40273-018-0661-2] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The manufacturer of the calcimimetic drug etelcalcetide was invited to make an evidence submission as part of the National Institute for Health and Care Excellence (NICE) Single Technology Appraisal (STA) programme. Within this submission, they reported evidence on the clinical and cost effectiveness of etelcalcetide for the treatment of secondary hyperparathyroidism (SHPT) in patients with chronic kidney disease (CKD) on haemodialysis. The Southampton Health Technology Assessments Centre (SHTAC), part of the Wessex Institute at the University of Southampton, was the independent Evidence Review Group (ERG) commissioned to appraise the company's submission. This article describes the ERG's review and critique of the company's submission and summarises the NICE Appraisal Committee's subsequent guidance (issued in June 2017). The clinical-effectiveness evidence submitted by the company consisted of two double-blind, randomised controlled trials (RCTs) comparing etelcalcetide with placebo, one RCT comparing etelcalcetide with cinacalcet, two single-arm extension studies of the above trials, and one single-arm study evaluating the effect of switching from cinacalcet to etelcalcetide. No study specifically examined the population specified in the NICE appraisal scope: patients refractory to standard therapy with phosphate binders and vitamin D (PBVD). None of these trials were designed to collect long-term efficacy data for outcomes such as mortality, bone fractures, cardiovascular events, or parathyroidectomies. Instead, biomarker data from the trials were mapped to long-term outcomes by an assumed linear relationship between the trial outcome, reduction of parathyroid hormone (PTH) by > 30%, and the log-hazard ratios for the occurrence of clinical events derived from a large, long-term RCT of cinacalcet (the EVOLVE trial). After submission of a confidential Patient Access Scheme (PAS) discount reducing etelcalcetide drug costs, the incremental cost-effectiveness ratio (ICER) for etelcalcetide versus cinacalcet was £14,778 per quality-adjusted life-year (QALY) gained in the company's base case. While this value is lower than the NICE threshold range of £20,000 and £30,000 per QALY gained, it was the opinion of the ERG that the ICER was highly uncertain due to efficacy data limitations for etelcalcetide, inadequate synthesis of clinical-effectiveness evidence, and strong assumptions connecting short-term biomarker data with long-term clinical outcomes. The ERG produced an alternative base case for etelcalcetide versus cinacalcet, with an ICER of £22,400 per QALY gained, also subject to uncertainty. The NICE Appraisal Committee recommended etelcalcetide as an option for the treatment of SHPT in adults with CKD only if treatment with a calcimimetic is indicated and cinacalcet is not suitable, subject to the company's provision of the agreed PAS discount.
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Affiliation(s)
- Micah Rose
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Alpha House, Enterprise Road, Southampton Science Park, Southampton, SO16 7NS, UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Alpha House, Enterprise Road, Southampton Science Park, Southampton, SO16 7NS, UK.
| | - Petra Harris
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Alpha House, Enterprise Road, Southampton Science Park, Southampton, SO16 7NS, UK
| | - Karen Pickett
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Alpha House, Enterprise Road, Southampton Science Park, Southampton, SO16 7NS, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Alpha House, Enterprise Road, Southampton Science Park, Southampton, SO16 7NS, UK
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Coulton S, Dale V, Deluca P, Gilvarry E, Godfrey C, Kaner E, McGovern R, Newbury-Birch D, Patton R, Parrott S, Perryman K, Phillips T, Shepherd J, Drummond C. Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches. Alcohol Alcohol 2018; 52:312-317. [PMID: 28371897 DOI: 10.1093/alcalc/agx017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/12/2017] [Indexed: 11/14/2022] Open
Abstract
Aims The aim of the study was to explore the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use in a primary care population in the UK. Methods The study was a randomized evaluation of screening approach (targeted versus universal) for consecutive attendees at primary care aged 18 years or more. Targeted screening involved screening any patient attending with one of the targeted presentations, conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries or a new patient registration. In the universal arm of the study all presentations in the recruitment period were included. Universal screening included all patients presenting to allocated practices. Results A total of 3562 potential participants were approached. The odds ratio of being screen positive was higher for the targeted group versus the universal group. Yet the vast majority of those screening positive in the universal group of the study would have been missed by a targeted approach. A combination of age and gender was a more efficient approach than targeting by clinical condition or context. Conclusions While screening targeted by age and gender is more efficient than universal screening, targeting by clinical condition or presentation is not. Further universal screening is more effective in identifying the full range of patients who could benefit from brief alcohol interventions, and would therefore have greater public health impact. Trial registration Current Controlled Trials ISRCTN06145674.
