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Peacock A, Dehle FC, Mesa Zapata OA, Gennari F, Williams MRI, Hamad N, Larsen S, Harrison SJ, Taylor C. Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host Disease. J Health Econ Outcomes Res 2024; 11:23-31. [PMID: 38312919 PMCID: PMC10838062 DOI: 10.36469/001c.92028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/26/2023] [Indexed: 02/06/2024]
Abstract
Background: The mainstay first-line therapy for chronic graft-vs-host disease (cGVHD) is corticosteroids; however, for steroid-refractory patients, there is a distinct lack of cost-effective or efficacious treatment. The aim of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with standard-of-care therapies for the treatment of cGVHD in Australia. The study formed part of an application to the Australian Government to reimburse ECP for these patients. Methods: A cost-utility analysis was conducted comparing ECP to standard of care, which modeled the response to treatment and disease progression of cGVHD patients in Australia. Mycophenolate, tacrolimus, and cyclosporin comprised second-line standard of care based on a survey of Australian clinicians. Health states in the model included treatment response, disease progression, and death. Transition probabilities were obtained from Australian-specific registry data and randomized controlled evidence. Quality-of-life values were applied based on treatment response. The analysis considered costs of second-line treatment and disease management including immunosuppressants, hospitalizations and subsequent therapy. Disease-specific mortality was calculated for treatment response and progression. Results: Over a 10-year time horizon, ECP resulted in an average cost reduction of $23 999 and an incremental improvement of 1.10 quality-adjusted life-years per patient compared with standard of care. The sensitivity analysis demonstrated robustness over a range of plausible scenarios. Conclusion: This analysis demonstrates that ECP improves quality of life, minimizes the harms associated with immunosuppressant therapy, and is a highly cost-effective option for steroid-refractory cGVHD patients in Australia. Based in part on this analysis, ECP was listed on the Medicare Benefits Schedule for public reimbursement.
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Affiliation(s)
| | | | | | | | | | - Nada Hamad
- Department of Haematology St Vincent's Hospital, Sydney, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Stephen Larsen
- Sydney Medical School, University of Sydney, Sydney, Australia
- Institute of Haematology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simon J Harrison
- Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Colman Taylor
- HTANALYSTS, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
- The University of New South Wales, Sydney, Australia
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Babore Y, Li X, Clark T, Troiano M, Peacock A, Mantell M, Vance A. Abstract No. 205 Safety and Effectiveness of Concurrent Below- and Above-the-Ankle Intervention in Patients with Critical Limb Ischemia. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Babore Y, Vance A, Cohean R, Mantell M, Troiano M, Peacock A, Reddy S, Clark T. Abstract No. 33 End-Stage Renal Disease and Risk of Major Adverse Limb Events Following Peripheral Vascular Intervention. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Peacock A, Dehle F, Mesa Zapata OA, Prince HM, Gennari F, Taylor C. Cost-Effectiveness of Extracorporeal Photopheresis for the Treatment of Patients With Erythrodermic (Stage T 4, M 0) Cutaneous T-Cell Lymphoma in the Australian Setting. Value Health 2022; 25:965-974. [PMID: 35667784 DOI: 10.1016/j.jval.2021.11.1364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/19/2021] [Accepted: 11/10/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Cutaneous T-cell lymphoma (CTCL) is a rare and incurable disease, and patients currently experience a lack of treatment options in Australia. This analysis evaluated the cost-effectiveness of extracorporeal photopheresis (ECP) compared with standard of care therapy for the treatment of patients with erythrodermic (stage T4, M0) CTCL, who are refractory to previous systemic treatment. METHODS A Markov model was developed from the perspective of the Australian government. Health states were treatment specific and transition probabilities were modeled from time-to-next-treatment data from a published Australian observational study of ECP and comparator treatments. Quality of life utility values were based on psoriasis as a proxy for CTCL, which was validated by consultation with local clinicians. The time horizon for the model was 5 years. The ECP treatment regimen was compared with a weighted treatment comparator based on results of a treatment survey and Australian prescribing data. RESULTS ECP as a second-line treatment option for CTCL was less costly and more effective than other treatment strategies. ECP had an average cost saving of $37 592 and incremental quality-adjusted life-year gained of 0.20 to 0.21, attributed to patients being able to better tolerate ECP thus avoiding subsequent treatment with high-cost alternatives. CONCLUSIONS This is the first published cost-utility analysis of ECP for CTCL. This analysis demonstrates that ECP is a cost-effective option for the treatment of patients with erythrodermic CTCL in Australia.
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Affiliation(s)
- Adrian Peacock
- Health Technology Analysts, Sydney, New South Wales, Australia
| | - Francis Dehle
- Health Technology Analysts, Sydney, New South Wales, Australia
| | | | - H Miles Prince
- Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Colman Taylor
- Health Technology Analysts, Sydney, New South Wales, Australia; The George Institute for Global Health, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia.
