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Li Y, Ren T, Burgess M, Chen Z, Carney PW, O'Brien TJ, Kwan P, Foster E. Early Access to First-Seizure Clinics, Subsequent Outcomes, and Factors Associated With Attendance. JAMA Neurol 2024:2819302. [PMID: 38778793 DOI: 10.1001/jamaneurol.2024.1187] [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: 05/25/2024]
Abstract
Importance First-seizure clinics (FSCs) aim to deliver prompt specialist care to patients with new-onset undifferentiated seizure events. Objective To determine whether FSC attendance and time to FSC are associated with subsequent health care utilization and mortality and to investigate factors associated with FSC nonattendance. Design, Setting, and Participants This was a record-linkage, retrospective, cohort study of patients who booked appointments at 2 FSCs between 2007 and 2018. Patients' records were linked to state-wide administrative databases between 2000 and 2021. The setting comprised the FSCs of 2 major metropolitan public hospitals in Melbourne, Australia, providing national inpatient and outpatient adult epilepsy services. Of patients who booked appointments at the FSCs, those who were successfully linked for analysis were included in the study. Patients who recorded only canceled appointments were excluded from analysis of outcomes. Study data were analyzed from January 2000 to December 2021. Exposure FSC attendance. Main Outcomes and Measures Subsequent all-cause and seizure-related emergency department (ED) presentations and hospital admissions. Results Of 10 162 patients with appointments at FSCs, 9392 were linked for analysis, with mean (SD) follow-up time 6.9 (2.8) years after FSC referral. A total of 703 patients were excluded. Among 9392 linked patients, 5398 were male (57.5%; mean [SD] age, 59.7 [11.2] years). FSC attendance was associated with reduced subsequent all-cause emergency presentations (adjusted incidence rate ratio [aIRR], 0.72; 95% CI, 0.66-0.79) and all-cause hospitalization (aIRR, 0.81; 95% CI, 0.75-0.88). Those who attended at the first-scheduled appointment, compared with those who attended only a rescheduled, delayed appointment, had reduced subsequent all-cause emergency presentations (aIRR, 0.83; 95% CI, 0.76-0.91), all-cause hospitalization (aIRR, 0.71; 95% CI, 0.65-0.79), seizure-related presentations (aIRR, 0.40; 95% CI, 0.33-0.49), and mortality (hazard ratio, 0.82; 95% CI, 0.69-0.98). Male sex was associated with nonattendance (adjusted relative risk [aRR], 1.12; 95% CI, 1.03-1.22), as were injury at emergency presentation (aRR, 1.12; 95% CI, 1.01-1.24), psychiatric comorbidity (aRR, 1.68; 95% CI, 1.55-1.81), previous seizure-related presentations (aRR, 1.35; 95% CI, 1.22-1.49), and delays (>14 days) between FSC referral and appointment (aRR, 1.35; 95% CI, 1.18-1.54). Hospitalization at referral was associated with reduced nonattendance (aRR, 0.80; 95% CI, 0.72-0.90), as were non-English language preference (aRR, 0.81; 95% CI, 0.69-0.94), distance greater than 6 mi from home to clinic (aRR, 0.85; 95% CI, 0.76-0.95), and physical comorbidity (aRR, 0.80; 95% CI, 0.72-0.89). Conclusions and Relevance Results of this cohort study suggest that FSC attendance, particularly early attendance, was associated with reduced rates of subsequent hospital utilization. This knowledge may support adequately resourcing FSCs to improve equitable, timely access. Future study directions include assessing interventions that may support FSC attendance for at-risk groups.
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Affiliation(s)
- Yingtong Li
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tianrui Ren
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael Burgess
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Patrick W Carney
- Department of Neurology, Eastern Health, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- The Florey, Melbourne Brain Centre, Heidelberg, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Emma Foster
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
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Ren T, Li Y, Burgess M, Sharma S, Rychkova M, Dunne J, Lee J, Laloyaux C, Lawn N, Kwan P, Chen Z. Long-term physical and psychiatric morbidities and mortality of untreated, deferred, and immediately treated epilepsy. Epilepsia 2024; 65:148-164. [PMID: 38014587 DOI: 10.1111/epi.17819] [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: 06/20/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE In Australia, 30% of newly diagnosed epilepsy patients were not immediately treated at diagnosis. We explored health outcomes between patients receiving immediate, deferred, or no treatment, and compared them to the general population. METHODS Adults with newly diagnosed epilepsy in Western Australia between 1999 and 2016 were linked with statewide health care data collections. Health care utilization, comorbidity, and mortality at up to 10 years postdiagnosis were compared between patients receiving immediate, deferred, and no treatment, as well as with age- and sex-matched population controls. RESULTS Of 603 epilepsy patients (61% male, median age = 40 years) were included, 422 (70%) were treated immediately at diagnosis, 110 (18%) received deferred treatment, and 71 (12%) were untreated at the end of follow-up (median = 6.8 years). Immediately treated patients had a higher 10-year rate of all-cause admissions or emergency department presentations than the untreated (incidence rate ratio [IRR] = 2.0, 95% confidence interval [CI] = 1.4-2.9) and deferred treatment groups (IRR = 1.7, 95% CI = 1.0-2.8). They had similar 10-year risks of mortality and developing new physical and psychiatric comorbidities compared with the deferred and untreated groups. Compared to population controls, epilepsy patients had higher 10-year mortality (hazard ratio = 2.6, 95% CI = 2.1-3.3), hospital admissions (IRR = 2.3, 95% CI = 1.6-3.3), and psychiatric outpatient visits (IRR = 3.2, 95% CI = 1.6-6.3). Patients with epilepsy were also 2.5 (95% CI = 2.1-3.1) and 3.9 (95% CI = 2.6-5.8) times more likely to develop a new physical and psychiatric comorbidity, respectively. SIGNIFICANCE Newly diagnosed epilepsy patients with deferred or no treatment did not have worse outcomes than those immediately treated. Instead, immediately treated patients had greater health care utilization, likely reflecting more severe underlying epilepsy etiology. Our findings emphasize the importance of individualizing epilepsy treatment and recognition and management of the significant comorbidities, particularly psychiatric, that ensue following a diagnosis of epilepsy.
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Affiliation(s)
- Tianrui Ren
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yingtong Li
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Michael Burgess
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sameer Sharma
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Maria Rychkova
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Dunne
- Discipline of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - Judy Lee
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | | | - Nicholas Lawn
- Western Australian Adult Epilepsy Service, Perth, Western Australia, Australia
| | - Patrick Kwan
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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King K, Burgess M, Schultz ET, Knighton J. Forecasting hydrologic controls on juvenile anadromous fish out-migration with process-based modeling and machine learning. J Environ Manage 2023; 344:118420. [PMID: 37336016 DOI: 10.1016/j.jenvman.2023.118420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
River herring (Alosa sp.) are ecologically and economically foundational species in freshwater streams, estuaries, and oceanic ecosystems. The migration between fresh and saltwater is a key life stage of river herring, where the timing and magnitude of out-migration by juveniles can be limited when streams dry and hydrologic connectivity is lost. Operational decisions by water managers (e.g., restricting community water use) can impact out-migration success; however, these decisions are largely made without reliable predictions of outmigration potential across the migration season. This research presents a model to generate short-term forecasts of the probability of herring out-migration loss. We monitored streamflow and herring out-migration for 2 years at three critical runs along Long Island Sound (CT, USA) to develop empirical understandings of the hydrologic controls on out-migration. We used calibrated Soil and Water Assessment Tool hydrologic models of each site to generate 10,000 years of daily synthetic meteorological and streamflow records. These synthetic meteorological and streamflow data were used to train random forest models to provide rapid within-season forecasts of out-migration loss from two simple predictors: current spawning reservoir depth and the previous 30-day precipitation total. The resulting models were approximately 60%-80% accurate with a 1.5-month lead time and 70-90% accurate within 2 weeks. We anticipate that this tool will support regional decisions on spawning reservoir operations and community water withdrawals. The architecture of this tool provides a framework to facilitate broader predictions of the ecological consequences of streamflow connectivity loss in human-impacted watersheds.
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Affiliation(s)
- Katherine King
- Department of Natural Resources and the Environment, University of Connecticut, Storrs, CT, 06269, USA
| | - Michael Burgess
- Department of Ecology & Evolutionary Biology, University of Connecticut, Storrs, CT, 06269, USA
| | - Eric T Schultz
- Department of Ecology & Evolutionary Biology, University of Connecticut, Storrs, CT, 06269, USA
| | - James Knighton
- Department of Natural Resources and the Environment, University of Connecticut, Storrs, CT, 06269, USA.
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Burgess M, Savage S, Mitchell R, Mitra B. Pathology testing in non-trauma patients presenting to the emergency department with recurrent seizures. Emerg Med Australas 2023; 35:834-841. [PMID: 37263625 DOI: 10.1111/1742-6723.14253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Excessive pathology testing is associated with ED congestion, increased healthcare costs and adverse patient health outcomes. This study aimed to determine the frequency, yield and influence of pathology tests among patients presenting to the ED with atraumatic recurrent seizures. METHODS This was a retrospective cohort study conducted at a level 4 adult ED in Australia and included atraumatic patients presenting to ED with recurrent seizures over a 4-year period (2017-2020). The primary outcome was the frequency of pathology tests. Additionally, the proportion of abnormal pathology test results and the association between pathology tests and change in management were assessed. RESULTS Of the 398 eligible presentations, 346 (86.9%, 95% confidence interval [CI] 83.3-89.9%) underwent at least one pathology test. In total 18.3% (n = 517) of pathology tests had an abnormal result which led to 15 changes in ED management among 12 presentations. Patients who had an abnormal pathology test result were more likely to undergo a change in antiepileptic drug management (odds ratio 2.08, 95% CI 1.23-3.65; P = 0.008). CONCLUSION Most patients presenting to the ED with atraumatic recurrent seizures underwent pathology tests. Abnormalities were frequently detected but were uncommonly associated with change in management. Abnormal pathology test results were associated with changes in antiepileptic drug management although rarely led to acute changes in patient management. This study suggests that pathology tests may be excessively requested in this population.
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Affiliation(s)
- Michael Burgess
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simon Savage
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert Mitchell
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
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Cass SH, Tobin JWD, Seo YD, Gener-Ricos G, Keung EZ, Burton EM, Davies MA, McQuade JL, Lazar AJ, Mason R, Millward M, Sandhu S, Khoo C, Warburton L, Guerra V, Haydon A, Dearden H, Menzies AM, Carlino MS, Smith JL, Mollee P, Burgess M, Mapp S, Keane C, Atkinson V, Parikh SA, Markovic SN, Ding W, Call TG, Hampel PJ, Long GV, Wargo JA, Ferrajoli A. Efficacy of immune checkpoint inhibitors for the treatment of advanced melanoma in patients with concomitant chronic lymphocytic leukemia. Ann Oncol 2023; 34:796-805. [PMID: 37414216 DOI: 10.1016/j.annonc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced melanoma (AM). However, data on ICI effectiveness have largely been restricted to clinical trials, thereby excluding patients with co-existing malignancies. Chronic lymphocytic leukemia (CLL) is the most prevalent adult leukemia and is associated with increased risk of melanoma. CLL alters systemic immunity and can induce T-cell exhaustion, which may limit the efficacy of ICIs in patients with CLL. We, therefore, sought to examine the efficacy of ICI in patients with these co-occurring diagnoses. PATIENTS AND METHODS In this international multicenter study, a retrospective review of clinical databases identified patients with concomitant diagnoses of CLL and AM treated with ICI (US-MD Anderson Cancer Center, N = 24; US-Mayo Clinic, N = 15; AUS, N = 19). Objective response rates (ORRs), assessed by RECIST v1.1, and survival outcomes [overall survival (OS) and progression-free survival (PFS)] among patients with CLL and AM were assessed. Clinical factors associated with improved ORR and survival were explored. Additionally, ORR and survival outcomes were compared between the Australian CLL/AM cohort and a control cohort of 148 Australian patients with AM alone. RESULTS Between 1997 and 2020, 58 patients with concomitant CLL and AM were treated with ICI. ORRs were comparable between AUS-CLL/AM and AM control cohorts (53% versus 48%, P = 0.81). PFS and OS from ICI initiation were also comparable between cohorts. Among CLL/AM patients, a majority were untreated for their CLL (64%) at the time of ICI. Patients with prior history of chemoimmunotherapy treatment for CLL (19%) had significantly reduced ORRs, PFS, and OS. CONCLUSIONS Our case series of patients with concomitant CLL and melanoma demonstrate frequent, durable clinical responses to ICI. However, those with prior chemoimmunotherapy treatment for CLL had significantly worse outcomes. We found that CLL disease course is largely unchanged by treatment with ICI.
