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Prion agents (1st section). Transfusion 2024; 64 Suppl 1:S4-S18. [PMID: 38394039 DOI: 10.1111/trf.17627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/25/2024]
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Hartley D, French S. A Bayesian method for calibration and aggregation of expert judgement. Int J Approx Reason 2021. [DOI: 10.1016/j.ijar.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Keckler M, Anderson K, McAllister S, Rasheed J, Noble-Wang J. Development and implementation of evidence-based laboratory safety management tools for a public health laboratory. SAFETY SCIENCE 2019; 117:205-216. [PMID: 31156293 PMCID: PMC6537614 DOI: 10.1016/j.ssci.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We developed an evidence-based continuous quality improvement (CQI) cycle for laboratory safety as a method of utilizing survey data to improve safety in a public health laboratory setting. • Expert Opinion: The CQI cycle begins with the solicitation of laboratory staff input via an annual survey addressing potential chemical, physical and radiological hazards associated with multiple laboratory activities. The survey collects frequency, severity and exposure data related to these activities in the context of the most pathogenic organisms handled at least weekly. • Gap Analysis: Step 2 of the CQI cycle used survey data to identify areas needing improvement. Typically, the traditional two-dimensional risk assessment matrix is used to prioritize mitigations. However, we added an additional dimension - frequency of exposure - to create three-dimensional risk maps to better inform and communicate risk priorities. • Mitigation Measures: Step 3 of the CQI cycle was to use these results to develop mitigations. This included evaluating the identified risks to determine what risk control measures (elimination, substitution, engineering, administrative or PPE) were needed. In the 2016 iteration of the CQI cycle described here, all mitigations were based on administrative controls. • Evaluation and Feedback: The last step of the CQI cycle was to evaluate the inferred effects of interventions through subsequent surveys, allowing for qualitative assessment of intervention effectiveness while simultaneously restarting the cycle by identifying new hazards. Here we describe the tools used to drive this CQI cycle, including the survey tool, risk analysis method, design of interventions and inference of mitigation effectiveness.
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Affiliation(s)
- M.S. Keckler
- Centers for Disease Control and Prevention, National Center for Emerging Zoonotic and Infectious Diseases, Division of Healthcare Quality Promotion, Clinical and Environmental Microbiology Branch, United States
- Centers for Disease Control and Prevention, Center for Surveillance, Epidemiology and Laboratory Services, Laboratory Leadership Service Fellowship, United States
| | - K. Anderson
- Centers for Disease Control and Prevention, National Center for Emerging Zoonotic and Infectious Diseases, Division of Healthcare Quality Promotion, Clinical and Environmental Microbiology Branch, United States
| | - S. McAllister
- Centers for Disease Control and Prevention, National Center for Emerging Zoonotic and Infectious Diseases, Division of Healthcare Quality Promotion, Clinical and Environmental Microbiology Branch, United States
| | - J.K. Rasheed
- Centers for Disease Control and Prevention, National Center for Emerging Zoonotic and Infectious Diseases, Division of Healthcare Quality Promotion, Clinical and Environmental Microbiology Branch, United States
| | - J. Noble-Wang
- Centers for Disease Control and Prevention, National Center for Emerging Zoonotic and Infectious Diseases, Division of Healthcare Quality Promotion, Clinical and Environmental Microbiology Branch, United States
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Hald T, Aspinall W, Devleesschauwer B, Cooke R, Corrigan T, Havelaar AH, Gibb HJ, Torgerson PR, Kirk MD, Angulo FJ, Lake RJ, Speybroeck N, Hoffmann S. World Health Organization Estimates of the Relative Contributions of Food to the Burden of Disease Due to Selected Foodborne Hazards: A Structured Expert Elicitation. PLoS One 2016; 11:e0145839. [PMID: 26784029 PMCID: PMC4718673 DOI: 10.1371/journal.pone.0145839] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 12/06/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The Foodborne Disease Burden Epidemiology Reference Group (FERG) was established in 2007 by the World Health Organization (WHO) to estimate the global burden of foodborne diseases (FBDs). This estimation is complicated because most of the hazards causing FBD are not transmitted solely by food; most have several potential exposure routes consisting of transmission from animals, by humans, and via environmental routes including water. This paper describes an expert elicitation study conducted by the FERG Source Attribution Task Force to estimate the relative contribution of food to the global burden of diseases commonly transmitted through the consumption of food. METHODS AND FINDINGS We applied structured expert judgment