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Poole SF, Amin OJ, Solomon A, Barton LX, Campion RP, Edmonds KW, Wadley P. Thermally stable Peltier controlled vacuum chamber for electrical transport measurements. Rev Sci Instrum 2024; 95:035108. [PMID: 38446000 DOI: 10.1063/5.0186155] [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] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
The design, manufacture, and characterization of an inexpensive, temperature-controlled vacuum chamber with millikelvin stability for electrical transport measurements at and near room temperature is reported. A commercially available Peltier device and a high-precision temperature controller are used to actively heat and cool the sample space. The system was designed to minimize thermal fluctuations in spintronic and semiconductor transport measurements, but the general principle is relevant to a wide range of electrical measurement applications. The main issues overcome are the mounting of a sample with a path of high thermal conductivity through to the Peltier device and the heat sinking of the said Peltier device inside a vacuum. A copper slug is used as the mount for a sample, and a large copper block is used as a thermal feedthrough before a passive heat sink is used to cool this block. The Peltier device provides 20 W of heating and cooling power, achieving a maximum range of 30 K below and 40 K above the ambient temperature. The temperature stability is within 5 mK at all set points with an even better performance above the ambient temperature. A vacuum pressure of 10-8 hPa is achievable. As a demonstration, we present experimental results from current-induced electrical switching of a CuMnAs thin film. Transport measurements with and without the Peltier control emphasize the importance of a constant temperature in these applications. The thermal lag between the sample space measurement and the sample itself is observed through magnetoresistance values measured during a temperature sweep.
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Affiliation(s)
- S F Poole
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - O J Amin
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - A Solomon
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - L X Barton
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - R P Campion
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - K W Edmonds
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - P Wadley
- School of Physics and Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
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Malzbender K, Barbarino P, Barkman Ferrell P, Bradshaw A, Brookes AJ, Díaz C, van der Flier WM, Georges J, Hansson O, Hartmanis M, Jönsson L, Krishnan R, MacLeod T, Mangialasche F, Mecocci P, Minguillon C, Middleton L, Pla S, Sardi SP, Schöll M, Suárez-Calvet M, Weidner W, Visser PJ, Zetterberg H, Bose N, Solomon A, Kivipelto M. Validation, Deployment, and Real-World Implementation of a Modular Toolbox for Alzheimer's Disease Detection and Dementia Risk Reduction: The AD-RIDDLE Project. J Prev Alzheimers Dis 2024; 11:329-338. [PMID: 38374739 DOI: 10.14283/jpad.2024.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
The Real-World Implementation, Deployment, and Validation of Early Detection Tools and Lifestyle Enhancement (AD-RIDDLE) project, recently launched with the support of the EU Innovative Health Initiative (IHI) public-private partnership and UK Research and Innovation (UKRI), aims to develop, test, and deploy a modular toolbox platform that can reduce existing barriers to the timely detection, and therapeutic approaches in Alzheimer's disease (AD), thus accelerating AD innovation. By focusing on health system and health worker practices, AD-RIDDLE seeks to improve and smooth AD management at and between each key step of the clinical pathway and across the disease continuum, from at-risk asymptomatic stages to early symptomatic ones. This includes innovation and improvement in AD awareness, risk reduction and prevention, detection, diagnosis, and intervention. The 24 partners in the AD-RIDDLE interdisciplinary consortium will develop and test the AD-RIDDLE toolbox platform and its components individually and in combination in six European countries. Expected results from this cross-sectoral research collaboration include tools for earlier detection and accurate diagnosis; validated, novel digital cognitive and blood-based biomarkers; and improved access to individualized preventative interventions (including multimodal interventions and symptomatic/disease-modifying therapies) across diverse populations, within the framework of precision medicine. Overall, AD-RIDDLE toolbox platform will advance management of AD, improving outcomes for patients and their families, and reducing costs.
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Affiliation(s)
- K Malzbender
- Miia Kivipelto, MD, PhD, Center for Alzheimer's Research, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, , Phone: +46 73 99 409 22
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Ahmed F, Liberda EN, Solomon A, Davey R, Sutherland B, Tsuji LJS. Indigenous land-based approaches to well-being: The Sibi (River) program in subarctic Ontario, Canada. Int J Circumpolar Health 2023; 82:2252595. [PMID: 37656164 PMCID: PMC10478584 DOI: 10.1080/22423982.2023.2252595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/31/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
The Albany River system holds a special significance for the Omushkego Cree of subarctic Ontario, Canada, embodying their cultural roots, history, and the Cree way of life and worldviews. Through the Sibi program, youth learned traditional fishing practices from Elders and on-the-land experts, gaining valuable knowledge on the land and river. The program addressed barriers to being on the land, while also creating a space for the transfer of Indigenous knowledge and revitalising community social networks. The program took place in the summer, following the Omushkego Cree's seasonal cycle and employed community-based participatory research approach. Photovoice and semi-structured interviews were used to identify elements of well-being from an Indigenous perspective. Regardless of age or experience, participants expressed positive emotions while being on the land, highlighting how strengthening social and community networks, intergenerational knowledge transfer, and fostering cultural continuity contribute to improved well-being. Program outcomes emphasize the importance of collaboration with communities to gain insights into their needs, priorities, and values, ultimately creating more sustainable and effective well-being programs. By fostering engagement and recognizing the environment's significance, sustainable and long-term solutions can be pursued to address challenges faced by communities, ultimately advancing health and well-being for both present and future generations.The Albany River system holds a special significance for the Omushkego Cree of subarctic Ontario, Canada, embodying their cultural roots, history, and the Cree way of life and worldviews. Through the Sibi program, youth learned traditional fishing practices from Elders and on-the-land experts, gaining valuable knowledge on the land and river. The program addressed barriers to being on the land, while also creating a space for the transfer of Indigenous knowledge and revitalising community social networks. The program took place in the summer, following the Omushkego Cree's seasonal cycle and employed community-based participatory research approach. Photovoice and semi-structured interviews were used to identify elements of well-being from an Indigenous perspective. Regardless of age or experience, participants expressed positive emotions while being on the land, highlighting how strengthening social and community networks, intergenerational knowledge transfer, and fostering cultural continuity contribute to improved well-being. Program outcomes emphasize the importance of collaboration with communities to gain insights into their needs, priorities, and values, ultimately creating more sustainable and effective well-being programs. By fostering engagement and recognizing the environment's significance, sustainable and long-term solutions can be pursued to address challenges faced by communities, ultimately advancing health and well-being for both present and future generations.