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Rosenkranz S, Benza RL, Ghofrani HA, Gruenig E, Hoeper MM, Peacock A, Simonneau G, Vizza D, Meier C, Vogtlaender K, Vonk-Noordegraaf A. Changes in cMRI parameters following a switch to riociguat from phosphodiesterase type 5 inhibitors (PDE5i) in patients with pulmonary arterial hypertension: a REPLACE substudy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The REPLACE study investigated the effect of switching to riociguat (RIO) in patients with pulmonary arterial hypertension receiving PDE5i but still at intermediate risk. The centrally adjudicated composite primary endpoint was clinical improvement in the absence of clinical worsening, where clinical improvement was defined as meeting at least two of the following criteria: 6-minute walk distance (6MWD), increase by ≥10% or ≥30 m from baseline (BL) to Wk 24; World Health Organization functional class (WHO FC) I or II at Wk 24; or N-terminal prohormone of brain natriuretic peptide reduction of ≥30% from BL to Wk 24. Twice as many patients switching to RIO (45/111, 41%) met the primary endpoint compared with those remaining on PDE5i (23/113, 20%); odds ratio (OR): 2.78 (95% confidence interval [CI] 1.53–5.06); p=0.0007.
Purpose
Assess changes in right and left ventricular (RV; LV) function using cardiac magnetic resonance imaging (cMRI) in a subgroup of patients participating in REPLACE.
Methods
REPLACE was a randomised, open-label, 24-week, Phase 4 study (NCT02891850). Patients in WHO FC III, with 6MWD 165–440 m, were randomised to switch to RIO 2.5 mg–max tid or remain on PDE5i. Background endothelin receptor antagonist therapy was permitted in both arms.
cMRI was performed on a subset of patients from the full analysis set as an exploratory substudy. The following parameters were measured at BL and Wk 24: RV and LV end-diastolic and end-systolic volumes (RVEDV; RVESV; LVEDV; LVESV), RV stroke volume and stroke volume index (RVSV; RVSVI), LV stroke volume (LVSV), RV ejection fraction (RVEF), and pericardial effusion.
Results
Twenty-seven patients participated in the cMRI substudy. This comprised 11/111 (10%) patients in the RIO arm (mean [standard deviation {SD}] 40.0 [12.4] years), and 16/113 (14%) patients (mean 44.5 [17.6] years) in the PDE5i arm. Like the main population, the treatment response in the cMRI subpopulation favoured RIO versus PDE5i (OR: 6.11 [95% CI 0.90–41.60]). From BL to Wk 24, RVEDV and RVESV decreased in the RIO treatment arm but increased in the PDE5i treatment arm (Table 1). Similar, but less pronounced, changes were observed for the left ventricle (LVESV, LVEDV). RVSV and RVEF levels were close to normal at BL and did not increase in either arm at Wk 24 (Table 1). Pericardial effusion, which was present in 5 patients in each group at BL, decreased in 1 patient in the RIO arm and no patients in the PDE5i arm.
Conclusions
Decreases in RVEDV and RVESV suggest improvements in cardiac function in the RIO arm compared with the PDE5i arm. Values for RVEF and RVSVI were close to normal at BL and did not change at Wk 24. Improvements in cMRI parameters were in line with the clinical improvement observed in patients switching to RIO in the overall population.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The REPLACE study was co-funded by Bayer AG (Berlin, Germany) and Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. (Kenilworth, NJ, USA)
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Affiliation(s)
- S Rosenkranz
- Heart Center at the University of Cologne, Cologne, Germany
| | - R L Benza
- Ohio State University Hospital, Ohio, United States of America
| | - H A Ghofrani
- University of Giessen and Marburg Lung Centre, member of the German Centre for Lung Research (DZL), Giessen, Germany
| | - E Gruenig
- Thorax Clinic at the University Hospital, Heidelberg, Germany
| | - M M Hoeper
- Hannover Medical School, member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - A Peacock
- Scottish Pulmonary Vascular Unit, Regional Lung and Heart Centre, Glasgow, United Kingdom
| | - G Simonneau
- Hôpital Bicêtre, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - D Vizza
- `La Sapienza' University of Rome, Rome, Italy
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Conway A, Valerio H, Peacock A, Degenhardt L, Hayllar J, Harrod ME, Henderson C, Read P, Gilliver R, Christmass M, Dunlop A, Montebello M, Whitton G, Reid D, Lam T, Alavi M, Silk D, Marshall AD, Treloar C, Dore GJ, Grebely J. Non-fatal opioid overdose, naloxone access, and naloxone training among people who recently used opioids or received opioid agonist treatment in Australia: The ETHOS Engage study. Int J Drug Policy 2021; 96:103421. [PMID: 34452808 DOI: 10.1016/j.drugpo.2021.103421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/07/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Overdose is a major cause of morbidity and mortality among people who use opioids. Naloxone can reverse opioid overdoses and can be distributed and administered with minimal training. People with experience of overdose are a key population to target for overdose prevention strategies. This study aims to understand if factors associated with recent non-fatal opioid overdose are the same as factors associated with naloxone access and naloxone training in people who recently used opioids or received opioid agonist treatment (OAT). METHODS ETHOS Engage is an observational study of people who inject drugs in Australia. Logistic regression models were used to estimate odds ratios for non-fatal opioid overdose, naloxone access and naloxone training. RESULTS Between May 2018-September 2019, 1280 participants who recently used opioids or received OAT were enrolled (62% aged >40 years; 35% female, 80% receiving OAT, 62% injected drugs in the preceding month). Recent opioid overdose (preceding 12 months) was reported by 7% of participants, lifetime naloxone access by 17%, and lifetime naloxone training by 14%. Compared to people receiving OAT with no additional opioid use, recent opioid, benzodiazepine (preceding six months), and hazardous alcohol use was associated with recent opioid overdose (aOR 3.91; 95%CI: 1.68-9.10) and lifetime naloxone access (aOR 2.12; 95%CI 1.29-3.48). Among 91 people who reported recent overdose, 65% had never received take-home naloxone or naloxone training. CONCLUSIONS Among people recently using opioids or receiving OAT, benzodiazepine and hazardous alcohol use is associated with non-fatal opioid overdose. Not all factors associated with non-fatal overdose correspond to factors associated with naloxone access. Naloxone access and training is low across all groups. Additional interventions are needed to scale up naloxone provision.