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Affiliation(s)
- S H Cass
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J W D Tobin
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - Y D Seo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Gener-Ricos
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| | - E Z Keung
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - E M Burton
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - M A Davies
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - J L McQuade
- Department of Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - A J Lazar
- Departments of Pathology and Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - R Mason
- Gold Coast University Hospital, Southport
| | | | - S Sandhu
- Peter Macallum Cancer Centre, Melbourne
| | - C Khoo
- Peter Macallum Cancer Centre, Melbourne
| | - L Warburton
- Fiona Stanley Hospital, Perth; Edith Cowan University, Joondalup; Future Health Research and Innovation Fund/Raine Clinician Research Fellowship
| | - V Guerra
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
| | | | - H Dearden
- Melanoma Institute Australia, The University of Sydney, Sydney
| | - A M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; The University of Sydney Charles Perkins Centre, Sydney; The University of Sydney Royal North Shore and Mater Hospitals, Sydney
| | - M S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney; Westmead Hospital, Sydney, Australia
| | - J L Smith
- Westmead Hospital, Sydney, Australia
| | - P Mollee
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - M Burgess
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - S Mapp
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - C Keane
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | - V Atkinson
- Haematology Department, Princess Alexandra Hospital, Woolloongabba; University of Queensland, Brisbane, Australia
| | | | | | - W Ding
- Mayo Clinic, Rochester, USA
| | | | | | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney; Faculty of Medicine and Health, The University of Sydney, Sydney; The University of Sydney Charles Perkins Centre, Sydney; The University of Sydney Royal North Shore and Mater Hospitals, Sydney
| | - J A Wargo
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA.
| | - A Ferrajoli
- Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston
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Edwards L, Bentley C, Burgess M, Sapir-Pichhadze R, Hartell D, Keown P, Bryan S. Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation. BMC Nephrol 2023; 24:165. [PMID: 37296384 PMCID: PMC10255937 DOI: 10.1186/s12882-023-03224-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly. METHODS Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed. RESULTS Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes. CONCLUSIONS Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.
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Affiliation(s)
- Louisa Edwards
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada.
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
| | | | - Michael Burgess
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- W. Maurice Young Centre for Applied Ethics, UBC, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Vancouver, Canada
| | | | - Paul Keown
- Department of Medicine, UBC, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Slomp C, Edwards L, Burgess M, Sapir-Pichhadze R, Keown P, Bryan S. Public values and guiding principles for implementing epitope compatibility in kidney transplantation allocation criteria: results from a Canadian online public deliberation. BMC Public Health 2023; 23:844. [PMID: 37165330 PMCID: PMC10170053 DOI: 10.1186/s12889-023-15790-w] [Citation(s) in RCA: 2] [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: 11/26/2022] [Accepted: 04/30/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Epitope compatibility in deceased donor kidney allocation is an emerging area of precision medicine (PM), seeking to improve compatibility between donor kidneys to transplant candidates in the hope of avoiding kidney rejection. Though the potential benefits of using epitope compatibility are promising, the implied modification of deceased organ allocation criteria requires consideration of significant clinical and ethical trade-offs. As a matter of public policy, these trade-offs should consider public values and preferences. We invited members of the Canadian public to participate in a deliberation about epitope compatibility in deceased donor kidney transplantation; to identify what is important to them and to provide recommendations to policymakers. METHODS An online public deliberation was conducted with members of the Canadian public, in which participants were asked to construct recommendations for policymakers regarding the introduction of epitope compatibility to kidney allocation criteria. In the present paper, a qualitative analysis was conducted to identify the values reflected in participants' recommendations. All virtual sessions were recorded, transcribed, and analyzed using NVivo 12 software. RESULTS Thirty-two participants constructed nine recommendations regarding the adoption of epitope compatibility into deceased donor kidney allocation. Five values were identified that drove participants' recommendations: Health Maximization, Protection/Mitigation of Negative Impacts, Fairness, Science/Evidence-based Healthcare, and Responsibility to Maintain Trust. Conflicts between these values were discussed in terms of operational principles that were required for epitope compatibility to be implemented in an acceptable manner: the needs for Flexibility, Accountability, Transparent Communication and a Transition Plan. All nine recommendations were informed by these four principles. Participant deliberations were often dominated by the conflict between Health Maximization and Fairness or Protection/Mitigation of Negative Impacts, which was discussed as the need for Flexibility. Two additional values (Efficient Use of Resources and Logic/Rationality) were also discussed and were reasons for some participants voting against some recommendations. CONCLUSIONS Public recommendations indicate support for using epitope compatibility in deceased donor kidney allocation. A flexible approach to organ allocation decision-making may allow for the balancing of Health Maximization against maintaining Fairness and Mitigating Negative Impacts. Flexibility is particularly important in the context of epitope compatibility and other PM initiatives where evidence is still emerging.
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Affiliation(s)
- Caitlin Slomp
- BC Children's Hospital Research Institute, 938 W 28th Ave, BC, V5Z 4H4, Vancouver, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.
| | - Louisa Edwards
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Michael Burgess
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Paul Keown
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada
| | - Stirling Bryan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Landreth K, Burgess M, Watson L, Lorusso JM, Grayson B, Harte MK, Neill JC. Handling prevents and reverses cognitive deficits induced by sub-chronic phencyclidine in a model for schizophrenia in rats. Physiol Behav 2023; 263:114117. [PMID: 36781093 DOI: 10.1016/j.physbeh.2023.114117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
Treatments for schizophrenia are not effective in ameliorating cognitive deficits. Therefore, novel therapies are needed to treat cognitive impairments associated with schizophrenia (CIAS), which are modelled in rats through administration of sub-chronic phencyclidine (scPCP). We have previously shown that enrichment via voluntary exercise prevents and reverses impairments in novel object recognition (NOR) in this model. The present study aimed to investigate if handling could prevent delay-induced NOR deficits and prevent and reverse scPCP-induced NOR deficits. Two cohorts of adult female Lister Hooded rats were used. In experiment one, handling (five minutes/day, five days/week for two weeks), took place before scPCP administration (2 mg/kg, i.p. twice-daily for seven days). NOR tests were conducted at two, four, and seven weeks post-handling with a one-minute inter-trial interval (ITI) and at five weeks post-dosing with a six-hour ITI. In experiment two, rats were handled after scPCP administration and tested immediately in the one-minute ITI NOR task and again at two weeks post-handling. In both handling regimens, the scPCP control groups failed to discriminate novelty, conversely the scPCP handled groups significantly discriminated in this task. In the 6 h ITI test, vehicle control and scPCP control failed to discriminate novelty; however, the vehicle handled and scPCP handled groups did significantly discriminate. Handling rats prevented and reversed scPCP-induced deficits and prevented delay-induced NOR deficits. These findings add to evidence that environmental enrichment is a viable treatment for cognitive deficits in rodent tests and models of relevance to schizophrenia, with potential to translate into effective treatments for CIAS.
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Affiliation(s)
- K Landreth
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - M Burgess
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - L Watson
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - J M Lorusso
- Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - B Grayson
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom.
| | - M K Harte
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - J C Neill
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PT, United Kingdom; Medical Psychedelics Working Group, Drug Science, United Kingdom
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9
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Sato S, Gillette M, de Santiago PR, Kuhn E, Burgess M, Doucette K, Feng Y, Mendez-Dorantes C, Ippoliti PJ, Hobday S, Mitchell MA, Doberstein K, Gysler SM, Hirsch MS, Schwartz L, Birrer MJ, Skates SJ, Burns KH, Carr SA, Drapkin R. LINE-1 ORF1p as a candidate biomarker in high grade serous ovarian carcinoma. Sci Rep 2023; 13:1537. [PMID: 36707610 PMCID: PMC9883229 DOI: 10.1038/s41598-023-28840-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/25/2023] [Indexed: 01/29/2023] Open
Abstract
Long interspersed element 1 (LINE-1) open reading frame 1 protein (ORF1p) expression is a common feature of many cancer types, including high-grade serous ovarian carcinoma (HGSOC). Here, we report that ORF1p is not only expressed but also released by ovarian cancer and primary tumor cells. Immuno-multiple reaction monitoring-mass spectrometry assays showed that released ORF1p is confidently detectable in conditioned media, ascites, and patients' plasma, implicating ORF1p as a potential biomarker. Interestingly, ORF1p expression is detectable in fallopian tube (FT) epithelial precursors of HGSOC but not in benign FT, suggesting that ORF1p expression in an early event in HGSOC development. Finally, treatment of FT cells with DNA methyltransferase inhibitors led to robust expression and release of ORF1p, validating the regulatory role of DNA methylation in LINE-1 repression in non-tumorigenic tissue.
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Affiliation(s)
- Sho Sato
- Penn Ovarian Cancer Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Michael Gillette
- The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.,Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Pamela R de Santiago
- Penn Ovarian Cancer Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Eric Kuhn
- The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Michael Burgess
- The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Kristen Doucette
- The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Yi Feng
- Penn Ovarian Cancer Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | | | - Paul J Ippoliti
- The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Sara Hobday
- Penn Ovarian Cancer Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Marilyn A Mitchell
- Penn Ovarian Cancer Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Kai Doberstein
- Penn Ovarian Cancer Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Stefan M Gysler
- Penn Ovarian Cancer Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Lauren Schwartz
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael J Birrer
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Steven J Skates
- Harvard Medical School, Boston, MA, 02115, USA.,Biostatistics and Computational Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen H Burns
- Harvard Medical School, Boston, MA, 02115, USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steven A Carr
- The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Ronny Drapkin
- Penn Ovarian Cancer Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA. .,Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA.
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10
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Burgess M, Mitchell R, Mitra B. Diagnostic testing in nontrauma patients presenting to the emergency department with recurrent seizures: A systematic review. Acad Emerg Med 2022; 29:649-657. [PMID: 34534387 DOI: 10.1111/acem.14391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/27/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a lack of consensus regarding the role of investigations among patients presenting to the emergency department (ED) with recurrent seizures. The aim of this systematic review was to determine the frequency and utility of commonly requested investigations for nontrauma patients presenting to the ED with recurrent seizures. METHODS The MEDLINE, EMBASE, and Cochrane Library databases were searched (March 2021) for articles on this topic using search terms related to recurrent seizures, investigations, and the ED. The inclusion criteria required that articles include adult nontrauma patients presenting to the ED. Studies exclusively investigating first-episode seizures, trauma patients, and status epilepticus were excluded. Eligible studies were assessed for bias using the Newcastle-Ottawa scale. Results of studies were presented using proportions. RESULTS There were six cohort studies included that contributed data from 36,595 patients. All six studies assessed at least one of our primary outcomes for computed tomography (CT) brain scans. The proportion of patients who underwent a head CT ranged from 13% to 42%. The rates of abnormal head CT findings ranged from 8% to 21%. One study reported on magnetic resonance imaging (MRI) and found it used infrequently in 0.79% of cases. The proportion and yield of nonneuroimaging investigations were not well evaluated in this patient population. Only one study reported on the utility of sodium levels or blood glucose results for this population and reported abnormalities in sodium levels for 19% of patients and abnormalities in glucose levels in 50% of patients. CONCLUSIONS In this population, CT brain scans appeared to be performed uncommonly but with moderate rates of abnormal findings. In the absence of prolonged alteration of consciousness, a history of brain tumor, or positive neurologic findings, however, neuroimaging was of low yield. Given the heterogeneity and potential limitations of these studies, further research on this topic is required.
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Affiliation(s)
- Michael Burgess
- National Trauma Research Institute The Alfred Hospital Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Robert Mitchell
- Emergency and Trauma Centre The Alfred Hospital Melbourne Victoria Australia
| | - Biswadev Mitra
- National Trauma Research Institute The Alfred Hospital Melbourne Victoria Australia
- School of Public Health & Preventive Medicine Monash University Melbourne Victoria Australia
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11
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Greig M, Pesut B, Marck P, Burgess M. Nursing students' experiences of moral uncertainty in the context of global health practicums. Nurs Inq 2021; 29:e12477. [PMID: 34907621 DOI: 10.1111/nin.12477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
More students than ever are electing to take part in international practicums from health-related disciplines. With the goal of better understanding the moral experiences and ethical implications of global health practicums (GHPs), the purpose of this Interpretive Descriptive study was to examine the moral uncertainty of nursing students from one university in Canada. Seventeen nurses who had participated in a GHP in their undergraduate nursing program participated in semi-structured interviews. Data were analyzed inductively using constant comparative data analysis techniques, and a thematic account of participants' experiences was developed. Findings suggest that nursing students experienced considerable amounts of moral uncertainty during their GHP. Most often, participants' experiences of uncertainty stemmed from a misalignment between their expectations and reality, including encountering different approaches to healthcare, being situated in new cultural and clinical care environments, and grappling with how best to stay within one's scope of student professional practice. Participants inconsistently reflected on these experiences, which may present a missed opportunity for professional growth through the development of a heightened social consciousness. Educators can facilitate this process by implementing robust predeparture training for GHPs, clarifying program objectives, and providing clinical debriefing.