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Affiliation(s)
- Fatima Ahmed
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON, Canada
| | - Eric N. Liberda
- School of Occupation and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON, Canada
| | | | | | - Bernard Sutherland
- Fort Albany First Nation, ON, Canada
- Peetabeck Academy, Mundo Peetabeck Education Authority, Fort Albany First Nation, ON, Canada
| | - Leonard J. S. Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON, Canada
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Tsuji SRJ, Zuk AM, Solomon A, Edwards-Wheesk R, Ahmed F, Tsuji LJS. What Is Wellbeing, and What Is Important for Wellbeing? Indigenous Voices from across Canada. Int J Environ Res Public Health 2023; 20:6656. [PMID: 37681798 PMCID: PMC10487260 DOI: 10.3390/ijerph20176656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
Indigenous peoples' perceptions of wellbeing differ from non-Indigenous constructs. Thus, it is imperative to recognize that Indigenous peoples will conceptualize wellbeing from their perspectives and set their own wellbeing priorities. In keeping with this viewpoint, the aims of the present study were to conceptualize wellbeing and determine what was (and is) important for wellbeing from Canadian Indigenous peoples' perspectives. In this paper, we take a partnership approach based on the elements of respect, equity, and empowerment. One primary data source and two existing data sources were examined and analyzed thematically utilizing a combination approach of deductive and inductive coding. Indigenous leadership and organizations viewed wellbeing holistically and conceptualized wellbeing multidimensionally. From across Canada, wellbeing was communicated as physical, economic, political, social, and cultural. The scaling of wellbeing represented a collectivist perspective, and land was the connecting thread between all types of wellbeing, being a place to practice cultural traditions, reassert one's Indigenous identity, find solace, and pass on Indigenous knowledge and languages. Although wellbeing was discussed in the context of the individual, family, community, and nation, wellbeing was most often discussed at the cultural level by regional and national Indigenous leadership and organizations. Even in acknowledging the great cultural diversity among Canadian Indigenous nations, four concordant themes were identified regionally and nationally, with respect to what was important for cultural wellbeing: land and water, sustainability, and inherent obligations; being on the land, and indigenous languages and knowledge systems; sustainable development; and meaningful involvement in decision-making, and free, prior, and informed consent. Taking into account these themes is foundational for any interaction with Indigenous peoples, especially in the context of land, culture, and development. There needs to be a new beginning on the journey to reconciliation with land and cultural wellbeing at the forefront.
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Affiliation(s)
- Stephen R. J. Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (F.A.); (L.J.S.T.)
- School of Environmental Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Aleksandra M. Zuk
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (F.A.); (L.J.S.T.)
- School of Nursing, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Andrew Solomon
- Fort Albany First Nation, Fort Albany, ON P0L 1H0, Canada
| | | | - Fatima Ahmed
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (F.A.); (L.J.S.T.)
| | - Leonard J. S. Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (F.A.); (L.J.S.T.)
- Department of Health and Society, University of Toronto, Toronto, ON M1C 1A4, Canada
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Zioni N, Bercovich AA, Chapal-Ilani N, Bacharach T, Rappoport N, Solomon A, Avraham R, Kopitman E, Porat Z, Sacma M, Hartmut G, Scheller M, Muller-Tidow C, Lipka D, Shlush E, Minden M, Kaushansky N, Shlush LI. Inflammatory signals from fatty bone marrow support DNMT3A driven clonal hematopoiesis. Nat Commun 2023; 14:2070. [PMID: 37045808 PMCID: PMC10097668 DOI: 10.1038/s41467-023-36906-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/20/2023] [Indexed: 04/14/2023] Open
Abstract
Both fatty bone marrow (FBM) and somatic mutations in hematopoietic stem cells (HSCs), also termed clonal hematopoiesis (CH) accumulate with human aging. However it remains unclear whether FBM can modify the evolution of CH. To address this question, we herein present the interaction between CH and FBM in two preclinical male mouse models: after sub-lethal irradiation or after castration. An adipogenesis inhibitor (PPARγ inhibitor) is used in both models as a control. A significant increase in self-renewal can be detected in both human and rodent DNMT3AMut-HSCs when exposed to FBM. DNMT3AMut-HSCs derived from older mice interacting with FBM have even higher self-renewal in comparison to DNMT3AMut-HSCs derived from younger mice. Single cell RNA-sequencing on rodent HSCs after exposing them to FBM reveal a 6-10 fold increase in DNMT3AMut-HSCs and an activated inflammatory signaling. Cytokine analysis of BM fluid and BM derived adipocytes grown in vitro demonstrates an increased IL-6 levels under FBM conditions. Anti-IL-6 neutralizing antibodies significantly reduce the selective advantage of DNMT3AMut-HSCs exposed to FBM. Overall, paracrine FBM inflammatory signals promote DNMT3A-driven clonal hematopoiesis, which can be inhibited by blocking the IL-6 pathway.