using Cooke's Classical Model to obtain estimates for 14 subregions for the relative contributions of different transmission pathways for eleven diarrheal diseases, seven other infectious diseases and one chemical (lead). Experts were identified through international networks followed by social network sampling. Final selection of experts was based on their experience including international working experience. Enrolled experts were scored on their ability to judge uncertainty accurately and informatively using a series of subject-matter specific 'seed' questions whose answers are unknown to the experts at the time they are interviewed. Trained facilitators elicited the 5th, and 50th and 95th percentile responses to seed questions through telephone interviews. Cooke's Classical Model uses responses to the seed questions to weigh and aggregate expert responses. After this interview, the experts were asked to provide 5th, 50th, and 95th percentile estimates for the 'target' questions regarding disease transmission routes. A total of 72 experts were enrolled in the study. Ten panels were global, meaning that the experts should provide estimates for all 14 subregions, whereas the nine panels were subregional, with experts providing estimates for one or more subregions, depending on their experience in the region. The size of the 19 hazard-specific panels ranged from 6 to 15 persons with several experts serving on more than one panel. Pathogens with animal reservoirs (e.g. non-typhoidal Salmonella spp. and Toxoplasma gondii) were in general assessed by the experts to have a higher proportion of illnesses attributable to food than pathogens with mainly a human reservoir, where human-to-human transmission (e.g. Shigella spp. and Norovirus) or waterborne transmission (e.g. Salmonella Typhi and Vibrio cholerae) were judged to dominate. For many pathogens, the foodborne route was assessed relatively more important in developed subregions than in developing subregions. The main exposure routes for lead varied across subregions, with the foodborne route being assessed most important only in two subregions of the European region. CONCLUSIONS For the first time, we present worldwide estimates of the proportion of specific diseases attributable to food and other major transmission routes. These findings are essential for global burden of FBD estimates. While gaps exist, we believe the estimates presented here are the best current source of guidance to support decision makers when allocating resources for control and intervention, and for future research initiatives.
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Affiliation(s)
- Tine Hald
- Technical University of Denmark, Lyngby, Denmark
| | - Willy Aspinall
- Aspinall & Associates, Tisbury, England
- Bristol University, Bristol, England
| | - Brecht Devleesschauwer
- Ghent University, Merelbeke, Belgium
- Université catholique de Louvain, Brussels, Belgium
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Roger Cooke
- Resources for the Future, Washington, District of Columbia, United States of America
- Technical University of Delft, Delft, the Netherlands
| | | | - Arie H. Havelaar
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- University of Florida, Gainesville, Florida, United States of America
- Utrecht University, Utrecht, Netherlands
| | - Herman J. Gibb
- Gibb Epidemiology Consulting LLC, Arlington, Virginia, United States of America
| | | | | | - Fred J. Angulo
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robin J. Lake
- Institute of Environmental Science and Research, Christchurch, New Zealand
| | | | - Sandra Hoffmann
- U.S. Dept. of Agriculture, Economic Research Service, Washington, District of Columbia, United States of America
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Tyshenko MG, Oraby T, Darshan S, Westphal M, Croteau MC, Aspinall W, Elsaadany S, Krewski D, Cashman N. Expert elicitation on the uncertainties associated with chronic wasting disease. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2016; 79:729-745. [PMID: 27556566 DOI: 10.1080/15287394.2016.1174007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A high degree of uncertainty exists for chronic wasting disease (CWD) transmission factors in farmed and wild cervids. Evaluating the factors is important as it helps to inform future risk management strategies. Expert opinion is often used to assist decision making in a number of health, science, and technology domains where data may be sparse or missing. Using the "Classical Model" of elicitation, a group of experts was asked to estimate the most likely values for several risk factors affecting CWD transmission. The formalized expert elicitation helped structure the issues and hence provide a rational basis for estimating some transmission risk factors for which evidence is lacking. Considered judgments regarding environmental transmission, latency of CWD transmission, management, and species barrier were provided by the experts. Uncertainties for many items were determined to be large, highlighting areas requiring more research. The elicited values may be used as surrogate values until research evidence becomes available.