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Affiliation(s)
- Madeleine Greig
- School of Nursing, Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, Canada
| | - Barbara Pesut
- School of Nursing, Faculty of Health and Social Development, University of British Columbia - Okanagan Campus, Kelowna, Canada
| | - Patricia Marck
- School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, Canada
| | - Michael Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, Vancouver, Canada
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12
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Schöffski P, Bahleda R, Wagner A, Burgess M, Junker N, Chisamore M, Peterson P, Ceccarelli M, William T. 154P Results of an open-label, phase Ia/Ib study of olaratumab plus pembrolizumab in patients with unresectable, locally advanced or metastatic soft tissue sarcoma. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.173] [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: 10/19/2022] Open
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13
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Jenei K, Burgess M, Peacock S, Raymakers AJ. Experiences and perspectives of individuals accessing CAR-T cell therapy: A qualitative analysis of online Reddit discussions. J Cancer Policy 2021; 30:100303. [DOI: 10.1016/j.jcpo.2021.100303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/16/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
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14
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Keshishian H, McDonald ER, Mundt F, Melanson R, Krug K, Porter DA, Wallace L, Forestier D, Rabasha B, Marlow SE, Jane‐Valbuena J, Todres E, Specht H, Robinson ML, Jean Beltran PM, Babur O, Olive ME, Golji J, Kuhn E, Burgess M, MacMullan MA, Rejtar T, Wang K, Mani DR, Satpathy S, Gillette MA, Sellers WR, Carr SA. A highly multiplexed quantitative phosphosite assay for biology and preclinical studies. Mol Syst Biol 2021; 17:e10156. [PMID: 34569154 PMCID: PMC8474009 DOI: 10.15252/msb.202010156] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022] Open
Abstract
Reliable methods to quantify dynamic signaling changes across diverse pathways are needed to better understand the effects of disease and drug treatment in cells and tissues but are presently lacking. Here, we present SigPath, a targeted mass spectrometry (MS) assay that measures 284 phosphosites in 200 phosphoproteins of biological interest. SigPath probes a broad swath of signaling biology with high throughput and quantitative precision. We applied the assay to investigate changes in phospho-signaling in drug-treated cancer cell lines, breast cancer preclinical models, and human medulloblastoma tumors. In addition to validating previous findings, SigPath detected and quantified a large number of differentially regulated phosphosites newly associated with disease models and human tumors at baseline or with drug perturbation. Our results highlight the potential of SigPath to monitor phosphoproteomic signaling events and to nominate mechanistic hypotheses regarding oncogenesis, response, and resistance to therapy.
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Affiliation(s)
- Hasmik Keshishian
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | | | - Filip Mundt
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
- Present address:
Novo Nordisk Foundation Center for Protein ResearchFaculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
- Present address:
Department of Oncology and PathologyScience for Life LaboratoryKarolinska InstitutetStockholmSweden
| | - Randy Melanson
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Karsten Krug
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Dale A Porter
- Novartis Institute of Biomedical ResearchCambridgeMAUSA
- Present address:
Cedilla TherapeuticsCambridgeMAUSA
| | - Luke Wallace
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Dominique Forestier
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Bokang Rabasha
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Sara E Marlow
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Judit Jane‐Valbuena
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Ellen Todres
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Harrison Specht
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | | | | | - Ozgun Babur
- Computer Science DepartmentUniversity of Massachusetts BostonBostonMAUSA
| | - Meagan E Olive
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Javad Golji
- Novartis Institute of Biomedical ResearchCambridgeMAUSA
| | - Eric Kuhn
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Michael Burgess
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Melanie A MacMullan
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Tomas Rejtar
- Novartis Institute of Biomedical ResearchCambridgeMAUSA
| | - Karen Wang
- Novartis Institute of Biomedical ResearchCambridgeMAUSA
| | - DR Mani
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Shankha Satpathy
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
| | - Michael A Gillette
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMAUSA
| | - William R Sellers
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
- Department of Medical OncologyDana‐Farber Cancer Institute and Harvard Medical SchoolBostonMAUSA
| | - Steven A Carr
- Broad Institute of Massachusetts Institute of Technology and HarvardCambridgeMAUSA
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15
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Jenei K, Peacock S, Burgess M, Mitton C. Describing Sources of Uncertainty in Cancer Drug Formulary Priority Setting across Canada. Curr Oncol 2021; 28:2708-2719. [PMID: 34287280 PMCID: PMC8293120 DOI: 10.3390/curroncol28040236] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Over the years, there have been significant advances in oncology. However, the rate that therapeutics come to market has increased, while the strength of evidence has decreased. Currently, there is limited understanding about how these uncertainties are managed in provincial funding decisions for cancer therapeutics. We conducted qualitative interviews with six senior officials from four different Canadian provinces (British Columbia, Alberta, Quebec, and Ontario) and a document review of the uncertainties found in submissions to the pan-Canadian Oncology Drug Review (pCODR). Participants reported considerable uncertainty related to a lack of solid clinical evidence (early-phase clinical trials: generalizability, immature data, and the use of unvalidated surrogate outcomes). Proposed strategies to deal with the uncertainty included risk-sharing agreements, collection of real-world evidence (RWE), and ongoing collaboration between federal groups and provinces. The document review added to the reported uncertainties by classifying them into five main categories: trial validity, population, comparators, outcomes, and intervention. This study highlights how decision makers must deal with significant amounts of uncertainty in funding decisions for cancer drugs, most of which stems from methodological limitations in clinical trials. There is a critical need for transparent priority-setting processes and mechanisms to reevaluate drugs to ensure benefit given the high level of uncertainty of novel therapeutics.
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Affiliation(s)
- Kristina Jenei
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.B.); (C.M.)
| | - Stuart Peacock
- Canadian Control Research, BC Cancer, Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, BC V5Z 4E6, Canada;
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Michael Burgess
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.B.); (C.M.)
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.B.); (C.M.)
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16
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Samarasinghe KTG, Jaime-Figueroa S, Burgess M, Nalawansha DA, Dai K, Hu Z, Bebenek A, Holley SA, Crews CM. Targeted degradation of transcription factors by TRAFTACs: TRAnscription Factor TArgeting Chimeras. Cell Chem Biol 2021; 28:648-661.e5. [PMID: 33836141 DOI: 10.1016/j.chembiol.2021.03.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022]
Abstract
Many diseases, including cancer, stem from aberrant activation or overexpression of oncoproteins that are associated with multiple signaling pathways. Although proteins with catalytic activity can be successfully drugged, the majority of other protein families, such as transcription factors, remain intractable due to their lack of ligandable sites. In this study, we report the development of TRAnscription Factor TArgeting Chimeras (TRAFTACs) as a generalizable strategy for targeted transcription factor degradation. We show that TRAFTACs, which consist of a chimeric oligonucleotide that simultaneously binds to the transcription factor of interest (TOI) and to HaloTag-fused dCas9 protein, can induce degradation of the former via the proteasomal pathway. Application of TRAFTACs to two oncogenic TOIs, NF-κB and brachyury, suggests that TRAFTACs can be successfully employed for the targeted degradation of other DNA-binding proteins. Thus, TRAFTAC technology is potentially a generalizable strategy to induce degradation of other transcription factors both in vitro and in vivo.
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Affiliation(s)
- Kusal T G Samarasinghe
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Saul Jaime-Figueroa
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Michael Burgess
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Dhanusha A Nalawansha
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Katherine Dai
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Zhenyi Hu
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Adrian Bebenek
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Scott A Holley
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA
| | - Craig M Crews
- Department of Molecular, Cellular & Developmental Biology, Yale University, New Haven, CT 06511, USA; Department of Chemistry, Yale University, New Haven, CT 06511, USA; Department of Pharmacology, Yale University, New Haven, CT 06511, USA.
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17
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Aitken M, Braunack-Mayer A, Flack F, McGrail KM, Burgess M, Paprica PA. Involving the Public in Data Linkage Research. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Introduction“The Consensus Statement on Public Involvement and Engagement with Data-Intensive Health Research”, recent data breaches, and growing public awareness and controversy associated with secondary use of health data all highlight the need to understand what data sharing the public will support, under what circumstances, for what purposes and with whom.
Objectives and ApproachThis symposium explores methods and findings from public engagement at all stages of data linkage research, beginning with short presentations (~6-8 minutes) on recent work:
Mhairi Aitken: Consensus Statement - principles and an application using deliberative workshops to explore public expectations of public benefits from data-intensive health research
Annette Braunack-Mayer/Felicity Flack: Surveys and citizens’ juries: Sharing government data with private industry
Kim McGrail/Mike Burgess: Public deliberations on cross-sector data linkage, and combining public and private sources of data
Alison Paprica: Plain language communication informed by Health Data Research Network Canada’s Public Advisory Council.
Half the session will be spent interacting with the audience through live polling. The moderator will post a series of poll question such as “What is the most important thing for meaningful public engagement?” to prompt audience thinking on the topic. After the audience responses are revealed, panelists will share their own views about what they think is the best answer, and the main reason(s) behind their choice. The last 10-15 minutes of the session will be reserved for Q&A and dialogue with the audience.
ResultsWe anticipate that this approach will surface emerging and tacit knowledge from presenters and the audience, and augment that through generative discussion.
Conclusion / ImplicationsSession attendees will leave with a better understanding of the current state of knowledge and ways to talk about that understanding with other researchers, policy makers and the public.
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18
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Dryzek JS, Nicol D, Niemeyer S, Pemberton S, Curato N, Bächtiger A, Batterham P, Bedsted B, Burall S, Burgess M, Burgio G, Castelfranchi Y, Chneiweiss H, Church G, Crossley M, de Vries J, Farooque M, Hammond M, He B, Mendonça R, Merchant J, Middleton A, Rasko JEJ, Van Hoyweghen I, Vergne A. Global citizen deliberation on genome editing. Science 2020; 369:1435-1437. [PMID: 32943515 DOI: 10.1126/science.abb5931] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- John S Dryzek
- Author affiliations are listed in the supplementary materials.
| | - Dianne Nicol
- Author affiliations are listed in the supplementary materials
| | - Simon Niemeyer
- Author affiliations are listed in the supplementary materials
| | - Sonya Pemberton
- Author affiliations are listed in the supplementary materials
| | - Nicole Curato
- Author affiliations are listed in the supplementary materials
| | - André Bächtiger
- Author affiliations are listed in the supplementary materials
| | | | - Bjørn Bedsted
- Author affiliations are listed in the supplementary materials
| | - Simon Burall
- Author affiliations are listed in the supplementary materials
| | - Michael Burgess
- Author affiliations are listed in the supplementary materials
| | - Gaetan Burgio
- Author affiliations are listed in the supplementary materials
| | | | | | - George Church
- Author affiliations are listed in the supplementary materials
| | - Merlin Crossley
- Author affiliations are listed in the supplementary materials
| | | | - Mahmud Farooque
- Author affiliations are listed in the supplementary materials
| | - Marit Hammond
- Author affiliations are listed in the supplementary materials
| | - Baogang He
- Author affiliations are listed in the supplementary materials
| | | | | | - Anna Middleton
- Author affiliations are listed in the supplementary materials
| | - John E J Rasko
- Author affiliations are listed in the supplementary materials
| | | | - Antoine Vergne
- Author affiliations are listed in the supplementary materials
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19
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Erikainen S, Friesen P, Rand L, Jongsma K, Dunn M, Sorbie A, McCoy M, Bell J, Burgess M, Chen H, Chico V, Cunningham-Burley S, Darbyshire J, Dawson R, Evans A, Fahy N, Finlay T, Frith L, Goldenberg A, Hinton L, Hoppe N, Hughes N, Koenig B, Lignou S, McGowan M, Parker M, Prainsack B, Shabani M, Staunton C, Thompson R, Varnai K, Vayena E, Williams O, Williamson M, Chan S, Sheehan M. Public involvement in the governance of population-level biomedical research: unresolved questions and future directions. J Med Ethics 2020; 47:medethics-2020-106530. [PMID: 33023977 DOI: 10.1136/medethics-2020-106530] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 05/26/2023]
Abstract
Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance.
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Affiliation(s)
- Sonja Erikainen
- Centre for Biomedicine, Self and Society, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Phoebe Friesen
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Leah Rand
- Harvard Medical School and PORTAL, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Karin Jongsma
- Department of Medical Humanities, Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michael Dunn
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Annie Sorbie
- Mason Institute for Medicine, Life Sciences and the Law, Edinburgh Law School, University of Edinburgh, Edinburgh, UK
| | - Matthew McCoy
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman, Philadelphia, Pennsylvania, USA
| | - Jessica Bell
- HeLEX, University of Oxford, Oxford, Oxfordshire, UK
| | - Michael Burgess
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Haidan Chen
- School of Health Humanities, Peking University, Beijing, China
| | - Vicky Chico
- School of Law, University of Sheffield, Sheffield, UK
| | - Sarah Cunningham-Burley
- Centre for Biomedicine, Self and Society, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Julie Darbyshire
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | | | - Nick Fahy
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Teresa Finlay
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Frith
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Aaron Goldenberg
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lisa Hinton
- THIS Institute, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Nils Hoppe
- Centre for Ethics and Law in the Life Sciences, Leibniz University, Hannover, Germany
| | - Nigel Hughes
- Observational Health Data Analytics/Epidemiology, Janssen Research and Development, Raritan, New Jersey, USA
| | - Barbara Koenig
- Department of Political Science, University of Vienna, Vienna, Austria
| | - Sapfo Lignou
- NeuroSec and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Michelle McGowan
- Ethics Center, Cincinnati Children's Hospital Medical Center Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Parker
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Barbara Prainsack
- Department of Political Science, University of Vienna, Vienna, Austria
| | - Mahsa Shabani
- Faculty of Criminology, Criminal Law and Social Law, University of Ghent, Ghent, Belgium
| | - Ciara Staunton
- Middlesex University School of Law, Middlesex University London, London, UK
| | - Rachel Thompson
- Research Institute for Ethics and Law, Swansea University, Swansea, UK
| | - Kinga Varnai
- OUH NHS FT and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Effy Vayena
- The Health Ethics and Policy Lab, University of Zurich, Zurich, Switzerland
| | - Oli Williams
- King's College London and THIS Institute, University of Cambridge, Cambridge, UK
| | | | - Sarah Chan
- Centre for Biomedicine, Self and Society, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Mark Sheehan
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Grignani G, Burgess M, Depenni R, Guida M, Spagnolo F, Spada F, De Braud F, Pulini J, Shankar S, Tian C, Lebbé C. 1089P POD1UM-201: A phase II study of retifanlimab (INCMGA00012) in advanced or metastatic Merkel cell carcinoma (MCC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Pesut B, Thorne S, Storch J, Chambaere K, Greig M, Burgess M. Riding an elephant: A qualitative study of nurses' moral journeys in the context of Medical Assistance in Dying (MAiD). J Clin Nurs 2020; 29:3870-3881. [PMID: 32700402 PMCID: PMC7540490 DOI: 10.1111/jocn.15427] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 12/23/2019] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES To describes nurses' moral experiences with Medical Assistance in Dying in the Canadian context. BACKGROUND Nurses perform important roles in Medical Assistance in Dying in Canada and do so within a unique context in which Medical Assistance in Dying is provided through healthcare services and where accessibility is an important principle. International literature indicates that participating in Medical Assistance in Dying can be deeply impactful for nurses and requires a high degree of moral sense-making. DESIGN A qualitative interview study guided by Interpretive Description using the COREQ checklist. RESULTS Fifty-nine nurses from across Canada participated in the study. The decision to participate in Medical Assistance in Dying was influenced by family and community, professional experience and nurses' proximity to the act of Medical Assistance in Dying. Nurses described a range of deep and sometimes conflicting emotional reactions provoked by Medical Assistance in Dying. Nurses used a number of moral waypoints to make sense of their decision including patient choice, control and certainty; an understanding that it was not about the nurse; a commitment to staying with patients through suffering; consideration of moral consistency; issues related to the afterlife; and the peace and gratitude demonstrated by patients and families. DISCUSSION The depth of nurses' intuitional moral responses and their need to make sense of these responses are consistent with Haidt's theory of moral experience in which individuals use reasoning primarily to explain their moral intuition and in which moral change occurs primarily through compassionate social interaction. Further, work on the moral identity of nursing provides robust explanation of how nurses' moral decisions are contextually and relationally mediated and how they seek to guard patient vulnerability, even at their own emotional cost. CONCLUSION Medical Assistance in Dying is impactful for nurses, and for some, it requires intensive and ongoing moral sense-making. RELEVANCE TO CLINICAL PRACTICE There is a need to provide support for nurses' moral deliberation and emotional well-being in the context of Medical Assistance in Dying care.