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Affiliation(s)
- N Zioni
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - A Akhiad Bercovich
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - N Chapal-Ilani
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Tal Bacharach
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - N Rappoport
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
- Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - A Solomon
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - R Avraham
- Department of Biological Regulation, Weizmann Institute of Science, Rehovot, Israel
| | - E Kopitman
- Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - Z Porat
- Life Sciences Core Facilities, Weizmann Institute of Science, Rehovot, Israel
| | - M Sacma
- Institute of Molecular Medicine Ulm University, Ulm, Germany
| | - G Hartmut
- Institute of Molecular Medicine Ulm University, Ulm, Germany
| | - M Scheller
- Department of Medicine, Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - C Muller-Tidow
- Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
- European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Heidelberg, Heidelberg, Germany
| | - D Lipka
- German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Partner Site Heidelberg, Heidelberg, Germany
| | - E Shlush
- IVF Unit, Galilee Medical Center, Nahariya, Israel
| | - M Minden
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON, Canada
- Division of Hematology, University Health Network, Toronto, ON, Canada
| | - N Kaushansky
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Liran I Shlush
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
- Hematology and Bone Marrow Transplantation Institute Rambam Healthcare campus Haifa, Haifa, Israel.
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Garg T, Park H, Solomon A, Lee C, Weiss C, Li X, Singh H. Abstract No. 171 Benchtop Testing with Procedural Feasibility and Safety Evaluation of an Ultrahigh-Resolution Optical Coherence Tomography Catheter for Assessment of the Biliary Tree. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.227] [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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Ahmed F, Liberda EN, Solomon A, Davey R, Sutherland B, Tsuji LJS. Indigenous Land-Based Approaches to Well-Being: The Niska (Goose) Harvesting Program in Subarctic Ontario, Canada. Int J Environ Res Public Health 2023; 20:3686. [PMID: 36834382 PMCID: PMC9958717 DOI: 10.3390/ijerph20043686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Historically, goose harvesting provided a source of culturally significant, safe, and nutritious food for the Omushkego Cree of subarctic Ontario, Canada. Disruptions stemming from colonization and climate change have led to a decrease in harvesting, resulting in higher rates of food insecurity. The aim of the Niska program was to reconnect Elders and youth to revitalize goose harvesting activities and associated Indigenous knowledge within the community. The program and evaluation were built using a two-eyed seeing (Etuaptmumk) and community-based participatory research approach. Salivary cortisol, a biomedical measure of stress, was collected before (n = 13) and after (n = 13) participation in the spring harvest. Likewise, cortisol samples were collected before (n = 12) and after (n = 12) the summer harvest. Photovoice and semi-directed interviews were employed after the spring (n = 13) and summer (n = 12) harvests to identify key elements of well-being from an Indigenous perspective. The changes observed in cortisol levels for the spring (p = 0.782) and summer (p = 0.395) harvests were not statistically significant. However, there was a noteworthy increase in the subjective well-being observed through the qualitative measures (semi-directed interviews and photovoice), highlighting the importance of using multiple perspectives when assessing well-being, especially in Indigenous peoples. Future programs should incorporate multiple perspectives when addressing complex environmental and health issues, such as food security and environmental conservation, especially in Indigenous homelands worldwide.