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Affiliation(s)
- A Conway
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia.
| | - H Valerio
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - A Peacock
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; School of Psychology, University of Tasmania, Hobart, Tasmania, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - J Hayllar
- Alcohol and Drug Service, Metro North Mental Health, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - M E Harrod
- NSW Users and AIDS Association, NSW, Australia
| | - C Henderson
- NSW Users and AIDS Association, NSW, Australia
| | - P Read
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Kirketon Road Centre, Sydney, NSW, Australia
| | - R Gilliver
- Kirketon Road Centre, Sydney, NSW, Australia
| | - M Christmass
- Next Step Drug and Alcohol Services, Mental Health Commission, WA, Australia; National Drug Research Institute, Curtin University, WA, Australia
| | - A Dunlop
- Centre for Translational Neuroscience and Mental Health, Hunter Medical Research Institute & University of Newcastle, Newcastle, NSW, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - M Montebello
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia; Drug and Alcohol Services, Northern Sydney Local Health District, Sydney, NSW, Australia; University of Sydney, Sydney, NSW, Australia
| | - G Whitton
- Drug Health Service, South West Sydney LHD, NSW, Australia
| | - D Reid
- Drug and Alcohol Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - T Lam
- Drug Health, Western Sydney Local Health District, Sydney, NSW, Australia
| | - M Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - D Silk
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - A D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - G J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - J Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Altaf N, Ariyaratne TV, Peacock A, Deltetto I, El-Hoss J, Thomas S, Taylor C, Mwipatayi BP. A Budget Impact Model for the use of Drug-Eluting Stents in Patients with Symptomatic Lower-Limb Peripheral Arterial Disease: An Australian Perspective. Cardiovasc Intervent Radiol 2021; 44:1375-1383. [PMID: 34155526 PMCID: PMC8382623 DOI: 10.1007/s00270-021-02848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/13/2021] [Indexed: 11/23/2022]
Abstract
Purpose Improvement in long-term outcomes through innovative, cost-effective medical technologies is a focus for endovascular procedures aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). The advent of drug-eluting stents (DES) has improved symptomatic PAD treatment via a reduction in high rates of target lesion revascularisation (TLR). The present study aimed to compare the 5-year financial impact of treatment with Eluvia, a new paclitaxel-eluting stent, versus treatment with Zilver PTX, a drug-coated stent, among patients in Australia by developing a budget impact model (BIM). Methods A BIM was developed from an Australian public hospital payer perspective using Australian national cost weights (AUD), published literature, and public hospital audit data. Clinical outcomes, including clinically driven TLRs (CD-TLRs), adverse events, and length of stay, were based on the 2-year results of the IMPERIAL trial, which compared Eluvia DES to Zilver PTX. Results Assuming EVP eligibility rate of 80% and DES uses rate ranging from 10 to 28% (superficial femoral artery lesions only), the 5-year model forecasted a treatment population between 14,428 and 40,399 patients. The model estimated 1499–4198 fewer CD-TLRs and 16,515–46,243 fewer hospital days with Eluvia DES use. This translated to 5-year potential savings of $4.3–$12.1 million to the Australian public hospital payer attributable to reduced CD-TLRs for Eluvia DES and $33.1–$92.6 million to Australian public hospitals owing to reduced adverse events and hospital bed days. Conclusion Eluvia DES use as treatment for symptomatic lower-limb PAD could lead to potential savings for the Australian public healthcare system based on improved patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-021-02848-8.