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Affiliation(s)
- Barbara Pesut
- University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Sally Thorne
- University of British Columbia, Vancouver, BC, Canada
| | | | - Kenneth Chambaere
- Ghent University, Ghent, Belgium.,Vrije Universeteit Brussel (VUB), Brussels, Belgium
| | - Madeleine Greig
- University of British Columbia, Okanagan, Kelowna, BC, Canada
| | - Michael Burgess
- University of British Columbia, Okanagan, Kelowna, BC, Canada
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22
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Pelin A, Huh M, Tang M, LeBouef F, Keller B, Duong J, Knowles K, Petryk J, Jennings V, Melcher A, Singaravelu R, Crupi M, Pikor L, Breitbach C, Bernstein S, Burgess M, Bell JC. Abstract PR19: Utilizing novel oncolytic vaccinia virus for selective expression of immunotherapeutic payloads in metastatic tumors. Cancer Immunol Res 2020. [DOI: 10.1158/2326-6074.tumimm18-pr19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The treatment paradigm for patients with metastatic cancer has evolved rapidly with the approval of agents targeting CTLA-4 and the PD-1/L1 immune checkpoint axis. Despite the profound impact these agents have had, they are minimally effective in the majority of cancer patients. Rational combinations of complementary immune-modulating agents have thus far not led to clear patient benefit, and newer technologies that are better able to safely combine multiple modes of action could well prove to be vital. Oncolytic viruses (OVs) have the capacity to be the ideal therapeutic partner for immune checkpoint therapeutics in several ways. First, on their own OVs can “heat up” immunologically “cold” tumors by initiating a proinflammatory infection within the tumor microenvironment (TME). Second, some OVs can be engineered to strategically express one or more immune-modulating molecules. Finally, certain OVs have the capacity to be delivered systemically and thus enhance immune cell recruitment and activation in all metastatic sites. We have selected a novel vaccinia virus as our therapeutic OV platform and are using it to engineer multi-mechanistic cancer therapeutics. Previously it has been demonstrated that oncolytic vaccinia viruses can be delivered systemically and spread within metastatic lesions. These clinical candidates, however, contain multiple potent immune-suppressive genes. Furthermore, in clinical studies some of these therapeutics exhibited off-tumor infections (e.g., pox lesions), which may ultimately limit their ability to be used to deliver potent immune modulators. We used a combination of functional genomics and bio-selection strategies to generate a novel oncolytic vaccinia backbone (termed SKV) containing a large genome deletion that exhibited augmented oncolytic activity and improved tumor selectivity. Our new best-in-class vaccinia robustly stimulates anti-immune responses, rapidly spreads within and between tumors, and has a substantially improved preclinical safety profile when compared to other vaccinia clinical candidates. As predicted, SKV synergizes well with immune checkpoint inhibitor antibodies and potently activates human immune cells. Due to the exquisite tumor selectivity of SKV, we have been able to engineer and express three potent immune modulators that are safest and most effective when expressed within the TME: anti-CTLA4 antibody, membrane tethered IL-12, and the antigen-presenting cell-activating ligand FLT-3L. Tumor-selective transgene expression has been demonstrated in murine tumor models in which therapeutic payload concentrations (e.g., >1 ug/ml IL-12) were achieved within the TME without any detectable transgene product in the systemic circulation (serum). Expression of the therapeutic payloads increased survival versus the SKV backbone control in an immunocompetent, syngeneic tumor model. Ongoing toxicity and efficacy studies are being carried out prior to clinical evaluation of the novel virus construct.
This abstract is also being presented as Poster A02.
Citation Format: Adrian Pelin, Mike Huh, Matt Tang, Fabrice LeBouef, Brian Keller, Jessie Duong, Katherine Knowles, Julia Petryk, Vicki Jennings, Alan Melcher, Ragunath Singaravelu, Mathieu Crupi, Larissa Pikor, Caroline Breitbach, Steven Bernstein, Michael Burgess, John C. Bell. Utilizing novel oncolytic vaccinia virus for selective expression of immunotherapeutic payloads in metastatic tumors [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology and Immunotherapy; 2018 Nov 27-30; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Immunol Res 2020;8(4 Suppl):Abstract nr PR19.
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Affiliation(s)
- Adrian Pelin
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| | - Mike Huh
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| | - Matt Tang
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| | | | - Brian Keller
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| | - Jessie Duong
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| | | | - Julia Petryk
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| | | | | | | | - Mathieu Crupi
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| | - Larissa Pikor
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
| | | | | | | | - John C. Bell
- 1Ottawa Hospital Research Institute, Ottawa, ON, Canada,
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23
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Garcia JS, Bhatt S, Fell G, Sperling AS, Burgess M, Keshishian H, Yilma B, Brunner A, Neuberg D, Carr SA, Ebert BL, Ballen K, Stone RM, DeAngelo DJ, Medeiros BC, Letai A. Increased mitochondrial apoptotic priming with targeted therapy predicts clinical response to re-induction chemotherapy. Am J Hematol 2020; 95:245-250. [PMID: 31804723 PMCID: PMC10683501 DOI: 10.1002/ajh.25692] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/30/2019] [Indexed: 02/06/2023]
Abstract
Most patients with relapsed or refractory (R/R) acute myeloid leukemia (AML) do not benefit from current re-induction or approved targeted therapies. In the absence of targetable genetic mutations, there is minimal guidance on optimal treatment selection particularly in the R/R setting highlighting an unmet need for clinically useful functional biomarkers. Blood and bone marrow samples from patients treated on two clinical trials were used to test the combination of lenalidomide (LEN) and MEC (mitoxantrone, etoposide, and cytarabine) chemotherapy in R/R AML patients. The bone marrow samples were available to test the clinical utility of the mitochondrial apoptotic BH3 and dynamic BH3 profiling (DBP) assays in predicting response, as there was no clear genetic biomarker identifying responders. To test whether LEN-induced mitochondrial priming predicted clinical response to LEN-MEC therapy, we performed DBP on patient myeloblasts. We found that short-term ex vivo treatment with lenalidomide discriminated clinical responders from non-responders based on drug-induced change in priming (delta priming). Using paired patient samples collected before and after clinical LEN treatment (prior to MEC dosing), we confirmed LEN-induced increased apoptotic priming in vivo, suggesting LEN enhanced vulnerability of myeloblasts to cytotoxic MEC chemotherapy. This is the first study demonstrating the potential role of DBP in predicting clinical response to a combination regimen. Our findings demonstrate that functional properties of relapsed AML can identify active therapies.
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Affiliation(s)
| | - Shruti Bhatt
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Michael Burgess
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | - Binyam Yilma
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Steven A. Carr
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | - Karen Ballen
- University of Virginia Health System, Charlottesville, Virginia
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Abstract
BACKGROUND Medical Assistance in Dying, also known as euthanasia or assisted suicide, is expanding internationally. Canada is the first country to permit Nurse Practitioners to provide euthanasia. These developments highlight the need for nurses to reflect upon the moral and ethical issues that euthanasia presents for nursing practice. PURPOSE The purpose of this article is to provide a narrative review of the ethical arguments surrounding euthanasia in relationship to nursing practice. METHODS Systematic search and narrative review. Nine electronic databases were searched using vocabulary developed from a stage 1 search of Medline and CINAHL. Articles that analysed a focused ethical question related to euthanasia in the context of nursing practice were included. Articles were synthesized to provide an overview of the literature of nursing ethics and euthanasia. ETHICAL CONSIDERATIONS This review was conducted as per established scientific guidelines. We have tried to be fair and respectful to the authors discussed. FINDINGS Forty-three articles were identified and arranged inductively into four themes: arguments from the nature of nursing; arguments from ethical principles, concepts and theories; arguments for moral consistency; and arguments from the nature of the social good. Key considerations included nursing's moral ontology, the nurse-patient relationship, potential impact on the profession, ethical principles and theories, moral culpability for acts versus omissions, the role of intention and the nature of the society in which euthanasia would be enacted. In many cases, the same assumptions, values, principles and theories were used to argue both for and against euthanasia. DISCUSSION The review identified a relative paucity of literature in light of the expansion of euthanasia internationally. However, the literature provided a fulsome range of positions for nurses to consider as they reflect on their own participation in euthanasia. Many of the arguments reviewed were not nursing-specific, but rather are relevant across healthcare disciplines. Arguments explicitly grounded within the nature of nursing and nurse-patient relationships warrant further exploration.
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Affiliation(s)
- Barbara Pesut
- Barbara Pesut, School of Nursing, Canada Research Chair in Health, Ethics, and Diversity, The University of British Columbia, Okanagan, 1147 Research Road, Kelowna, BC, Canada V1V 1V7.
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25
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Tu B, Harrop D, Chacko Y, Neill J, Burgess M. 509 Likelihood of Achieving LDL-C Target <1.4mmol/L in Patients With Established Cardiovascular Disease in Australian Real-World Practice. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McGrail K, Burgess M, O'Doherty K, Bentley C, Teng J. Data intensive science and the public good: Results of public deliberations in British Columbia, Canada. Int J Popul Data Sci 2019. [DOI: 10.23889/ijpds.v4i3.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
IntroductionResearch using linked data sets can lead to new insights and discoveries that positively impact society. However, the use of linked data raises concerns relating to illegitimate use, privacy, and security (e.g., identity theft, marginalization of some groups). It is increasingly recognized that the public needs to be consulted to develop data access systems that consider both the potential benefits and risks of research. Indeed, there are examples of data sharing projects being derailed because of backlash in the absence of adequate consultation. (e.g., care.data in the UK).
Objectives and methodsThis talk will describe the results of public deliberations held in Vancouver, British Columbia in April 2018 and the fall of 2019. The purpose of these events was to develop informed and civic-minded public advice regarding the use and the sharing of linked data for research in the context of rapidly evolving data availability and researcher aspirations.
ResultsIn the first deliberation, participants developed and voted on 19 policy-relevant statements. Taken together, these statements provide a broad view of public support and concerns regarding the use of linked data sets for research and offer guidance on measures that can be taken to improve the trustworthiness of policies and process around data sharing and use. The second deliberation will focus on the interplay between public and private sources of data, and role of individual and collective or community consent I the future.
ConclusionGenerally, participants were supportive of research using linked data because of the value such uses can provide to society. Participants expressed a desire to see the data access request process made more efficient to facilitate more research, as long as there are adequate protections in place around security and privacy of the data. These protections include both physical and process-related safeguards as well as a high degree of transparency.
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27
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Mitton C, Seixas BV, Peacock S, Burgess M, Bryan S. Health Technology Assessment as Part of a Broader Process for Priority Setting and Resource Allocation. Appl Health Econ Health Policy 2019; 17:573-576. [PMID: 31161365 DOI: 10.1007/s40258-019-00488-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Over the last two decades, economic evaluation of health technologies has developed enormously, affirming its importance within the pursuit of efficiency in the management of health care systems. One concern that has been raised with health technology assessment (HTA) has been its operationalization within the realm of decision making. Here, we suggest a mechanism by which HTA can be understood as an input into a broader framework for priority setting and resource allocation. When HTA is seen in this light, topics that at times have had some lack of clarity, such as public engagement and disinvestment, simply become steps in the overall decision-making process.