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Affiliation(s)
- Simon Coulton
- Centre for Health Services Studies, University of Kent, Canterbury CT2 7NZ, Kent, UK
| | - Veronica Dale
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Paolo Deluca
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK
| | - Eilish Gilvarry
- Plummer Court - Northumberland Tyne and Wear NHS Foundation Trust, Newcastle NE1 6UR, UK
| | - Christine Godfrey
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK
| | - Ruth McGovern
- Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK
| | | | - Robert Patton
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Katherine Perryman
- Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester M13 9PL, UK
| | - Thomas Phillips
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.,Humber NHS Foundation Trust, Willerby HU10 6ED, UK
| | - Jonathan Shepherd
- Crime and Security Research Group, Cardiff University, Cardiff CF10 3DB, Wales, UK
| | - Colin Drummond
- Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK
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Dickson R, Boland A, Duarte R, Kotas E, Woolacott N, Hodgson R, Riemsma R, Grimm S, Ramaekers B, Joore M, Büyükkaramikli N, Kaltenthaler E, Stevenson M, Pandor A, Edwards S, Hoyle M, Shepherd J, Armoiry X, Brazzelli M. EMA and NICE Appraisal Processes for Cancer Drugs: Current Status and Uncertainties. Appl Health Econ Health Policy 2018; 16:429-432. [PMID: 29808296 PMCID: PMC6028888 DOI: 10.1007/s40258-018-0393-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Rumona Dickson
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK.
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK
| | - Eleanor Kotas
- Liverpool Reviews and Implementation Group, University of Liverpool, Whelan Building, Liverpool, L69 3GB, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Sabine Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nasuh Büyükkaramikli
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Eva Kaltenthaler
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Matt Stevenson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Abdullah Pandor
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Martin Hoyle
- Peninsula Technology Assessment Group, University of Exeter Medical School, Exeter, UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | | | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Coulton S, Dale V, Deluca P, Gilvarry E, Godfrey C, Kaner E, McGovern R, Newbury-Birch D, Patton R, Parrott S, Perryman K, Phillips T, Shepherd J, Drummond C, Heather N. Corrigendum: Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches. Alcohol Alcohol 2018; 53:499. [PMID: 29617716 DOI: 10.1093/alcalc/agy022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Indexed: 11/13/2022] Open
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Bollu LR, Shepherd J, Zhao D, Ma Y, Mazumdar A, Brown PH. Abstract 2532: Wild-type p53 represses MELK expression by blocking the recruitment of FOXM1 to MELK promoter. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2532] [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: Triple-negative breast cancer (TNBC) is the most aggressive form of breast cancer with poor prognosis due to frequent distant metastasis and lack of successful targeted therapies. To identify potential druggable targets, previously we performed a gene expression analysis and identified protein kinases that are highly expressed in TNBCs. In this study, we investigated the molecular mechanism through which wild-type p53 represses MELK expression in TNBC cells. Through these studies, we discovered that the expression of Maternal Embryonic Leucine zipper Kinase (MELK) is highly elevated in TNBC when wild-type p53 is lost or mutated. We also show that overexpression of wild-type p53 represses MELK expression without binding to MELK promoter.
Experimental Design and Methods: To identify the p53-responsive region in MELK promoter, we have made multiple promoter deletions using PCR deletion mutagenesis. The p53-responsive region was determined by measuring the activity of these promoter constructs in the presence of wild-type p53 using luciferase assays. TransFac software was used to identify potential transcription factors in the p53-responsive region. The effect of overexpression of p53 and FOXM1 on MELK expression was examined through Western blotting analysis. Using co-immuno precipitation (Co-IP) studies, we determined the protein-protein interactions between wild-type p53 and FOXM1. The effect of wild-type on FOXM1 recruitment was determined using chromatin immuno precipitation (ChIP) assays.
Results: Through promoter deletion analysis, we identified that deletion of the region between -1.69kb to -0.69kb in MELK promoter significantly reduced p53-dependent suppressive effect on MELK promoter activity. Screening this p53-responsive region using TransFac software, we identified a binding site for FOXM1, a previously reported MELK transcription factor. Similar to the regulation of MELK by wild-type p53, overexpression of wild-type p53 repressed FOXM1 and knockdown of wild-type p53 increased FOXM1 expression. Overexpression of FOXM1 increased MELK expression in p53-null and p53-mutant cells but not in p53 wild-type cells. Co-IP studies revealed that wild-type p53 interacts with FOXM1. ChIP studies revealed that overexpression of wild-type p53 significantly reduced the recruitment of FOXM1 to MELK promoter in TNBC cells.
