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Radhoe SP, Boersma E, Bertrand M, Remme W, Ferrari R, Fox K, MacMahon S, Chalmers J, Simoons ML, Brugts JJ. The Effects of a Perindopril-Based Regimen in Relation to Statin Use on the Outcomes of Patients with Vascular Disease: a Combined Analysis of the ADVANCE, EUROPA, and PROGRESS Trials. Cardiovasc Drugs Ther 2024; 38:131-139. [PMID: 36194352 PMCID: PMC10876738 DOI: 10.1007/s10557-022-07384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effects of a perindopril-based regimen on cardiovascular (CV) outcomes in patients with vascular disease in relation to background statin therapy. METHODS A pooled analysis of the randomized ADVANCE, EUROPA, and PROGRESS trials was performed to evaluate CV outcomes in 29,463 patients with vascular disease treated with perindopril-based regimens versus placebo. The primary endpoint was a composite of CV mortality, nonfatal myocardial infarction, and stroke. Multivariable Cox regression analyses were performed to assess the effects of a perindopril-based regimen versus placebo in relation to statin use. RESULTS At randomization, 39.5% of the overall combined study population used statins. After a mean follow-up of 4.0 years (SD 1.0), the cumulative event-free survival was highest in the statin/perindopril group and lowest in the no statin/placebo group (91.2% vs. 85.6%, respectively, log-rank p < 0.001). In statin users (adjusted hazard ratio [aHR] 0.87, 95% confidence interval [CI] 0.77-0.98) and non-statin users (aHR 0.80, 95% CI 0.74-0.87), a perindopril-based regimen was associated with a significantly lower risk of the primary endpoint when compared to placebo. The additional treatment effect appeared numerically greater in non-statin users, but the observed difference was statistically nonsignificant. CONCLUSION Our data suggest that the treatment benefits of a perindopril-based regimen in patients with vascular disease are independent of statin use.
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Affiliation(s)
- S P Radhoe
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands.
| | - E Boersma
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | | | - W Remme
- STICARES Cardiovascular Research Institute, Rhoon, the Netherlands
| | - R Ferrari
- Department of Cardiology, University of Ferrara, Ferrara, Italy
| | - K Fox
- NHLI, Imperial College and Royal Brompton Hospital, London, UK
| | - S MacMahon
- The George Institute for Global Health, The University of NSW, Sydney, NSW, Australia
| | - J Chalmers
- The George Institute for Global Health, The University of NSW, Sydney, NSW, Australia
| | - M L Simoons
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - J J Brugts
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
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Lancaster JJ, Grijalva A, Fink J, Ref J, Daugherty S, Whitman S, Fox K, Gorman G, Lancaster LD, Avery R, Acharya T, McArthur A, Strom J, Pierce MK, Moukabary T, Borgstrom M, Benson D, Mangiola M, Pandey AC, Zile MR, Bradshaw A, Koevary JW, Goldman S. Biologically derived epicardial patch induces macrophage mediated pathophysiologic repair in chronically infarcted swine hearts. Commun Biol 2023; 6:1203. [PMID: 38007534 PMCID: PMC10676365 DOI: 10.1038/s42003-023-05564-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 11/09/2023] [Indexed: 11/27/2023] Open
Abstract
There are nearly 65 million people with chronic heart failure (CHF) globally, with no treatment directed at the pathologic cause of the disease, the loss of functioning cardiomyocytes. We have an allogeneic cardiac patch comprised of cardiomyocytes and human fibroblasts on a bioresorbable matrix. This patch increases blood flow to the damaged heart and improves left ventricular (LV) function in an immune competent rat model of ischemic CHF. After 6 months of treatment in an immune competent Yucatan mini swine ischemic CHF model, this patch restores LV contractility without constrictive physiology, partially reversing maladaptive LV and right ventricular remodeling, increases exercise tolerance, without inducing any cardiac arrhythmias or a change in myocardial oxygen consumption. Digital spatial profiling in mice with patch placement 3 weeks after a myocardial infarction shows that the patch induces a CD45pos immune cell response that results in an infiltration of dendritic cells and macrophages with high expression of macrophages polarization to the anti-inflammatory reparative M2 phenotype. Leveraging the host native immune system allows for the potential use of immunomodulatory therapies for treatment of chronic inflammatory diseases not limited to ischemic CHF.
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Affiliation(s)
- J J Lancaster
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - A Grijalva
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - J Fink
- Division of Blood & Marrow Transplant & Cellular Therapy, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA
| | - J Ref
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - S Daugherty
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - S Whitman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - K Fox
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
- Division of Cardiothoracic Surgery, Department of Surgery, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - G Gorman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - L D Lancaster
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - R Avery
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - T Acharya
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - A McArthur
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - J Strom
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M K Pierce
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - T Moukabary
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M Borgstrom
- Research & Discovery Tech, Research Computing Specialist, Principal, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - D Benson
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
| | - M Mangiola
- Department of Pathology, NYU Grossman School of Medicine, New York City, NY, 11016, USA
| | - A C Pandey
- Section of Cardiology, Tulane University Heart and Vascular Institute, John W. Deming Department of Medicine, Section of Cardiology, Department of Medicine, Southeast Louisiana Veterans Healthcare System, Tulane University School of Medicine, New Orleans, LA, 70122, USA
| | - M R Zile
- Ralph H. Johnson VA Medical Center, Division of Cardiology, Medical University of South Carolina, Thurmond/Gazes Building, 30 Courtenay Drive, Charleston, SC, 29425, USA
| | - A Bradshaw
- Ralph H. Johnson VA Medical Center, Division of Cardiology, Medical University of South Carolina, Thurmond/Gazes Building, 30 Courtenay Drive, Charleston, SC, 29425, USA
| | - J W Koevary
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA
- Biomedical Engineering, College of Engineering, University of Arizona, 1127 E. James E. Rogers Way, Tucson, AZ, 85721, USA
| | - S Goldman
- Sarver Heart Center, Department of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724, USA.
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Cowell K, Pang TY, Kwok JS, McCrowe C, Langenberg F, Easton D, Williams C, Davis SM, Donnan GA, De Aizpurua H, Balabanski A, Dos Santos A, Fox K. Can We Miniaturize CT Technology for a Successful Mobile Stroke Unit Roll-Out? Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-5. [PMID: 38083304 DOI: 10.1109/embc40787.2023.10340965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Mortality from stroke remains high in Australia, especially for patients located outside the metropolitan cities. This is because they have limited access to specialized stroke facilities for optimal stroke treatment. Mobile stroke units have the capability to take CT scanners out to the patient however current CT commercial scanner designs are large and heavy. As such, this paper aims to design and develop a lightweight CT scanner for use in a mobile stroke unit (either road-based or air-based ambulance) to bring healthcare solution to patients in the rural and remote areas. We used the engineering design optimization approach to redesign and reduce the weight of the existing CT scanner with without compromised it structural performance. We managed to reduce the weight the CT scanner by three-fold while reducing design costs by allowing numerous simulations to be performed using computer software to achieve our design goals. The results are not only useful to optimize CT scanner structure to retrofit on a mobile stroke unit, but also bring the medical device solution to the market and support scalable solution to the larger community. Such an advance will allow for improved equity in healthcare whereby patients can be treated irrespective of location.
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Fernández Silva B, Jackson M, Fox K, Wynne BP. Tool for automatic macrozone characterization from EBSD data sets of titanium alloys. J Appl Crystallogr 2023; 56:737-749. [PMID: 37284269 PMCID: PMC10241041 DOI: 10.1107/s1600576723003862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
Microtexture heterogeneities are commonly found in titanium forgings because of the thermomechanical processing. Also known as macrozones, these regions can reach millimetres in length, with grains sharing a similar crystallographic orientation leading to less resistance to crack propagation. Since the link between macrozones and the reduction of cold-dwell-fatigue performance on rotative components in gas turbine engines was established, efforts have been put into macrozone definition and characterization. The electron backscatter diffraction (EBSD) technique, widely used for texture analysis, allows for a qualitative macrozone characterization; however, further processing is required to define the boundaries and disorientation spread of each macrozone. Current approaches often use c-axis misorientation criteria, but this can sometimes lead to a large disorientation spread within a macrozone. This article describes the development and application of a computational tool implemented in MATLAB for automatic macrozone identification from EBSD data sets on the basis of a more conservative approach where both the c-axis tilting and rotation are considered. The tool allows for detection of macrozones according to the disorientation angle and density-fraction criteria. The clustering efficiency is validated by pole-figure plots, and the effects of the key parameters defining the macrozone clustering (disorientation and fraction) are discussed. In addition, this tool was successfully applied to both fully equiaxed and bimodal microstructures of titanium forgings.
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Affiliation(s)
- B Fernández Silva
- Department of Material Science and Engineering, University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - M Jackson
- Department of Material Science and Engineering, University of Sheffield, Sheffield S1 3JD, United Kingdom
| | - K Fox
- Rolls-Royce plc, PO Box 31, Derby DE24 8BJ, United Kingdom
| | - B P Wynne
- Department of Material Science and Engineering, University of Sheffield, Sheffield S1 3JD, United Kingdom
- Department of Mechanical and Aerospace Engineering, University of Strathclyde, 75 Montrose Street, Glasgow G1 1XJ, United Kingdom
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Pareek M, Bhatt DL, Zheng L, Lee JJ, Leiter LA, Simon T, Mehta SR, Harrington RA, Fox K, Himmelmann A, Vidal-Petiot E, Steg PG. Blood pressure and clinical outcomes in patients with diabetes and stable coronary artery disease in THEMIS. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1226] [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: 11/12/2022] Open
Abstract
Abstract
Background
Various BP characteristics, e.g., systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP), as well as heart rate (HR) may affect the risk of both cardiovascular events and bleeding events. However, the exact way in which these characteristics and outcomes are associated among patients with diabetes and stable coronary artery disease (CAD) remains debated. Moreover, it is unknown whether the risks and benefits of intensified antiplatelet therapy in this patient population are affected by their baseline BP and HR.
Purpose
To assess the relationship between BP components (including HR) and cardiovascular and bleeding events, and to determine if the effects of ticagrelor vs. placebo varied across the BP and HR spectrum, in patients with diabetes and stable CAD.
Methods
THEMIS was a randomized, controlled trial in which 19,220 individuals ≥50 years of age with stable CAD and type 2 diabetes were randomized to receive either ticagrelor plus aspirin or placebo plus aspirin. Patients with a prior myocardial infarction or stroke, or already on dual antiplatelet therapy, were excluded. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was TIMI major bleeding. We examined prognostic implications of BP components using 1) restricted cubic splines for the overall trends with outcomes; 2) Cox proportional-hazards regression models with predefined BP component intervals adjusted for demographic, clinical, and laboratory variables; and 3) Cox regression models for the effects of ticagrelor vs. placebo on outcomes across the spectrum of BP component values (test for interaction). THEMIS is registered at ClinicalTrials.gov (NCT01991795).
Results
Mean values of baseline BP components were similar between the two study groups. Median follow-up duration was 39.9 months (range 0–57), with 1554 primary efficacy events and 306 primary safety events occurring over the course of the study. All BP components (including HR) displayed various, independent relationships with the tested outcomes. For example, in adjusted spline models, SBP displayed non-linear relationships with the primary outcome, all-cause death, any bleeding, serious adverse events, and intracranial bleeding, and linear relationships with the remaining outcomes. Figure 1 shows the associations of each BP component with the primary efficacy outcome. BP components did not substantially modify the risks and benefits of ticagrelor vs. placebo for the tested outcomes.
Conclusions
BP components were independently associated with efficacy and safety outcomes in patients with stable CAD and type 2 diabetes. However, no important modification of BP components on the effect of ticagrelor vs. placebo was detected.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- M Pareek
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - D L Bhatt
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - L Zheng
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - J J Lee
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - L A Leiter
- St. Michael's Hospital , Toronto , Canada
| | - T Simon
- Sorbonne University , Paris , France
| | - S R Mehta
- McMaster University , Hamilton , Canada
| | - R A Harrington
- Stanford University Medical Center , Stanford , United States of America
| | - K Fox
- Royal Brompton Hospital Imperial College London , London , United Kingdom
| | - A Himmelmann
- AstraZeneca BioPharmaceuticals , Molndal , Sweden
| | - E Vidal-Petiot
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
| | - P G Steg
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
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Barrowcliff A, Khan M, Fox K, Khatib R. Management of statin intolerance in a pharmacy led cardiology innovative medicines optimisation lipid clinic. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2759] [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: 11/13/2022] Open
Abstract
Abstract
Background
Statins are cornerstone in the management of atherosclerotic cardiovascular disease. If a patient has experienced clinically significant adverse drug reactions (ADRs), representing an unacceptable risk or may result in adherence issues, we would consider them intolerant. The prevalence is lower in randomised trials than cohort observational studies, 5% vs. 17%.
Purpose
To assess how many people we reviewed in clinic were able to be re-challenged and successfully continued on a statin, free from side effects.
Methods
Over 6 months we reviewed all patients referred to our innovative clinic for lipid optimisation labelled as “statin intolerant”. Initially, as per our protocol, we adopted a person-centred approach and explored this label (actual vs. potential concerns, any previous issues, symptoms experienced and timings, statins tried (if any), and patient's feelings on re-challenge). A statin re-challenge was offered if not contraindicated. If agreed, based on shared-decision making, we offered patients a once weekly statin (usually rosuvastatin 5mg) with a clear self-management plan to up/down-titrate frequency and dose, until they identify a tolerated regimen. We measured LDL-C at baseline and every 3 months thereafter until satisfactory.
Results
Of 207 patients referred 152 (73%) were labelled as “statin intolerant”. Average age was 62 (±11), 51% females. 78% for secondary prevention and 37% had familial hypercholesterolaemia. The average baseline LDL-C was 4.4mmol/L. 108 (71%) qualified for PCSK9 inhibitors therapy (PCSK9i) as per UK NICE guidance.
The top 3 reported ADRs were musculoskeletal side effects (48%), GI upsets (13%) and deranged LFTs (7%).
25 (58%) of those “intolerant” who did not qualify for PCSK9i attempted a re-challenge with statins vs. 44 (41%) among those who qualified.
Of the 69 patients, who accepted a re-challenge, 43 (62%) were successfully restarted on a statin. At an average of 14 months post re-challenge, LDL-C (available for >80% of the sample) was reduced by an average of 31% in those not on PCSK9i, compared to a 62% reduction (sustained over an average of 40 months) in those on combination therapy with PCSK9i.
The top 3 rosuvastatin regimens established were 5mg OD (29%), 5mg weekly (24%) and 10mg OD (15%). Approximately 80% of patients were on rosuvastatin, and the rest accepted atorvastatin, pravastatin or simvastatin.
There was no attempt to re-challenge in 77 (51%) patients, mostly due to choice (45%) or statins re-challenged prior to referral (44%). We stopped statins in 6 cases due to intolerable ADRs.
Conclusion(s)
By using a person-centred approach, and a variety of strategies to tackle “statin intolerance” we have successfully re-established over 60% of patients with very high CVD risk on statins. While patients who qualified for PCSK9i therapy were less likely to consider re-challenge with statins (41% v 58%), combination lipid-lowering therapies produced better reduction in LDL-C.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - M Khan
- Leeds Teaching Hospitals , Leeds , United Kingdom
| | - K Fox
- Leeds Teaching Hospitals , Leeds , United Kingdom
| | - R Khatib
- Leeds Teaching Hospitals , Leeds , United Kingdom
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Reyburn R, Tuivaga E, Ratu F, Dunne E, Nand D, Kado J, Jenkins K, Tikoduadua L, Jenney A, Howden B, Ballard S, Fox K, Devi R, Satzke C, Rafai E, Kama M, Flasche S, Mulholland E, Russell F. The impact of 10-valent pneumococcal vaccine introduction on invasive disease in Fiji. Lancet Reg Health West Pac 2022; 20:100352. [PMID: 35028629 PMCID: PMC8741523 DOI: 10.1016/j.lanwpc.2021.100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND In 2012, Fiji introduced the 10-valent pneumococcal conjugate vaccine (PCV10). We assessed the impact of PCV10 on invasive pneumococcal disease (IPD), probable bacterial or pneumococcal meningitis (PBPM), meningitis and sepsis 3-5 years post-introduction. METHODS Laboratory-confirmed IPD and PBPM cases were extracted from national laboratory records. ICD-10-AM coded all-cause meningitis and sepsis cases were extracted from national hospitalisation records. Incidence rate ratios were used to compare outcomes pre/post-PCV10, stratified by age groups: 1-23m, 2-4y, 5-9y, 10-19y, 20-54y, ≥55y. To account for different detection and serotyping methods in the pre-and post-PCV10 period, a Bayesian inference model estimated serotype-specific changes in IPD, using pneumococcal carriage and surveillance data. FINDINGS There were 423 IPD, 1,029 PBPM, 1,391 all-cause meningitis and 7,611 all-cause sepsis cases. Five years post-PCV10 introduction, IPD declined by 60% (95%CI: 37%, 76%) in children 1-23m months old, and in age groups 2-4y, 5-9y, 10-19y although confidence intervals spanned zero. PBPM declined by 36% (95%CI: 21%, 48%) among children 1-23 months old, and in all other age groups, although some confidence intervals spanned zero. Among children <5y of age, PCV10-type IPD declined by 83% (95%CI; 70%, 90%) and with no evidence of change in non-PCV10-type IPD (9%, 95%CI; -69, 43%). There was no change in all-cause meningitis or sepsis. Post-PCV10, the most common serotypes in vaccine age-eligible and non-age eligible people were serotypes 8 and 23B, and 3 and 7F, respectively. INTERPRETATIONS Our study demonstrates the effectiveness of PCV10 against IPD in a country in the Asia-Pacific of which there is a paucity of data. FUNDING This study was support by the Department of Foreign Affairs and Trade of the Australian Government and Fiji Health Sector Support Program (FHSSP). FHSSP is implemented by Abt JTA on behalf of the Australian Government.