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Affiliation(s)
- Nishath Altaf
- Department of Vascular Surgery, Royal Perth Hospital, Royal Perth Bentley Group, Level 6, North Block, Wellington Street, Perth, WA, 6000, Australia.
| | | | | | | | - Jad El-Hoss
- Boston Scientific Corporation, Sydney, NSW, Australia
| | - Shannon Thomas
- Department of Vascular Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Colman Taylor
- Health Technology Analysts, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia.,The University of NSW, Sydney, NSW, Australia
| | - Bibombe Patrice Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Royal Perth Bentley Group, Level 6, North Block, Wellington Street, Perth, WA, 6000, Australia
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Piron L, Valcarcel D, Lennholm M, Stuart C, Carvalho I, Felton R, Ferreira D, Fontana M, Lomas P, La Luna ED, Peacock A, Pau A, Piron C, Rimini F, Sozzi C. Progress in preparing real-time control schemes for Deuterium-Tritium operation in JET. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Taylor C, Hoek AC, Deltetto I, Peacock A, Ha DTP, Sieburg M, Hoang D, Trieu K, Cobb LK, Jan S, Webster J. The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam. ACTA ACUST UNITED AC 2021; 79:32. [PMID: 33706807 PMCID: PMC7953693 DOI: 10.1186/s13690-021-00540-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam. Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (− 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (− 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (− 243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00540-4.
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Affiliation(s)
- Colman Taylor
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia. .,Health Technology Analysts Pty Ltd, Surry Hills, Australia.
| | - Annet C Hoek
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Irene Deltetto
- Health Technology Analysts Pty Ltd, Surry Hills, Australia
| | - Adrian Peacock
- Health Technology Analysts Pty Ltd, Surry Hills, Australia
| | | | | | | | - Kathy Trieu
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Laura K Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York, NY, USA
| | - Stephen Jan
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
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Fontana M, Challis C, Conway N, Felton R, Goodyear A, Hogben C, Peacock A, Schmuck S. Real-time applications of Electron Cyclotron Emission interferometry for disruption avoidance during the plasma current ramp-up phase at JET. Fusion Engineering and Design 2020. [DOI: 10.1016/j.fusengdes.2020.111934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Rosenkranz S, Channick R, Cottreel E, Galie N, Kiely D, Marcus J, Swift A, Tawakol A, Torbicki A, Vonk Noordegraaf A, Wetherill G, Peacock A. Effect of macitentan on left ventricular (LV) function in pulmonary arterial hypertension (PAH): results from REPAIR. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
PAH impacts right ventricular (RV) structure and function but also leads to changes in the LV due to RV/LV interaction and underfilling. REPAIR, the first PAH study to use a primary endpoint assessed by cardiac MRI (cMRI), reported that RV stroke volume (RVSV) increased by 12 mL and pulmonary vascular resistance (PVR) decreased by 38% from baseline (BL) to Week 26 with macitentan.
Purpose
To assess the effect of macitentan on LV function in patients with PAH.
Methods
REPAIR (NCT02310672) was a 52-week, multicentre, open-label, single-arm, phase 4 study assessing the effect of macitentan primarily on RV structure and function, determined by cMRI and right heart catheterisation. Macitentan 10 mg was initiated in treatment-naïve patients, in patients receiving stable background phosphodiesterase type-5 inhibitor (PDE5i) at BL, or in initial combination with PDE5i. Exploratory LV endpoints were assessed by cMRI at Weeks 26 and 52. Safety was assessed up to end of study treatment +30 days in all patients who received ≥1 dose of macitentan (N=87). Patients with BL and Week 26 assessments for both PVR and RVSV were included in the modified Full Analysis Set (mFAS; N=71).
Results
In the mFAS, 57 (80%) patients were female. At BL, median age was 45 years; median (Q1, Q3) six-minute walk distance was 395 (323, 483) m; 48%/51% of patients were WHO functional class II/III; 59% had idiopathic PAH. Compared to BL, at Weeks 26 and 52 there were significant changes in LV cMRI parameters (table). The most common AEs were peripheral oedema (22%), headache (21%) and dizziness (14%).