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Affiliation(s)
- Fatima Ahmed
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada
| | - Eric N. Liberda
- School of Occupation and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Andrew Solomon
- Fort Albany First Nation, Fort Albany, ON P0L 1H0, Canada
| | - Roger Davey
- Fort Albany First Nation, Fort Albany, ON P0L 1H0, Canada
| | - Bernard Sutherland
- Peetabeck Academy, Mundo Peetabeck Education Authority, Fort Albany, ON P0L 1H0, Canada
| | - Leonard J. S. Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada
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Hendrix S, Soininen H, Solomon A, Visser P, van Hees A, Counotte D, Nicodemus-Johnson J, Dickson S, Blennow K, Kivipelto M, Hartmann T. Combined Evidence for a Long-Term, Clinical Slowing Effect of Multinutrient Intervention in Prodromal Alzheimer’s Disease: Post-Hoc Analysis of 3-Year Data from the LipiDiDiet Trial. J Prev Alzheimers Dis 2023. [DOI: 10.14283/jpad.2023.29] [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: 03/19/2023]
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Barbera M, Perera D, Matton A, Mangialasche F, Rosenberg A, Middleton L, Ngandu T, Solomon A, Kivipelto M. Multimodal Precision Prevention - A New Direction in Alzheimer's Disease. J Prev Alzheimers Dis 2023; 10:718-728. [PMID: 37874092 DOI: 10.14283/jpad.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
At least 40% of all dementia has been linked to modifiable risk factors suggesting a clear potential for preventative approaches targeting these factors. Despite the recent promising findings from anti-amyloid monoclonal antibodies, a limited proportion of patients are expected to be eligible for these novel AD treatments. Given the heterogeneous nature of AD and the complex multi-level pathological processes leading to dementia (involving, e.g., shared risk factors, interaction of different pathology mechanisms, and their putative synergistic effects on cognition), targeting a single pathology may not be sufficient to halt or significantly impact disease progression. With exponentially increasing numbers of patients world-wide, in parallel to the unprecedented population ageing, new multimodal therapy approaches targeting several modifiable risk factors and disease mechanisms simultaneously are urgently required. Developing the next generation of combination therapies with lifestyle intervention and pharmacological treatments, implementing the right interventions for the right people at the right time, and defining accessible and sustainable strategies worldwide are crucial. Here, we summarize the state-of-the-art multimodal lifestyle-based approaches, especially findings and lessons learned from the FINGER trial, for prevention and risk reduction of cognitive impairment and dementia. We also discuss some emerging underlying biological mechanisms and the current development of precision prevention approaches. We present an example of a novel trial design combining healthy lifestyle changes with a repurposed putative disease-modifying drug and place this study in the context of the World-Wide FINGERS, the first interdisciplinary network of multimodal trials dedicated to the prevention and risk reduction of cognitive impairment and dementia.
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Affiliation(s)
- M Barbera
- Miia Kivipelto, Address: Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Vägen 37A, 171 64 Solna, Sweden, , Phone: +46 73-994-0922
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Saunders TS, Protsiv M, Jenkins ND, Solomon A, Blennow K, Ritchie C, Muniz-Terrera G. Association between Longitudinal Cerebrospinal Fluid Alzheimer's Biomarkers and the Lifestyle for Brain Health (LIBRA) Index: Findings from the European Prevention of Alzheimer's Dementia Cohort Study (EPAD LCS). J Prev Alzheimers Dis 2023; 10:543-550. [PMID: 37357296 DOI: 10.14283/jpad.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND In the absence of preventative pharmacological interventions for Alzheimer's Disease dementia, there is a growing interest in modifiable risk factors associated with AD. Such risk factors are thought to contribute up to 40% of the risk of dementia. The Lifestyle for Brain Health (LIBRA) index, a dementia risk score which focuses exclusively on modifiable factors, has been found to be associated with increased risk of dementia and cognitive decline. It is currently unclear how the LIBRA index relates to cerebrospinal fluid (CSF) biomarkers of Alzheimer's Disease. OBJECTIVES To examine the association between LIBRA index scores and trajectories of phospho-tau 181 and total tau in the European Prevention of Alzheimer's Dementia Longitudinal Cohort Study (EPAD LCS), and to examine whether these trajectories differ between participants with high and low CSF amyloid-beta 1-42 (Aβ42). DESIGN Analysis of CSF biomarker and LIBRA index scores from the European Prevention of Alzheimer's Dementia Longitudinal Cohort Study. SETTING The European Prevention of Alzheimer's Dementia Longitudinal Cohort Study is a multi-centre, pan-European study. MEASUREMENTS Cerebrospinal fluid samples were taken by lumbar puncture and analysed using electrochemiluminescence. LIBRA index scores were calculated from self-reported variables, questionnaires, and physiological measurements. RESULT In the total sample (n = 1715; mean age = 66.0, 56.4% female), there were no significant associations between LIBRA scores (mean = 0.73 points) and rate of change in cerebrospinal fluid biomarkers. In participants with high Aβ, reflecting less deposition in the brain, (n = 1134), LIBRA scores were significantly associated with the rate of change in total tau, where higher LIBRA scores (denoting higher dementia risk) were associated with increases in t-tau. There were no significant associations between LIBRA scores and change in cerebrospinal biomarkers in participants with low Aβ. CONCLUSION We found an association between modifiable risk factors and total tau accumulation in participants without dementia and without Aβ accumulation. This suggests that increasing levels of total tau may be driven by factors other than Aβ accumulation and highlights the need for developing and examining tau-targeting drugs in Alzheimer's Disease development.