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Affiliation(s)
- Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Brayan V Seixas
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Stuart Peacock
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, BC, Canada
| | - Michael Burgess
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- W. Maurice Young Centre for Applied Ethics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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28
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Jones R, Ravi V, Brohl A, Chawla S, Ganjoo K, Italiano A, Attia S, Burgess M, Thornton K, Cranmer L, Liu L, Theuer C, Maki R. Results of the TAPPAS trial: An adaptive enrichment phase III trial of TRC105 and pazopanib (P) versus pazopanib alone in patients with advanced angiosarcoma (AS). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Sperling AS, Burgess M, Keshishian H, Gasser JA, Bhatt S, Jan M, Słabicki M, Sellar RS, Fink EC, Miller PG, Liddicoat BJ, Sievers QL, Sharma R, Adams DN, Olesinski EA, Fulciniti M, Udeshi ND, Kuhn E, Letai A, Munshi NC, Carr SA, Ebert BL. Patterns of substrate affinity, competition, and degradation kinetics underlie biological activity of thalidomide analogs. Blood 2019; 134:160-170. [PMID: 31043423 PMCID: PMC6624968 DOI: 10.1182/blood.2019000789] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/26/2019] [Indexed: 12/15/2022] Open
Abstract
Pharmacologic agents that modulate ubiquitin ligase activity to induce protein degradation are a major new class of therapeutic agents, active in a number of hematologic malignancies. However, we currently have a limited understanding of the determinants of activity of these agents and how resistance develops. We developed and used a novel quantitative, targeted mass spectrometry (MS) assay to determine the relative activities, kinetics, and cell-type specificity of thalidomide and 4 analogs, all but 1 of which are in clinical use or clinical trials for hematologic malignancies. Thalidomide analogs bind the CRL4CRBN ubiquitin ligase and induce degradation of particular proteins, but each of the molecules studied has distinct patterns of substrate specificity that likely underlie the clinical activity and toxicities of each drug. Our results demonstrate that the activity of molecules that induce protein degradation depends on the strength of ligase-substrate interaction in the presence of drug, the levels of the ubiquitin ligase, and the expression level of competing substrates. These findings highlight a novel mechanism of resistance to this class of drugs mediated by competition between substrates for access to a limiting pool of the ubiquitin ligase. We demonstrate that increased expression of a nonessential substrate can lead to decreased degradation of other substrates that are critical for antineoplastic activity of the drug, resulting in drug resistance. These studies provide general rules that govern drug-dependent substrate degradation and key differences between thalidomide analog activity in vitro and in vivo.
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Affiliation(s)
- Adam S Sperling
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | - Jessica A Gasser
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Shruti Bhatt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Max Jan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Mikołaj Słabicki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Division of Translational Oncology, National Center for Tumor Diseases Heidelberg, German Cancer Research Center, Heidelberg, Germany; and
| | - Rob S Sellar
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Emma C Fink
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Peter G Miller
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Brian J Liddicoat
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Quinlan L Sievers
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Rohan Sharma
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | - Dylan N Adams
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
| | - Elyse A Olesinski
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Eric Kuhn
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Anthony Letai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Nikhil C Munshi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Benjamin L Ebert
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Hematology, Brigham and Women's Hospital, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
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Stephenson K, Twumasi-Boateng K, Patrick A, Breitbach C, Burgess M, Lichty B. Abstract 1449: MG1 Maraba boost following adenovirus prime generates tumor antigen-specific T cells which are potentiated by anti-PD-1 antibody combination. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1449] [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
Immune checkpoint inhibitors, such as antibodies blocking PD-1 and PD-L1, have been shown to potentiate pre-existing immune responses and improve patient survival. MG1 Maraba is a novel oncolytic virus that we bioselected and engineered to cause cancer cell death through two distinct and complementary mechanisms-of-action, direct cancer lysis and tumor-antigen specific T cell generation. MG1 Maraba encoding tumor antigens has been demonstrated to boost pre-existing immune responses. We are currently using a non-replicating adenovirus as the priming entity in our ongoing preclinical and clinical studies for our MG1 Maraba product candidates. This therapeutic platform is able to generate a large number of highly-functional antigen-specific T cells, in addition to its oncolytic activity, in mice, non-human primates (NHP) and patients treated with Adenovirus and oncolytic MG1 Maraba, expressing the same tumour associated antigen. This study investigates the ability of αPD-1 to potentiate immune responses generated by Ad/MG1 prime/boosting, and whether the timing of αPD-1 administration impacts the immune responses and therapeutic outcome. The combination of αPD-1 and Ad/MG1 treatment was investigated in a challenging murine model of metastatic melanoma. In three independent experiments, mice bearing advanced B16F10 lung metastases treated with Ad/MG1-hDCT in combination with αPD1 antibody, overall survival was increased to greater than 90%, compared to survival rates of less than 40% in mice treated with Ad/MG1-hDCT alone. The increased efficacy was correlated with improved anti-tumour immune responses in the αPD-1 combination group. The strongest effects of αPD-1 were observed when αPD-1 treatment was initiated immediately following Ad-hDCT immunization leading to significantly increased anti-tumour immune responses at all timepoints analyzed. When delayed until 1 week after MG1 treatment, αPD-1 was unable to improve the anti-tumour immune responses, or therapeutic efficacy, elicited by Ad/MG1 treatment. Similar effects were observed using an αPD-L1 targeted antibody. Therefore, the timing of PD-1/L1 blockade during Ad/MG1 treatment was determined to be a critical parameter for successful therapeutic outcomes. In addition, a non-human primate study is underway to assess the combination of αPD-1 with Ad/MG1-E6E7 (expressing HPV E6 and E7) when delivered concurrent with adenovirus immunization. Moreover, these data highlight the timing of checkpoint inhibitor treatment as a critical parameter for consideration when administering immune checkpoint inhibitors with other agents, including oncolytic viral immunotherapies.
Citation Format: Kyle Stephenson, Kwame Twumasi-Boateng, Amy Patrick, Caroline Breitbach, Michael Burgess, Brian Lichty. MG1 Maraba boost following adenovirus prime generates tumor antigen-specific T cells which are potentiated by anti-PD-1 antibody combination [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1449.
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Aitken M, Tully MP, Porteous C, Denegri S, Cunningham-Burley S, Banner N, Black C, Burgess M, Cross L, van Delden JJM, Ford E, Fox S, Fitzpatrick NK, Gallacher K, Goddard C, Hassan L, Jamieson R, Jones KH, Kaarakainen M, Lugg-Widger F, McGrail K, McKenzie A, Moran R, Murtagh MJ, Oswald M, Paprica A, Perrin N, Richards EV, Rouse J, Webb J, Willison DJ. Consensus Statement on Public Involvement and Engagement with Data Intensive Health Research. Int J Popul Data Sci 2019; 4:586. [PMID: 34095528 PMCID: PMC8142968 DOI: 10.23889/ijpds.v4i1.586] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This consensus statement reflects the deliberations of an international group of stakeholders with a range of expertise in public involvement and engagement (PI&E) relating to data-intensive health research. It sets out eight key principles to establish a secure role for PI&E in and with the research community internationally and ensure best practice in its execution. Our aim is to promote culture change and societal benefits through ensuring a socially responsible trajectory for innovations in this field.
Our key premise is that the public should not be characterised as a problem to be overcome but a key part of the solution to establish socially beneficial data-intensive health research for all.
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Affiliation(s)
- Mhairi Aitken
- University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, NINE Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX
| | - Mary P Tully
- University of Manchester, Div Pharmacy and Optometry, Oxford Road, Manchester, M13 9PL, UK
| | - Carol Porteous
- University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, NINE Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX
| | - Simon Denegri
- NIHR, INVOLVE, Alpha House, University of Southampton Science Park, Chilworth, Southampton, SO16 7NS, UK
| | - Sarah Cunningham-Burley
- University of Edinburgh, Usher Institute of Population Health Sciences and Informatics, NINE Edinburgh BioQuarter, 9 Little France Road, Edinburgh, EH16 4UX
| | - Natalie Banner
- Wellcome Trust, Gibbs Building, 215 Euston Road, London NW1 2BE, UK
| | - Corri Black
- University of Aberdeen, Institute of Applied Health Sciences, Aberdeen Centre for Health Data Science, School of Medicine, Medical Science and Nutrition, Foresterhill, Aberdeen AB25 2ZD
| | - Michael Burgess
- University of British Columbia, Faculty of Medicine, School of Population and Public Health, 2206 East Mall Vancouver, BC Canada V6T 1Z3
| | - Lynsey Cross
- Swansea University. Population Data Science, Medical School, Singleton Campus, Swansea SA2 8PP, UK
| | - Johannes JM van Delden
- University Medical Centre Utrecht, Julius Centre for Health Sciences, Uniwersiteitsweg 100, 3584 CG Utrecht, Netherlands
| | - Elizabeth Ford
- Brighton and Sussex Medical School, Watson Building, University of Brighton, Falmer, Brighton, BN1 9PH, UK
| | - Sarah Fox
- University of Manchester, Div Pharmacy and Optometry, Oxford Road, Manchester, M13 9PL, UK
| | | | - Kay Gallacher
- HeRC Patient & Public Involvement (H@PPI) Forum, The Health eResearch Centre Vaughan House Portsmouth Street Manchester M13 9GB
| | - Catharine Goddard
- University of Dundee, School of Life Sciences, University of Dundee, Dow Street, Dundee, DD1 5EH, UK
| | - Lamiece Hassan
- University of Manchester, Div Pharmacy and Optometry, Oxford Road, Manchester, M13 9PL, UK
| | - Ron Jamieson
- Public Panel, Farr Institute of Health Informatics Research, Scotland, UK
| | - Kerina H Jones
- Swansea University. Population Data Science, Medical School, Singleton Campus, Swansea SA2 8PP, UK
| | - Minna Kaarakainen
- University of Helsinki, Center for Consumer Society Research, PL 24 (Unioninkatu 40) HELSINGIN YLIOPISTO Finland
| | - Fiona Lugg-Widger
- Cardiff University, Centre for Trials, 702C, Neuadd Meirionnydd, Heath Park, Cardiff, UK
| | - Kimberlyn McGrail
- University of British Columbia, Faculty of Medicine, School of Population and Public Health, 2206 East Mall Vancouver, BC Canada V6T 1Z3
| | - Anne McKenzie
- University of Western Australia, Faculty of Health and Medical Sciences, School of Population and Global Health, 35 Stirling Highway, 6009 Perth Australia
| | | | - Madeleine J Murtagh
- Newcastle University, The School of Geography, Politics and Sociology, Windsor Terrace, Newcastle upon Tyne NE2 4HE , UK
| | - Malcolm Oswald
- University of Manchester, Div Pharmacy and Optometry, Oxford Road, Manchester, M13 9PL, UK
| | - Alison Paprica
- University of Toronto, Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, Health Sciences Building,155 College Street, Toronto, ON M5T 3M6, Canada
| | | | - Emma Victoria Richards
- Swansea University. Population Data Science, Medical School, Singleton Campus, Swansea SA2 8PP, UK
- CIPHER Consumer Panel
| | - John Rouse
- Public Panel, Farr Institute of Health Informatics Research, London, UK
| | - Joanne Webb
- Administrative Data Service (Administrative Data Research Network), University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
| | - Donald J Willison
- University of Toronto, Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, Health Sciences Building,155 College Street, Toronto, ON M5T 3M6, Canada
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Bell JC, Pelin A, Huh M, Tang M, Boeuf FL, Keller B, Duong J, Clark-Knowles K, Petryk J, Jennings VA, Melcher A, Crupi M, Pikor L, Breitbach C, Bernstein S, Burgess M. Abstract B101: Novel oncolytic vaccinia virus platform for systemic delivery of immunotherapeutic payloads. Cancer Immunol Res 2019. [DOI: 10.1158/2326-6074.cricimteatiaacr18-b101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The treatment paradigm for patients with metastatic cancer has evolved rapidly with the approval of agents targeting CTLA-4 and the PD-1/L1 immune checkpoint axis. Despite the profound impact these agents have had, they are minimally effective in the majority of cancer patients. Rational combinations of complementary immune modulating agents have thus far not led to clear patient benefit, and newer technologies that are better able to safely combine multiple modes of action could well prove to be vital. Oncolytic viruses (OVs) have the capacity to be the ideal therapeutic partner for immune checkpoint therapeutics in several ways. First, on their own OVs can “heat-up” immunologically “cold” tumors by initiating a pro-inflammatory infection within the tumor microenvironment (TME). Second, some OVs can be engineered to strategically express one or more immune-modulating molecules. Finally, certain OVs have the capacity to be delivered systemically and thus enhance immune cell recruitment and activation in all metastatic sites. We have selected a novel vaccinia virus as our therapeutic OV platform and are using it to engineer multi-mechanistic cancer therapeutics. Previously it has been demonstrated that certain oncolytic vaccinia viruses can be delivered systemically and spread within metastatic lesions. These early clinical viruses, however, contain multiple potent immune suppressive genes and are not ideal for the generation of antitumor immune responses “in situ.” Furthermore, in clinical studies some of these therapeutics exhibited off-tumor infections (e.g., pox lesions), which may ultimately limit their ability to be used to deliver potent immune modulators. We used a combination of functional genomics and bio-selection strategies to optimize the vaccinia virus platform. Initially we developed a fitness assay to identify the vaccinia strain with the best ability to replicate in and kill both established cancer cell lines and cancer patient tumor explants. Next, we used a transposon insertion strategy and deep sequencing of viral populations to systematically examine the role of each vaccinia virus gene in its ability to be an anticancer therapeutic. Ultimately, we identified large regions (25Kb) of the vaccinia genome that when deleted, augment the oncolytic activity of a newly generated vaccinia backbone termed SKV. Our new best-in-class vaccinia, SKV, robustly stimulates anti-immune responses, rapidly spreads within and between tumors and has a substantially improved preclinical safety profile when compared to other vaccinia clinical candidates. As predicted, SKV synergizes well with immune checkpoint inhibitor antibodies and potently activates human immune cells. Due to the exquisite tumor selectivity of SKV, we have been able to engineer and express from the backbone a combination of very potent immune modulators that are safest and most effective when expressed within the TME. These include an immune checkpoint inhibitor, a membrane tethered cytokine and antigen-presenting cell activating ligand in a single virus. Ongoing toxicity and efficacy studies are being carried out to prepare our novel virus construct for clinical launch.