Conclusions
Macitentan led to improvements in LV mass, volume and function, including clinically-relevant increases in LV stroke volume, at both 26 and 52 weeks in patients with PAH. Safety was consistent with other macitentan clinical trial data.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Actelion Pharmaceuticals Ltd
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Affiliation(s)
- S Rosenkranz
- Heart Center at the University of Cologne, and Cologne Cardiovascular Research Center (CCRC), Cologne, Germany
| | - R Channick
- David Geffen School of Medicine at UCLA, Los Angeles, United States of America
| | - E Cottreel
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - N Galie
- Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, Bologna, Italy
| | - D.G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - J.T Marcus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - A.J Swift
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - A Tawakol
- Massachusetts General Hospital - Harvard Medical School, Boston, United States of America
| | - A Torbicki
- Department of Pulmonary Circulation CMKP, European Health Center, Otwock, Poland
| | - A Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - G Wetherill
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | - A Peacock
- Scottish Pulmonary Vascular Unit, Glasgow, United Kingdom
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Ahn J, Ariyaratne T, Peacock A, Deltetto I, Taylor C, Kim E. PCV11 Cost-Effectiveness of Intravascular Ultrasound (IVUS) during Drug-Eluting Stent Implantation in Korea. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Gao C, Peters M, Jayaraajan K, Todd M, Cashman S, Nambiar A, Cumberbatch M, Lamb B, Peacock A, Van Son M, Van Rossum P, Pickard R, Erotocritou P, Smith D, Kasivisvanathan V, Shah T. Development of a risk calculator to predict spontaneous stone passage in patients with acute ureteric colic. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Lyons AB, Peacock A, McKenzie SA, Jacobsen G, Naik HB, Shi VY, Hamzavi IH, Hsiao JL. Retrospective cohort study of pregnancy outcomes in hidradenitis suppurativa. Br J Dermatol 2020; 183:945-947. [PMID: 32333790 PMCID: PMC8174655 DOI: 10.1111/bjd.19155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - A Peacock
- Department of Internal Medicine, St Mary Mercy Hospital, Livonia, MI, USA
| | - S A McKenzie
- Department of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - G Jacobsen
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - H B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - V Y Shi
- Department of Dermatology, University of Arizona, Tucson, AZ, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - J L Hsiao
- Department of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
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Noordegraaf AV, Channick R, Cottreel E, Kiely D, Martin N, Moiseeva O, Peacock A, Tawakol A, Torbicki A, Rosenkranz S, Galiè N. Results from the REPAIR Study Final Analysis: Effects of Macitentan on Right Ventricular (RV) Remodelling in Pulmonary Arterial Hypertension (PAH). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Shah T, Keefe A, Gao C, Manning T, Peacock A, Cashman S, Nambiar A, Lamb B, Cumberbatch M, Erotocritou P, Pickard R, Smith D, Kasivisvanathan V. A Multi-Centre Cohort Study Evaluating the Role of Inflammatory Markers in Patient's Presenting With Acute Ureteric Colic (MIMIC). Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Jacka B, Peacock A, Degenhardt L, Bruno R, Clare P, Kemp R, Dev A, Larance B. Trends in PIEDs use among male clients of needle-syringe programs in Queensland, Australia; 2007-2015. Int J Drug Policy 2017. [PMID: 28651113 DOI: 10.1016/j.drugpo.2017.05.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- B Jacka
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia; Kirby Institute, UNSW, Sydney, NSW, Australia
| | - A Peacock
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia; School of Medicine (Psychology), University of Tasmania, Tasmania Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - R Bruno
- School of Medicine (Psychology), University of Tasmania, Tasmania Australia
| | - P Clare
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia
| | - R Kemp
- Communicable Diseases Branch, Queensland Health, QLD, Australia
| | - A Dev
- Chief Medical Officer and Healthcare Regulation Branch, Queensland Health, QLD Australia
| | - B Larance
- National Drug and Alcohol Research Centre, UNSW, Sydney, NSW, Australia.
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19
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Batistoni P, Popovichev S, Crowe R, Cufar A, Ghani Z, Keogh K, Peacock A, Price R, Baranov A, Korotkov S, Lykin P, Samoshin A. Technical preparations for the in-vessel 14 MeV neutron calibration at JET. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Boscary J, Peacock A, Stadler R, Mendelevitch B, Tittes H, Tretter J, Smirnow M, Li C. Actively Water-Cooled Plasma Facing Components of the Wendelstein 7-X Stellarator. Fusion Science and Technology 2017. [DOI: 10.13182/fst12-499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. Boscary
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, 85748 Garching, Germany
| | - A. Peacock
- European Commission c/o Max-Planck-Institut für Plasmaphysik, EURATOM Association, 85748 Garching, Germany
| | - R. Stadler
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, 85748 Garching, Germany
| | - B. Mendelevitch
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, 85748 Garching, Germany
| | - H. Tittes
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, 85748 Garching, Germany
| | - J. Tretter
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, 85748 Garching, Germany
| | - M. Smirnow
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, 85748 Garching, Germany
| | - C. Li
- Max-Planck-Institut für Plasmaphysik, EURATOM Association, 85748 Garching, Germany
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21
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Peacock A, Cheung A, Kim P, Poon SK. Socialising Health Burden Through Different Network Topologies: A Simulation Study. Stud Health Technol Inform 2017; 239:112-118. [PMID: 28756445] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An aging population and the expectation of premium quality health services combined with the increasing economic burden of the healthcare system requires a paradigm shift toward patient oriented healthcare. The guardian angel theory described by Szolovits [1] explores the notion of enlisting patients as primary providers of information and motivation to patients with similar clinical history through social connections. In this study, an agent based model was developed to simulate to explore how individuals are affected through their levels of intrinsic positivity. Ring, point-to-point (paired buddy), and random networks were modelled, with individuals able to send messages to each other given their levels of variables positivity and motivation. Of the 3 modelled networks it is apparent that the ring network provides the most equal, collective improvement in positivity and motivation for all users. Further study into other network topologies should be undertaken in the future.