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Affiliation(s)
- T S Saunders
- Mr Tyler Saunders, 1 George Square, Edinburgh, EH8 9JZ,
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Geschwind M, Lopez-Chiriboga AS, Blackburn K, Turaga S, Binks S, Zitser J, Gelfand J, Day G, Dunham S, Rodenbeck S, Clardy S, Solomon A, Pittock S, McKeon A, Dubey D, Zekeridou A, Toledano M, Turner L, Vernino S, Irani S, Flanagan E. Autoimmune Encephalitis Misdiagnosis in Adults; A Multicenter Observational Study of Outpatient Subspecialty Clinics. Neurology 2022. [DOI: 10.1212/01.wnl.0000903448.98416.0e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
ObjectiveTo determine the diseases misdiagnosed as AE and potential reasons for misdiagnosis.BackgroundMisdiagnosis of autoimmune encephalitis (AE) may harm patients.Design/MethodsPatients with AE misdiagnosis were identified (1/1/2014-12/31/2020) from outpatient AE subspecialty clinics including: Mayo Clinic (n = 44); Oxford (n = 18); UT Southwestern (n = 18); UCSF (n = 17); Washington University (n = 6); University of Utah (n = 4). Inclusion criteria were adults (=18 years) with: 1) A prior diagnosis of AE; and 2) An alternative diagnosis made at a participating center. We collected data on clinical features, investigations, fulfillment of possible AE criteria, alternative diagnoses, and potential contributors to misdiagnosis.ResultsWe identified 107 patients misdiagnosed with AE. Thirty (28%) fulfilled diagnostic criteria for “possible AE”. Median onset age was 48 years (inter-quartile range, 35.5-60.5) and 65 (61%) were female. Correct diagnoses included: functional neurologic disorder, 27 (25%); neurodegenerative disease, 22 (21%); primary psychiatric disease, 19 (18%); cognitive deficits from comorbidities, 11 (10%); cerebral neoplasm, 10 (9%); and other, 18 (17%). Onset was insidious (>3 months) in 51 (48%). MRI brain was suggestive of encephalitis in 19/104 (18%) and CSF pleocytosis occurred in 16/84 (19%). Thyroid-peroxidase antibodies were elevated in 24/62 (39%). Positive neural autoantibodies were more frequent in serum (48/105[46%]) than CSF (7/91[8%]; p<0.001) and serum antibodies included: GAD65, 14; voltage-gated-potassium-channel-complex [LGI1, CASPR2 negative], 10; NMDA-receptor by cell-based assay only, 10 (6 negative in CSF); and other, 18. Immunotherapy adverse effects were observed in 17/84 (20%). Potential contributors to misdiagnosis included: over-interpretation of a non-specific positive serum antibody, 53 (50%); misinterpretation of functional, psychiatric, or non-specific cognitive dysfunction as encephalopathy, 41 (38%).ConclusionsRed flags suggesting alternative diagnoses to AE include lack of fulfillment of “possible autoimmune encephalitis” criteria, positive non-specific serum antibody, and insidious onset. Avoiding AE misdiagnosis will prevent morbidity from unnecessary immunotherapies and delayed treatment of the correct diagnosis.
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Affiliation(s)
- S Babu
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, 603103 Tamil Nadu, India
| | - M Krishnan
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, 603103 Tamil Nadu, India
| | - M Chinnaiyan
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA
| | - P Daniel
- Department of Medical Biochemistry, Dr. A.L.M PG Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu 600113, India
- Department of Biochemistry, Tagore Dental College and Hospital, Chennai, Tamil Nadu 600127, India
| | - A Solomon
- Department of Mental Health Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India
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Krishnan M, Babu S, Jayaraman S, Daniel P, Solomon A, Chinnaiyan M. MICRORNA-31 AS A POTENTIAL THERAPEUTIC BIOMARKER FOR ORAL SQUAMOUS CELL CARCINOMA: CURRENT EVIDENCE AND FUTURE PROSPECTS. Exp Oncol 2022; 44:263-264. [PMID: 36325699 DOI: 10.32471/exp-oncology.2312-8852.vol-44-no-3.18569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- M Krishnan
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chengalpattu District, Tamil Nadu 603103, India
| | - S Babu
- Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chengalpattu District, Tamil Nadu 603103, India
| | - S Jayaraman
- Centre of Molecular Medicine and Diagnostics (COMManD), Department Biochemistry
| | - P Daniel
- Department of Medical Biochemistry, Dr. A.L.M PG Institute of Basic Medical Sciences, University of Madras, Chennai, Tamil Nadu 600113, India
- Department of Biochemistry, Tagore Dental College and Hospital, Chennai, Tamil Nadu 600127, India
| | - A Solomon
- Department of Mental Health Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 602105, India
| | - M Chinnaiyan
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA
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Sindi S, Thunborg C, Rosenberg A, Andersen P, Andrieu S, Broersen LM, Coley N, Couderc C, Duval CZ, Faxen-Irving G, Hagman G, Hallikainen M, Håkansson K, Lehtisalo J, Levak N, Mangialasche F, Pantel J, Kekkonen E, Rydström A, Stigsdotter-Neely A, Wimo A, Ngandu T, Soininen H, Hartmann T, Solomon A, Kivipelto M. Multimodal Preventive Trial for Alzheimer's Disease: MIND-ADmini Pilot Trial Study Design and Progress. J Prev Alzheimers Dis 2022; 9:30-39. [PMID: 35098971 PMCID: PMC8783958 DOI: 10.14283/jpad.2022.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Interventions simultaneously targeting multiple risk factors and mechanisms are most likely to be effective in preventing cognitive impairment. This was indicated in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) testing a multidomain lifestyle intervention among at-risk individuals. The importance of medical food at the early symptomatic disease stage, prodromal Alzheimer’s disease (AD), was emphasized in the LipiDiDiet trial. The feasibility and effects of multimodal interventions in prodromal AD are unclear. Objectives To evaluate the feasibility of an adapted FINGER-based multimodal lifestyle intervention, with or without medical food, among individuals with prodromal AD. Methods MIND-ADmini is a multinational proof-of-concept 6-month randomized controlled trial (RCT), with four trial sites (Sweden, Finland, Germany, France). The trial targeted individuals with prodromal AD defined using the International Working Group-1 criteria, and with vascular or lifestyle-related risk factors. The parallel-group RCT includes three arms: 1) multimodal lifestyle intervention (nutritional guidance, exercise, cognitive training, vascular/metabolic risk management and social stimulation); 2) multimodal lifestyle intervention+medical food (Fortasyn Connect); and 3) regular health advice/ care (control group). Primary outcomes are feasibility and adherence. Secondary outcomes are adherence to the individual intervention domains and healthy lifestyle changes. Results Screening began on 28 September 2017 and was completed on 21 May 2019. Altogether 93 participants were randomized and enrolled. The intervention proceeded as planned. Conclusions For the first time, this pilot trial tests the feasibility and adherence to a multimodal lifestyle intervention, alone or combined with medical food, among individuals with prodromal AD. It can serve as a model for combination therapy trials (non-pharma, nutrition-based and/or pharmacological interventions).