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Affiliation(s)
- R. Reyburn
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - E.J. Tuivaga
- The Ministry of Health and Medical Services, Suva, Fiji
| | - F.T. Ratu
- The Ministry of Health and Medical Services, Suva, Fiji
| | - E.M. Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - D. Nand
- The Ministry of Health and Medical Services, Suva, Fiji
| | - J. Kado
- Fiji National University, Suva, Fiji
| | - K. Jenkins
- Australia's support to the Fiji health sector, Suva, Fiji
| | - L. Tikoduadua
- The Ministry of Health and Medical Services, Suva, Fiji
| | - A. Jenney
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Fiji National University, Suva, Fiji
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Victoria, Australia
| | - B.P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
- WHO Regional Reference Laboratory for Invasive Bacterial-Vaccine Preventable Diseases (IB-VPD) for Western Pacific Region, Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - S.A. Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
- WHO Regional Reference Laboratory for Invasive Bacterial-Vaccine Preventable Diseases (IB-VPD) for Western Pacific Region, Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - K. Fox
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R. Devi
- The Ministry of Health and Medical Services, Suva, Fiji
| | - C. Satzke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - E. Rafai
- The Ministry of Health and Medical Services, Suva, Fiji
| | - M. Kama
- The Ministry of Health and Medical Services, Suva, Fiji
| | - S. Flasche
- Centre for Mathematical Modelling for Infectious diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - E.K. Mulholland
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Centre for Mathematical Modelling for Infectious diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - F.M. Russell
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Fox K, Burgess A, Williamson ME, Massey J, Shaler G, Pearson K, MacKenzie J, Merchant K, Zhu X, Ward M. Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment. J Sch Health 2022; 92:71-78. [PMID: 34806199 DOI: 10.1111/josh.13104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In rural areas with health professional workforce shortages, telehealth offers an opportunity to address service gaps and meet the health needs of students. Few studies have examined telehealth implementation in rural schools. This study explores facilitators and barriers to the implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school-based telehealth initiatives. METHODS We conducted semi-structured qualitative interviews with 50 key informants involved in the implementation of telehealth programs funded through the School-Based Telehealth Network Grant Program. Researchers completed a thematic analysis of interview transcripts. RESULTS The most commonly cited barriers were technology, reimbursement for services, and facilitating acceptance of the telehealth among school staff, clinicians, parents, and students. Key informants identified strategies for facilitating program implementation, including technology training and support, marketing efforts, and integration into existing school processes. CONCLUSIONS School-based telehealth can augment clinical capacity in areas with clinician shortages. Entities interested in such an approach to care must engage with their school community to ensure successful implementation. For rural, school-based telehealth to gain greater adoption and be sustained, these services must be reimbursable by Medicaid and private insurers.
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Affiliation(s)
- Kimberley Fox
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | | | | | - John Massey
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | - George Shaler
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | - Karen Pearson
- University of Southern Maine, 34 Bedford Street, Portland, ME, 04104
| | | | - Kimberly Merchant
- University of Iowa, College of Public Health, 145 North Riverside Drive, N242 CPHB, Iowa City, Iowa, 52242
| | - Xi Zhu
- University of Iowa, College of Public Health, 145 North Riverside Drive, N222 CPHB, Iowa City, IA, 52242
| | - Marcia Ward
- University of Iowa, College of Public Health, 145 North Riverside Drive, N236 CPHB, Iowa City, Iowa, 52242
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Graham C, Tan M, Chew D, Gale C, Fox K, Bagai A, Henderson M, Quraishi A, Dery J, Cheema A, Fisher H, Brieger D, Lutchmedial S, Lavi S, Wong B, Cieza T, Mehta S, Goodman S, Yan A. USE AND OUTCOME OF DUAL ANTIPLATELET THERAPY FOR ACUTE CORONARY SYNDROME IN PATIENTS WITH CHRONIC KIDNEY DISEASE: INSIGHTS FROM THE CANADIAN OBSERVATIONAL ANTIPLATELET STUDY (COAPT), A MULTICENTRE PROSPECTIVE COHORT STUDY. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Chan J, Mungun T, Batsaixan P, Ulziibayar M, Suuri B, Otgonbayar D, Luvsantseren D, Nguyen CD, Narangarel D, Dunne EM, Fox K, Hinds J, Nation ML, Pell CL, Mulholland EK, Satzke C, von Mollendorf C, Russell FM. Direct and indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with pneumonia from formal and informal settlements in Mongolia: an observational study. Lancet Reg Health West Pac 2021; 15:100231. [PMID: 34528012 PMCID: PMC8342962 DOI: 10.1016/j.lanwpc.2021.100231] [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] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
Background Within Ulaanbaatar, Mongolia, risk factors for pneumonia are concentrated among children living in informal settlements comprised of temporary shelters (gers). We used pneumococcal carriage surveillance among children from formal and informal settlements hospitalised with pneumonia to evaluate the direct and indirect effects of 13-valent pneumococcal conjugate vaccine (PCV13) against vaccine-type (VT) pneumococcal carriage following a phased introduction of PCV13. Methods We enrolled and collected nasopharyngeal swabs from children 2-59 months of age presenting to hospital. Pneumococci were detected using lytA qPCR and serotyped using microarray on a random monthly selection of swabs between November 2015 and March 2019 from two districts in Ulaanbaatar. PCV13 status was determined using written records. We quantified the associations between individual PCV13 status (direct effects) and district-level PCV13 coverage (indirect effects) and VT carriage using generalised estimating equations and explored interactions by settlement type. Findings A total of 1 292 swabs from 6 046 participants were tested for pneumococci. Receipt of PCV13 and increasing PCV13 coverage independently reduced the risk of VT carriage. For each percent increase in PCV13 coverage, the adjusted odds of VT carriage decreased by 1•0% (OR 95% CI 0•983-0•996; p=0•001), with a predicted decrease in VT carriage rate from 29•1% to 13•1% as coverage reached 100%. There was a trend towards a slower decline within informal settlements (p=0•100). Adjusted PCV13 vaccine effectiveness against VT carriage was 39•1% (95% CI 11•4-58•1%, p=0•009). Interpretation Substantial indirect effects were observed following PCV13 introduction, including among children living within informal settlements. Funding Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance.
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Affiliation(s)
- Jocelyn Chan
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tuya Mungun
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Purevsuren Batsaixan
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Mukhchuluun Ulziibayar
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Bujinlkham Suuri
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Dashpagam Otgonbayar
- National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Dashtseren Luvsantseren
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Dorj Narangarel
- National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Kimberley Fox
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - Jason Hinds
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom.,BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Monica L Nation
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Casey L Pell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - E Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Claire von Mollendorf
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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11
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Mollendorf CV, Lim R, Choummanivong M, Sychareun V, Vilivong K, Lai JY, Chan J, Dunne EM, Phommachanh S, Moore K, Ortika BD, Gray A, Weaver R, Mayxay M, Phetsouvanh R, Datta SS, Fox K, Newton PN, Kim Mulholland E, Nguyen CD, Dance DA, Satzke C, Xeuatvongsa A, Russell FM. 370Measuring pneumococcal conjugate vaccine impact in a low-resource setting with minimal baseline data. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.687] [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
We aimed to measure 13-valent pneumococcal conjugate vaccine (PCV13) impact on various pneumococcal endpoints with minimal baseline data.
Methods
PCV13 was introduced in October 2013 in Lao People’s Democratic Republic. We implemented studies to evaluate PCV13 impact: retrospective record review of pneumonia cases for three years pre-PCV13; prospective study of acute respiratory infection (ARI) for 4.5 years post-PCV to demonstrate effectiveness against hypoxic pneumonia; invasive pneumococcal disease (IPD) surveillance (2004-2019); carriage in children hospitalised with ARI (2013-2019); and community carriage surveys pre- and two years post-PCV13.
Results
Annual incidence of hospitalized pneumonia pre-PCV13 in children 2-59 months was 1,530 (95% confidence interval [CI] 1,477-1,584) per 100,000. Vaccine effectiveness against hypoxic pneumonia was 37% (95% CI 6-57%). In children <5 years, 85% (11/13) of IPD cases were due to PCV13 serotypes pre-PCV13, and 43% (3/7) post-PCV13; and in individuals ≥5 years, 61% (27/44) and 42% (17/40), respectively. In hospitalised children, vaccine type carriage prevalence reduced from 20.0% (95% CI 15.2-24.9%) in 2013 to 12.8% (95% CI 8.5-17.1%) in 2019 with increasing vaccine coverage. Results were consistent with community carriage studies.
Conclusions
Despite limited baseline data in Laos, we found evidence of PCV13 impact using a variety of methods. Our approach could be used in similar settings to augment existing WHO guidelines.
Key messages
A combination of methods may be useful to determine the impact of vaccine introduction in countries with limited surveillance.
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Affiliation(s)
- Claire von Mollendorf
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ruth Lim
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | | | - Keoudomphone Vilivong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
| | - Jana Y.R. Lai
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Jocelyn Chan
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Eileen M. Dunne
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Sysavanh Phommachanh
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | - Kerryn Moore
- Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Amy Gray
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Rupert Weaver
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Mayfong Mayxay
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao PDR
| | - Rattanaphone Phetsouvanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | | | - Kimberley Fox
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - E. Kim Mulholland
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cattram D. Nguyen
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - David A.B. Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Catherine Satzke
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Anonh Xeuatvongsa
- National Immunization Programme, Ministry of Health, Vientiane, Lao PDR
| | - Fiona M. Russell
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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12
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von Mollendorf C, Lim R, Choummanivong M, Sychareun V, Vilivong K, Lai JYR, Chan J, Dunne EM, Phommachanh S, Moore KA, Ortika BD, Gray A, Weaver R, Mayxay M, Phetsouvanh R, Datta SS, Fox K, Newton PN, Mulholland KE, Nguyen CD, Dance DAB, Satzke C, Russell FM. Evaluation strategies for measuring pneumococcal conjugate vaccine impact in low-resource settings. Expert Rev Vaccines 2021; 21:1137-1145. [PMID: 34378467 DOI: 10.1080/14760584.2021.1965474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Pneumococcal conjugate vaccines (PCVs) are effective in reducing pneumococcal disease. We measured 13-valent PCV (PCV13) effect on different pneumococcal outcomes using diverse studies in Lao People's Democratic Republic. METHODS Studies included: pre-PCV13 population-based record review of hospitalized childhood pneumonia cases; acute respiratory infection (ARI) study post-PCV13 to demonstrate effectiveness (VE) against hypoxic pneumonia; invasive pneumococcal disease (IPD) surveillance in all ages (2004-2018); carriage studies in children hospitalized with ARI (2013-2019); community carriage surveys pre- and post-PCV13. RESULTS Annual pneumonia incidence rate in children pre-PCV13 was 1,530 (95% confidence interval [CI] 1,477-1,584) per 100,000. Adjusted VE against hypoxic pneumonia was 37% (95% CI 6-57%). For IPD, 85% (11/13) of cases were due to vaccine-types pre-PCV13, and 43% (3/7) post-PCV13 in children aged <5 years; for ≥5 years, 61% (27/44) and 42% (17/40), respectively. For ARI cases, adjusted VE for vaccine-type carriage was 39% (95% CI 4-60) in <5 year olds; slightly higher than community surveys (23% [95% CI 4-39%] in 12-23 month olds). CONCLUSIONS Despite limited baseline data, we found evidence of PCV13 impact on disease and carriage. Our approach could be used in similar settings to augment existing WHO PCV evaluation guidelines.