Conclusion: These studies elucidated the regulation of MELK expression by wild-type p53 and demonstrated that wild-type p53 represses MELK expression by inhibiting expression and recruitment of FOXM1 to the MELK promoter. In this study, we identified a novel mechanism for upregulation of MELK expression in TNBC, which is associated with poor prognosis of breast cancer patients.
This work was supported by Susan G Komen Promise Grant (PB, SH, GM), SAB Komen grant (PB) and Young Foundation grant (PB).
Citation Format: Lakshmi Reddy Bollu, Jonathan Shepherd, Dekuang Zhao, Yanxia Ma, Abhijit Mazumdar, Powel H. Brown. Wild-type p53 represses MELK expression by blocking the recruitment of FOXM1 to MELK promoter [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2532.
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Affiliation(s)
| | | | | | - Yanxia Ma
- UT MD Anderson Cancer Ctr., Houston, TX
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Ma Y, Shepherd J, Zhao D, Bollu L, Hill J, Zhang Y, Mazumdar A, Brown PH. Abstract 3347: SOX9 is a critical regulator of triple-negative breast cancer growth and invasion. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-3347] [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: 11/16/2022]
Abstract
Abstract
Background: Triple-negative breast cancers (TNBCs) have the worst prognosis of all breast cancers, and have few available therapies other than non-specific and toxic chemotherapy. To identify novel targets for TNBCs, we investigated expression levels of transcription factors (TFs) in TNBCs compared to those in Non-TNBCs. Our previous analyses identified the TFs highly expressed in TNBCs. Of these, six SRY (Sex Determining Region Y)-related HMG-box (SOX) TFs were highly expressed in TNBCs as compared to non-TNBCs. SOX genes belong to a superfamily of gene. There are approximately 20 SOX genes in humans and mice.
Hypothesis: SOX TFs are important regulators of TNBC cell growth and metastasis.
Material and Methods: We measured breast cancer cell growth using an automated cell counting assay. Cell migration and invasion were detected by transwell assays in non-TNBC (MCF7 and ZR75-1) and TNBC (MDA231 and MDA468) cells. DOX-inducible SOX9-knockout (KO) cell lines were established in MDA231, MDA468, and LM2 cell lines using an inducible Cas9-CRISPR system. A SOX9 expressing lentivirus was used to overexpress SOX9, and siRNAs were used to knockdown (KD) SOXs in the different breast cancer cells. Cell cycle phase and apoptosis were detected using flow cytometric analysis. Protein and mRNA levels of SOX9 in cell lines were examined by western blotting and qRT-PCR assays. SOX9 RNA expression data were obtained from the Oncomine Database. The Curtis dataset was used to analyze survival according to SOX9 expression using Kaplan-Meier survival curves and the statistical significance was determined using the log-rank test.
Results: We performed a screen using specific siRNA targeting the 6 SOX transcription factors (SOX4, 6, 8, 9, 10 and 11) that are high-expressed in TNBC, and measured the effect of loss on SOX expression on TNBC cell growth and invasion. SOX4, 6, 8, 9, and 10-KD using siRNA caused decreased cell proliferation (by 30% or more) of MDA231 and MDA468 TNBC cells, but not of MCF7 and T47D cell lines (non-TNBC). SOX11 or 17-KD had no effect on breast cancer growth. SOX9-KD and SOX9-KO decreased cell migration and invasion of MDA231 and MDA468 cells. Reduced expression of SOX9 also inhibited the in vivo growth and metastasis of MDA MB-231 and LM2 cells in mice. In contrast, overexpression of SOX9 in MCF7 and ZR75-1 cells increased cell migration and invasion. Our studies also demonstrated that loss of SOX9 induced a G1 to S cell cycle arrest and apoptosis. In addition, high expression of SOX9 was correlated with worse overall survival and 5-year disease-free survival in patients with TNBC breast cancer.
Conclusion: Our results demonstrate that the SOX9 acts as an essential molecule regulating TNBC growth and invasion. In the future, it may be possible to target SOX9 and its downstream genes to treat TNBC and prevent its metastasis.