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Affiliation(s)
- S Sindi
- Professor Miia Kivipelto, MD, PhD, Karolinska Institutet, Dept NVS, Division of Clinical Geriatrics, Center for Alzheimer Research QA32, Karolinska vägen 37 A, SE-171 64 Solna, Sweden; Mobile: +46 (0)73 99 409 22,
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Ontaneda D, Sati P, Raza P, Kilbane M, Gombos E, Alvarez E, Azevedo C, Calabresi P, Cohen JA, Freeman L, Henry RG, Longbrake EE, Mitra N, Illenberger N, Schindler M, Moreno-Dominguez D, Ramos M, Mowry E, Oh J, Rodrigues P, Chahin S, Kaisey M, Waubant E, Cutter G, Shinohara R, Reich DS, Solomon A, Sicotte NL. Central vein sign: A diagnostic biomarker in multiple sclerosis (CAVS-MS) study protocol for a prospective multicenter trial. Neuroimage Clin 2021; 32:102834. [PMID: 34592690 PMCID: PMC8482479 DOI: 10.1016/j.nicl.2021.102834] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 01/06/2023]
Abstract
The specificity and implementation of current MRI-based diagnostic criteria for multiple sclerosis (MS) are imperfect. Approximately 1 in 5 of individuals diagnosed with MS are eventually determined not to have the disease, with overreliance on MRI findings a major cause of MS misdiagnosis. The central vein sign (CVS), a proposed MRI biomarker for MS lesions, has been extensively studied in numerous cross sectional studies and may increase diagnostic specificity for MS. CVS has desirable analytical, measurement, and scalability properties. "Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS)" is an NIH-supported, 2-year, prospective, international, multicenter study conducted by the North American Imaging in MS Cooperative (NAIMS) to evaluate CVS as a diagnostic biomarker for immediate translation into clinical care. Study objectives include determining the concordance of CVS and McDonald Criteria to diagnose MS, the sensitivity of CVS to detect MS in those with typical presentations, and the specificity of CVS among those with atypical presentations. The study will recruit a total of 400 participants (200 with typical and 200 with atypical presentations) across 11 sites. T2*-weighted, high-isotropic-resolution, segmented echo-planar MRI will be acquired at baseline and 24 months on 3-tesla scanners, and FLAIR* images (combination of FLAIR and T2*) will be generated for evaluating CVS. Data will be processed on a cloud-based platform that contains clinical and CVS rating modules. Imaging quality control will be conducted by automated methods and neuroradiologist review. CVS will be determined by Select6* and Select3* lesion methods following published criteria at each site and by central readers, including neurologists and neuroradiologists. Automated CVS detection and algorithms for incorporation of CVS into McDonald Criteria will be tested. Diagnosis will be adjudicated by three neurologists who served on the 2017 International Panel on the Diagnosis of MS. The CAVS-MS study aims to definitively establish CVS as a diagnostic biomarker that can be applied broadly to individuals presenting for evaluation of the diagnosis of MS.
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Affiliation(s)
- D Ontaneda
- Cleveland Clinic Foundation, Cleveland, OH, United States.