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Affiliation(s)
- Claire von Mollendorf
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department Of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Ruth Lim
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Molina Choummanivong
- Faculty of Public Health, University Of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Vanphanom Sychareun
- Faculty of Public Health, University Of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Keoudomphone Vilivong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Jana Y R Lai
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Jocelyn Chan
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Eileen M Dunne
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department Of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Sysavanh Phommachanh
- Institute of Research and Education Development (IRED), University of Health Sciences, Ministry of Health, Vientiane, Lao PDR
| | - Kerryn A Moore
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Belinda D Ortika
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Amy Gray
- Department Of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Rupert Weaver
- Department Of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Mayfong Mayxay
- Faculty of Public Health, University Of Health Sciences, Ministry of Health, Vientiane, Lao PDR.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre For Tropical Medicine And Global Health, University Of Oxford, Oxford UK
| | - Rattanaphone Phetsouvanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre For Tropical Medicine And Global Health, University Of Oxford, Oxford UK
| | - Siddhartha S Datta
- Division of Combating Communicable Disease, World Health Organization, Vientiane Lao PDR
| | - Kimberley Fox
- Expanded Programme on Immunization, Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre For Tropical Medicine And Global Health, University Of Oxford, Oxford UK.,Faculty of Infectious & Tropical Diseases, London School Of Hygiene And Tropical Medicine, London, UK
| | - Kim E Mulholland
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department Of Paediatrics, The University of Melbourne, Melbourne, Australia.,Faculty of Infectious & Tropical Diseases, London School Of Hygiene And Tropical Medicine, London, UK
| | - Cattram D Nguyen
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department Of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR.,Centre For Tropical Medicine And Global Health, University Of Oxford, Oxford UK.,Faculty of Infectious & Tropical Diseases, London School Of Hygiene And Tropical Medicine, London, UK
| | - Catherine Satzke
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department Of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department Of Microbiology And Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Fiona M Russell
- Infection And Immunity, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia.,Department Of Paediatrics, The University of Melbourne, Melbourne, Australia
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13
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Corroenne R, Yepez M, Pyarali M, Fox K, Mastrobattista JM, Mack LM, Lee W, Whitehead WE, Castillo HA, Castillo J, Mehollin-Ray AR, Espinoza J, Shamshirsaz AA, Nassr AA, Belfort MA, Sanz Cortes M. Longitudinal evaluation of motor function in patients who underwent prenatal or postnatal neural tube defect repair. Ultrasound Obstet Gynecol 2021; 58:221-229. [PMID: 32730648 DOI: 10.1002/uog.22165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/10/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare the evolution of motor function from mid-gestation to 12 months of age between prenatally and postnatally repaired cases of open neural tube defect (ONTD). METHODS This was a retrospective cohort study of all fetuses that underwent prenatal (fetoscopic or open hysterotomy) or postnatal ONTD repair at a single institution between November 2011 and December 2018. The anatomical level of the lesion was defined as the upper bony spinal defect at initial magnetic resonance imaging assessment. Prenatal motor function of the lower extremities was evaluated by ultrasound according to the metameric level of the neurological lesion, based on the methodology of Carreras et al. Fetal motor function was assessed at referral, at 6 weeks after surgery in prenatally repaired cases or 6 weeks after referral in postnatally repaired cases (6-week follow-up) and at the last scan before delivery. In addition, motor function was assessed by a detailed neurological examination at birth and 12 months of age. First sacral (S1) neurological level of the lesion was considered as intact motor function. For statistical comparisons, we attributed numerical scores to each neurological level and motor function was expressed as median (range) neurological level. Motor function (as numerical score) and the proportion of cases with intact motor function and with motor function two or more levels better than expected based on the anatomical level of the lesion were compared between the prenatal- and postnatal-repair groups. Fetal motor function was compared to the anatomical level of the lesion at referral and a better motor function was defined when it was two or more levels better than the anatomical level of the lesion. To assess the evolution of motor function, we compared motor function at referral with that at each follow-up assessment using paired t-tests. RESULTS We included 127 patients with ONTD, of whom 93 underwent prenatal (51 fetoscopic and 42 open hysterotomy) and 34 postnatal repair. At the time of referral, cases in the prenatal- and postnatal-repair groups presented with a similar anatomical level of lesion (L3 (T9-S1) vs L3 (T7-S1); P = 0.52), similar motor function (S1 (L1-S1) vs S1 (L1-S1); P = 0.52) and a similar proportion of cases with intact motor function (81% vs 79%; P = 0.88) and with motor function two or more levels better than expected based on the anatomical level of the lesion (62% vs 74%; P = 0.24). When compared with prenatally repaired cases, postnatally repaired cases showed worse motor function at birth (S1 (L1-S1) vs L4 (L1-S1); P < 0.01) and at 12 months of age (S1 (L1-S1) vs L4 (L1-S1); P < 0.01). In the prenatal-repair group, motor function remained stable from the time of referral to 12 months of age (P = 0.26). Furthermore, the proportion of patients with intact motor function at referral (81% (75/93)) was similar to that at the 6-week follow-up (74% (64/87)), at the last scan before birth (74% (42/57)), at birth (68% (63/93)) and at 12 months of age (67% (39/58)) in the prenatal-repair group. In the postnatal-repair group, worse motor function, starting from the third trimester to 12 months of age, was observed. The proportion of patients with intact motor function at referral (79% (27/34)) was similar to that at 6-week follow-up (80% (12/15); P = 0.92), but was lower at the last assessment before birth (25% (2/8); P < 0.01), at birth (24% (8/34); P < 0.01) and at 12 months of age (28% (7/25); P < 0.01). Similar findings were noted when assessing the evolution of the proportion of cases with motor function two or more levels better than expected based on the anatomical level of the lesion in each group. CONCLUSIONS Infants with ONTD that underwent postnatal repair had worse motor function at birth and at 12 months of age than at mid-gestation and when compared with infants that underwent prenatal ONTD repair. Prenatal motor function assessment by ultrasound is an adequate tool to identify those infants who should have a good clinical motor function after delivery. Information obtained by fetal motor function assessment can have an important role for patient counseling and case selection for surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Corroenne
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M Yepez
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M Pyarali
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - K Fox
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - J M Mastrobattista
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - L M Mack
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - W Lee
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - W E Whitehead
- Department of Neurosurgery, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - H A Castillo
- Department of Developmental Pediatrics, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - J Castillo
- Department of Developmental Pediatrics, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - A R Mehollin-Ray
- E. B. Singleton Department of Pediatric Radiology, Texas Children's Hospital & Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - A A Nassr
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
| | - M Sanz Cortes
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, USA
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14
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Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, Eminton Z, Ball D, Barrett C, Johnson L, Nuttall J, Fox K, Connolly D, O'Kane P, Hobson A, Chauhan A, Uren N, Mccann GP, Berry C, Carter J, Roobottom C, Mamas M, Rajani R, Ford I, Douglas P, Hlatky MA. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J 2021; 42:3844-3852. [PMID: 34269376 PMCID: PMC8648068 DOI: 10.1093/eurheartj/ehab444] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. Methods and results Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). Conclusion A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
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Affiliation(s)
- N Curzen
- Faculty of Medicine, University of Southampton.,Coronary Research Group, University Hospital Southampton
| | - Z Nicholas
- Coronary Research Group, University Hospital Southampton
| | - B Stuart
- Clinical Trials Unit, University of Southampton
| | - S Wilding
- Clinical Trials Unit, University of Southampton
| | - K Hill
- Clinical Trials Unit, University of Southampton
| | - J Shambrook
- Cardiothoracic Radiology, University Hospital Southampton
| | - Z Eminton
- Clinical Trials Unit, University of Southampton
| | - D Ball
- Clinical Trials Unit, University of Southampton
| | - C Barrett
- Clinical Trials Unit, University of Southampton
| | - L Johnson
- Clinical Trials Unit, University of Southampton
| | - J Nuttall
- Clinical Trials Unit, University of Southampton
| | - K Fox
- Imperial College, London, UK
| | | | - P O'Kane
- Dorset Heart Centre, University Hospitals Dorset, Bournemouth
| | - A Hobson
- Queen Alexandra Hospital, Portsmouth
| | | | - N Uren
- Royal Infirmary, Edinburgh
| | - G P Mccann
- Department of Cardiovascular Sciences, University of Leicester & NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow
| | - J Carter
- University Hospital of North Tees, Stockton on Tees
| | | | - M Mamas
- Royal Stoke University Hospital, Stoke-on-Trent
| | - R Rajani
- Guy's & St Thomas' Hospital, London
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow
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15
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Chan J, Lai JYR, Nguyen CD, Vilivong K, Dunne EM, Dubot-Pérès A, Fox K, Hinds J, Moore KA, Nation ML, Pell CL, Xeuatvongsa A, Vongsouvath M, Newton PN, Mulholland K, Satzke C, Dance DAB, Russell FM. Indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with acute respiratory infection despite heterogeneous vaccine coverage: an observational study in Lao People's Democratic Republic. BMJ Glob Health 2021; 6:bmjgh-2021-005187. [PMID: 34108146 PMCID: PMC8191607 DOI: 10.1136/bmjgh-2021-005187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Empiric data on indirect (herd) effects of pneumococcal conjugate vaccines (PCVs) in settings with low or heterogeneous PCV coverage are limited. The indirect effects of PCV, which benefits both vaccinated and non-vaccinated individuals, are mediated by reductions in vaccine-type (VT) carriage (a prerequisite for disease). The aim of this study among hospitalised children in Lao People’s Democratic Republic (Lao PDR) is to determine the effectiveness of a 13-valent PCV (PCV13) against VT pneumococcal nasopharyngeal carriage (direct effects) and the association between village-level PCV13 coverage and VT carriage (indirect effects). Methods Pneumococcal nasopharyngeal carriage surveillance commenced in December 2013, shortly after PCV13 introduction (October 2013). We recruited and swabbed children aged 2–59 months admitted to hospital with acute respiratory infection. Pneumococci were detected using lytA quantitative real-time PCR and serotyped using microarray. PCV13 status and village-level PCV13 coverage were determined using written immunisation records. Associations between both PCV13 status and village-level PCV13 coverage and VT carriage were calculated using generalised estimating equations, controlling for potential confounders. Results We enrolled 1423 participants and determined PCV13 coverage for 368 villages (269 863 children aged under 5 years). By 2017, median village-level vaccine coverage reached 37.5%, however, the IQR indicated wide variation among villages (24.1–56.4). Both receipt of PCV13 and the level of PCV13 coverage were independently associated with a reduced odds of VT carriage: adjusted PCV13 effectiveness was 38.1% (95% CI 4.1% to 60.0%; p=0.032); and for each per cent increase in PCV13 coverage, the estimated odds of VT carriage decreased by 1.1% (95% CI 0.0% to 2.2%; p=0.056). After adjustment, VT carriage decreased from 20.0% to 12.8% as PCV13 coverage increased from zero to 60% among under 5. Conclusions Despite marked heterogeneity in PCV13 coverage, we found evidence of indirect effects in Lao PDR. Individual vaccination with PCV13 was effective against VT carriage.
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Affiliation(s)
- Jocelyn Chan
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Jana Y R Lai
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Keoudomphone Vilivong
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Audrey Dubot-Pérès
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Unité des Virus Émergents, UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection, Marseille, France
| | - Kimberley Fox
- Regional Office for the Western Pacific, World Health Organization (WHO), Manila, Philippines
| | - Jason Hinds
- Institute for Infection and Immunity, St George's University of London, London, UK.,BUGS Bioscience London Bioscience Innovation Centre, London, UK
| | - Kerryn A Moore
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Monica L Nation
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Casey L Pell
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Anonh Xeuatvongsa
- National Immunization Programme, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | | | - Paul N Newton
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Kim Mulholland
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Catherine Satzke
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - David A B Dance
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Fiona M Russell
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
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16
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Fox K, Fox J, Bexfield N, Freeman P. Computerised decision support in veterinary medicine, exemplified in a canine idiopathic epilepsy care pathway. J Small Anim Pract 2021; 62:911-917. [PMID: 34155645 DOI: 10.1111/jsap.13345] [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: 11/11/2020] [Revised: 02/23/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022]
Abstract
Computerised decision support is of emerging and increasing importance in human medicine, but as yet has not been thoroughly applied or evaluated in veterinary medicine. In this essay, the authors report on the first example of a veterinary care pathway, a specific form of computerised decision support, which guides clinicians through a clinical workflow and incorporates individual patient data to inform patient-specific decision recommendations. The veterinary care pathway was designed using consensus statements and specialist neurologist opinion to create a decision support tool concerning canine idiopathic epilepsy. The authors evaluated the care pathway by comparing 35 clinical decisions made by referral clinicians in historical cases of idiopathic epilepsy to decisions recommended by the care pathway when presented with the same clinical case. Their results show that in 77.1% (95% confidence interval [59.9, 89.6]) of cases the care pathway recommended a decision that was the same or similar to a specialist neurologist's decision. Whilst further studies are needed to explore the potential use of such technology in clinical practice, the authors believe this first application provides great promise of a new and alternative method of clinical decision support.
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Affiliation(s)
- K Fox
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
| | - J Fox
- Department of Engineering, University of Oxford, Oxford, Oxfordshire, OX1 3PJ, UK
| | - N Bexfield
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
| | - P Freeman
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
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17
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Murthy BP, Sterrett N, Weller D, Zell E, Reynolds L, Toblin RL, Murthy N, Kriss J, Rose C, Cadwell B, Wang A, Ritchey MD, Gibbs-Scharf L, Qualters JR, Shaw L, Brookmeyer KA, Clayton H, Eke P, Adams L, Zajac J, Patel A, Fox K, Williams C, Stokley S, Flores S, Barbour KE, Harris LQ. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-April 10, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:759-764. [PMID: 34014911 PMCID: PMC8136424 DOI: 10.15585/mmwr.mm7020e3] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Whiteman A, Wang A, McCain K, Gunnels B, Toblin R, Lee JT, Bridges C, Reynolds L, Murthy BP, Qualters J, Singleton JA, Fox K, Stokley S, Harris L, Gibbs-Scharf L, Abad N, Brookmeyer KA, Farrall S, Pingali C, Patel A, Link-Gelles R, Dasgupta S, Gharpure R, Ritchey MD, Barbour KE. Demographic and Social Factors Associated with COVID-19 Vaccination Initiation Among Adults Aged ≥65 Years - United States, December 14, 2020-April 10, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:725-730. [PMID: 33983911 PMCID: PMC8118148 DOI: 10.15585/mmwr.mm7019e4] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Compared with other age groups, older adults (defined here as persons aged ≥65 years) are at higher risk for COVID-19-associated morbidity and mortality and have therefore been prioritized for COVID-19 vaccination (1,2). Ensuring access to vaccines for older adults has been a focus of federal, state, and local response efforts, and CDC has been monitoring vaccination coverage to identify and address disparities among subpopulations of older adults (2). Vaccine administration data submitted to CDC were analyzed to determine the prevalence of COVID-19 vaccination initiation among adults aged ≥65 years by demographic characteristics and overall. Characteristics of counties with low vaccination initiation rates were quantified using indicators of social vulnerability data from the 2019 American Community Survey.* During December 14, 2020-April 10, 2021, nationwide, a total of 42,736,710 (79.1%) older adults had initiated vaccination. The initiation rate was higher among men than among women and varied by state. On average, counties with low vaccination initiation rates (<50% of older adults having received at least 1 vaccine dose), compared with those with high rates (≥75%), had higher percentages of older adults without a computer, living in poverty, without Internet access, and living alone. CDC, state, and local jurisdictions in partnerships with communities should continue to identify and implement strategies to improve access to COVID-19 vaccination for older adults, such as assistance with scheduling vaccination appointments and transportation to vaccination sites, or vaccination at home if needed for persons who are homebound.† Monitoring demographic and social factors affecting COVID-19 vaccine access for older adults and prioritizing efforts to ensure equitable access to COVID-19 vaccine are needed to ensure high coverage among this group.
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19
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Affiliation(s)
- K Fox
- Baylor College of Medicine, Houston, Texas, USA
| | - S L Collins
- The Fetal Medicine Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,The Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
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20
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Gautier A, Ducrocq G, Elbez Y, Fox K, Ferrari R, Ford I, Tardif J, Tendera M, Steg G. Chronic coronary syndrome patients with polyarterial disease are a high risk but heterogenous subset of patients. Insights from the CLARIFY registry. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Steg P, Bhatt D, James S, Darlington O, Hoskin L, Simon T, Fox K, Leiter L, Mehta S, Harrington R, Himmelmann A, Ridderstrale W, Andersson M, Mellstrom C, Mcewan P. Cost-effectiveness of ticagrelor in patients with type 2 diabetes and coronary artery disease with a history of PCI: an economic evaluation of THEMIS-PCI using a Swedish healthcare perpective. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3538] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) evaluated ticagrelor compared to placebo for the prevention of myocardial infarction (MI), stroke and cardiovascular (CV) death in 19 220 patients with type 2 diabetes (T2DM) and stable coronary artery disease (CAD) with no prior myocardial infarction (MI) or stroke. THEMIS-PCI was a pre-specified subgroup of 11 154 patients who had a history of percutaneous coronary intervention (PCI) when entering the study. In THEMIS, ticagrelor reduced CV death, MI or stroke, although with an increase in major bleeding compared to aspirin alone, and there was a significant interaction between a prior history of PCI and the net benefit of ticagrelor. In the THEMIS-PCI population, ticagrelor plus aspirin provided a favourable net clinical benefit with a significant 15% reduction in all-cause death, MI, stroke, fatal bleed, or intracranial haemorrhage.
Objective
The objective of this analysis was to estimate the cost-effectiveness of ticagrelor for the prevention of CV events based on the results of the THEMIS-PCI population using a lifetime horizon from a Swedish healthcare perspective.
Methods
A lifetime Markov state transition model was developed with health states aligned to the THEMIS trial endpoints. Health state transitions were informed by parametric survival equations fitted to patient level data from THEMIS-PCI population. Treatment discontinuation rates were informed by the THEMIS-PCI population, with all patients assumed to discontinue treatment with ticagrelor after four years. The incidence of bleeding and dyspnoea were modelled as adverse events. Costs (2019 Euros) and utility data were derived from the published literature and the THEMIS-PCI population, respectively, and discounted at 3.0% annually. Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were conducted to quantify uncertainty of key input parameters.
Results
Treatment with ticagrelor plus aspirin over four years resulted in estimated Quality Adjusted Life Year (QALY) gains of 0.09 at an incremental cost of €1,891 compared to aspirin alone. The estimated incremental cost-effectiveness ratio (ICER) was €19,959/QALY. PSA indicated that ticagrelor was cost-effective in 93% of simulations using a willingness-to-pay threshold of €47,000/QALY and DSA showed that cost-effectiveness was robust to changes in key input parameters (ICER range: €16,504 to €25,012/QALY).
Conclusion
Based on the results of the THEMIS trial, dual antiplatelet therapy with ticagrelor plus aspirin is likely to be a cost-effective treatment compared with aspirin alone for the prevention of CV events in patients with T2DM and CAD with a history of PCI.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): AstraZeneca
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Affiliation(s)
- P Steg
- Hospital Bichat-Claude Bernard, Paris, France
| | - D.L Bhatt
- Brigham and Women's Hospital, Boston, United States of America
| | - S.K James
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - O Darlington
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - L Hoskin
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
| | - T Simon
- Hôpital Saint Antoine, Sorbonne-Université, Paris, France
| | - K Fox
- Royal Brompton Hospital Imperial College London, London, United Kingdom
| | | | - S Mehta
- McMaster University, Hamilton, Canada
| | | | | | | | | | | | - P Mcewan
- Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom
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22
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Biscaglia S, Campo G, Fox K, Tardif J, Tendera M, Greenlaw N, Ford I, Stanley B, Ferrari R, Steg P. Prognosis in patients with prior myocardial infarction and PEGASUS-TIMI 54 criteria in the CLARIFY registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
The PEGASUS-TIMI 54 trial showed that prolonged treatment with ticagrelor reduces the cumulative occurrence of ischemic adverse events. CLARIFY is the biggest real life registry on chronic coronary syndrome.