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Affiliation(s)
- Michael G Tyshenko
- a McLaughlin Centre for Population Health Risk Assessment , Institute of Population Health, University of Ottawa , Ottawa , Ontario , Canada
| | - Tamer Oraby
- b Department of Mathematics , University of Texas-Pan American , Edinburg , Texas , USA
| | - Shalu Darshan
- a McLaughlin Centre for Population Health Risk Assessment , Institute of Population Health, University of Ottawa , Ottawa , Ontario , Canada
| | - Margit Westphal
- a McLaughlin Centre for Population Health Risk Assessment , Institute of Population Health, University of Ottawa , Ottawa , Ontario , Canada
| | - Maxine C Croteau
- a McLaughlin Centre for Population Health Risk Assessment , Institute of Population Health, University of Ottawa , Ottawa , Ontario , Canada
| | - Willy Aspinall
- c Aspinall and Associates , Tisbury , United Kingdom
- d School of Earth Sciences and Cabot Institute , University of Bristol , Bristol , United Kingdom
| | - Susie Elsaadany
- e Professional Guidelines and Public Health Practice Division, Centre for Infectious Disease Prevention and Control , Public Health Agency of Canada , Ottawa , Ontario , Canada
| | - Daniel Krewski
- a McLaughlin Centre for Population Health Risk Assessment , Institute of Population Health, University of Ottawa , Ottawa , Ontario , Canada
- f Department of Epidemiology and Community Medicine , University of Ottawa , Ottawa , Ontario , Canada
| | - Neil Cashman
- g Brain Research Centre , University of British Columbia , Vancouver , British Columbia , Canada
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Oraby T, Tyshenko MG, Westphal M, Darshan S, Croteau MC, Aspinall W, Elsaadany S, Cashman N, Krewski D. Using expert judgments to improve chronic wasting disease risk management in Canada. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2016; 79:713-728. [PMID: 27556565 DOI: 10.1080/15287394.2016.1174005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
ABSTARCT Chronic wasting disease (CWD) is a neurodegenerative, protein misfolding disease affecting cervids in North America in epidemic proportions. While the existence of CWD has been known for more than 40 years, risk management efforts to date have not been able to curtail the spread of this condition. An expert elicitation exercise was carried out in May 2011 to obtain the views of international experts on both the etiology of CWD and possible CWD risk management strategies. This study presents the results of the following three components of the elicitation exercise: (1) expert views of the most likely scenarios for the evolution of the CWD among cervid populations in Canada, (2) ranking analyses of the importance of direct and indirect transmission routes, and (3) rating analyses of CWD control measures in farmed and wild cervids. The implications of these findings for the development of CWD risk management strategies are described in a Canadian context.
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Affiliation(s)
- Tamer Oraby
- a Department of Mathematics , University of Texas Rio Grande Valley , Edinburg , Texas , USA
| | - Michael G Tyshenko
- b McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health , University of Ottawa , Ottawa , Ontario , Canada
| | - Margit Westphal
- b McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health , University of Ottawa , Ottawa , Ontario , Canada
| | - Shalu Darshan
- b McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health , University of Ottawa , Ottawa , Ontario , Canada
| | - Maxine C Croteau
- b McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health , University of Ottawa , Ottawa , Ontario , Canada
| | - Willy Aspinall
- c Aspinall and Associates , Tisbury , United Kingdom
- h Risk Sciences International , Ottawa , Ontario , Canada
| | - Susie Elsaadany
- d School of Earth Sciences and Cabot Institute , University of Bristol , Bristol , United Kingdom
| | - Neil Cashman
- e Blood Safety Surveillance and Health Care Acquired Infections Division , Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada , Ottawa , Ontario , Canada
| | - Daniel Krewski
- b McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health , University of Ottawa , Ottawa , Ontario , Canada
- f Brain Research Centre , University of British Columbia , Vancouver , British Columbia , Canada
- g Department of Epidemiology and Community Medicine, Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada
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Mangano FG, Colombo M, Veronesi G, Caprioglio A, Mangano C. Mesenchymal stem cells in maxillary sinus augmentation: A systematic review with meta-analysis. World J Stem Cells 2015; 7:976-991. [PMID: 26240683 PMCID: PMC4515439 DOI: 10.4252/wjsc.v7.i6.976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/27/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effectiveness of mesenchymal stem cells (MSCs) in maxillary sinus augmentation (MSA), with various scaffold materials.
METHODS: MEDLINE, EMBASE and SCOPUS were searched using keywords such as sinus graft, MSA, maxillary sinus lift, sinus floor elevation, MSC and cell-based, in different combinations. The searches included full text articles written in English, published over a 10-year period (2004-2014). Inclusion criteria were clinical/radiographic and histologic/ histomorphometric studies in humans and animals, on the use of MSCs in MSA. Meta-analysis was performed only for experimental studies (randomized controlled trials and controlled trials) involving MSA, with an outcome measurement of histologic evaluation with histomorphometric analysis reported. Mean and standard deviation values of newly formed bone from each study were used, and weighted mean values were assessed to account for the difference in the number of subjects among the different studies. To compare the results between the test and the control groups, the differences of regenerated bone in mean and 95% confidence intervals were calculated.