Citation Format: John C. Bell, Adrian Pelin, Michael Huh, Matthew Tang, Fabrice Le Boeuf, Brian Keller, Jessie Duong, Katherine Clark-Knowles, Julia Petryk, Victoria A. Jennings, Alan Melcher, Mathieu Crupi, Larissa Pikor, Caroline Breitbach, Steven Bernstein, Michael Burgess. Novel oncolytic vaccinia virus platform for systemic delivery of immunotherapeutic payloads [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr B101.
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Affiliation(s)
- John C. Bell
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Adrian Pelin
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Michael Huh
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Matthew Tang
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Fabrice Le Boeuf
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Brian Keller
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Jessie Duong
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Katherine Clark-Knowles
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Julia Petryk
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Victoria A. Jennings
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Alan Melcher
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Mathieu Crupi
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Larissa Pikor
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Caroline Breitbach
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Steven Bernstein
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
| | - Michael Burgess
- Ottawa Hospital Research Institute, Centre for Cancer Therapeutics, Ottawa, Canada; Turnstone Biologics, Ottawa, Canada
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Neal CA, Brantley SR, Antolik L, Babb JL, Burgess M, Calles K, Cappos M, Chang JC, Conway S, Desmither L, Dotray P, Elias T, Fukunaga P, Fuke S, Johanson IA, Kamibayashi K, Kauahikaua J, Lee RL, Pekalib S, Miklius A, Million W, Moniz CJ, Nadeau PA, Okubo P, Parcheta C, Patrick MR, Shiro B, Swanson DA, Tollett W, Trusdell F, Younger EF, Zoeller MH, Montgomery-Brown EK, Anderson KR, Poland MP, Ball JL, Bard J, Coombs M, Dietterich HR, Kern C, Thelen WA, Cervelli PF, Orr T, Houghton BF, Gansecki C, Hazlett R, Lundgren P, Diefenbach AK, Lerner AH, Waite G, Kelly P, Clor L, Werner C, Mulliken K, Fisher G, Damby D. The 2018 rift eruption and summit collapse of Kīlauea Volcano. Science 2018; 363:367-374. [PMID: 30538164 DOI: 10.1126/science.aav7046] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/03/2018] [Indexed: 11/02/2022]
Abstract
In 2018, Kīlauea Volcano experienced its largest lower East Rift Zone (LERZ) eruption and caldera collapse in at least 200 years. After collapse of the Pu'u 'Ō'ō vent on 30 April, magma propagated downrift. Eruptive fissures opened in the LERZ on 3 May, eventually extending ~6.8 kilometers. A 4 May earthquake [moment magnitude (M w) 6.9] produced ~5 meters of fault slip. Lava erupted at rates exceeding 100 cubic meters per second, eventually covering 35.5 square kilometers. The summit magma system partially drained, producing minor explosions and near-daily collapses releasing energy equivalent to M w 4.7 to 5.4 earthquakes. Activity declined rapidly on 4 August. Summit collapse and lava flow volume estimates are roughly equivalent-about 0.8 cubic kilometers. Careful historical observation and monitoring of Kīlauea enabled successful forecasting of hazardous events.
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Affiliation(s)
- C A Neal
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA.
| | - S R Brantley
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - L Antolik
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - J L Babb
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - M Burgess
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - K Calles
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - M Cappos
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - J C Chang
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - S Conway
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - L Desmither
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - P Dotray
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - T Elias
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - P Fukunaga
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - S Fuke
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - I A Johanson
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - K Kamibayashi
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - J Kauahikaua
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - R L Lee
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - S Pekalib
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - A Miklius
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - W Million
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - C J Moniz
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - P A Nadeau
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - P Okubo
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - C Parcheta
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - M R Patrick
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - B Shiro
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - D A Swanson
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - W Tollett
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - F Trusdell
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - E F Younger
- U.S. Geological Survey, Hawaiian Volcano Observatory, 51 Crater Rim Dr., Hawai'i National Park, Hawaii, HI 96718, USA
| | - M H Zoeller
- Center for the Study of Active Volcanoes, University of Hawai'i at Hilo, 200 W. Kāwili St., Hilo, HI 96720, USA
| | - E K Montgomery-Brown
- U.S. Geological Survey, California Volcano Observatory, 345 Middlefield Rd., Menlo Park, CA 94025, USA.
| | - K R Anderson
- U.S. Geological Survey, California Volcano Observatory, 345 Middlefield Rd., Menlo Park, CA 94025, USA
| | - M P Poland
- U.S. Geological Survey, Yellowstone Volcano Observatory, 1300 SE Cardinal Ct., Suite 100, Vancouver, WA 98683-9589, USA
| | - J L Ball
- U.S. Geological Survey, California Volcano Observatory, 345 Middlefield Rd., Menlo Park, CA 94025, USA
| | - J Bard
- U.S. Geological Survey, Cascades Volcano Observatory, 1300 SE Cardinal Ct., Suite 100, Vancouver, WA 98683-9589, USA
| | - M Coombs
- U.S. Geological Survey, Alaska Volcano Observatory, 4230 University Dr., Anchorage, AK 99508, USA
| | - H R Dietterich
- U.S. Geological Survey, Alaska Volcano Observatory, 4230 University Dr., Anchorage, AK 99508, USA
| | - C Kern
- U.S. Geological Survey, Cascades Volcano Observatory, 1300 SE Cardinal Ct., Suite 100, Vancouver, WA 98683-9589, USA
| | - W A Thelen
- U.S. Geological Survey, Cascades Volcano Observatory, 1300 SE Cardinal Ct., Suite 100, Vancouver, WA 98683-9589, USA
| | - P F Cervelli
- U.S. Geological Survey, Alaska Volcano Observatory, 4230 University Dr., Anchorage, AK 99508, USA
| | - T Orr
- U.S. Geological Survey, Alaska Volcano Observatory, 4230 University Dr., Anchorage, AK 99508, USA
| | - B F Houghton
- Department of Earth Sciences, University of Hawai'i at Manoa, 1680 East-West Rd., Honolulu, HI 96822, USA
| | - C Gansecki
- Geology Department, University of Hawai'i at Hilo, 200 W. Kāwili St., Hilo, HI 96720, USA
| | - R Hazlett
- Geology Department, University of Hawai'i at Hilo, 200 W. Kāwili St., Hilo, HI 96720, USA
| | - P Lundgren
- Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Dr., Pasadena, CA 91109, USA
| | - A K Diefenbach
- U.S. Geological Survey, Cascades Volcano Observatory, 1300 SE Cardinal Ct., Suite 100, Vancouver, WA 98683-9589, USA
| | - A H Lerner
- Department of Earth Sciences, University of Oregon, 100 Cascades Hall, Eugene, OR 97403, USA
| | - G Waite
- Department of Geological and Mining Engineering and Sciences, Michigan Technological University, 630 Dow Environmental Sciences, 1400 Townsend Dr., Houghton, MI 49931, USA
| | - P Kelly
- U.S. Geological Survey, Cascades Volcano Observatory, 1300 SE Cardinal Ct., Suite 100, Vancouver, WA 98683-9589, USA
| | - L Clor
- U.S. Geological Survey, Cascades Volcano Observatory, 1300 SE Cardinal Ct., Suite 100, Vancouver, WA 98683-9589, USA
| | - C Werner
- U.S. Geological Survey Contractor, 392 Tukapa St., RD1, New Plymouth 4371, New Zealand
| | - K Mulliken
- State of Alaska Division of Geological and Geophysical Surveys, Alaska Volcano Observatory, 3354 College Rd., Fairbanks, AK 99709, USA
| | - G Fisher
- U.S. Geological Survey, National Civil Applications Center, 12201 Sunrise Valley Dr., MS-562, Reston, VA 20192, USA
| | - D Damby
- U.S. Geological Survey, California Volcano Observatory, 345 Middlefield Rd., Menlo Park, CA 94025, USA
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Yoong J, Chosich B, Burgess M, Earnest A, Runacres F, William L, Franco M, Poon P. Cancer patients’ perceptions of palliative care. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy295.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Teng J, McGrail K, Bentley C, Burgess M, O'Doherty K. Public views and recommendations on the use of linked data for research: preliminary results from a public deliberation engagement. Int J Popul Data Sci 2018. [DOI: 10.23889/ijpds.v3i4.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
IntroductionThe use of linked data for research is increasing, including in complexity of requests. Rules around access to and use of data necessarily trade-off risks related to privacy to achieve social benefits. Including informed and civic-minded public recommendations that consider different perspectives on privacy and benefit will improve related policy.
Objectives and ApproachPopulation Data BC is conducting a deliberative public engagement regarding the use of complex linked data for research. Members of the public will be provided with written materials and hear speakers outlining considerations from multiple perspectives in data access and use, including benefits for health research, risks to privacy, and implications for disability and minority groups. Participants in the deliberation will then discuss questions about the use of linked data and ideas around principles for that use in small and large groups, and develop recommendations for data sharing policies.
ResultsWe will be sharing our preliminary analysis of the public deliberation results at the conference. The public deliberation encourages the participants to develop policy recommendations that respect diversity of perspectives while negotiating constructive advice. It asks the group to make recommendations and to identify and explore issues on which the group has persistent disagreement. We will discuss insights into how the public values the use of data linkage and under what conditions such use becomes problematic. For example, we are hoping to gain insight about how publics determine if a project is in the public interest, or conversely, how a project may pose unacceptable harm.
Conclusion/ImplicationsChanges in available data and increasing ability to link data makes it essential to include public views in systems of data access governance. Understanding the hopes and concerns of the public regarding the use of linked data for research will help develop data access regulations that reflect wide public interests.
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Steel D, Fazelpour S, Gillette K, Crewe B, Burgess M. Multiple diversity concepts and their ethical-epistemic implications. Eur J Philos Sci 2018; 8:761-780. [PMID: 30956737 PMCID: PMC6414089 DOI: 10.1007/s13194-018-0209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/31/2018] [Indexed: 06/09/2023]
Abstract
A concept of diversity is an understanding of what makes a group diverse that may be applicable in a variety of contexts. We distinguish three diversity concepts, show that each can be found in discussions of diversity in science, and explain how they tend to be associated with distinct epistemic and ethical rationales. Yet philosophical literature on diversity among scientists has given little attention to distinct concepts of diversity. This is significant because the unappreciated existence of multiple diversity concepts can generate unclarity about the meaning of "diversity," lead to problematic inferences from empirical research, and obscure complex ethical-epistemic questions about how to define diversity in specific cases. We illustrate some ethical-epistemic implications of our proposal by reference to an example of deliberative mini-publics on human tissue biobanking.
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Affiliation(s)
- Daniel Steel
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, 6356 Agricultural Road, Vancouver, BC V62 1Z2 Canada
| | - Sina Fazelpour
- Department of Philosophy, University of British Columbia, 1866 Main Mall, Vancouver, BC V6T 1Z1 Canada
| | - Kinley Gillette
- Department of Philosophy, University of British Columbia, 1866 Main Mall, Vancouver, BC V6T 1Z1 Canada
| | - Bianca Crewe
- Department of Philosophy, University of British Columbia, 1866 Main Mall, Vancouver, BC V6T 1Z1 Canada
| | - Michael Burgess
- W. Maurice Young Centre for Applied Ethics, University of British Columbia, 6356 Agricultural Road, Vancouver, BC V62 1Z2 Canada
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Wu C, Chaudhary K, Burgess M, Na Y, Welch D, Black P, Wang T, Wuu C, Hei T, Konofagou E, Cheng S. Focused Ultrasound-Induced Blood Brain Barrier Opening Increases Antibody Penetration and Trend for Local Control of the Non-irradiated Tumor in Mice With Bilateral Intracranial Melanoma Metastases Treated With Anti-PDL1 and Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.371] [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: 10/18/2022]
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Zheng B, Wong P, Yang W, Narla R, Burgess M, Escoubet L, Raymon H, Hariharan K, Boylan J, Hege K, Sung V. Abstract 2009: CC-90002 (anti-CD47 antibody) in vivo anti-tumor activity is associated with an increase in M1-polarized macrophages. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
CD47, also known as integrin-associated protein, is over-expressed in several tumor types, including AML, NHL, breast cancer and multiple myeloma. Elevated expression of CD47 on the cell surface protects tumors from phagocytosis by macrophages through binding to signal regulatory protein alpha (SIRPα) on the surface of macrophages. The CD47-SIRPα interaction triggers events that culminate in the inhibition of the phagocytic process. Macrophages are one of the immune cell types frequently found in the tumor microenvironment and exist as a heterogeneous population that includes both M1 and M2 macrophages. While the spectrum of macrophage subpopulations are likely quite diverse, traditionally, it is thought that M1 macrophages are pro-inflammatory, enhancing immune responses against tumor cells, while M2 macrophages are pro-tumor, since they express a wide array of anti-inflammatory molecules, cytokines and growth factors that promote tumor growth, angiogenesis and an immunosuppressive microenvironment. We evaluated CC-90002 efficacy in the RPMI-8226 multiple myeloma and MDA-MB-231 breast cancer xenograft models and enumerated mouse M1/M2-like macrophage populations within in the tumor before and after C-90002 treatment. In both RPMI-8226 and MDA-MB-231 models, M2 macrophages were the primary resident macrophage. Our studies show that when mice bearing RPMI-8226 multiple myeloma xenografts were treated with CC-90002 (a humanized anti-CD47 antibody), tumor regression was preceded by infiltration of macrophages into the xenograft. In the MDA-MB-231 breast cancer model, resident macrophages appeared to mediate the CC-90002 anti-tumor efficacy in vivo without additional macrophage trafficking. Interestingly, in both models, M1 macrophages appear to mediate CC-90002 efficacy regardless of whether macrophages infiltrate the tumor or are tumor-resident. In the MDA-MB-231 breast cancer model where CC-90002 did not induce infiltration, it is possible that resident tumor macrophages were re-educated to an M1 phenotype. In in vitro experiments using human monocyte-derived macrophages, both M1 and M2 macrophages are able to promote phagocytosis and additionally, we observed that CC-90002 selectively inhibited migration of M2 macrophages toward tumor cell conditioned media. This would presumably shift the overall balance of tumor-associated macrophages toward the M1 phenotype and suggests that inhibiting CD47 can both promote tumor phagocytosis and skew tumor macrophage subpopulations toward an anti-tumor phenotype. CC-90002 is currently being tested in two ongoing Phase I clinical studies in subjects with advanced solid and hematologic cancers (NCT02367196, NCT02641002).