Purpose
- To evaluate the percentage of patients eligible for long-term ticagrelor therapy in the CLARIFY registry.
– To compare the outcome of this subgroup of patients with those with PEGASUS exclusion criteria or without PEGASUS inclusion criteria.
Methods
Within the CLARIFY population, we selected post MI patients and we excluded those with missing info (post MI evaluable population). Then, we divided patients into 3 groups: excluded (meeting PEGASUS exclusion criteria, namely use of P2Y12 receptor antagonists or chronic oral anticoagulant, any stroke, coronary-artery bypass grafting in the past 5 years); eligible (meeting PEGASUS high-risk inclusion criteria, namely age≥65 years; diabetes; multivessel disease; creatinine clearance <60 ml/min) and ineligible (not meeting PEGASUS high-risk inclusion criteria).
We therefore compared the ischemic (CV death, MI and stroke) and bleeding (major bleeding) outcome of the 3 groups adjusting for age, sex, smoking and geographical region.
Results
Among the 11811 post-MI evaluable patients, 4706 (39.8%) were included in the eligible group, 5715 (48.4%) in the excluded group, and 1390 in the ineligible group (11.8%). Both the ischemic and bleeding endpoints were significantly different among the 3 groups with the excluded patients with the worst and ineligible patients with the best outcome (see table). The same trend was shown for CV death, while the occurrence of MI was not significantly different among the 3 groups. In the eligible group, the ratio between ischemic and bleeding events was 6:1, whereas between CV death and major bleeding was 3.5:1.
Conclusions
Around 40% of CLARIFY post-MI patients could benefit from prolonged ticagrelor therapy. In this group of patients, ischemic risk seems to be higher than the bleeding one.
Ischemic & bleeding risk in the 3 groups
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): CLARIFY registry was funded by Servier
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Affiliation(s)
- S Biscaglia
- Azienda Ospedaliero Universitaria Sant'Anna, Ferrara, Ferrara, Italy
| | - G Campo
- Azienda Ospedaliero Universitaria Sant'Anna, Ferrara, Ferrara, Italy
| | - K Fox
- Imperial College London, NHLI, London, United Kingdom
| | - J.C Tardif
- Montreal Heart Institute, Montreal, Canada
| | - M Tendera
- School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - N Greenlaw
- University of Glasgow, Glasgow, United Kingdom
| | - I Ford
- University of Glasgow, Glasgow, United Kingdom
| | - B Stanley
- University of Glasgow, Glasgow, United Kingdom
| | - R Ferrari
- University Hospital of Ferrara, Medical Sciences, Ferrara, Italy
| | - P.G Steg
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T, Paris, France
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23
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Jonk YC, Burgess A, Williamson ME, Thayer D, MacKenzie J, McGuire C, Fox K, Coburn AF. Telehealth Use in a Rural State: A Mixed-Methods Study Using Maine's All-Payer Claims Database. J Rural Health 2020; 37:769-779. [PMID: 33085154 DOI: 10.1111/jrh.12527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study assesses trends in telehealth use in Maine-a rural state with comprehensive telehealth policies-across payers, services, and rurality, and identifies barriers and facilitators to the adoption and use of telehealth services. METHODS Using a mixed-methods approach, researchers analyzed data from Maine's All Payer Claims Database (2008-2016) and key informant interviews with health care organization leaders to examine telehealth use and explore factors impacting telehealth adoption and implementation. FINDINGS Despite a 14-fold increase in the use of telehealth over the 9-year study period, use remains low-0.28% of individuals used telehealth services in 2016 compared with 0.02% in 2008. Services provided via telehealth varied by rurality; speech language pathology (SLP) was the most common type of service among rural residents, while psychiatric services were most common among urban residents. Medicaid was the primary payer for over 70% of telehealth claims in both rural and urban areas of the state, driving the increase of telehealth claims over time. Issues challenging organizations seeking to deploy telehealth included provider resistance, staff turnover, provider shortages, and lack of broadband. Key informants identified inadequate and inconsistent reimbursement as barriers to comprehensive, systematic billing for telehealth services, resulting in underrepresentation of telehealth services in claims data. CONCLUSIONS Claims covered by Medicaid account for much of the observed expansion of telehealth use in Maine. Telehealth appears to be improving access to behavioral health and SLP services. Provider shortages, broadband, and Medicare and commercial coverage policies limit the use of telehealth services in rural areas.
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Affiliation(s)
- Yvonne C Jonk
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine
| | - Amanda Burgess
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine.,Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | | | - Deborah Thayer
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine.,Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | - Jennifer MacKenzie
- Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | - Catherine McGuire
- Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | - Kimberley Fox
- Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
| | - Andrew F Coburn
- Maine Rural Health Research Center, Muskie School of Public Service, University of Southern Maine, Portland, Maine.,Cutler Institute for Health & Social Policy, University of Southern Maine, Portland, Maine
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24
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Aliabadi N, Antoni S, Mwenda JM, Weldegebriel G, Biey JNM, Cheikh D, Fahmy K, Teleb N, Ashmony HA, Ahmed H, Daniels DS, Videbaek D, Wasley A, Singh S, de Oliveira LH, Rey-Benito G, Sanwogou NJ, Wijesinghe PR, Liyanage JBL, Nyambat B, Grabovac V, Heffelfinger JD, Fox K, Paladin FJ, Nakamura T, Agócs M, Murray J, Cherian T, Yen C, Parashar UD, Serhan F, Tate JE, Cohen AL. Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008-16: findings from the Global Rotavirus Surveillance Network. Lancet Glob Health 2020; 7:e893-e903. [PMID: 31200889 PMCID: PMC7336990 DOI: 10.1016/s2214-109x(19)30207-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 12/27/2022]
Abstract
Summary Background Rotavirus vaccine use in national immunisation programmes has led to declines in hospital admissions for rotavirus gastroenteritis among children; however, the global impact of rotavirus vaccine introduction has not been described using primary data. We describe the impact of rotavirus vaccine introduction on admissions for acute rotavirus gastroenteritis in primarily low-income and middle-income countries, using 9 years of data from the WHO-coordinated Global Rotavirus Surveillance Network (GRSN). Methods Between Jan 1, 2008, and Dec 31, 2016, children younger than 5 years of age who were admitted to hospital with acute gastroenteritis were prospectively enrolled in GRSN sites. We included sites that enrolled children and collected stool specimens monthly and tested at least 100 specimens annually in the impact analysis, with a separate analysis taking into account site continuity. We compared proportions of acute gastroenteritis cases positive for rotavirus in the pre-vaccine and post-vaccine periods and calculated mean proportion changes for WHO regions, with 95% CIs; these findings were then compared with interrupted time series analyses. We did further sensitivity analyses to account for rotavirus vaccination coverage levels and sites that collected specimens for at least 11 months per year and tested at least 80 specimens per year. We also analysed the age distribution of rotavirus-positive cases before and after vaccine introduction. Findings 403 140 children younger than 5 years of age admitted to hospital with acute gastroenteritis from 349 sites in 82 countries were enrolled over the study period, of whom 132 736 (32.9%) were positive for rotavirus. We included 305 789 children from 198 sites in 69 countries in the impact analysis. In countries that had not introduced rotavirus vaccine in their national immunisation programmes, rotavirus was detected in 38.0% (95% CI 4.8–73.4) of admissions for acute gastroenteritis annually whereas in those that have introduced the vaccine, rotavirus was detected in 23.0% (0.7–57.7) of admissions for acute gastroenteritis, showing a 39.6% (35.4–43.8) relative decline following introduction. Interrupted time series analyses confirmed these findings. Reductions by WHO regions ranged from 26.4% (15.0–37.8) in the Eastern Mediterranean Region to 55.2% (43.0–67.4) in the European Region and were sustained in nine countries (contributing up to 31 sites) for 6–10 years. The age distribution of children with rotavirus gastroenteritis shifted towards older children after rotavirus vaccine introduction. Interpretation A significant and sustained reduction in the proportion of hospital admissions for acute gastroenteritis due to rotavirus was seen among children younger than 5 years in GRSN sites following rotavirus vaccine introduction. These findings highlight the need to incorporate rotavirus vaccines into immunisation programmes in countries that have not yet introduced them and underline the importance of high-quality surveillance.
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Affiliation(s)
- Negar Aliabadi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sébastien Antoni
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jason M Mwenda
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Goitom Weldegebriel
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Harare, Zimbabwe
| | - Joseph N M Biey
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Dah Cheikh
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Kamal Fahmy
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Nadia Teleb
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | | | - Hinda Ahmed
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Danni S Daniels
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Dovile Videbaek
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Annemarie Wasley
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Simarjit Singh
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | | | - Gloria Rey-Benito
- Regional Office for the Americas, World Health Organization, Washington, DC, USA
| | - N Jennifer Sanwogou
- Regional Office for the Americas, World Health Organization, Washington, DC, USA
| | | | | | - Batmunkh Nyambat
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Varja Grabovac
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - James D Heffelfinger
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Kimberley Fox
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Fem Julia Paladin
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Tomoka Nakamura
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Mary Agócs
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jillian Murray
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Thomas Cherian
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Catherine Yen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fatima Serhan
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jacqueline E Tate
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam L Cohen
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
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Lai J, Nguyen C, Tabwaia B, Nikuata A, Baueri N, Timeon E, Diaaldeen M, Iuta T, Ozturk MH, Moore A, Hall A, Nyambat B, Davis S, Rahman A, Erasmus W, Fox K, Russell F. Temporal decline in diarrhea episodes and mortality in Kiribati children two years following rotavirus vaccine introduction, despite high malnutrition rates: a retrospective review. BMC Infect Dis 2020; 20:207. [PMID: 32164562 PMCID: PMC7069014 DOI: 10.1186/s12879-020-4874-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/11/2020] [Indexed: 11/24/2022] Open
Abstract
Background Kiribati introduced rotavirus vaccine in 2015. To estimate the impact of rotavirus vaccine on acute gastroenteritis (AGE) and severe acute malnutrition (SAM) among children under 5 in Kiribati, a retrospective review of inpatient and outpatient AGE and hospitalized SAM was undertaken. Methods Inpatient data for admissions and hospital deaths due to AGE, SAM and all-causes were collected for children under 5 from all hospitals on the main island, Tarawa, from January 2010–December 2013 (pre-rotavirus vaccine) and January 2016–September 2017 (post-rotavirus vaccine). National outpatient diarrhea data were collected from January 2010 to August 2017 for under 5. An interrupted time-series analysis was undertaken to estimate the effect of rotavirus vaccine on the rates of inpatient and outpatient AGE, inpatient SAM; and inpatient case fatality rates for AGE and SAM, were calculated pre- and post-rotavirus vaccine introduction. Results The incidence rate of AGE admissions from Tarawa and national AGE outpatient presentations significantly declined by 37 and 44%, respectively, 2 years following rotavirus vaccine introduction. There was a significant decline in the percentage of AGE contributing to all-cause under 5 admissions (12·8% vs. 7·2%, p < 0·001) and all-cause under-five mortality (15·9% vs. 5·7%, p = 0·006) pre- and post-rotavirus vaccine introduction. The estimated incidence rate of inpatient SAM decreased by 24% in under 5 s, 2 years following rotavirus vaccine introduction. Conclusions AGE morbidity and mortality and hospitalized SAM rates have declined following rotavirus vaccine introduction in Kiribati children.
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Affiliation(s)
- Jana Lai
- Murdoch Children's Research Institute, Melbourne, Australia. .,Australian National University, Canberra, Australia.
| | - Cattram Nguyen
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Beia Tabwaia
- Ministry of Health and Medical Services, Tarawa, Kiribati
| | | | | | - Eretii Timeon
- Ministry of Health and Medical Services, Tarawa, Kiribati
| | | | | | | | | | | | - Batmunkh Nyambat
- WHO Regional Office for the Western Pacific, Manila, Philippines
| | | | | | | | - Kimberley Fox
- WHO Regional Office for the Western Pacific, Manila, Philippines.,Center for Disease Control and Prevention, Atlanta, USA
| | - Fiona Russell
- Murdoch Children's Research Institute, Melbourne, Australia.,Centre for International Child Health, Dept. of Paediatrics, The University of Melbourne, Melbourne, Australia
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26
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Yu KH, Palmer N, Fox K, Prock L, Mandl KD, Kohane IS, Prilutsky D. The phenotypical implications of immune dysregulation in fragile X syndrome. Eur J Neurol 2020; 27:590-593. [PMID: 31953887 DOI: 10.1111/ene.14146] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Immune system dysfunction and inflammatory dysregulation have been shown in several animal models of fragile X syndrome (FXS). However, the phenotypical implications of this dysregulation have not been systematically evaluated in a large patient cohort. METHODS Five thousand seven hundred thirty-six FXS patients from a nationwide health insurance database were identified and compared to 573 600 age- and sex-matched controls. The phenome-wide association studies codes of FXS patients and those without FXS were compared and the false discovery rate was controlled at 0.05 using the Benjamini-Hochberg procedure. RESULTS In addition to the commonly reported comorbidities of FXS, an over-representation of infectious diseases, including otitis media, cellulitis and abscess of fingers or toes, viral enteritis, candidiasis and pneumonia, was discovered. In addition, there was an under-representation of autoimmune disorders in FXS patients. CONCLUSIONS Our systematic comorbidity analyses identified immunologically-based phenotypes associated with FXS. Our findings align with previous observations of compromised immunity and phagocytic defects in animal models of FXS. These results suggest the importance of immune-related pathways in FXS patients and their relevance to the FMR1 gene.
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Affiliation(s)
- K-H Yu
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - N Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - K Fox
- Aetna Inc., Hartford, Connecticut, USA
| | - L Prock
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - K D Mandl
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - I S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - D Prilutsky
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
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27
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Sen J, Tonkin A, Varigos J, Fonguh S, Berkowitz S, Yusuf S, Verhamme P, Vanassche T, Anand S, Fox K, Eikelboom J, Amerena J. 023 Risk Stratification Using CHA2DS2-VASc and CHADS2 Scores in Patients With Chronic Atherosclerotic Cardiovascular Disease Receiving Aspirin With or Without Rivaroxaban: An Analysis of the COMPASS Trial. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.030] [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: 11/17/2022]
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28
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Chiu ES, Fox K, Wolfe L, Vandewoude S. A novel test for determination of wild felid-domestic cat hybridization. Forensic Sci Int Genet 2019; 44:102160. [PMID: 31683165 DOI: 10.1016/j.fsigen.2019.102160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/23/2019] [Accepted: 09/04/2019] [Indexed: 12/22/2022]
Abstract
In October 2018, Colorado Parks and Wildlife seized an animal believed to be an illegally possessed bobcat. The owner claimed the animal was a bobcat/domestic cat hybrid, exempted from license requirements. Burden of proof lay with CPW to determine the lineage of the animal. Commercial microsatellite arrays and DNA barcoding have not been developed for identification of bobcat/domestic cat hybrids, and limited time and resources prevented development of such tests for this application. Instead, we targeted endogenous feline leukemia virus (enFeLV) to quickly and inexpensively demonstrate the absence of domestic cat DNA in the contested animal. Using this assay, we were able to confirm that the contested animal lacked enFeLV, and therefore was not a domestic cat hybrid.
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Affiliation(s)
- E S Chiu
- Colorado State University, 1619 Campus Delivery, Fort Collins, CO 80523 USA
| | - K Fox
- Colorado Parks and Wildlife, 317 W Prospect Rd, Fort Collins, CO 80526 USA
| | - L Wolfe
- Colorado Parks and Wildlife, 317 W Prospect Rd, Fort Collins, CO 80526 USA
| | - S Vandewoude
- Colorado State University, 1619 Campus Delivery, Fort Collins, CO 80523 USA.
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29
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Fox K, Virdone S, Pieper K. P5708Balancing risk and benefit in patients with atrial fibrillation: the GARFIELD-AF risk score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0649] [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: 11/13/2022] Open
Abstract
Abstract
Background
The GARFIELD-AF risk tool was originally developed to predict future risk of adverse events in patients with atrial fibrillation (AF) using a range of baseline clinical variables. In the present work a new, improved risk tool was developed using data from all five GARFIELD cohorts gathered over 2 years' follow-up.
Purpose
To derive a new integrated risk tool for predicting mortality, stroke/systemic embolism (SE), and major bleeding in AF patients up to 2 years after enrolment and compare the risk tool versus CHA2DS2-VASc and HAS-BLED.