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Affiliation(s)
- Adrian Peacock
- The University of Sydney, School of Information Technologies, Australia
| | - Anthony Cheung
- The University of Sydney, School of Mathematics and Statistics, Australia
| | - Peter Kim
- The University of Sydney, School of Mathematics and Statistics, Australia
| | - Simon K Poon
- The University of Sydney, School of Information Technologies, Australia
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22
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Hadinnapola C, Haimel M, Bleda M, Bogaard H, Coghlan G, Corris P, Gibbs S, Kiely D, Lawrie A, Peacock A, Pepke-Zaba J, Southgate L, Toshner M, Trembath R, Noordegraaf AV, Wharton J, Wilkins M, Wort SJ, Graf S, Morrell NM. S107 Genotype-phenotype associations in pulmonary arterial hypertension caused by BMPR2 and EIF2AK4 variants. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Stadler RJ, Peacock A, Boscary J, Mendelevitch B, Scholz P, Schubert W. Conceptual design of the W7-X port liners. Fusion Engineering and Design 2016. [DOI: 10.1016/j.fusengdes.2016.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Birdi-Chouhan G, Shelton RM, Bowen J, Goldberg-Oppenheimer P, Page SJ, Hanna JV, Peacock A, Wright AJ, Grover LM. Soluble silicon patterns and templates: calcium phosphate nanocrystal deposition in collagen type 1. RSC Adv 2016. [DOI: 10.1039/c6ra19784a] [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: 01/08/2023] Open
Abstract
OSA interactsviaionic cross-linking to collagen molecules; free hydroxyl ions recruit CaP nano-precursors and aid nucleation within the fibrils.
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Affiliation(s)
- G. Birdi-Chouhan
- School of Chemical Engineering
- University of Birmingham
- Birmingham
- UK
| | - R. M. Shelton
- School of Dentistry
- University of Birmingham
- Birmingham
- UK
| | - J. Bowen
- Department of Engineering and Innovation
- The Open University
- Milton Keynes
- UK
| | | | - S. J. Page
- Department of Physics
- University of Warwick
- Coventry
- UK
| | - J. V. Hanna
- Department of Physics
- University of Warwick
- Coventry
- UK
| | - A. Peacock
- School of Chemistry
- University of Birmingham
- Birmingham
- UK
| | - A. J. Wright
- School of Chemistry
- University of Birmingham
- Birmingham
- UK
| | - L. M. Grover
- School of Chemical Engineering
- University of Birmingham
- Birmingham
- UK
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25
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Peacock A. A Mixed Hazard? Alcohol, Caffeinated Energy Drinks and the Consequences of Co-ingestion. Drug Alcohol Rev 2015. [DOI: 10.1111/dar.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Junghanns P, Boscary J, Peacock A. Experience gained with the 3D machining of the W7-X HHF divertor target elements. Fusion Engineering and Design 2015. [DOI: 10.1016/j.fusengdes.2014.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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Smirnow M, Boscary J, Tittes H, Schubert W, Peacock A. Mechanical examination and analysis of W7-X divertor module sub-structures. Fusion Engineering and Design 2015. [DOI: 10.1016/j.fusengdes.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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28
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Titus* PH, Zhang H, Lumsdaine A, McGinnis WD, Lore J, Neilson H, Brown T, Boscary J, Peacock A, Fellinger J. Analysis of the Wendelstein 7-X Test Divertor Unit Scraper Element with Radiation Shields. Fusion Science and Technology 2015. [DOI: 10.13182/fst15-105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - H. Zhang
- Princeton Plasma Physics Lab, Princeton, New Jersey, USA
| | - A. Lumsdaine
- Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
| | - W. D. McGinnis
- Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
| | - J. Lore
- Oak Ridge National Laboratory, Oak Ridge, Tennessee, USA
| | - H. Neilson
- Princeton Plasma Physics Lab, Princeton, New Jersey, USA
| | - T. Brown
- Princeton Plasma Physics Lab, Princeton, New Jersey, USA
| | - J. Boscary
- Max Planck Institute for Plasma Physics, Garching, Germany
| | - A. Peacock
- Max Planck Institute for Plasma Physics, Garching, Germany
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Mouser PJ, N'Guessan LA, Qafoku NP, Sinha M, Williams KH, Dangelmayr M, Resch CT, Peacock A, Wang Z, Figueroa L, Long PE. Influence of Carbon and Microbial Community Priming on the Attenuation of Uranium in a Contaminated Floodplain Aquifer. Ground Water 2015; 53:600-613. [PMID: 25047748 DOI: 10.1111/gwat.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 06/01/2014] [Indexed: 06/03/2023]
Abstract
The capacity for subsurface sediments to sequester radionuclide contaminants, such as uranium (U), and retain them after bioremediation efforts are completed is critical to the long-term stewardship of re-mediated sites. In U bioremediation strategies, carbon amendment stimulates bioreduction of U(VI) to U(IV), immobilizing it within the sediments. Sediments enriched in natural organic matter are naturally capable of sequestering significant U, but may serve as sources to the aquifer, contributing to plume persistence. Two types of organic-rich sediments were compared to better understand U release mechanisms. Sediments that were artificially primed for U removal were retrieved from an area previously biostimulated while detrital-rich sediments were collected from a location never subject to amendment. Batch incubations demonstrated that primed sediments rapidly removed uranium from the groundwater, whereas naturally reduced sediments released a sizeable portion of U before U(VI)-reduction commenced. Column experiments confirmed that U release persisted for 65 pore volumes in naturally reduced sediments, demonstrating their sink-source behavior. Acetate addition to primed sediments shifted the microbial community from sulfate-reducing bacteria within Desulfobacteraceae to the iron-reducing Geobacteraceae and Firmicutes, associated with efficient U(VI) removal and retention, respectively. In contrast, Geobacteraceae communities in naturally reduced sediments were replaced by sequences with similarity to Pseudomonas spp. during U release, while U(VI) removal only occurred with enrichment of Firmicutes. These investigations stress the importance of characterizing zones with heterogeneous carbon pools at U-contaminated sites prior to the determination of a remedial strategy to identify areas, which may contribute to long-term sourcing of the contaminants.