RESULTS: Thirty-nine studies (18 animal studies and 21 human studies) published over a 10-year period (between 2004 and 2014) were considered to be eligible for inclusion in the present literature review. These studies demonstrated considerable variation with respect to study type, study design, follow-up, and results. Meta-analysis was performed on 9 studies (7 animal studies and 2 human studies). The weighted mean difference estimate from a random-effect model was 9.5% (95%CI: 3.6%-15.4%), suggesting a positive effect of stem cells on bone regeneration. Heterogeneity was measured by the I2 index. The formal test confirmed the presence of substantial heterogeneity (I2 = 83%, P < 0.0001). In attempt to explain the substantial heterogeneity observed, we considered a meta-regression model with publication year, support type (animal vs humans) and follow-up length (8 or 12 wk) as covariates. After adding publication year, support type and follow-up length to the meta-regression model, heterogeneity was no longer significant (I2 = 33%, P = 0.25).
CONCLUSION: Several studies have demonstrated the potential for cell-based approaches in MSA; further clinical trials are needed to confirm these results.
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Custer B, Janssen MP. Health economics and outcomes methods in risk-based decision-making for blood safety. Transfusion 2015; 55:2039-47. [DOI: 10.1111/trf.13080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 02/05/2015] [Accepted: 02/10/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Brian Custer
- Blood Systems Research Institute and
- Department of Laboratory Medicine; University of California; San Francisco California
| | - Mart P. Janssen
- Transfusion Technology Assessment Unit; Sanquin Research; Amsterdam the Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
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Butler AJ, Thomas MK, Pintar KDM. Systematic review of expert elicitation methods as a tool for source attribution of enteric illness. Foodborne Pathog Dis 2015; 12:367-82. [PMID: 25826450 DOI: 10.1089/fpd.2014.1844] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Expert elicitation is a useful tool to explore sources of uncertainty and to answer questions where data are expensive or difficult to collect. It has been used across a variety of disciplines and represents an important method for estimating source attribution for enteric illness. A systematic review was undertaken to explore published expert elicitation studies, identify key considerations, and to make recommendations for designing an expert elicitation in the context of enteric illness source attribution. Fifty-nine studies were reviewed. Five key themes were identified: the expert panel including composition and recruitment; the pre-elicitation material, which clarifies the research question and provides training in uncertainty and probability; the choice of elicitation tool and method (e.g., questionnaires, surveys, and interviews); research design; and analysis of elicited data. Careful consideration of these themes is critical in designing and implementing an expert elicitation in order to reduce bias and produce the best possible results. While there are various epidemiological and microbiological methods available to explore source attribution of enteric illness, expert elicitation provides an opportunity to identify gaps in our understanding and where such studies are not feasible or available, represents the only possible method for synthesizing knowledge about transmission.
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Affiliation(s)
- Ainslie J Butler
- Centre for Foodborne, Environmental, and Zoonotic Infectious Diseases , Public Health Agency of Canada, Guelph, Canada
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Deveau M, Chen CP, Johanson G, Krewski D, Maier A, Niven KJ, Ripple S, Schulte PA, Silk J, Urbanus JH, Zalk DM, Niemeier RW. The Global Landscape of Occupational Exposure Limits--Implementation of Harmonization Principles to Guide Limit Selection. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12 Suppl 1:S127-44. [PMID: 26099071 PMCID: PMC4654639 DOI: 10.1080/15459624.2015.1060327] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Occupational exposure limits (OELs) serve as health-based benchmarks against which measured or estimated workplace exposures can be compared. In the years since the introduction of OELs to public health practice, both developed and developing countries have established processes for deriving, setting, and using OELs to protect workers exposed to hazardous chemicals. These processes vary widely, however, and have thus resulted in a confusing international landscape for identifying and applying such limits in workplaces. The occupational hygienist will encounter significant overlap in coverage among organizations for many chemicals, while other important chemicals have OELs developed by few, if any, organizations. Where multiple organizations have published an OEL, the derived value often varies considerably-reflecting differences in both risk policy and risk assessment methodology as well as access to available pertinent data. This article explores the underlying reasons for variability in OELs, and recommends the harmonization of risk-based methods used by OEL-deriving organizations. A framework is also proposed for the identification and systematic evaluation of OEL resources, which occupational hygienists can use to support risk characterization and risk management decisions in situations where multiple potentially relevant OELs exist.