Methods
GARFIELD-AF is an international prospective registry of nonvalvular AF patients diagnosed within 6 weeks prior to enrolment and having at least one risk factor for stroke. In this study only the first occurrence of events was considered. Event rates were estimated using a Poisson model. Potential predictors of events including a large set of demographics, clinical characteristics, choice of treatment, and lifestyle factors were identified, and a Cox proportional hazards model chosen for each outcome by least absolute shrinkage and selection operator (LASSO). Indices were compared versus models of CHA2DS2-VASc and HAS-BLED.
Results
Among a total 52,080 patients enrolled 52,032 (male, 55.8%; median age, 71 years) had available follow-up data. At 2 years, 3702 patients had died (event rate, 3.82 [95% CI, 3.70–3.95] per 100 patient-years) whereas non-haemorrhagic stroke/SE was noted in 957 patients (rate, 1.00 [95% CI, 0.94–1.06] per 100 patient-years) and major bleed/haemorrhagic stroke in 673 patients (rate, 0.70 [95% CI, 0.65–0.75] per 100 patient-years). The GARFIELD risk tool outperformed CHA2DS2-VASc and HAS-BLED at predicting all adverse events in the overall population and pre-selected subpopulations over 2 years. Notably, the new model identified use of OAC therapy, which is not included in CHA2DS2-VASc, as one of the strongest predictors of risk of mortality and stroke, and unlike HAS-BLED, could discriminate a lower risk of bleeding in patients treated with NOACs versus VKAs.
Population All-cause mortality Stroke/SE Major bleeding* GARFIELD CHA2DS2-VASc GARFIELD CHA2DS2-VASc GARFIELD CHA2DS2-VASc Overall 0.76 (0.75–0.76) 0.66 (0.65–0.67) 0.68 (0.67–0.70) 0.64 (0.62–0.66) – – AC treated 0.74 (0.73–0.75) 0.65 (0.64–0.66) 0.68 (0.66–0.70) 0.65 (0.62–0.67) 0.67 (0.64–0.69) 0.63 (0.61–0.65) *Model only considers AC-treated patients.
Conclusions
The GARFIELD-AF risk tool demonstrated good calibration and discrimination, outperforming CHA2DS2-VASc at predicting risk of death and non-haemorrhagic stroke and HAS-BLED for major bleed in AF patients over 2 years.
Acknowledgement/Funding
The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.
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Affiliation(s)
- K Fox
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Virdone
- Thrombosis Research Institute, London, United Kingdom
| | - K Pieper
- Thrombosis Research Institute, London, United Kingdom
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30
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Chan J, Lai JY, von Mollendorf C, Blyth C, Dance DAB, Datta S, Dunne EM, Ford R, Fox K, Hinds J, Vilivong K, La Vincente S, Lehmann D, Moore KA, Mungun T, Nation ML, Newton PN, Nguyen CD, Pomat W, Xeuatvongsa A, Satzke C, Mulholland EK, Russell FM. Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study. The Lancet Global Health 2019. [DOI: 10.1016/s2214-109x(19)30100-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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31
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Triolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK, Greenbaum CJ, Atkinson M, Baidal D, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Clements M, Colman P, DiMeglio L, Gitelman S, Goland R, Gottlieb P, Herold K, Knip M, Krischer J, Lernmark A, Moore W, Moran A, Muir A, Palmer J, Peakman M, Philipson L, Raskin P, Redondo M, Rodriguez H, Russell W, Spain L, Schatz D, Sosenko J, Wentworth J, Wherrett D, Wilson D, Winter W, Ziegler A, Anderson M, Antinozzi P, Benoist C, Blum J, Bourcier K, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Insel R, Kaufman F, Kay T, Leschek E, Mahon J, Marks J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Pugliese A, Roep B, Roncarolo M, Savage P, Simell O, Sherwin R, Siegelman M, Skyler J, Steck A, Thomas J, Trucco M, Wagner J, Krischer JP, Leschek E, Rafkin L, Bourcier K, Cowie C, Foulkes M, Insel R, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, Ballard W, Miers R, Eberhard C, Sparks K, Thraikill K, Edwards J, Fowlkes S, Kemp A, Morales L, Holland L, Johnson P, Paul A, Ghatak K, Fiske S, Phelen H, Leyland T, Henderson D, Brenner E, Oppenheimer I, Mamkin C, Moniz C, Clarson M, Lovell A, Peters V, Ford J, Ruelas D, Borut D, Burt M, Jordan S, Castilla P, Flores M, Ruiz L, Hanson J, Green-Blair R, Sheridan K, Garmeson J, Wintergerst G, Pierce A, Omoruyi M, Foster S, Kingery A, Lunsford I, Cervantes T, Parker P, Price J, Urben I, Guillette H, Doughty H, Haydock V, Parker P, Bergman S, Duncum C, Rodda A, Perelman R, Calendo C, Barrera E, Arce-Nunez Y, Geyer S, Martinez M, De la Portilla I, Cardenas L, Garrido M, Villar R, Lorini E, Calandra G, D’Annuzio K, Perri N, Minuto C, Hays B, Rebora R, Callegari O, Ali J, Kramer B, Auble S, Cabrera P, Donohoue R, Fiallo-Scharer M, Hessner P, Wolfgram A, Henderson C, Kansra N, Bettin R, McCuller A, Miller S, Accacha J, Corrigan E, Fiore R, Levine T, Mahoney C, Polychronakos V, Henry M, Gagne H, Starkman M, Fox D, Chin F, Melchionne L, Silverman I, Marshall L, Cerracchio J, Cruz A, Viswanathan J, Heyman K, Wilson S, Chalew S, Valley S, Layburn A, Lala P, Clesi M, Genet G, Uwaifo A, Charron T, Allerton W, Hsiao B, Cefalu L, Melendez-Ramirez R, Richards C, Alleyn E, Gustafson M, Lizanna J, Wahlen S, Aleiwe M, Hansen H, Wahlen C, Karges C, Levy A, Bonaccorso R, Rapaport Y, Tomer D, Chia M, Goldis L, Iazzetti M, Klein C, Levister L, Waldman E, Keaton N, Wallach M, Regelmann Z, Antal M, Aranda C, Reynholds A, Vinik P, Barlow M, Bourcier M, Nevoret J, Couper S, Kinderman A, Beresford N, Thalagne H, Roper J, Gibbons J, Hill S, Balleaut C, Brennan J, Ellis-Gage L, Fear T, Gray L, Law P, Jones C, McNerney L, Pointer N, Price K, Few D, Tomlinson N, Leech D, Wake C, Owens M, Burns J, Leinbach A, Wotherspoon A, Murray K, Short G, Curry S, Kelsey J, Lawson J, Porter S, Stevens E, Thomson S, Winship L, Liu S, Wynn E, Wiltshire J, Krebs P, Cresswell H, Faherty C, Ross L, Denvir J, Drew T, Randell P, Mansell S, Lloyd J, Bell S, Butler Y, Hooton H, Navarra A, Roper G, Babington L, Crate H, Cripps A, Ledlie C, Moulds R, Malloy J, Norton B, Petrova O, Silkstone C, Smith K, Ghai M, Murray V, Viswanathan M, Henegan O, Kawadry J, Olson L, Maddox K, Patterson T, Ahmad B, Flores D, Domek S, Domek K, Copeland M, George J, Less T, Davis M, Short A, Martin J, Dwarakanathan P, O’Donnell B, Boerner L, Larson M, Phillips M, Rendell K, Larson C, Smith K, Zebrowski L, Kuechenmeister M, Miller J, Thevarayapillai M, Daniels H, Speer N, Forghani R, Quintana C, Reh A, Bhangoo P, Desrosiers L, Ireland T, Misla C, Milliot E, Torres S, Wells J, Villar M, Yu D, Berry D, Cook J, Soder A, Powell M, Ng M, Morrison Z, Moore M, Haslam M, Lawson B, Bradley J, Courtney C, Richardson C, Watson E, Keely D, DeCurtis M, Vaccarcello-Cruz Z, Torres K, Muller S, Sandberg H, Hsiang B, Joy D, McCormick A, Powell H, Jones J, Bell S, Hargadon S, Hudson M, Kummer S, Nguyen T, Sauder E, Sutton K, Gensel R, Aguirre-Castaneda V, Benavides, Lopez D, Hemp S, Allen J, Stear E, Davis T, O’Donnell R, Jones A, Roberts J, Dart N, Paramalingam L, Levitt Katz N, Chaudhary K, Murphy S, Willi B, Schwartzman C, Kapadia D, Roberts A, Larson D, McClellan G, Shaibai L, Kelley G, Villa C, Kelley R, Diamond M, Kabbani T, Dajani F, Hoekstra M, Sadler K, Magorno J, Holst V, Chauhan N, Wilson P, Bononi M, Sperl A, Millward M, Eaton L, Dean J, Olshan H, Stavros T, Renna C, Milliard, Brodksy L, Bacon J, Quintos L, Topor S, Bialo B, Bancroft A, Soto W, Lagarde H, Tamura R, Lockemer T, Vanderploeg M, Ibrahim M, Huie V, Sanchez R, Edelen R, Marchiando J, Palmer T, Repas M, Wasson P, Wood K, Auker J, Culbertson T, Kieffer D, Voorhees T, Borgwardt L, DeRaad K, Eckert E, Isaacson H, Kuhn A, Carroll M, Xu P, Schubert G, Francis S, Hagan T, Le M, Penn E, Wickham C, Leyva K, Rivera J, Padilla I, Rodriguez N, Young K, Jospe J, Czyzyk B, Johnson U, Nadgir N, Marlen G, Prakasam C, Rieger N, Glaser E, Heiser B, Harris C, Alies P, Foster H, Slater K, Wheeler D, Donaldson M, Murray D, Hale R, Tragus D, Word J, Lynch L, Pankratz W, Badias F, Rogers R, Newfield S, Holland M, Hashiguchi M, Gottschalk A, Philis-Tsimikas R, Rosal S, Franklin S, Guardado N, Bohannon M, Baker A, Garcia T, Aguinaldo J, Phan V, Barraza D, Cohen J, Pinsker U, Khan J, Wiley L, Jovanovic P, Misra M, Bassi M, Wright D, Cohen K, Huang M, Skiles S, Maxcy C, Pihoker K, Cochrane J, Fosse S, Kearns M, Klingsheim N, Beam C, Wright L, Viles H, Smith S, Heller M, Cunningham A, Daniels L, Zeiden J, Field R, Walker K, Griffin L, Boulware D, Bartholow C, Erickson J, Howard B, Krabbenhoft C, Sandman A, Vanveldhuizen J, Wurlger A, Zimmerman K, Hanisch L, Davis-Keppen A, Bounmananh L, Cotterill J, Kirby M, Harris A, Schmidt C, Kishiyama C, Flores J, Milton W, Martin C, Whysham A, Yerka T, Bream S, Freels J, Hassing J, Webster R, Green P, Carter J, Galloway D, Hoelzer S, Roberts S, Said P, Sullivan H, Freeman D, Allen E, Reiter E, Feinberg C, Johnson L, Newhook D, Hagerty N, White L, Levandoski J, Kyllo M, Johnson C, Gough J, Benoit P, Iyer F, Diamond H, Hosono S, Jackman L, Barette P, Jones I, Sills S, Bzdick J, Bulger R, Ginem J, Weinstock I, Douek R, Andrews G, Modgill G, Gyorffy L, Robin N, Vaidya S, Crouch K, O’Brien C, Thompson N, Granger M, Thorne J, Blumer J, Kalic L, Klepek J, Paulett B, Rosolowski J, Horner M, Watkins J, Casey K, Carpenter C, Michelle Kieffer MH, Burns J, Horton C, Pritchard D, Soetaert A, Wynne C, Chin O, Molina C, Patel R, Senguttuvan M, Wheeler O, Lane P, Furet C, Steuhm D, Jelley S, Goudeau L, Chalmers D, Greer C, Panagiotopoulos D, Metzger D, Nguyen M, Horowitz M, Linton C, Christiansen E, Glades C, Morimoto M, Macarewich R, Norman K, Patin C, Vargas A, Barbanica A, Yu P, Vaidyanathan W, Nallamshetty L, Osborne R, Mehra S, Kaster S, Neace J, Horner G, Reeves C, Cordrey L, Marrs T, Miller S, Dowshen D, Oduah V, Doyle S, Walker D, Catte H, Dean M, Drury-Brown B, Hackman M, Lee S, Malkani K, Cullen K, Johnson P, Parrimon Y, Hampton M, McCarrell C, Curtis E, Paul, Zambrano Y, Paulus K, Pilger J, Ramiro J, Luvon Ritzie AQ, Sharma A, Shor A, Song X, Terry A, Weinberger J, Wootten M, Lachin JM, Foulkes M, Harding P, Krause-Steinrauf H, McDonough S, McGee PF, Owens Hess K, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Leschek E, Spain L, Savage P, Aas S, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Vigersky R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Veatch R, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Leschek E, Marks J, Matheson D, Rafkin L, Rodriguez H, Spain L, Wilson D, Redondo M, Gomez D, McDonald A, Pena S, Pietropaolo M, Shippy K, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Pat Gallagher M, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Jo Ricci M, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Teresa Muscato M, Viscardi M, Bingley P, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del A, Rio A, Logan H, Collier C, Rishton G, Whalley A, Ali S, Ramtoola T, Quattrin L, Mastrandea A, House M, Ecker C, Huang C, Gougeon J, Ho D, Pacuad D, Dunger J, May C, O’Brien C, Acerini B, Salgin A, Thankamony R, Williams J, Buse G, Fuller M, Duclos J, Tricome H, Brown D, Pittard D, Bowlby A, Blue T, Headley S, Bendre K, Lewis K, Sutphin C, Soloranzo J, Puskaric H, Madison M, Rincon M, Carlucci R, Shridharani B, Rusk E, Tessman D, Huffman H, Abrams B, Biederman M, Jones V, Leathers W, Brickman P, Petrie D, Zimmerman J, Howard L, Miller R, Alemzadeh D, Mihailescu R, Melgozza-Walker N, Abdulla C, Boucher-Berry D, Ize-Ludlow R, Levy C, Swenson, Brousell N, Crimmins D, Edler T, Weis C, Schultz D, Rogers D, Latham C, Mawhorter C, Switzer W, Spencer P, Konstantnopoulus S, Broder J, Klein L, Knight L, Szadek G, Welnick B, Thompson R, Hoffman A, Revell J, Cherko K, Carter E, Gilson J, Haines G, Arthur B, Bowen W, Zipf P, Graves R, Lozano D, Seiple K, Spicer A, Chang J, Fregosi J, Harbinson C, Paulson S, Stalters P, Wright D, Zlock A, Freeth J, Victory H, Maheshwari A, Maheshwari T, Holmstrom J, Bueno R, Arguello J, Ahern L, Noreika V, Watson S, Hourse P, Breyer C, Kissel Y, Nicholson M, Pfeifer S, Almazan J, Bajaj M, Quinn K, Funk J, McCance E, Moreno R, Veintimilla A, Wells J, Cook S, Trunnel J, Henske S, Desai K, Frizelis F, Khan R, Sjoberg K, Allen P, Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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Bonifacio J, Lupisan S, Roque V, Ducusin MJ, Grabovac V, Batmunkh N, Heffelfinger JD, Fox K, Toda K, de Quiroz Castro M, Kirkwood C, Tandoc A. Molecular characterization of rotavirus diarrhea among children aged under five years in the Philippines, 2013-2015. Vaccine 2018; 36:7888-7893. [PMID: 30467066 DOI: 10.1016/j.vaccine.2018.08.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 08/30/2017] [Revised: 04/25/2018] [Accepted: 08/20/2018] [Indexed: 01/30/2023]
Abstract
With the availability of new and existing rotavirus vaccines, credible and reliable data on burden of rotavirus-associated disease are needed to enable evidence-based decision making regarding the introduction of rotavirus vaccines. The national rotavirus surveillance program in the Philippines, a sentinel-based surveillance, was established in 2012 to determine the proportion of laboratory-confirmed rotavirus cases among children under five years with acute gastroenteritis and to describe the geographic distribution and molecular epidemiology of rotavirus in the country. During 2013 to 2015, rotavirus infection was the cause of acute gastroenteritis among children under five years admitted to hospitals or evaluated in emergency rooms, constituting more than one-third of gastroenteritis hospitalizations at the sentinel site hospitals. The predominant genotype observed was G1P[8]. Although a rotavirus surveillance network has been established, findings suggest the need to strengthen the network in the country and to continue monitoring prevalent rotavirus strains to help identify the possible emergence of new strains.