| | - P Sati
- Cedars Sinai, Los Angeles, CA, United States; NINDS, NIH, Bethesda, MD, United States
| | - P Raza
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - M Kilbane
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - E Gombos
- Cedars Sinai, Los Angeles, CA, United States
| | - E Alvarez
- Neurology, U of Colorado, Denver, CO, United States
| | | | - P Calabresi
- Neurology, Johns Hopkins, Baltimore, MD, United States
| | - J A Cohen
- Cleveland Clinic Foundation, Cleveland, OH, United States
| | - L Freeman
- Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - R G Henry
- University of California San Francisco, San Francisco, CA, United States
| | | | - N Mitra
- University of Pennsylvania, Philadelphia, PA, United States
| | - N Illenberger
- University of Pennsylvania, Philadelphia, PA, United States
| | - M Schindler
- University of Pennsylvania, Philadelphia, PA, United States
| | | | - M Ramos
- QMENTA Inc, Boston, MA, United States
| | - E Mowry
- Neurology, Johns Hopkins, Baltimore, MD, United States
| | - J Oh
- University of Toronto, Toronto, ON, Canada
| | | | - S Chahin
- Washington University, St. Louis, MO, United States
| | - M Kaisey
- Cedars Sinai, Los Angeles, CA, United States
| | - E Waubant
- University of California San Francisco, San Francisco, CA, United States
| | - G Cutter
- UAB School of Public Health, Birmingham, AL, United States
| | - R Shinohara
- University of Pennsylvania, Philadelphia, PA, United States
| | - D S Reich
- NINDS, NIH, Bethesda, MD, United States
| | - A Solomon
- The University of Vermont, Burlington, VT, United States
| | - N L Sicotte
- Cedars Sinai, Los Angeles, CA, United States
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Oliver BJ, Walsh K, Messier R, Mehta F, Cabot A, Klawiter E, Pagnotta P, Solomon A, England SE. System-Level Variation in Multiple Sclerosis Care Outcomes: Initial Findings from the Multiple Sclerosis Continuous Quality Improvement Research Collaborative. Popul Health Manag 2021; 25:46-56. [PMID: 34134513 DOI: 10.1089/pop.2021.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Multiple sclerosis (MS) is a "3C" (complex, chronic, costly) condition that is a common and disabling neurological illness affecting approximately 1 million adults in the United States. MS has been studied at the basic science, individual, and population levels, but not at the system level to assess small-area variation effects on MS population health outcomes. System-level effects have been observed in other 3C conditions including cystic fibrosis, rheumatoid arthritis, and inflammatory bowel disease. The authors report here on system-level variation findings from the baseline period during the first year of the Multiple Sclerosis Continuous Quality Improvement (MS-CQI) study. Stepwise binary logistic regression analyses were conducted to investigate system-level (small-area variation) effects on MS relapses (exacerbations), disease-modifying therapy (DMT) utilization, and brain MRI utilization, controlling for demographics (age and sex) and other potential confounders. Significant differences were observed in people with MS (PwMS) between centers for a number of demographic and disease characteristics, including sex, age, and MS subtype. Controlling for these factors, significant system-level effects were observed on outcomes, including DMT utilization, MRI utilization, and relapses. Significant relationships also were observed between outcomes and urgent care utilization, including emergency department visits and hospitalizations. This initial study provides evidence establishing the presence of system-level variation effects on MS outcomes in a multicenter population study - where PwMS get their care can influence their outcomes. Results support continued systems-level research and improvement initiatives to optimize MS population health outcomes in this challenging and costly complex chronic condition.
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Affiliation(s)
- Brant J Oliver
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock-Health, Lebanon, New Hampshire, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Multiple Sclerosis Specialty Care Program, Concord Hospital Neurology, Concord, New Hampshire, USA
| | - Karen Walsh
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | | | - Falguni Mehta
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock-Health, Lebanon, New Hampshire, USA
| | - Ann Cabot
- Multiple Sclerosis Specialty Care Program, Concord Hospital Neurology, Concord, New Hampshire, USA
| | - Eric Klawiter
- Multiple Sclerosis Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia Pagnotta
- Multiple Sclerosis Center, Department of Neurology, University of Vermont Medical Center and Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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Ritchie CW, Muniz-Terrera G, Kivipelto M, Solomon A, Tom B, Molinuevo JL. The European Prevention of Alzheimer's Dementia (EPAD) Longitudinal Cohort Study: Baseline Data Release V500.0. J Prev Alzheimers Dis 2021; 7:8-13. [PMID: 32010920 DOI: 10.14283/jpad.2019.46] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The European Prevention of Alzheimer's Dementia (EPAD) Programme is a pan-European project whose objective is to deliver a platform, adaptive, Phase 2 proof of concept (PoC) trial for the secondary prevention of Alzheimer's dementia. A component of this platform is the Longitudinal Cohort Study (LCS) which acts as a readiness cohort for the PoC Trial as well as generating data for disease modelling work in the preclinical and prodromal phases of Alzheimer's dementia. OBJECTIVES The first data wave has been collected, quality checked, released and now available for analysis to answer numerous research questions. Here we describe the results from key variables in the EPAD LCS with the objective of using these results to compliment analyses of these data in the future. DESIGN EPAD LCS is a cohort study whose primary objective is as a readiness cohort for the EPAD PoC Trial. As such recruitment is not capped at any particular number but will continue to facilitate delivery of the EPAD PoC Trial. Research Participants are seen annually (with an additional 6 month visit in the first year). SETTING The EPAD Trial Delivery Network comprises currently 21 centres across Europe. PARTICIPANTS Research participants are included if they are over 50 years old and do not have a diagnosis of dementia. MEASUREMENTS All research participants undergo multiple assessments to fully characterise the biology of Alzheimer's disease and relate this to risk factors (both fixed and modifiable) and biomarker expression of disease through brain imaging, fluid samples (CSF, blood, urine and saliva), cognitive performance, functional abilities and neuropsychiatric symptomatology. RESULTS V500.0 represents the first 500 research participants baselined into EPAD LCS. The mean age was 66.4 (SD=6.7) and 47.8% were male. The data was split for presentation into 4 groups: [1] CDR=0 and Amyloid + (preclinical AD), [2] CDR=0 and Amyloid -, [3] CDR=0.5 and Amyloid + (prodromal AD) and [4] CDR=0.5 and Amyloid -. CONCLUSIONS The EPAD LCS is achieving its primary objective of trial readiness and the structured approach to data release as manifest by this first data release of V500.0 will assist researchers to describe and compare their findings as well as in systematic reviews and meta-analyses. It is anticipated given current recruitment rates that V1500.0 data release will take place in Autumn 2019. V500.1 (when the 1 year follow up is completed on the V500.0 (sub)cohort will be in Autumn 2019 also.