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Affiliation(s)
| | - L A N'Guessan
- Pacific Northwest National Laboratory, Richland, WA 99352
- Lawrence Berkeley National Laboratory, Berkeley, CA 94720
| | - N P Qafoku
- Pacific Northwest National Laboratory, Richland, WA 99352
| | - M Sinha
- Pacific Northwest National Laboratory, Richland, WA 99352
- Environmental Science and Engineering, Colorado School of Mines, Golden, CO 80401
| | | | | | - C T Resch
- Pacific Northwest National Laboratory, Richland, WA 99352
| | - A Peacock
- Washington State University, Richland, WA 99354
| | - Z Wang
- Pacific Northwest National Laboratory, Richland, WA 99352
| | | | - P E Long
- Microbial Insights, Rockford, TN 37853
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Shapey IM, Agrawal S, Peacock A, Super P. A prospective cross-sectional study of laparoscopic subtotal Lind fundoplication for gastro-oesophageal reflux disease--a durable and effective anti-reflux procedure. Int J Surg 2014; 13:257-260. [PMID: 25529280 DOI: 10.1016/j.ijsu.2014.12.013] [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: 09/18/2014] [Accepted: 12/08/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Laparoscopic partial fundoplication for gastro-oesophageal reflux disease (GORD) is reported to have fewer side effects when compared to Nissen fundoplication, but doubts remain over its long term durability in controlling reflux. The aim of this study was to assess outcome of symptoms for all patients presenting with GORD undergoing routine laparoscopic subtotal Lind fundoplication. MATERIALS & METHODS All patients undergoing laparoscopic fundoplication between August, 1999 and November, 2007 performed by a single surgeon were included in the study. The anti-reflux procedure studied was laparoscopic Lind (300°) fundoplication with crural repair in all cases. Patients completed pre and post-operative questionnaires containing validated scoring systems for heartburn, gas bloat, dysphagia and overall patient satisfaction. RESULTS Over the 100-month period, 320 consecutive patients underwent laparoscopic subtotal Lind fundoplication. Of these, 256 (80%) replied to the questionnaire at a mean of 31 months (range 3-96 months) following surgery. 91.4% of respondents had an improvement in heartburn symptom score with a significant reduction in score from 7.74 preoperatively to 1.25 postoperatively (p<0.001). There was also a significant reduction of mean modified Visick score for reflux control (heartburn and regurgitation) from 3.49 preoperatively to 1.48 after surgery (p<0.001). In total, 22 patients developed recurrent reflux symptoms with half of these reporting their recurrence within two years following surgery. Because of this all were tested with post-operative pH testing, yet only one had a 24-h pH time outside the normal range. Overall patient satisfaction was high with a visual analogue score of 9 and 88% of the patients claimed they would have the operation again. CONCLUSION Laparoscopic Lind fundoplication demonstrates excellent reflux control when performed routinely for all patients presenting with GORD. This technique is both durable and efficacious in controlling reflux symptoms.