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Affiliation(s)
- Joseph Bonifacio
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines.
| | - Socorro Lupisan
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Vito Roque
- Department of Health, Manila, Philippines
| | | | - Varja Grabovac
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Nyambat Batmunkh
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - James D Heffelfinger
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kimberley Fox
- World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Kohei Toda
- Office of the World Health Organization Representative in the Philippines, Manila, Philippines
| | | | - Carl Kirkwood
- Enteric Viruses Group, Murdoch Childrens Research Institute, VIC, Australia
| | - Amado Tandoc
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
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Ronco C, Heifetz A, Fox K, Curtin C, Brendolan A, Gastaldon F, Crepaldi C, Fortunato A, Pietribasi G, Caberlotto A, Brunello A, Manani SM, Zanella M, La Greca G. Beta 2-microglobulin Removal by Synthetic Dialysis Membranes. Mechanisms and Kinetics of the Molecule. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Beta 2-microglobulin (ß2-m) accumulation represents a possible complication of long term dialysis. It is therefore important to evaluate the capacity of removal of this molecule from the patient by different dialysis membranes. The present study is aimed at evaluating the mechanisms involved in ß2-m removal by three different synthetic membranes: a) highly asymmetric hydrophobic polysulfone (Biosulfane, NMC), b) moderately asymmetric and hydrophobic polysulfone (PS600, Fresenius), c) Polyacylonitrile (AN69HF, Hospal). The adsorption capacity and sieving coefficients of the three membranes for native and labeled ß2-m were studied in vitro utilizing human blood. The amount adsorbed by the membrane was measured by the elution of the molecule obtained with a detergent solution. Clearances, total removal and membrane adsorption were studied in six patients treated in a randomized sequence with the three membranes. For this purpose, plasma and dialysate measurements as well as total collection of spent dialysate and ß2-m elution from the used dialyzers were carried out. Ex novo generation of ß2-m did not take place during in vitro circulation. The molecule was removed by the studied membranes both by filtration and adsorption. The Biosulfane membrane removed ß2-m mostly by adsorption while the PS600 membrane removed ß2-m almost entirely by filtration. Intermediate behaviour was shown by AN69 membrane. Similar quantities of ß2-m were removed from the patients with the three membranes. Total removal could only be precisely measured by adding the quantity of ß2-m eluted from the membrane to the amount recovered in the spent dialysate. Out of total removal, adsorption was more than 90% with Biosulfane, while only 5% with the PS600. These findings contribute to the understanding of the discrepancy found between the clearance measured from the plasma side and that measured from the dialysate side. In conclusion, clearance and sieving measurements for ß2-m cannot be correctly performed unless the capacity of adsorption of the membrane is taken into account.
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Affiliation(s)
- C. Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Heifetz
- Washington Research Center, Washington, DC
| | - K. Fox
- National Medical Care, Rockleigh, New Jersey - USA
| | - C. Curtin
- National Medical Care, Rockleigh, New Jersey - USA
| | - A. Brendolan
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - F. Gastaldon
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - C. Crepaldi
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Fortunato
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - G. Pietribasi
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Caberlotto
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Brunello
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - S. Milan Manani
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - M. Zanella
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - G. La Greca
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
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McKernon SL, Fox K, Balmer M. A randomised control trial evaluating non-technical skills acquisition using simulated situational training in oral surgery. Br Dent J 2018; 225:sj.bdj.2018.808. [PMID: 30287966 DOI: 10.1038/sj.bdj.2018.808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
- S L McKernon
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
| | - K Fox
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
| | - M Balmer
- University of Liverpool, School of Dentistry, Pembroke Place, Liverpool, Merseyside L3 5PS
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Boivin-Proulx L, Deneault-Marchand A, Matteau A, Mansour S, Camm J, Fox K, Potter B. UPTAKE OF THE 2016 CCS AF GUIDELINES FOR PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.169] [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: 10/28/2022] Open
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Brugts JJ, Bertrand M, Remme W, Ferrari R, Fox K, MacMahon S, Chalmers J, Simoons ML, Boersma E. The Treatment Effect of an ACE-Inhibitor Based Regimen with Perindopril in Relation to Beta-Blocker use in 29,463 Patients with Vascular Disease: a Combined Analysis of Individual Data of ADVANCE, EUROPA and PROGRESS Trials. Cardiovasc Drugs Ther 2018; 31:391-400. [PMID: 28856537 PMCID: PMC5607906 DOI: 10.1007/s10557-017-6747-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In everyday practice, angiotensin converting enzyme inhibitors and beta-blockers are cornerstone treatments in patients with (cardio-)vascular disease. Clear data that evaluate the effects of the combination of these agents on morbidity and mortality are lacking. METHODS In this retrospective pooled analysis of three large perindopril outcome trials (ADVANCE, EUROPA, PROGRESS), clinical outcomes were evaluated in 29,463 patients with vascular disease. Multivariate Cox regression analyses were performed in patients randomized to a perindopril-based regimen or placebo (treatment effect), and data were stratified according to background beta-blocker treatment. The primary endpoint was a composite of cardiovascular mortality, non-fatal myocardial infarction, and stroke. RESULTS The cumulative incidence of the primary endpoint over mean follow-up of 4.0 years (Sd 1.0) was significantly lower in the beta-blocker/perindopril group (9.6%; 545/5700 patients) as compared to beta-blocker/placebo (11.8%; 676/5718 patients) (p < 0.01). Adding perindopril to existing beta-blocker treatment reduced the relative risk of the primary endpoint by 20% (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.71-0.90), non-fatal myocardial infarction by 23% (HR 0.77; 95% CI 0.65-0.91), and all-cause mortality by 22% (HR 0.78; 95% CI 0.68-0.88) as compared to placebo. Significant treatment benefit was not observed for stroke (HR 0.93; 95% CI 0.75-1.15). Significance was maintained for the primary endpoint and cardiovascular endpoints when data were further stratified by baseline hypertension. However, the mortality benefit was only observed in patients with hypertension with background beta-blocker use. CONCLUSIONS These data suggest that the beneficial cardioprotective effects of perindopril treatment are additive to the background beta-blockers use.
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Affiliation(s)
- J J Brugts
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | | | - W Remme
- STICARES Cardiovascular Research Institute, Rhoon, The Netherlands
| | - R Ferrari
- Centro Cardiologico Universitario University of Ferrara, Italy and Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Ravenna, Italy
| | - K Fox
- NHLI, Imperial College and ICMS, Royal Brompton Hospital, London, UK
| | - S MacMahon
- The George Institute for Global Health, The Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - J Chalmers
- The George Institute for Global Health, The Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - M L Simoons
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Huyen DTT, Hong DT, Trung NT, Hoa TTN, Oanh NK, Thang HV, Thao NTT, Hung DM, Iijima M, Fox K, Grabovac V, Heffelfinger J, Batmunkh N, Anh DD. Epidemiology of acute diarrhea caused by rotavirus in sentinel surveillance sites of Vietnam, 2012-2015. Vaccine 2018; 36:7894-7900. [PMID: 29784467 DOI: 10.1016/j.vaccine.2018.05.008] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/10/2018] [Accepted: 05/01/2018] [Indexed: 11/26/2022]
Abstract
A prospective, multicentre study was conducted in four sentinel surveillance hospitals to assess the trend and epidemiology of acute diarrhea caused by Rotavirus in Vietnam. During the period 2012-2015, a total 8,889 children under 5 years of age were enrolled in the surveillance, and 8689 stool samples were collected. Of these cases, Rotavirus was most common pathogen 46.7% (4054 cases); in which 26.6% (1117) rotavirus-positive stool samples were evaluated to identify genotypes. The proportion of rotavirus positive specimens decreased annually from 54.7% in 2012 to 36.6% in 2015. Rotavirus was detected year-round, but most rotavirus gastroenteritis cases (77.1%) occurred between December and May, corresponding to the rotavirus seasonality. It is found that the peaks varied by regions. Rotavirus positivities varied between the youngest and oldest age, but children 6-11 months old (38.8%) and 12-23 months old (38.4%) counted for most cases. A significant higher number of diarrhea within 24 hours (8.3 times, 95%CI: 8.1-8.4 times) and higher proportion of severe dehydration (12.9%) in Rotavirus positive group than that in Rotavirus negative group (7.7 times, 95%CI: 7.6-7.9 times; and 9.7%, respectively). A downtrend of prevalence of G1P[8] was observed from 82% in 2013 to 15% in 2015. However, G2P[4] was found in 5% of samples in 2012, 9% in 2013, 36% in 2014, and 28% in 2015. Rotavirus infection is the most important cause of acute diarrhea among hospitalized children in Vietnam, and a rotavirus vaccination program for children may significantly reduce this disease.
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Affiliation(s)
| | - Duong Thi Hong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | | | | | | | | | | | - Kimberley Fox
- Global Immunization Division, Centers for Diesease Control and Prevention, USA.
| | - Varja Grabovac
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines.
| | - James Heffelfinger
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines.
| | - Nyambat Batmunkh
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines.
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
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SoukAloun D, Douangbouphaa V, Phetsouvanh R, Sibounheuang B, Vongsouvat M, Chanmala K, Vongphachanh T, Maniphonh S, Phouangsouvanh I, Fox K, Logronio J, Grabovac V, Heffelfinger J, Jeong H, Kim K, Nyambat B. Rotavirus diarrhea in hospitalized children under 5 years of age in Vientiane, Lao PDR, 2009-2015. Vaccine 2018; 36:7878-7882. [PMID: 29739715 DOI: 10.1016/j.vaccine.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 03/14/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Diarrhea is a leading cause of death in children <5 years worldwide, causing an estimated 215,000 deaths in 2013. This evaluation tracks the epidemiologic patterns and most common rotavirus genotypes among hospitalized children in this age group with acute gastroenteritis in Lao PDR. METHODS Children <5 years in a central tertiary hospital in the capital city were prospectively enrolled into the surveillance platform during January 2009-December 2015. We collected information regarding clinical characteristics of enrolled children. Stool samples were obtained within 24 h of hospital admission and tested for rotavirus using rotavirus antigen detection enzyme immunoassay. Samples were sent to the regional reference laboratories in Australia and South Korea for genotyping. Bivariate analyses compared demographic and clinical characteristics between rotavirus positive and negative children using Chi-square statistical testing. Seasonality of rotavirus and annual genotype distribution are also described. RESULTS We enrolled 1853 children <5 years with acute gastroenteritis during the surveillance period and collected 1772 fecal specimens, 982 (55%) of which tested positive for rotavirus. A higher proportion of rotavirus acute gastroenteritis was observed among children 12-23 months of age as compared to rotavirus negative children in the same age group, 41% vs 36%. Eighty-six percent of rotavirus positive children experienced vomiting, as compared to 65% of rotavirus negative children. Eighty-five percent (n = 830/982) of rotavirus positive specimens occurred during the dry season (January-April). The most common genotypes identified were G1, G2, G3 and P8 and P4. The most prevalent combined genotype differed annually during the surveillance period. CONCLUSION Surveillance continues to be important in documenting the burden of rotavirus in children <5 years in Lao PDR as well as providing a baseline for determining the impact of rotavirus vaccine once it is introduced into Lao PDR's national immunization schedule.
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Affiliation(s)
- Douangdao SoukAloun
- Department of Pediatrics, Mahosot Hospital, Vientiane, Lao Democratic People's Republic.
| | - Vannida Douangbouphaa
- Department of Pediatrics, Mahosot Hospital, Vientiane, Lao Democratic People's Republic.
| | | | - Bountoy Sibounheuang
- Microbiology Section, Mahosot Hospital, Vientiane, Lao Democratic People's Republic
| | - Manivanh Vongsouvat
- Microbiology Section, Mahosot Hospital, Vientiane, Lao Democratic People's Republic
| | - Keomany Chanmala
- Department of Pediatrics, Mahosot Hospital, Vientiane, Lao Democratic People's Republic
| | - Thonglay Vongphachanh
- Department of Pediatrics, Mahosot Hospital, Vientiane, Lao Democratic People's Republic
| | - Soudalinh Maniphonh
- Department of Pediatrics, Mahosot Hospital, Vientiane, Lao Democratic People's Republic
| | | | - Kimberley Fox
- WHO Western Pacific Regional Office, Manila, Philippines
| | | | - Varja Grabovac
- WHO Western Pacific Regional Office, Manila, Philippines
| | | | - Hyesook Jeong
- Division of Vaccine Research, Korea Centers of Disease Control and Prevention, Seoul, Republic of Korea
| | - Kisang Kim
- Division of Vaccine Research, Korea Centers of Disease Control and Prevention, Seoul, Republic of Korea
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Lopez AL, Raguindin PF, Esparagoza J, Fox K, Batmunkh N, Bonifacio J, Parashar UD, Tate JE, Ducusin MJ. Impact of rotavirus vaccine on diarrheal hospitalization and outpatient consultations in the Philippines: First evidence from a middle-income Asian country. Vaccine 2018; 36:3308-3314. [PMID: 29729994 PMCID: PMC5980826 DOI: 10.1016/j.vaccine.2018.04.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/21/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
Starting in 2012, RVV was introduced in public health clinics of Agusan del Sur province. Declines in diarrheal hospitalizations and consults were seen following RVV introduction. No declines in diarrheal admissions were observed in a province where RVV was not introduced. This is the first evidence of the public health impact of RVV in a middle income country Asia.
Background Monovalent rotavirus (RV) vaccine was introduced in the Philippines in a phased manner beginning in 2012. To assess the impact of RV vaccine, we conducted a retrospective review of diarrheal admissions in two hospitals. Methods Records of physician-diagnosed diarrheal admissions were reviewed in D.O. Plaza Hospital (DOPH) from 2009 to 2016 in Agusan del Sur where RV vaccine was introduced in the immunization program; and in Cotabato Regional Medical Center (CRMC) from 2011 to 2016 in a region where the vaccine was not introduced. Reports from consultations in public health clinics in Agusan Del Sur and RV vaccine coverage were obtained. Results All-cause diarrheal admissions among children <5 years old in DOPH declined from 2013 to 2016 following RV vaccine introduction in 2012. Using the 2009–2011 mean number of hospitalizations as baseline (X‾ = 1,141), the reductions were 28% (n = 821), 56% (n = 507), 63% (n = 417) and 59% (n = 466) in 2013, 2014, 2015 and 2016, respectively. In comparison, no substantial declines in diarrheal hospitalizations were seen in CRMC from 2011 to 2016. A declining trend was also seen in outpatient consultations in Agusan del Sur following RV vaccine introduction with declines of 27% (n = 2,333), 33% (n = 2,143), 45% (n = 1,764) and 67% (n = 1,059) in 2013, 2014, 2015 and 2016. From September 2012 to December 2016, the 1 and 2-dose RV vaccine coverage gradually increased from 5% and 4% in 2012 to 92% and 88% in 2015, but decreased in 2016 to 53% and 52%, respectively. Discussion RV vaccine introduction was associated with a substantial decline in diarrheal hospitalizations and outpatient consultations for diarrhea in Agusan del Sur, Philippines.
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Affiliation(s)
- Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.
| | - Peter Francis Raguindin
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Joel Esparagoza
- Democrito O. Plaza Memorial Hospital, Prosperidad, Philippines
| | - Kimberley Fox
- Expanded Programme on Immunization, World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Nyambat Batmunkh
- Expanded Programme on Immunization, World Health Organization, Regional Office for the Western Pacific, Manila, Philippines
| | - Joseph Bonifacio
- Department of Virology, Research Institute for Tropical Medicine, Muntinlupa, Philippines
| | - Umesh D Parashar
- Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Murray S, Carrera C, Lazure P, Vardas P, Zamorano JL, Kearney P, Goncalves L, Fox K, Vahanian A. Identifying the needs for competency-based education in Europe: a needs assessment of cardiologists across 52 countries. J Eur CME 2018; 6:1337478. [PMID: 29644134 PMCID: PMC5843045 DOI: 10.1080/21614083.2017.1337478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/16/2017] [Indexed: 11/13/2022] Open
Abstract
Objective: This international needs assessment was mandated by the European Society of Cardiology (ESC) to obtain an in-depth understanding of the current gaps and challenges of European cardiology professionals, with the aim to provide evidence for the development of needs-driven educational and professional development activities. Methods: This ethics-approved needs assessment was conducted among cardiologists from all sub-specialties across 56 countries of Europe and the Mediterranean basin. A mixed-methods research approach was used, combining qualitative in-depth interviews and focus groups with a quantitative survey. Results: Seventy-four (74) cardiologists participated in the qualitative phase and 866 completed the survey. Respondents represented 52 of the 56 targeted countries. Three themes were identified: 1) Challenges in the clinical decision-making process, 2) Challenges in establishing the patient-physician relationship, and 3) Sub-optimal team communication and collaboration. Specific gaps and causalities related to each challenge were found. Although most of the gaps were common across countries and sub-specialties, some significant differences were noted. Conclusion: The findings of this needs assessment indicate gaps and challenges in clinical practice across countries and across sub-specialities. Taking cardiology as an example, this study identifies clear areas of focus, especially around issues of collaboration and communication, for targeted competency-based education in Europe.