Citation Format: Bing Zheng, Piu Wong, WenQing Yang, Rama Narla, Michael Burgess, Laure Escoubet, Heather Raymon, Kandasamy Hariharan, John Boylan, Kristen Hege, Victoria Sung. CC-90002 (anti-CD47 antibody) in vivo anti-tumor activity is associated with an increase in M1-polarized macrophages [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2009. doi:10.1158/1538-7445.AM2017-2009
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Affiliation(s)
| | - Piu Wong
- 1Celgene Corporation, San Francisco, CA
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Polisena J, Burgess M, Mitton C, Lynd LD. Engaging the Canadian public on reimbursement decision-making for drugs for rare diseases: a national online survey. BMC Health Serv Res 2017; 17:372. [PMID: 28549479 PMCID: PMC5446683 DOI: 10.1186/s12913-017-2310-4] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 05/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Funding of drugs for rare diseases (DRDs) requires decisions that balance fairness for all individuals within the healthcare system with compassion for affected individuals. Our study objective was to conduct a national online survey to determine the Canadian public's perspective, including regional variations, associated with DRD decision-making. METHODS The survey collected responses from 1631 Canadians. Respondents were asked to rank at least three and up to five DRD decision-making priorities, out of a total of eight priorities presented. They were also asked to compare and rate their agreement level on a 5-point Likert scale with four funding scenarios described. The frequency of each priority, independent of where it was ranked in relation to the other priorities, was calculated. Regression analyses were conducted to measure the association between respondents' demographics and selected priorities with their agreement level for each funding scenario. RESULTS Among the survey respondents, Improved Quality of Life and Effective Health Care were most frequently selected as top priorities. Also, 79.2% of respondents agreed with equal access to DRDs across Canada, and 73.0% agreed with DRD funding if additional expenses are justified in the DRD's cost-effectiveness. Approximately half agreed to pay for DRDs independent of their effectiveness. There were no geographic differences in priorities. Selecting Effective Health Care in the top priorities was positively associated with both prioritizing other programs over programs for rare diseases and DRD funding only if deemed as cost-effective. Respondents, who selected National Access as one of the top priorities, were less likely to agree to fund DRDs only if deemed as cost-effective and were more likely to agree with the scenario to provide national access to DRDs. CONCLUSIONS The survey results suggest the level of public support for funding decisions and programs that incorporate assessment of the effectiveness of drugs for improving quality of life, and to promote similar access across Canada. The responses anticipate public responses to different policy scenarios and the priorities that underlie them. Decision-makers may find it useful to consider whether and how to incorporate these results into policy decisions and their justification to citizens and patients.
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Affiliation(s)
- Julie Polisena
- Canadian Agency for Drugs and Technologies in Health, 600-865 Carling Ave, Ottawa, K1S 5S8, ON, Canada.
| | - Michael Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, University of British Columbia, Kelowna, BC, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver, BC, Canada
| | - Larry D Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada
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Burgess M, Leung M, Chellapah A, Clark JR, Batstone MD. Osseointegrated implants into a variety of composite free flaps: A comparative analysis. Head Neck 2016; 39:443-447. [DOI: 10.1002/hed.24609] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/13/2016] [Accepted: 08/22/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Michael Burgess
- Department of Maxillofacial SurgeryRoyal Brisbane HospitalBrisbane Queensland Australia
| | - Matthew Leung
- University of Sydney Medical SchoolNew South Wales Australia
| | | | - Jonathan R. Clark
- The Sydney Head and Neck Cancer InstituteChris O'Brien LifehouseSydney New South Wales Australia
- Central Clinical SchoolUniversity of SydneySydney New South Wales Australia
- South Western Clinical SchoolUniversity of New South WalesSydney New South Wales Australia
| | - Martin D. Batstone
- Department of Maxillofacial SurgeryRoyal Brisbane HospitalBrisbane Queensland Australia
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Mohan M, Shalin SC, Kothari A, Rico JCC, Caradine K, Burgess M. Lasiodiplodia species fungal osteomyelitis in a multiple myeloma patient. Transpl Infect Dis 2016; 18:761-764. [PMID: 27391908 DOI: 10.1111/tid.12573] [Citation(s) in RCA: 6] [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: 11/17/2015] [Revised: 02/26/2016] [Accepted: 04/18/2016] [Indexed: 11/27/2022]
Abstract
Lasiodiplodia species are environmental fungi that have been reported as a cause of infection in both immunocompetent and immunocompromised patients. We present a case of fungal osteomyelitis caused by Lasiodiplodia species in a patient with multiple myeloma after autologous stem cell transplant. The patient was successfully treated with a combination of surgery and oral voriconzole. To the best of our knowledge, this is the first reported case of fungal osteomyelitis caused by Lasiodiplodia species.
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Affiliation(s)
- M Mohan
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - S C Shalin
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - A Kothari
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - J C C Rico
- Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - K Caradine
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - M Burgess
- Division of Infectious Diseases and Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Burgess M, Leung M, Chellapah A, Crombie A, Clark J, Batstone M. A retrospective analysis of osseo-integrated implants placed into vascularised free-flaps of the head and neck – a multicentre analysis. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abbatiello SE, Schilling B, Mani DR, Zimmerman LJ, Hall SC, MacLean B, Albertolle M, Allen S, Burgess M, Cusack MP, Gosh M, Hedrick V, Held JM, Inerowicz HD, Jackson A, Keshishian H, Kinsinger CR, Lyssand J, Makowski L, Mesri M, Rodriguez H, Rudnick P, Sadowski P, Sedransk N, Shaddox K, Skates SJ, Kuhn E, Smith D, Whiteaker JR, Whitwell C, Zhang S, Borchers CH, Fisher SJ, Gibson BW, Liebler DC, MacCoss MJ, Neubert TA, Paulovich AG, Regnier FE, Tempst P, Carr SA. Large-Scale Interlaboratory Study to Develop, Analytically Validate and Apply Highly Multiplexed, Quantitative Peptide Assays to Measure Cancer-Relevant Proteins in Plasma. Mol Cell Proteomics 2015; 14:2357-74. [PMID: 25693799 DOI: 10.1074/mcp.m114.047050] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Indexed: 11/06/2022] Open
Abstract
There is an increasing need in biology and clinical medicine to robustly and reliably measure tens to hundreds of peptides and proteins in clinical and biological samples with high sensitivity, specificity, reproducibility, and repeatability. Previously, we demonstrated that LC-MRM-MS with isotope dilution has suitable performance for quantitative measurements of small numbers of relatively abundant proteins in human plasma and that the resulting assays can be transferred across laboratories while maintaining high reproducibility and quantitative precision. Here, we significantly extend that earlier work, demonstrating that 11 laboratories using 14 LC-MS systems can develop, determine analytical figures of merit, and apply highly multiplexed MRM-MS assays targeting 125 peptides derived from 27 cancer-relevant proteins and seven control proteins to precisely and reproducibly measure the analytes in human plasma. To ensure consistent generation of high quality data, we incorporated a system suitability protocol (SSP) into our experimental design. The SSP enabled real-time monitoring of LC-MRM-MS performance during assay development and implementation, facilitating early detection and correction of chromatographic and instrumental problems. Low to subnanogram/ml sensitivity for proteins in plasma was achieved by one-step immunoaffinity depletion of 14 abundant plasma proteins prior to analysis. Median intra- and interlaboratory reproducibility was <20%, sufficient for most biological studies and candidate protein biomarker verification. Digestion recovery of peptides was assessed and quantitative accuracy improved using heavy-isotope-labeled versions of the proteins as internal standards. Using the highly multiplexed assay, participating laboratories were able to precisely and reproducibly determine the levels of a series of analytes in blinded samples used to simulate an interlaboratory clinical study of patient samples. Our study further establishes that LC-MRM-MS using stable isotope dilution, with appropriate attention to analytical validation and appropriate quality control measures, enables sensitive, specific, reproducible, and quantitative measurements of proteins and peptides in complex biological matrices such as plasma.
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Affiliation(s)
- Susan E Abbatiello
- From the Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142
| | | | - D R Mani
- From the Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142
| | - Lisa J Zimmerman
- Department of Biochemistry, Vanderbilt University School of Medicine, and the Jim Ayers Institute for Precancer Detection and Diagnosis, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee 37232
| | - Steven C Hall
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143
| | - Brendan MacLean
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington 98195
| | - Matthew Albertolle
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143
| | - Simon Allen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143
| | - Michael Burgess
- From the Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142
| | | | - Mousumi Gosh
- Memorial Sloan-Kettering Cancer Center, New York, New York 10065
| | | | - Jason M Held
- Buck Institute for Research on Aging, Novato, California 94945
| | | | - Angela Jackson
- University of Victoria-Genome BC Proteomics Centre, Victoria, British Columbia V8Z 7X8 CAN
| | - Hasmik Keshishian
- From the Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142
| | | | - John Lyssand
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University School of Medicine, New York, New York 10016
| | - Lee Makowski
- Argonne National Laboratory (currently at Northeastern University, Boston Massachusetts 02115
| | - Mehdi Mesri
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Henry Rodriguez
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
| | - Paul Rudnick
- National Institute of Standards and Technology, Gaithersburg, Maryland 20899
| | - Pawel Sadowski
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University School of Medicine, New York, New York 10016
| | - Nell Sedransk
- National Institute of Statistical Sciences, Research Triangle Park, North Carolina 27709
| | - Kent Shaddox
- Department of Biochemistry, Vanderbilt University School of Medicine, and the Jim Ayers Institute for Precancer Detection and Diagnosis, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee 37232
| | - Stephen J Skates
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Eric Kuhn
- From the Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142
| | - Derek Smith
- University of Victoria-Genome BC Proteomics Centre, Victoria, British Columbia V8Z 7X8 CAN
| | | | - Corbin Whitwell
- Department of Biochemistry, Vanderbilt University School of Medicine, and the Jim Ayers Institute for Precancer Detection and Diagnosis, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee 37232
| | - Shucha Zhang
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109
| | - Christoph H Borchers
- University of Victoria-Genome BC Proteomics Centre, Victoria, British Columbia V8Z 7X8 CAN
| | - Susan J Fisher
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California 94143
| | | | - Daniel C Liebler
- Department of Biochemistry, Vanderbilt University School of Medicine, and the Jim Ayers Institute for Precancer Detection and Diagnosis, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee 37232
| | - Michael J MacCoss
- Department of Genome Sciences, University of Washington School of Medicine, Seattle, Washington 98195
| | - Thomas A Neubert
- Kimmel Center for Biology and Medicine at the Skirball Institute, New York University School of Medicine, New York, New York 10016
| | | | | | - Paul Tempst
- Memorial Sloan-Kettering Cancer Center, New York, New York 10065
| | - Steven A Carr
- From the Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142;
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Douglas CMW, Wilcox E, Burgess M, Lynd LD. Why orphan drug coverage reimbursement decision-making needs patient and public involvement. Health Policy 2015; 119:588-96. [PMID: 25641123 DOI: 10.1016/j.healthpol.2015.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
Recently there has been an increase in the active involvement of publics and patients in healthcare and research, which is extending their roles beyond the passive recipients of medicines. However, there has been noticeably less work engaging them into decision-making for healthcare rationing exercises, priority setting, health technology assessment, and coverage decision-making. This is particularly evident in reimbursement decision-making for 'orphan drugs' or drugs for rare diseases. Medicinal products for rare disease offer particular challenges in coverage decision-making because they often lack the 'evidence of efficacy' profiles of common drugs that have been trialed on larger populations. Furthermore, many of these drugs are priced in the high range, and with limited health care budgets the prospective opportunity costs of funding them means that those resources cannot be allocated elsewhere. Here we outline why decision-making for drugs for rare diseases could benefit from increased levels of publics and patients involvement, suggest some possible forms that involvement could take, and advocate for empirical experimentation in this area to evaluate the effects of such involvement. Focus is given to the Canadian context in which we are based; however, potentialities and challenges relating to involvement in this area are likely to be similar elsewhere.