Grant Support: These studies were supported by a Susan G. Komen for the Cure Promise Grant (PB).
Citation Format: Yanxia Ma, Jonathan Shepherd, Dekuang Zhao, Lakshmi Bollu, Jamal Hill, Yun Zhang, Abhijit Mazumdar, Powel H. Brown. SOX9 is a critical regulator of triple-negative breast cancer growth and invasion [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3347.
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Affiliation(s)
- Yanxia Ma
- MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Yun Zhang
- MD Anderson Cancer Center, Houston, TX
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Page N, Sivarajasingam V, Jones S, Shepherd J. Links between deprivation and risk of violence-related injury: a qualitative study to identify potential causal mechanisms. J Public Health (Oxf) 2018; 40:e59-e65. [PMID: 28977487 DOI: 10.1093/pubmed/fdx073] [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] [Received: 12/13/2016] [Accepted: 06/13/2017] [Indexed: 11/14/2022] Open
Abstract
Background Deprivation has been shown to have a greater effect on risk of violent injury among adolescent girls than boys, but the mechanisms underlying this association have not been identified. Methods In this qualitative study designed to identify causal mechanisms, focus groups involving girls aged 14-16 years attending secondary schools in South Wales, UK, were convened. Schools were recruited based on a measure of area-level deprivation. Discussions were audio-recorded and transcripts analysed thematically. Results Girls from more deprived areas tended not to participate in organized activities, obtained alcohol from multiple sources, consumed alcoholic drinks of varying strengths in both supervised and unsupervised settings, and tended not to feel trusted by their parents; this led to poor adolescent-parent communication. Girls from less deprived areas tended to participate in organized activities, obtain alcohol from parents, consume low strength alcohol in supervised settings, and have a trusting and communicative relationship with their parents. Conclusion Deprivation may increase risk of adolescent girls sustaining violence-related injury by increasing their time spent in unsupervised environments, with alcohol and without parental knowledge.
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Affiliation(s)
- N Page
- Wales Institute of Social and Economic Research, Data and Methods (WISERD), Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, UK
| | - V Sivarajasingam
- Violence Research Group, School of Dentistry, Cardiff University, Heath Park, Cardiff, UK
| | - S Jones
- Public Health Wales, Capital Quarter 2, Tyndall Street, Cardiff, UK
| | - J Shepherd
- Violence Research Group, School of Dentistry, Cardiff University, Heath Park, Cardiff, UK
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Sivarajasingam V, Read S, Svobodova M, Wight L, Shepherd J. Injury resulting from targeted violence: An emergency department perspective. Crim Behav Ment Health 2018; 28:295-308. [PMID: 29266565 DOI: 10.1002/cbm.2066] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/25/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Hate crimes - those perpetrated because of perceived difference, including disability, race, religion, sexual orientation or transgender status - have not been studied at the point of the victim's hospital emergency department (ED) use. AIM To investigate the frequency, levels of physical harm and circumstances of targeted violence in those seeking treatment at EDs in three UK cities. METHOD In a multimethods study, face-to-face semi-structured interviews were conducted with 124 adult ED attenders with violent injuries. Victim and perpetrator socio-demographics were recorded. Patient narratives about perceived motives and circumstances were transcribed, uploaded onto NVivo for thematic analysis. RESULTS Nearly a fifth (23, 18.5%) of the injured patients considered themselves to have been attacked by others motivated by hostility or prejudice to their 'difference' (targeted violence). Thematic analyses suggested these prejudices were to appearance (7 cases), racial tension (5 cases), territorial association (3 cases) and race, religious or sexual orientation (8 cases). According to victims, alcohol intoxication was particularly relevant in targeted violence (estimated reported frequency 90% and 56% for targeted and non-targeted violence, respectively). CONCLUSIONS Our findings support a broader concept of hate victimisation and suggest that emergency room violence surveys could act as a community tension sensor and early warning system in this regard. Tackling alcohol misuse seems as important in this as in other forms of violence perpetration. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Simon Read
- Violence Research Group, Cardiff University, School of Dentistry, Cardiff, CF14 4XY, UK
| | - Martina Svobodova
- Violence Research Group, Cardiff University, School of Dentistry, Cardiff, CF14 4XY, UK
| | - Lucy Wight
- Violence Research Group, Cardiff University, School of Dentistry, Cardiff, CF14 4XY, UK
| | - Jonathan Shepherd
- Violence Research Group, Cardiff University, School of Dentistry, Cardiff, CF14 4XY, UK