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Affiliation(s)
- S Murray
- AXDEV Group Inc., Brossard, Canada
| | - C Carrera
- Education Department, European Society of Cardiology, Sophia Antipolis, France
| | - P Lazure
- Performance Improvement Research Division, AXDEV Group Inc., Brossard, Canada
| | - P Vardas
- Cardiology Department, Heraklion University Hospital, Heraklion (Crete), Greece
| | - J L Zamorano
- Cardiology Department, University Hospital Ramon y Cajal, Madrid, Spain
| | - P Kearney
- Cardiovascular Division, Cork University Hospital, Cork, Ireland
| | - L Goncalves
- Cardiology Department, University Hospitals of Coimbra, Coimbra, Portugal
| | - K Fox
- Cardiovascular Medicine, Imperial College, London, UK
| | - A Vahanian
- Cardiology Department, Bichat-Claude Bernard Hospital, Paris, France
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Angkeabos N, Rin E, Vichit O, Chea C, Tech N, Payne DC, Fox K, Heffelfinger JD, Grabovac V, Nyambat B, Diorditsa S, Samnang C, Hossain MS. Pediatric hospitalizations attributable to rotavirus gastroenteritis among Cambodian children: Seven years of active surveillance, 2010-2016. Vaccine 2018; 36:7856-7861. [PMID: 29588120 DOI: 10.1016/j.vaccine.2018.03.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/06/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Each year, approximately 1,066 Cambodian children under five years old die of diarrhea, and 51% of these deaths are due to rotavirus gastroenteritis. Quantifying childhood hospitalizations caused by severe rotavirus infections is also important in demonstrating disease burden caused by this virus. The objective of this study is to update and confirm the current burden of pediatric hospitalizations attributable to rotavirus gastroenteritis among Cambodian children using seven years of continuous active, prospective surveillance from 2010 to 2016. We also characterize the circulating rotavirus genotypic strains during this period. METHODS Active surveillance for rotavirus gastroenteritis was conducted from January 2010 through December 2016 at a national hospital in Phnom Penh, Cambodia. Children <60 months of age who were hospitalized for acute gastroenteritis (AGE) were consented and enrolled. Information on gender, age, clinical characteristics, and month of onset were collected. Stool specimens were collected and tested by enzyme immunoassay for the presence of rotavirus antigen, and genotyping was performed on rotavirus test-positive specimens to characterize predominant rotavirus strains during the surveillance period. RESULTS Of 7007 children enrolled with AGE and having specimens collected, 3473 (50%) were attributed to rotavirus gastroenteritis. The majority of rotavirus hospitalizations occurred in children younger than two years old (92%). Year-round rotavirus transmission was observed, with seasonal peaks during the cooler, dry months between November and May. Genotypic trends in rotavirus were observed over the surveillance period; the predominant rotavirus strains changed from G1P[8] (2010-2012), to G2P[4] (2013-2014), the emergence of genotype G8P[8] in 2015, and G3P[8] in 2016. CONCLUSIONS Rotavirus is the leading cause of severe acute gastroenteritis hospitalizations in Cambodian children under five years old, with 50% of such hospitalizations attributable to rotavirus. Over 90% of rotavirus hospitalizations occurred in children under 2 years of age. Changes in the predominant rotavirus strains occurred over time among these unvaccinated children. This information is important to understand and prioritize the current potential impacts upon child health that could be achieved through the introduction of rotavirus vaccines in Cambodia.
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Affiliation(s)
- Nhep Angkeabos
- National Pediatric Hospital, Ministry of Health, Phnom Penh, Cambodia
| | - En Rin
- National Pediatric Hospital, Ministry of Health, Phnom Penh, Cambodia
| | - Ork Vichit
- National Immunization Program, Ministry of Health, Phnom Penh, Cambodia
| | - Choeung Chea
- National Pediatric Hospital, Ministry of Health, Phnom Penh, Cambodia
| | - Ngorn Tech
- National Pediatric Hospital, Ministry of Health, Phnom Penh, Cambodia
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Kimberley Fox
- Global Immunization Division, Centers for Disease Control & Prevention, Atlanta, USA
| | - James D Heffelfinger
- Expanded Programme on Immunization, Western Pacific Regional Office, Manila, Philippines
| | - Varja Grabovac
- Expanded Programme on Immunization, Western Pacific Regional Office, Manila, Philippines
| | - Batmunkh Nyambat
- Expanded Programme on Immunization, Western Pacific Regional Office, Manila, Philippines
| | - Sergey Diorditsa
- Expanded Programme on Immunization, Western Pacific Regional Office, Manila, Philippines
| | - Chham Samnang
- Expanded Programme on Immunization, World Health Organization, Phnom Penh, Cambodia
| | - Md Shafiqul Hossain
- Expanded Programme on Immunization, World Health Organization, Phnom Penh, Cambodia.
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Samdan A, Ganbold S, Guntev O, Orosoo S, Javzandorj N, Gongor A, Enkhtuvshin A, Demberelsuren S, Abdul W, Jee Y, Grabovac V, Kirkwood C, Fox K, Nyambat B. Hospital-based surveillance for rotavirus diarrhea in Ulaanbaatar, Mongolia, April 2009 through March 2016. Vaccine 2018; 36:7883-7887. [PMID: 29429811 DOI: 10.1016/j.vaccine.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/19/2017] [Revised: 12/17/2017] [Accepted: 02/01/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diarrheal disease is one of the leading causes of illness and death in young children in the world, especially the developing countries. Diarrheal disease results in about half a million childhood death per year, ranking second among all causes worldwide. Diarrheal disease due to rotavirus infection is currently the most common cause of severe diarrhea in infants and young children worldwide. Rotavirus immunization of infants is a safe and effective public health intervention for rotavirus infection control and expected to lead to a reduction of childhood morbidity and mortality. METHODS We conducted hospital-based surveillance at two representative hospitals in Mongolia to estimate the burden of hospitalizations for rotavirus diarrhea among children aged <5 years and to describe strain distribution patterns during 6-year study period. Fecal specimens were tested by rotavirus antigen detection enzyme immunoassay (EIA). Specimens that tested positive for rotavirus were further characterized to determine the genotype of strains by reverse-transcriptase polymerase chain reaction. RESULTS Between April 2009 and March 2016, among 7076 eligible children with diarrhea 6078 patients were enrolled nationally. Forty-six percent (2794/6078) of EIA a specimens were positive for rotavirus. Ninety-three percent (5649/6078) of hospitalizations for diarrhea involved children less than 2 years. No deaths were recorded due to rotavirus diarrhea. The most common genotype was G3P [8] (47.7%) followed by G9P [6] (14.4%), G2P [4] (12%), and G9P [8] (7.1%). CONCLUSIONS This study found a relatively high prevalence of severe rotavirus-associated diarrhea disease in Mongolia and infants were the most affected. It highlights the urgent need for introduction of rotavirus vaccine into the national immunization program. Continued surveillance is crucial and pre-vaccine introduction rotavirus genotype patterns in Mongolia are valuable and can be followed post-introduction to assess vaccine impact.
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Affiliation(s)
| | - Sarangua Ganbold
- National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | | | - Solongo Orosoo
- National Center for Mother and Child Health, Ulaanbaatar, Mongolia
| | | | - Amar Gongor
- National Center for Mother and Child Health, Ulaanbaatar, Mongolia
| | | | | | - Wajid Abdul
- World Health Organization (WHO) Country Office, Ulaanbaatar, Mongolia
| | - Youngmee Jee
- Korea Centers for Disease Control & Prevention, Osong, South Korea
| | - Varja Grabovac
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines
| | | | - Kimberley Fox
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines
| | - Batmunkh Nyambat
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines.
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DeMichele A, Soucier-Ernst DJ, Clark C, Shih N, Stavropoulos W, Maxwell KN, Feldman M, Lierbamen D, Morrissette JJD, Paul MR, Pan TC, Wang J, Belka GK, Chen Y, Yee S, Carpenter E, Fox K, Matro J, Clark A, Shah P, Domchek S, Bradbury A, Chodosh L. Abstract OT2-06-03: METAMORPH: METAstatic markers of recurrent tumor PHenotype for breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-06-03] [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
Up to 30% of patients diagnosed with breast cancer will develop recurrent disease within their lifetime, and currently this form of the disease is incurable. There are unmet needs to better understand underlying metastatic biology, identify new therapeutic targets and develop better methods for monitoring changes in disease, both to monitor response and elucidate resistance mechanisms. To address these needs, the METAMORPH Study encompasses a comprehensive approach that combines serial molecular tissue profiling at the RNA and DNA level with circulating markers (DTCs, CTCs, plasma tumor DNA), and ongoing assessment of therapeutic response.
METAMORPH is a prospective cohort study of women with suspected or confirmed recurrent breast cancer and accessible tumor by standard clinical biopsy, who are enrolled at the University of Pennsylvania prior to starting a new therapy for recurrent metastatic disease. The aims of this trial are to (1) evaluate the mechanisms through which recurrent breast cancer are genetically distinct from the primary tumor, (2) evaluate the circulating tumor biomarker trajectory of recurrent disease, (3) elucidate “escape pathways” of progressing tumors that emerge during the selective pressure of therapy, and (4) explore clinical utility of tumor and blood testing. The study protocol integrates research aims into clinical care, including a standardized approach to disease assessment and biopsy, pathologic confirmation of histology and receptor subtype, panel-based CLIA-approved genomic profiling, collection of research specimens, and standardized reporting of results, which are returned to patients and physicians. Patients are followed for treatment and outcome, and serial samples are collected at progression. A companion protocol, COMET, provides education about genomic testing and assesses patient understanding and impact of results. To date, 155 patients have enrolled, 142 (92%) have been biopsied, 120 (77%) have had sufficient DNA for molecular profiling and 109 (70%) have had genomic panel testing. Accrual is ongoing, with an initial target of 300 patients. Multiple sites within the UPHS Health System are enrolling. Contact information: angela.demichele@uphs.upenn.edu.
Key words: Metastatic disease, tumor profiling.
Citation Format: DeMichele A, Soucier-Ernst DJ, Clark C, Shih N, Stavropoulos W, Maxwell KN, Feldman M, Lierbamen D, Morrissette JJD, Paul MR, Pan T-C, Wang J, Belka GK, Chen Y, Yee S, Carpenter E, Fox K, Matro J, Clark A, Shah P, Domchek S, Bradbury A, Chodosh L. METAMORPH: METAstatic markers of recurrent tumor PHenotype for breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-06-03.
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Affiliation(s)
- A DeMichele
- University of Pennsylvania, Philadelphia, PA
| | | | - C Clark
- University of Pennsylvania, Philadelphia, PA
| | - N Shih
- University of Pennsylvania, Philadelphia, PA
| | | | - KN Maxwell
- University of Pennsylvania, Philadelphia, PA
| | - M Feldman
- University of Pennsylvania, Philadelphia, PA
| | - D Lierbamen
- University of Pennsylvania, Philadelphia, PA
| | | | - MR Paul
- University of Pennsylvania, Philadelphia, PA
| | - T-C Pan
- University of Pennsylvania, Philadelphia, PA
| | - J Wang
- University of Pennsylvania, Philadelphia, PA
| | - GK Belka
- University of Pennsylvania, Philadelphia, PA
| | - Y Chen
- University of Pennsylvania, Philadelphia, PA
| | - S Yee
- University of Pennsylvania, Philadelphia, PA
| | - E Carpenter
- University of Pennsylvania, Philadelphia, PA
| | - K Fox
- University of Pennsylvania, Philadelphia, PA
| | - J Matro
- University of Pennsylvania, Philadelphia, PA
| | - A Clark
- University of Pennsylvania, Philadelphia, PA
| | - P Shah
- University of Pennsylvania, Philadelphia, PA
| | - S Domchek
- University of Pennsylvania, Philadelphia, PA
| | - A Bradbury
- University of Pennsylvania, Philadelphia, PA
| | - L Chodosh
- University of Pennsylvania, Philadelphia, PA
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Lamy A, Eikelboom J, Bosch J, Fox K, Yusuf S, Tonkin A. Impact of Rivaroxaban Alone or in Combination With Aspirin Versus Aspirin in Preventing Graft Occlusion in Patients With CABG Surgery: The COMPASS CABG Analysis. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.618] [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: 10/28/2022]
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Lee MH, Fox K, Goldwasser S, Lau DWM, Aliahmad B, Sarossy M. Green lasers are beyond power limits mandated by safety standards. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:5144-5147. [PMID: 28269425 DOI: 10.1109/embc.2016.7591885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There has been an increasing number of reports of people losing vision from laser exposure from pocket laser pointers despite the safety limit of 1 milliwatt (1mW) imposed by the Australian government. We hypothesize that this is because commercially available red and green laser pointers are exceeding their labeled power outputs. We tested the power outputs of 4 red and 4 green lasers which were purchased for less than AUD$30 each. The average of 10 measurements was recorded for each laser. We found that 3 out of 4 red lasers conformed to the 1mW safety standard; in contrast, all of the green lasers exceeded this limit, with one of the lasers recording an output of 127.9 mW. This contrast in compliance is explained by the construction of these lasers - green lasers are typically Diode Pumped Solid State (DPSS) lasers that can emit excessive infrared (IR) radiation with poor workmanship or inconsistent adherence to practices of safe design and quality control; red lasers are diode lasers which have limited power outputs due to `Catastrophic Optical Damage' (COD). Relevant professional bodies ought to advocate more strongly for stringent testing, quality control and licensing of DPSS lasers with a view towards government intervention to banning green laser pointer use.
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DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Abstract P2-08-03: Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-08-03] [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: In vitro mechanisms link IL-6 to poor outcome in breast cancer via inflammatory pathways, activated JAK/STAT tumor signaling and upregulation of aromatase, leading to an aggressive tumor phenotype. Epidemiological data from our group and others support these mechanisms in women with ER-positive (+) disease. We therefore hypothesized that the JAK inhibitor, ruxolitinib (RUX, INCB018424; Incyte), would enhance activity of exemestane (EXE) in women with ER+ breast cancer who relapsed after non-steroidal aromatase inhibitor therapy, particularly among carriers of a germ-line polymorphism in IL-6, conferring elevated levels of IL-6 in the tumor microenvironment.
Methods: The “JAKEE trial” is a phase II trial to determine the safety and efficacy of RUX + EXE in postmenopausal women with relapsed, ER+ advanced breast cancer. Eligible patients were required to have progressed on a non-steroidal AI and either measureable or bone-only disease. CRP, a putative biomarker of tumor microenvironment inflammation, was measured at baseline and serially during treatment. Using a Simon 2-stage design, we treated 15 patients with RUX at 25 mg BID and EXE at 25mg daily on a continuous 28-day schedule. First stage results were previously presented (AACR, 2014). Accrual proceeded to second stage after no patient met the pre-defined stopping rule of grade (G) 3/4 toxicity requiring discontinuation from the study within the first treatment cycle. Due to the substantial rate of anemia requiring dose reductions, however, RUX dose was reduced to 15 mg BID in second stage.
Results: A total of 25 patients were enrolled; 24/25 had progressed on AI in metastatic setting; 1 relapsed on adjuvant AI. RUX+EXE was well-tolerated overall, with only 2 G4 events (creatinine elevation, hepatic failure); both were due to disease progression. 16% had G3 fatigue, anemia or hypertension; 12% had G3 neutropenia or depression. Other lower grade toxicities in >20% included musculoskeletal pain, increased ALT, and headache. Overall, patients stayed on therapy for a median of 3 cycles (range 2 – 21). There were no CR or PR, but 6/25 (24%) had prolonged disease control (SD> 6 months). Median CRP at study entry was 6.4 (range 0.3-38.9), with 8/25 (32%) having CRP>10. Achieving SD>6 months was not associated with baseline CRP (CRP>10 in 32% with vs. 33% without SD>6 months, p(exact)=1.0). A novel pharmacodynamic assay to assess STAT3 phosphorylation in peripheral blood mononuclear cells after RUX exposure demonstrated differential effects in patients with response.