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Affiliation(s)
- I M Shapey
- Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
| | - S Agrawal
- Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK
| | - A Peacock
- Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK
| | - P Super
- Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK
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31
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Thomson S, Peacock A, Johnson M. P169 Rates Of Recovery Of Oxygen Consumption And Heart Rate After Cardiopulmonary Exercise Testing Predict Survival In Patients With Precapillary Pulmonary Hypertension. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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Brewis M, Johnson M, Peacock A. P164 ntprobnp Predicts Survival And More Accurately Reflects Changing Right Ventricular Structure And Function Than 6mwd In Pulmonary Hypertension. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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33
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Crawley S, Blyth K, McLure L, Dargie H, Peacock A. S119 Left Ventricular Dysfunction Influences Survival In Connective Tissue Disease Associated Pulmonary Arterial Hypertension But Not Idiopathic Pulmonary Arterial Hypertension. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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34
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Li C, Boscary J, Dekorsy N, Junghanns P, Mendelevitch B, Peacock A, Pirsch H, Sellmeier O, Springer J, Stadler R, Streibl B. Production management and quality assurance for the fabrication of the In-Vessel Components of the stellarator Wendelstein 7-X. Fusion Engineering and Design 2014. [DOI: 10.1016/j.fusengdes.2014.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mendelevitch B, Vorköper A, Boscary J, Li C, Dekorsy N, Peacock A, Sellmeier O, Stadler R, Tittes H. Lessons learned from the design and fabrication of the baffles and heat shields of Wendelstein 7-X. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.05.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lumsdaine A, Tipton J, Lore J, McGinnis D, Canik J, Harris J, Peacock A, Boscary J, Tretter J, Andreeva T. Design and analysis of the W7-X divertor scraper element. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.05.075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stadler R, Vorköper A, Boscary J, Li C, Mendelevitch B, Peacock A, Pirsch H, Freier D, Lorenz A. Challenges in the realization of the In-Vessel-Components of Wendelstein 7-X. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.03.054] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Klinger T, Baylard C, Beidler C, Boscary J, Bosch H, Dinklage A, Hartmann D, Helander P, Maßberg H, Peacock A, Pedersen T, Rummel T, Schauer F, Wegener L, Wolf R. Towards assembly completion and preparation of experimental campaigns of Wendelstein 7-X in the perspective of a path to a stellarator fusion power plant. Fusion Engineering and Design 2013. [DOI: 10.1016/j.fusengdes.2013.02.153] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Boscary J, Peacock A, Friedrich T, Greuner H, Böswirth B, Tittes H, Schulmeyer W, Hurd F. Design improvement of the target elements of Wendelstein 7-X divertor. Fusion Engineering and Design 2012. [DOI: 10.1016/j.fusengdes.2012.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Adolescence is a time of great psychological and physical change. In the UK, girls enter puberty around the age of 10 years with a median age of menarche of 12.9 years; thereafter, it may be several years before regular menstrual cycles are established. Variations in the type and the frequency of periods may create anxiety regarding ill health or serious underlying disorders. With the increase in childhood obesity and subsequent polycystic ovary syndrome, there is a greater awareness and presentation of girls with disorders of menstruation. This review focuses on normal variations of menses and common pathological causes of menstrual problems, including amenorrhoea, dysmenorrhoea and menorrhagia. Further consideration is given to the variations of presentation of polycystic ovary syndrome. It provides a guide to evaluate the various symptoms, investigations and management options.
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Affiliation(s)
- A Peacock
- Department of Paediatric Endocrinology, Leeds Children's Hospital, Leeds LS1 3EX, UK
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Peacock A, Girlinger A, Vorköper A, Boscary J, Greuner H, Hurd F, Mendelevitch B, Pirsch H, Stadler R, Zangl G. The procurement and testing of the stainless steel in-vessel panels of the Wendelstein 7-X Stellarator. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.04.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Smirnow M, Drescher N, Höschen T, Peacock A, Boscary J, Tivey R. Development of a thermo-hydraulic bypass leakage test method for the Wendelstein 7-X target element cooling structure. Fusion Engineering and Design 2011. [DOI: 10.1016/j.fusengdes.2011.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Galie N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G. Corrigendum to: 'Guidelines for the diagnosis and treatment of pulmonary hypertension' [European Heart Journal (2009) 30, 2493-2537]. The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 2011. [DOI: 10.1093/eurheartj/ehr046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Crawley S, Johnson M, Peacock A. P30 The changing face of pulmonary hypertension: the role of heart and lung disease. Thorax 2010. [DOI: 10.1136/thx.2010.150961.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ling Y, Johnson M, Peacock A. P31 Disease targeted therapies and effect on survival in idiopathic, heritable and anorexigen-associated pulmonary arterial hypertension (PAH). Thorax 2010. [DOI: 10.1136/thx.2010.150961.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Peacock A, Pearson W. The Peacock versus the louse (pediculus humanus corporis): one soldier's contribution to combating trench fever in the First World War. J R Coll Physicians Edinb 2010; 40:256-62. [PMID: 20973437 DOI: 10.4997/jrcpe.2010.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Trench fever became a major worry for the Allied High Command during the First World War because of its debilitating effects on troop performance. The causes of the fever were not previously known, but entomological research identified the body louse (pediculus humanus corporis) as the carrier, and the Royal Army Medical Corps developed effective methods of control through disinfestation. These were markedly influenced by the researches of a young entomologist, Alexander David Peacock, which were conducted under campaign conditions. Peacock subsequently occupied a Chair of Zoology at St. Andrews University for 30 years.
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Affiliation(s)
- A Peacock
- Edinburgh Business School, Heriot-Watt University, Edinburgh
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