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Shepherd J, Frampton GK, Pickett K, Wyatt JC. Peer review of health research funding proposals: A systematic map and systematic review of innovations for effectiveness and efficiency. PLoS One 2018; 13:e0196914. [PMID: 29750807 PMCID: PMC5947897 DOI: 10.1371/journal.pone.0196914] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/23/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate methods and processes for timely, efficient and good quality peer review of research funding proposals in health. METHODS A two-stage evidence synthesis: (1) a systematic map to describe the key characteristics of the evidence base, followed by (2) a systematic review of the studies stakeholders prioritised as relevant from the map on the effectiveness and efficiency of peer review 'innovations'. Standard processes included literature searching, duplicate inclusion criteria screening, study keyword coding, data extraction, critical appraisal and study synthesis. RESULTS A total of 83 studies from 15 countries were included in the systematic map. The evidence base is diverse, investigating many aspects of the systems for, and processes of, peer review. The systematic review included eight studies from Australia, Canada, and the USA, evaluating a broad range of peer review innovations. These studies showed that simplifying the process by shortening proposal forms, using smaller reviewer panels, or expediting processes can speed up the review process and reduce costs, but this might come at the expense of peer review quality, a key aspect that has not been assessed. Virtual peer review using videoconferencing or teleconferencing appears promising for reducing costs by avoiding the need for reviewers to travel, but again any consequences for quality have not been adequately assessed. CONCLUSIONS There is increasing international research activity into the peer review of health research funding. The studies reviewed had methodological limitations and variable generalisability to research funders. Given these limitations it is not currently possible to recommend immediate implementation of these innovations. However, many appear promising based on existing evidence, and could be adapted as necessary by funders and evaluated. Where feasible, experimental evaluation, including randomised controlled trials, should be conducted, evaluating impact on effectiveness, efficiency and quality.
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Affiliation(s)
- Jonathan Shepherd
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Geoff K. Frampton
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Karen Pickett
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jeremy C. Wyatt
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Grimmett C, Pickett K, Shepherd J, Welch K, Recio-Saucedo A, Streit E, Seers H, Armstrong A, Cutress RI, Evans DG, Copson E, Meiser B, Eccles D, Foster C. Systematic review of the empirical investigation of resources to support decision-making regarding BRCA1 and BRCA2 genetic testing in women with breast cancer. Patient Educ Couns 2018; 101:779-788. [PMID: 29225062 DOI: 10.1016/j.pec.2017.11.016] [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: 06/08/2017] [Revised: 11/09/2017] [Accepted: 11/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Identify existing resources developed and/or evaluated empirically in the published literature designed to support women with breast cancer making decisions regarding genetic testing for BRCA1/2 mutations. METHODS Systematic review of seven electronic databases. Studies were included if they described or evaluated resources that were designed to support women with breast cancer in making a decision to have genetic counselling or testing for familial breast cancer. Outcome and process evaluations, using any type of study design, as well as articles reporting the development of decision aids, were eligible for inclusion. RESULTS Total of 9 publications, describing 6 resources were identified. Resources were effective at increasing knowledge or understanding of hereditary breast cancer. Satisfaction with resources was high. There was no evidence that any resource increased distress, worry or decisional conflict. Few resources included active functionalities for example, values-based exercises, to support decision-making. CONCLUSION Tailored resources supporting decision-making may be helpful and valued by patients and increase knowledge of hereditary breast cancer, without causing additional distress. PRACTICE IMPLICATIONS Clinicians should provide supportive written information to patients where it is available. However, there is a need for robustly developed decision tools to support decision-making around genetic testing in women with breast cancer.
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Affiliation(s)
- Chloe Grimmett
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Karen Pickett
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.
| | - Karen Welch
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.
| | - Alejandra Recio-Saucedo
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) Wessex, University of Southampton, Southampton, UK.
| | - Elke Streit
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK.
| | - Helen Seers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Armstrong
- Christie Hospital NHS Foundation Trust and Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Ramsey I Cutress
- University of Southampton and University Hospital Southampton, Somers Cancer Research Building, Southampton, UK.
| | - D Gareth Evans
- Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK.
| | - Ellen Copson
- University of Southampton and University Hospital Southampton, Somers Cancer Research Building, Southampton, UK.
| | - Bettina Meiser
- Faculty of Medicine, University of New South Wales, New South Wales, 2033, Australia.
| | - Diana Eccles
- University of Southampton and University Hospital Southampton, Somers Cancer Research Building, Southampton, UK.