Conclusions: Targeting JAK/STAT signaling in AI-resistant breast cancer with RUX+EXE was safe and well-tolerated. 24% of patients had prolonged SD, but baseline CRP level did not predict response. Correlative studies to determine whether host and/or tumor biomarkers predict response to therapy, including germline IL-6 genotype, immune profiles, p-STAT3 and estradiol levels, are currently underway.
Citation Format: DeMichele AM, Clark AS, Holmes R, Volpe M, Medrano C, Troxel A, Fox K, Domchek S, Matro J, Bradbury A, Shih N, Feldman M, Hexner E, Bromberg J. Targeting inflammatory pathways: A phase 2 trial of the JAK-inhibitor ruxolitinib in combination with exemestane for aromatase inhibitor-resistant, estrogen receptor-positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-08-03.
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Affiliation(s)
- AM DeMichele
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - AS Clark
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Holmes
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Volpe
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Medrano
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Troxel
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - K Fox
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Domchek
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Matro
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Bradbury
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - N Shih
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Feldman
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - E Hexner
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Bromberg
- University of Pennsylvania, Philadelphia, PA; Memorial Sloan Kettering Cancer Center, New York, NY
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Lawson KD, Lewsey JD, Ford I, Fox K, Ritchie LD, Tunstall-Pedoe H, Watt GCM, Woodward M, Kent S, Neilson M, Briggs AH. A cardiovascular disease policy model: part 2-preparing for economic evaluation and to assess health inequalities. Open Heart 2016; 3:e000140. [PMID: 27335653 PMCID: PMC4908904 DOI: 10.1136/openhrt-2014-000140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 02/17/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives This is the second of the two papers introducing a cardiovascular disease (CVD) policy model. The first paper described the structure and statistical underpinning of the state-transition model, demonstrating how life expectancy estimates are generated for individuals defined by ASSIGN risk factors. This second paper describes how the model is prepared to undertake economic evaluation. Design To generate quality-adjusted life expectancy (QALE), the Scottish Health Survey was used to estimate background morbidity (health utilities) and the impact of CVD events (utility decrements). The SF-6D algorithm generated utilities and decrements were modelled using ordinary least squares (OLS). To generate lifetime hospital costs, the Scottish Heart Health Extended Cohort (SHHEC) was linked to the Scottish morbidity and death records (SMR) to cost each continuous inpatient stay (CIS). OLS and restricted cubic splines estimated annual costs before and after each of the first four events. A Kaplan-Meier sample average (KMSA) estimator was then used to weight expected health-related quality of life and costs by the probability of survival. Results The policy model predicts the change in QALE and lifetime hospital costs as a result of an intervention(s) modifying risk factors. Cost-effectiveness analysis and a full uncertainty analysis can be undertaken, including probabilistic sensitivity analysis. Notably, the impacts according to socioeconomic deprivation status can be made. Conclusions The policy model can conduct cost-effectiveness analysis and decision analysis to inform approaches to primary prevention, including individually targeted and population interventions, and to assess impacts on health inequalities.
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Affiliation(s)
- K D Lawson
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK; Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - J D Lewsey
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - I Ford
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - K Fox
- BHF Centre for Research Excellence, University of Edinburgh , Edinburgh , UK
| | - L D Ritchie
- Centre of Academic Primary Care, University of Aberdeen , Aberdeen , UK
| | - H Tunstall-Pedoe
- Institute of Cardiovascular Research, Ninewells Hospital, University of Dundee , Dundee , UK
| | - G C M Watt
- General Practice & Primary Care , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - M Woodward
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia; Oxford Martin School, University of Oxford, Oxford, UK
| | - S Kent
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - M Neilson
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - A H Briggs
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
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Timpka J, Fox T, Fox K, Honig H, Odin P, Martinez-Martin P, Antonini A, Ray Chaudhuri K. Improvement of dyskinesias with L-dopa infusion in advanced Parkinson's disease. Acta Neurol Scand 2016; 133:451-8. [PMID: 26358227 DOI: 10.1111/ane.12483] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We wanted to investigate whether continuous intrajejunal levodopa-carbidopa intestinal gel (LCIG) therapy has an antidyskinetic effect in patients with Parkinson's disease (PD) and troublesome dyskinesias. We also sought to examine the effect of LCIG therapy on motor function and health-related quality of life (HRQoL). MATERIALS AND METHODS This open-label pilot study used a single group pre-post design with follow-up at 6 months. Nine patients with PD who reported to spend at least 3 h per day in on with troublesome dyskinesia were included. The patients were examined at baseline using clinical and self-assessment measures and then switched from peroral/transdermal pharmacotherapy to LCIG therapy. Data collection was repeated 6 months after the pharmaceutical intervention. Nonparametric statistical methods were used for data analyses. RESULTS The mean time spent in on with troublesome dyskinesia per day after 6 months of LCIG therapy decreased by 47% (P < 0.05). This observation was paralleled by a 112% increase in mean time spent in on without troublesome dyskinesia (P < 0.01). Patient self-assessment of dyskinesia intensity on the visual analog scale displayed a 90% reduction of mean dyskinesia intensity (P < 0.01) and patients also exhibited less dyskinesia during standardized levodopa tests. Furthermore, we noted improvements in motor function and HRQoL. CONCLUSIONS In this pilot study, we found indications that LCIG therapy has a substantial antidyskinetic effect and could be an alternative also for PD patients with dyskinesias as a major symptom. However, further studies with blinded evaluation and larger numbers of patients are warranted to confirm the findings.
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Affiliation(s)
- J. Timpka
- Department of Clinical Sciences, Neurology; Lund University; Lund Sweden
| | - T. Fox
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - K. Fox
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - H. Honig
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - P. Odin
- Department of Clinical Sciences, Neurology; Lund University; Lund Sweden
- Department of Neurology; Central Hospital; Bremerhaven Germany
| | - P. Martinez-Martin
- National Center of Epidemiology and CIBERNED; Carlos III Institute of Health; Madrid Spain
| | - A. Antonini
- Parkinson's Disease and Movement Disorders Unit; IRCCS Hospital San Camillo; Venice Italy
| | - K. Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence; King's College Hospital; King's College; London UK
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Clark AS, O'Dwyer P, Troxel A, Lal P, Feldman M, Gallagher M, Driscoll A, Colameco C, Lewis D, Rosen M, Matro J, Bradbury A, Domchek S, Fox K, DeMichele A. Abstract P6-13-08: Palbociclib and paclitaxel on an alternating schedule for advanced breast cancer: Results of a phase Ib trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-13-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Palbociclib (P) is an oral CDK 4/6 inhibitor (CDKi) that was recently FDA approved in combination with endocrine therapy for metastatic breast cancer. We have performed a Phase I trial of P in combination with paclitaxel (T) based on preclinical studies suggesting that P synergizes with T when given on an alternating schedule, enabling cell cycle synchronization in tumor cells. We now present the dose expansion cohort.
Methods: Patients (Pts) enrolled on the trial had Rb-expressing tumors of any estrogen/progesterone/HER2 receptor type, adequate organ function, and ≤3 prior chemotherapy regimens for metastatic breast cancer (mBC). Prior adjuvant or metastatic taxane was allowed. Dose escalation led to expansion at P100mg or 75mg, starting with 3 days of P (run-in) and reduction of P dosing from 5-day to 3-day intervals (days 2-4, 9-11, 16-18 of each 28 day cycle). T at 80mg/m2 was given weekly for 3 cycles; thereafter, T was administered days 1, 8 and 15 of 28 day cycle. Weekly toxicity assessments were performed; RECIST 1.0 response was assessed every 2 cycles as partial response (PR), stable disease (SD) or progressive disease (PD). Pts had the option to discontinue T and continue on P alone (3 on/1 off schedule) if they attained SD after cycle 6.
Results: 27 pts enrolled on study (15- dose escalation, 12- dose expansion). Results are shown in the Table. 21 pts had received prior taxane; pts had received a median of 2 chemotherapy regimens for mBC. DLTs were grade 3 AST/ALT (n=1, at 125 mg) and febrile neutropenia (FN) (n=1, at 100 mg). Uncomplicated grade 3/4 NTP was common and frequently led to dose reduction or dose interruption during the first cycle of therapy. Frequency of NTP did not change with reducing the days of P. Among 24 evaluable patients, 14 (58%), had PR or SD ≥ 6 months across all dose levels. Of 14 pts who responded, 10 (71%) had received prior taxane. 20 pts are off study; 19 for PD, and 2 for toxicity (NTP in cycle 17 and FN in cycle 1); 7 pts remain on study. Prolonged tumor responses were seen.
Conclusions: P and T can be safely combined on an alternating dosing schedule; the optimal combination dose is 75 mg of P and 80mg/m2 of weekly T. The high response rate warrants a randomized trial to determine the incremental benefit over T alone. Additional mechanistic studies are in progress to understand the in vivo effects of the alternating dosing schedule on cell cycle activity and tumor proliferation.
Starting Dose Level P (mg)Number (Total 27)DLTGrade 3/4 NTP (n)Final Dose P mg (n)Dose Interruption (n)Best Response (n)5030050 (1) 50 (1) 50 (1)No (2) Yes (1)PR (1) SD (1) PD (1)7530275 (1) 50 (1) 25 (1)No (1) Yes (2)PR (2) SD (1)100605100 (2) 75 (3) 25 (1)No (1) Yes (5)PR (2) SD (1) PD (3)12531- LFT375 (1) 50 (2)No (0) Yes (3)PR (1) SD (2)75 (Run-In)60175 (5) 50 (1)No (4) Yes (2)PR (1) SD (2) PD (1) N/A (2)*100 (Run-In)61- FN5100 (1) 75 (4) 25(1)No (1) Yes (5)PR (4) SD (1) N/A (1)^*2 pts not yet evaluable. ^1 pt went off study due to FN after cycle 1.
Citation Format: Clark AS, O'Dwyer P, Troxel A, Lal P, Feldman M, Gallagher M, Driscoll A, Colameco C, Lewis D, Rosen M, Matro J, Bradbury A, Domchek S, Fox K, DeMichele A. Palbociclib and paclitaxel on an alternating schedule for advanced breast cancer: Results of a phase Ib trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-13-08.
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Affiliation(s)
- AS Clark
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P O'Dwyer
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Troxel
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P Lal
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Feldman
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Gallagher
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Driscoll
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Colameco
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - D Lewis
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Rosen
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - J Matro
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A Bradbury
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S Domchek
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K Fox
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - A DeMichele
- Perelman School of Medicine, University of Pennsylvania; Division of Hematology/Oncology, Philadelphia, PA; Abramson Cancer Center, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Soucier-Ernst D, Colameco C, Troxel AB, Clark C, Shih N, Maxwell KN, Morrissette J, Lieberman D, Feldman M, Goodman N, Bradbury A, Clark A, Domchek S, Fox K, Glick J, Matro J, Nathanson K, Chodosh L, DeMichele A. Abstract P6-07-05: Mutational spectrum and tumor response in metastatic breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-07-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: While several comprehensive genomic sequencing tests are clinically available for breast cancer(BC), little is known about the spectrum of findings reported in the general population and clinical utility of findings for patients(pts). Here we report tumor sequencing from the METAMORPH study, a comprehensive genomic testing approach in pts with metastatic(met) BC.
Methods: Pts with either known or suspected BC mets consented to and clinically underwent concurrent diagnostic and research tumor biopsies(bx). FFPE specimens were profiled via Illumina TruSeq Cancer Panel next generation sequencing platform covering 212 amplicons in 47 cancer genes. Pathology, treatment and outcome data were prospectively collected and tracked. Aside from Her2-directed treatment, therapy was not mutation (mut)-matched.
Results: 64 pts enrolled between 11/2013 – 05/2015. Of these, 48 had bx successfully sequenced (75%). Of those without sequencing, 5 had negative/insufficient tissue, 2 had insufficient DNA, remainder no bx/pending. Median age of those sequenced was 56 (range 31-78); 81% Caucasian, 17% African American. 25% (12 pts) presented with de novo stage IV disease. Of those with recurrence (n=36), 83% had prior adjuvant chemotherapy; 81% hormone receptor positive(HR+) had prior endocrine therapy. Median # prior lines of therapy for met disease was 2 (IQR 0 – 8). Tumor characteristics, including mut analyses, are shown in Table 1. # muts did not differ significantly by subtype(p=0.22). Frequency of TP53 and PIK3CA hotspot muts was nearly identical to TCGA. Median # muts was 1 for pts with both de novo mets and recurrence(p=0.79). # of muts was not associated with time to recurrence(p=0.80). Excluding pts found to have TP53 mut only or ERBB2 alterations in known Her2+ disease, 42% of pts were identified as having at least one potentially actionable alteration (PIK3CA mut, AKT1 mut or EGFR amplification). Median time to treatment failure(TTF) on subsequent therapy was 4.1 months for overall group, and 4.1, 6.2, and 1.6 months for HR+/Her2-, any Her2+ and TN, respectively, adjusted for line of therapy(p=0.03). After adjustment for # lines of prior met therapy, TTF was 4.7 vs. 4.1 months for pts with any mut vs. none(p=0.89); 5.7 vs 4.1 months for PIK3CA+ vs. not (p=0.94); 3.3 vs. 6.5 months for TP53+ vs. not (p=0.03).
Conclusion: Pts with met BC have frequent and potentially actionable muts.While overall # of muts did not affect response, tumors with TP53 muts had shorter response to subsequent therapy in this cohort. Additional data are needed to determine the clinical utility of mut testing in met BC, for both standard and mut-matched therapy.
Total (n=48)HR+/Her2- (n=28)Any HER2+ (n=7)TN (n=13)Receptor concordant with primary 100%78%77%# Mutations Median (Range)1 (0-4)1 (0-3)1 (1-2)1 (0-4)014 (29%)10 (36 %)04 (31%)118 (38%)11 (39%)4 (57%)3 (23%)213 (27%)5 (18%)3 (43%)5 (38%)3+3 (6%)2 (7%)01 (8%)Prevalent Mutations (>20%)TP53 (38%), PIK3CA (35%)PIK3CA (50%), TP53 (25%)TP53 (60%), ERBB2amp (86%)TP53 (62%),PIK3CA (23%)Other Alterations (#)ATM (1), KIT (1), PDGFRA (1), PTEN(1), RB1 (1), SMAD4 (1), SMO (1), STK11 (1)AKT1 (1), ATM VUS (1), ERBB2 (1), PTEN (1), SMAD4 VUS (1), SMO VUS (1)ERBB2 (1), STK11(1)EGFR amp (2), KIT amp (1),PDGFRA amp (1), RB1 VUS (1)
Citation Format: Soucier-Ernst D, Colameco C, Troxel AB, Clark C, Shih N, Maxwell KN, Morrissette J, Lieberman D, Feldman M, Goodman N, Bradbury A, Clark A, Domchek S, Fox K, Glick J, Matro J, Nathanson K, Chodosh L, DeMichele A. Mutational spectrum and tumor response in metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-07-05.
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Affiliation(s)
| | - C Colameco
- University of Pennsylvania, Philadelphia, PA
| | - AB Troxel
- University of Pennsylvania, Philadelphia, PA
| | - C Clark
- University of Pennsylvania, Philadelphia, PA
| | - N Shih
- University of Pennsylvania, Philadelphia, PA
| | - KN Maxwell
- University of Pennsylvania, Philadelphia, PA
| | | | - D Lieberman
- University of Pennsylvania, Philadelphia, PA
| | - M Feldman
- University of Pennsylvania, Philadelphia, PA
| | - N Goodman
- University of Pennsylvania, Philadelphia, PA
| | - A Bradbury
- University of Pennsylvania, Philadelphia, PA
| | - A Clark
- University of Pennsylvania, Philadelphia, PA
| | - S Domchek
- University of Pennsylvania, Philadelphia, PA
| | - K Fox
- University of Pennsylvania, Philadelphia, PA
| | - J Glick
- University of Pennsylvania, Philadelphia, PA
| | - J Matro
- University of Pennsylvania, Philadelphia, PA
| | - K Nathanson
- University of Pennsylvania, Philadelphia, PA
| | - L Chodosh
- University of Pennsylvania, Philadelphia, PA
| | - A DeMichele
- University of Pennsylvania, Philadelphia, PA
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