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Affiliation(s)
- Conor M W Douglas
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Canada.
| | - Elizabeth Wilcox
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Michael Burgess
- School of Population and Public Health, University of British Columbia, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
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Chalmers D, Burgess M, Edwards K, Kaye J, Meslin EM, Nicol D. Marking Shifts in Human Research Ethics in the Development of Biobanking. Public Health Ethics 2014. [DOI: 10.1093/phe/phu023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Burgess M, Bowler M, Jones R, Hase M, Murdoch B. Improved Outcomes After Alloplastic TMJ Replacement: Analysis of a Multicenter Study From Australia and New Zealand. J Oral Maxillofac Surg 2014; 72:1251-7. [DOI: 10.1016/j.joms.2014.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/04/2014] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
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Caulfield T, Burningham S, Joly Y, Master Z, Shabani M, Borry P, Becker A, Burgess M, Calder K, Critchley C, Edwards K, Fullerton SM, Gottweis H, Hyde-Lay R, Illes J, Isasi R, Kato K, Kaye J, Knoppers B, Lynch J, McGuire A, Meslin E, Nicol D, O’Doherty K, Ogbogu U, Otlowski M, Pullman D, Ries N, Scott C, Sears M, Wallace H, Zawati MH. A review of the key issues associated with the commercialization of biobanks. J Law Biosci 2014; 1:94-110. [PMID: 27774156 PMCID: PMC5033518 DOI: 10.1093/jlb/lst004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
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Cikes M, Tong L, Jasaityte R, Hamilton J, Sutherland G, D'hooge J, Yurdakul S, Oner F, Avci BK, Sahin S, Direskeneli H, Aytekin S, Fang F, Chan A, Zhang Q, Sanderson J, Kwong J, Yu C, Zaidi A, Raju H, Ghani S, Gati S, Cox A, Sheikh N, Sharma R, Sharma S, Kutty S, Kottam A, Padiyath A, Gao S, Drvol L, Lof J, Li L, Rangamani S, Danford D, Kuehne T, Rosner A, Avenarius D, Malm S, Iqbal A, Baltabaeva A, Schirmer H, Bijnens B, Myrmel T, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Jorge C, Silva D, Placido R, Goncalves S, Almeida A, Nunes Diogo A, Poulidakis E, Aggeli C, Sideris S, Dilaveris P, Gatzoulis K, Felekos I, Koutagiar I, Sfendouraki E, Roussakis G, Stefanadis C, Zhang Q, Sun J, Gao R, Feng Y, Liu X, Sheng W, Liu F, Yu C, Hallioglu O, Citirik D, Buyukakilli B, Ozeren M, Gurgul S, Tasdelen B, Rodriguez Lopez A, Rodriguez Lopez A, Garcia Cuenllas L, Garcia Cuenllas L, Medrano C, Medrano C, Granja S, Granja S, Marin C, Marin C, Maroto E, Maroto E, Alvarez T, Alvarez T, Ballesteros F, Ballesteros F, Camino M, Camino M, Centeno M, Centeno M, Alraies M, Aljaroudi W, Halley C, Rodriguez L, Grimm R, Thomas J, Jaber W, Knight D, Coghlan J, Muthurangu V, Grasso A, Toumpanakis C, Caplin M, Taylor A, Davar J, Mohlkert LA, Halvorsen C, Hallberg J, Sjoberg G, Norman M, Cameli M, Losito M, Lisi M, Natali B, Massoni A, Maccherini M, Chiavarelli M, Massetti M, Mondillo S, Sljivic A, Stojcevski B, Celic V, Pencic B, Majstorovic A, Cosic Z, Backovic S, Ilic-Djordjevic I, Muraru D, Gripari P, Esposito R, Tamborini G, Galderisi M, Ermacora D, Maffessanti F, Santoro C, Pepi M, Badano L, Bombardini T, Cini D, Picano E, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Banovic M, Vukcevic V, Ostojic M, Markovic Z, Mladenovic A, Trifunovic D, Stojkovic S, Bacic D, Dedovic D, Seferovic P, Huttin O, Coulibaly S, Mercy M, Schwartz J, Zinzius P, Sellal J, Popovic B, Marie P, Juilliere Y, Selton-Suty C, Gurzun MM, Ionescu A, Bahlay B, Jones G, Rimbas R, Enescu O, Mihaila S, Ciobanu A, Vinereanu D, Vlasseros I, Koumoulidis A, Tousoulis D, Veioglanis S, Avgeropoulou A, Katsi V, Stefanadis C, Kallikazaros I, Kiviniemi T, Ylitalo A, Airaksinen K, Lehtinen T, Saraste A, Pietila M, Karjalainen P, Trifunovic D, Ostojic M, Stankovic S, Vujisic-Tesic B, Petrovic M, Banovic M, Boricic M, Draganic G, Petrovic M, Stepanovic J, Kuznetsov V, Yaroslavskaya E, Pushkarev G, Krinochkin D, Zyrianov I, Dekleva M, Stevanovic A, Kleut M, Suzic Lazic J, Markovic Nikolic N, Akhunova S, Saifullina G, Sadykov A, Loudon M, D'arcy J, Arnold L, Reynolds R, Mabbet C, Prendergast B, Dahl J, Videbaek L, Poulsen M, Rudbaek T, Pellikka P, Rasmussen L, Moller J, Lowery C, Frenneaux M, Dawson D, Dwivedi G, Singh S, Rudd A, Mahadevan D, Srinivasan J, Jiminez D, Sahinarslan A, Vecchio F, Maccarthy P, Wendler O, Monaghan M, Harimura Y, Seo Y, Ishizu T, Noguchi Y, Aonuma K, Urdaniz MM, Palomares JFR, Rius JB, Surribas IB, Tura GT, Garcia-Moreno LG, Alujas TG, Masip AE, Mas PT, Dorado DG, Meimoun P, Germain A, Clerc J, Elmkies F, Zemir H, Luycx-Bore A, Nasr GM, Erraki A, Dulgheru R, Magne J, Capoulade R, Elhonsali Z, Pierard LA, Pibarot P, Lancellotti P, Wrideier S, Butz T, Schilling I, Gkiouras G, Sasko B, Van Bracht M, Prull M, Trappe HJ, Castillo Bernal F, Mesa Rubio M, Ruiz Ortiz M, Delgado Ortega M, Morenate Navio M, Baeza Garzon M, Del Pino ML, Toledano Delgado F, Mazuelos F, Suarez de Lezo Herreros de Tejada J, Prinz C, Schumann M, Burghardt A, Seggewiss H, Oldenburg O, Horstkotte D, Faber L, Bistola V, Banner N, Hedger M, Simon A, Rahman Haley S, Baltabaeva A, Adamyan K, Tumasyan LR, Chilingaryan A, Makavos G, Kouris N, Kostopoulos V, Stamatelatou M, Damaskos D, Kartsagoulis E, Olympios C, Sade L, Eroglu S, Bircan A, Pirat B, Sezgin A, Aydinalp A, Muderrisoglu H, Sargento L, Satendra M, Sousa C, Longo S, Lousada N, Dos Reis RP, Kuznetsov V, Krinochkin D, Gapon L, Vershinina A, Shurkevich N, Bessonova M, Yaroslavskaya E, Kolunin G, Sargento L, Satendra M, Sousa C, Lousada N, Dos Reis RP, Azevedo O, Lourenco M, Machado I, Guardado J, Medeiros R, Pereira A, Quelhas I, Lourenco A, Duman D, Sargin F, Kilicaslan B, Inan A, Ozgunes N, Goktas P, Ikonomidis I, Tzortzis S, Paraskevaidis I, Andreadou I, Katseli C, Katsimbri P, Papadakis I, Pavlidis G, Anastasiou-Nana M, Lekakis J, Charalampopoulos A, Howard L, Davies R, Gin-Sing W, Tzoulaki I, Grapsa I, Gibbs J, Dobson RA, Cuthbertson DJ, Burgess M, Lichodziejewska B, Kurnicka K, Goliszek S, Kostrubiec M, Dzikowska-Diduch O, Ciurzynski M, Krupa M, Grudzka K, Palczewski P, Pruszczyk P, Mansencal N, Marcadet D, Montalvan B, Dubourg O, Matveeva N, Nartsissova G, Chernjavskiy A, Eicher JC, Berthier S, Lorcerie B, Philip JL, Wolf JE, Wiesen P, Ledoux D, Massion P, Piret S, Canivet JL, Cusma-Piccione M, Zito C, Imbalzano E, Saitta A, Donato D, Madaffari A, Luzza G, Pipitone V, Tripodi R, Carerj S, Bombardini T, Gherardi S, Arpesella G, Maccherini M, Serra W, Del Bene R, Sicari R, Picano E, Al-Mallah M, Ananthasubramaniam K, Alam M, Chattahi J, Zweig B, Boedeker S, Song T, Khoo J, Davies J, Ang KL, Galinanes M, Chin D, Papamichael ND, Karassavidou D, Mpougialkli M, Antoniou S, Giannitsi S, Chachalos S, Gouva C, Naka K, Katopodis K, Michalis L, Tsang W, Cui V, Ionasec R, Takeuchi M, Houle H, Weinert L, Roberson D, Lang R, Altman M, Aussoleil A, Bergerot C, Sibellas F, Bonnefoy-Cudraz E, Derumeaux GA, Thibault H, Mohamed A, Omran A, Hussein M, Shahgaldi K, Gunyeli E, Sahlen A, Manouras A, Winter R, Squeri A, Binno S, Ferdenzi E, Reverberi C, Baldelli M, Barbieri A, Iaccarino D, Naldi M, Bosi S, Kalinowski M, Szulik M, Streb W, Stabryla J, Nowak J, Rybus-Kalinowska B, Kukulski T, Kalarus Z, Ouss A, Riezebos R, Nestaas E, Skranes J, Stoylen A, Brunvand L, Fugelseth D, Magalhaes A, Silva Marques J, Martins S, Carrilho Ferreira P, Placido R, Jorge C, Silva D, Goncalves S, Almeida A, Nunes Diogo A, Nagy A, Kovats T, Apor A, Nagy A, Vago H, Toth A, Toth M, Merkely B, Ranjbar S, Karvandi M, Hassantash S, Da Silva SG, Marin C, Rodriguez A, Marcos C, Rodriguez-Ogando A, Maroto E, Medrano C, Del Valle DI, Lopez-Fernandez T, Gemma D, Gomez-Rubin M, De Torres F, Feliu J, Canales M, Buno A, Ramirez E, Lopez-Sendon J, Magalhaes A, Silva Marques J, Martins S, Placido R, Silva D, Jorge C, Calisto C, Goncalves S, Almeida A, Nunes Diogo A, Jorge C, Cortez-Dias N, Goncalves S, Ribeiro S, Santos L, Silva D, Barreiros C, Bernardes A, Carpinteiro L, Sousa J, Kim SH, Choi W, Chidambaram S, Arunkumar R, Venkatesan S, Gnanavelu G, Dhandapani V, Ravi M, Karthikeyan G, Meenakshi K, Muthukumar D, Swaminathan N, Vitarelli A, Barilla F, Capotosto L, Truscelli G, Dettori O, Caranci F, D-Angeli I, De Maio M, De Cicco V, Bruno P, Doesch C, Sueselbeck T, Haghi D, Streitner F, Borggrefe M, Papavassiliu T, Laser K, Schaefer F, Fischer M, Habash S, Degener F, Moysich A, Haas N, Kececioglu D, Burchert W, Koerperich H, Dwivedi G, Al-Shehri H, Dekemp R, Ali I, Alghamdi A, Klein R, Scullion A, Beanlands R, Ruddy T, Chow B, Lipiec P, Szymczyk E, Michalski B, Wozniakowski B, Rotkiewicz A, Stefanczyk L, Szymczyk K, Kasprzak J, Angelov A, Yotov Y, Mircheva L, Kisheva A, Kunchev O, Ikonomidis I, Tsantes A, Triantafyllidi H, Tzortzis S, Dima K, Trivilou P, Papadopoulos C, Travlou A, Anastasiou-Nana M, Lekakis J, Bader R, Agoston-Coldea L, Lupu S, Mocan T, Loegstrup B, Hofsten D, Christophersen T, Moller J, Bjerre M, Flyvbjerg A, Botker H, Egstrup K, Park Y, Choi J, Yun K, Lee S, Han D, Kim J, Kim J, Kim J, Chun K. Poster Session Wednesday 5 December all day Display * Determinants of left ventricular performance. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pimentel D, Burgess M. Nuclear war investigation related to a limited nuclear battle with emphasis on agricultural impacts in the United States. Ambio 2012; 41:894-9. [PMID: 22736383 PMCID: PMC3492557 DOI: 10.1007/s13280-012-0295-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 04/22/2012] [Accepted: 04/26/2012] [Indexed: 06/01/2023]
Abstract
A limited battle involving the nuclear arsenals of India and Pakistan would have significant climatic impacts upon agricultural crop production in the United States; corn, soybeans, and winter wheat yields would be significantly reduced in the Corn Belt region of the US. The most severe impacts would occur during the second year after the modeled nuclear battle.
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Affiliation(s)
- David Pimentel
- College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA.
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Dobson R, Burgess M, Wieshmann H, Cuthbertson D. A full house of metastatic carcinoid disease. Case Reports 2012; 2012:006350. [DOI: 10.1136/bcr-2012-006350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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