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Affiliation(s)
- M. Deveau
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada
- Faculty of Graduate and Postdoctoral Studies, University of Ottawa, Ottawa, Ontario, Canada
- Address correspondence to M. Deveau, McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, K1N 6N5, Canada. E-mail:
| | - C-P Chen
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - G. Johanson
- Work Environment Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - D. Krewski
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada
| | - A. Maier
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - K. J. Niven
- Shell Health, Shell International B.V., The Hague, The Netherlands
| | - S. Ripple
- Global Industrial Hygiene Expertise Center, The Dow Chemical Company, Midland, Michigan
| | - P. A. Schulte
- Education and Information Division, National Institute for Occupational Safety and Health, Cincinnati, Ohio
| | - J. Silk
- Directorate of Standards and Guidance, Occupational Safety and Health Administration, Washington, DC (Retired)
| | - J. H. Urbanus
- Shell Health, Shell International B.V., The Hague, The Netherlands
| | - D. M. Zalk
- ES&H Directorate, Lawrence Livermore National Laboratory, Livermore, California
| | - R. W. Niemeier
- Education and Information Division, National Institute for Occupational Safety and Health, Cincinnati, Ohio
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Investigation of the inhibitory effects of TiO2 on the β-amyloid peptide aggregation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 39:227-34. [DOI: 10.1016/j.msec.2014.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/12/2014] [Accepted: 03/01/2014] [Indexed: 11/21/2022]
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Fischer K, Lewandowski D, Janssen MP. Estimating unknown parameters in haemophilia using expert judgement elicitation. Haemophilia 2013; 19:e282-8. [PMID: 23672712 DOI: 10.1111/hae.12166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2013] [Indexed: 11/30/2022]
Abstract
The increasing attention to healthcare costs and treatment efficiency has led to an increasing demand for quantitative data concerning patient and treatment characteristics in haemophilia. However, most of these data are difficult to obtain. The aim of this study was to use expert judgement elicitation (EJE) to estimate currently unavailable key parameters for treatment models in severe haemophilia A. Using a formal expert elicitation procedure, 19 international experts provided information on (i) natural bleeding frequency according to age and onset of bleeding, (ii) treatment of bleeds, (iii) time needed to control bleeding after starting secondary prophylaxis, (iv) dose requirements for secondary prophylaxis according to onset of bleeding, and (v) life-expectancy. For each parameter experts provided their quantitative estimates (median, P10, P90), which were combined using a graphical method. In addition, information was obtained concerning key decision parameters of haemophilia treatment. There was most agreement between experts regarding bleeding frequencies for patients treated on demand with an average onset of joint bleeding (1.7 years): median 12 joint bleeds per year (95% confidence interval 0.9-36) for patients ≤ 18, and 11 (0.8-61) for adult patients. Less agreement was observed concerning estimated effective dose for secondary prophylaxis in adults: median 2000 IU every other day The majority (63%) of experts expected that a single minor joint bleed could cause irreversible damage, and would accept up to three minor joint bleeds or one trauma related joint bleed annually on prophylaxis. Expert judgement elicitation allowed structured capturing of quantitative expert estimates. It generated novel data to be used in computer modelling, clinical care, and trial design.
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Affiliation(s)
- K Fischer
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
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Maxillary sinus augmentation with adult mesenchymal stem cells: a review of the current literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:717-23. [PMID: 23313230 DOI: 10.1016/j.oooo.2012.09.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/07/2012] [Accepted: 09/16/2012] [Indexed: 12/22/2022]
Abstract
PURPOSE Mesenchymal stem cells (MSCs) have been applied in maxillary sinus augmentation (MSA) with clinically successful results. The purpose of this article was to evaluate the systematically acquired evidence for the effectiveness of cell-based approaches in MSA with various scaffolds, and to narratively assess evidence from additional articles that report effectiveness of cell-based approaches in MSA. MATERIALS AND METHODS Electronic database searches were performed. Inclusion criteria were studies of cell-based approaches in MSA with various scaffolds, in humans, with at least 3 to 4 months of follow-up. Meta-analysis was performed for randomized controlled trials (RCTs) with histologic/histomorphometric evaluation. RESULTS Fifteen studies (4 RCTs) were considered to be eligible for inclusion in the review. The meta-analysis suggested a marginal, nonstatistically significant positive effect of MSCs on the bone regrowth. CONCLUSIONS A number of studies have demonstrated the potential for cell-based approaches in MSA; further RCTs that clearly demonstrate benefits of cell-based approach are needed.
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