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
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Granowska M, Mather SJ, Jobling T, Naeem M, Burchell J, Taylor-Papadimitriou J, Shepherd J, Britton KE. Radiolabelled Stripped Mucin, SM3, Monoclonal Antibody for Immunoscintigraphy of Ovarian Tumours. Int J Biol Markers 2018; 5:89-96. [PMID: 2283483 DOI: 10.1177/172460089000500208] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A new monoclonal antibody, SM3, against stripped mucin core protein has been evaluated for the radioimmunoscintigraphy of ovarian cancer. It was radiolabelled with In-111, I-123 and Tc-99m and results showed a sensitivity of 95%, 100% and 100% and an accuracy of 73%, 86% and 100% for malignancy; respectively.
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Affiliation(s)
- M Granowska
- Department of Nuclear Medicine, St. Bartholomew's Hospital, London, England
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Shepherd J, Cooper K, Harris P, Picot J, Rose M. The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation. Health Technol Assess 2018; 20:1-222. [PMID: 27135404 DOI: 10.3310/hta20340] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is characterised by joint pain, swelling and a limitation of movement caused by inflammation. Subsequent joint damage can lead to disability and growth restriction. Treatment commonly includes disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. Clinical practice now favours newer drugs termed biologic DMARDs where indicated. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of four biologic DMARDs [etanercept (Enbrel(®), Pfizer), abatacept (Orencia(®), Bristol-Myers Squibb), adalimumab (Humira(®), AbbVie) and tocilizumab (RoActemra(®), Roche) - with or without methotrexate where indicated] for the treatment of JIA (systemic or oligoarticular JIA are excluded). DATA SOURCES Electronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and the Database of Abstracts of Reviews of Effects were searched for published studies from inception to May 2015 for English-language articles. Bibliographies of related papers, systematic reviews and company submissions were screened and experts were contacted to identify additional evidence. REVIEW METHODS Systematic reviews of clinical effectiveness, health-related quality of life and cost-effectiveness were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A cost-utility decision-analytic model was developed to compare the estimated cost-effectiveness of biologic DMARDs versus methotrexate. The base-case time horizon was 30 years and the model took a NHS perspective, with costs and benefits discounted at 3.5%. RESULTS Four placebo-controlled randomised controlled trials (RCTs) met the inclusion criteria for the clinical effectiveness review (one RCT evaluating each biologic DMARD). Only one RCT included UK participants. Participants had to achieve an American College of Rheumatology Pediatric (ACR Pedi)-30 response to open-label lead-in treatment in order to be randomised. An exploratory adjusted indirect comparison suggests that the four biologic DMARDs are similar, with fewer disease flares and greater proportions of ACR Pedi-50 and -70 responses among participants randomised to continued biologic DMARDs. However, confidence intervals were wide, the number of trials was low and there was clinical heterogeneity between trials. Open-label extensions of the trials showed that, generally, ACR responses remained constant or even increased after the double-blind phase. The proportions of adverse events and serious adverse events were generally similar between the treatment and placebo groups. Four economic evaluations of biologic DMARDs for patients with JIA were identified but all had limitations. Two quality-of-life studies were included, one of which informed the cost-utility model. The incremental cost-effectiveness ratios (ICERs) for adalimumab, etanercept and tocilizumab versus methotrexate were £38,127, £32,526 and £38,656 per quality-adjusted life year (QALY), respectively. The ICER for abatacept versus methotrexate as a second-line biologic was £39,536 per QALY. LIMITATIONS The model does not incorporate the natural history of JIA in terms of long-term disease progression, as the current evidence is limited. There are no head-to-head trials of biologic DMARDs, and clinical evidence for specific JIA subtypes is limited. CONCLUSIONS Biologic DMARDs are superior to placebo (with methotrexate where permitted) in children with (predominantly) polyarticular course JIA who have had an insufficient response to previous treatment. Randomised comparisons of biologic DMARDs with long-term efficacy and safety follow-up are needed to establish comparative effectiveness. RCTs for JIA subtypes for which evidence is lacking are also required. STUDY REGISTRATION This study is registered as PROSPERO CRD42015016459. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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