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Affiliation(s)
- C W Ritchie
- Craig William Ritchie, University of Edinburgh, United Kingdom,
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Rosenberg A, Mangialasche F, Ngandu T, Solomon A, Kivipelto M. Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer's Disease, and Dementia: From FINGER to World-Wide FINGERS. J Prev Alzheimers Dis 2021; 7:29-36. [PMID: 32010923 PMCID: PMC7222931 DOI: 10.14283/jpad.2019.41] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alzheimer’s disease (AD) and dementia are a global public health priority, and prevention has been highlighted as a pivotal component in managing the dementia epidemic. Modifiable risk factors of dementia and AD include lifestyle-related factors, vascular and metabolic disorders, and psychosocial factors. Randomized controlled clinical trials (RCTs) are needed to clarify whether modifying such factors can prevent or postpone cognitive impairment and dementia in older adults. Given the complex, multifactorial, and heterogeneous nature of late-onset AD and dementia, interventions targeting several risk factors and mechanisms simultaneously may be required for optimal preventive effects. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is the first large, long-term RCT to demonstrate that a multidomain lifestyle-based intervention ameliorating vascular and lifestyle-related risk factors can preserve cognitive functioning and reduce the risk of cognitive decline among older adults at increased risk of dementia. To investigate the multidomain intervention in other populations and diverse cultural and geographical settings, the World-Wide FINGERS (WW-FINGERS) network was recently launched (https://alz.org/wwfingers). Within this network, new FINGER-type trials with shared core methodology, but local culture and context-specific adaptations, will be conducted in several countries. The WW-FINGERS initiative facilitates international collaborations, provides a platform for testing multidomain strategies to prevent cognitive impairment and dementia, and aims at generating high-quality scientific evidence to support public health and clinical decision-making. Furthermore, the WW-FINGERS network can support the implementation of preventive strategies and translation of research findings into practice.
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Affiliation(s)
- A Rosenberg
- Miia Kivipelto, Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, 171 64 Solna, Sweden, Phone: +46 (0)73 99 40 922,
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Kolarich A, Ring N, Pang S, Farhan A, Covarrubias O, Ng R, Solomon A, Gullotti D, Holly B, Hong K, Georgiades C. Abstract No. 195 National trends in transjugular intrahepatic portosystemic shunt placement, revision, and trainee procedure involvement. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.201] [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: 10/21/2022] Open
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Kolarich A, Pang S, Solomon A, England R, Georgiades C. Abstract No. 105 Increasing consulting fee payments to interventional radiologists in the United States from industry, 2014 to 2018: analysis of the Open Payments Database. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.111] [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: 11/29/2022] Open
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Pang S, England R, Solomon A, Hong K, Singh H. Abstract No. 90 Single-use versus reusable endoscopes for percutaneous biliary endoscopy with lithotripsy: technical metrics, clinical outcomes, and cost comparison. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gong A, Solomon A, Motaghi M, Latif M, Holly B, Weiss C. Abstract No. 437 Fluoroscopically guided, percutaneously placed cecostomies versus surgically placed cecostomies in adult patients: a safety comparison. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hafezi Nejad N, Abou Areda M, Bailey C, Solomon A, Weiss C. Abstract No. 463 Percutaneous vertebral augmentation in the oldest old: comparative evaluation of comorbidities, outcomes and disparities. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.272] [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: 12/01/2022] Open
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Guan J, England R, Solomon A, Pang S, Hong K, Singh H. Abstract No. 91 Clinical outcomes of percutaneous biliary endoscopy: a 7-year single-institution experience. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.517] [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: 10/21/2022] Open
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Winocour PH, Moore-Haines K, Sullivan K, Currie A, Solomon A, Hardy D. HbA1c in a primary care cohort with diabetes and chronic kidney disease: the East and North Hertfordshire Institute of Diabetes and Endocrinology (ENHIDE) Diabetes Renal Telehealth Project. Br J Diabetes 2020. [DOI: 10.15277/bjd.2020.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Aim: Diabetes mellitus and chronic kidney disease (CKD) commonly co-occur. Control of glycaemia is nuanced, and should be individualised. The Diabetes Renal Telehealth Project identified 2,356 adults with diabetes and CKD, and evaluated determinants and patterns of HbA1c in order to identify under-treatment or potential over-treatment of glycaemia.Method: Comprehensive review of GP diabetes registers by the clinical investigators.Results: The study subjects (52% male, 48% female) were aged 77 years (range 19–103) with median estimated glomerular filtration rate 52 (range 3–171) mL/min and median albumin to creatinine ratio 34 (range <0.05–1428) mg/mmol. 81% were solely managed in primary care. Median HbA1c was 57 (range 10–148) mmol/mol (7.4% (3.1–15.7%)) and at the 58 mmol/mol target in 64%. Anaemia was present in 31%. 22% were solely on dietary management, 29% on insulin therapy (6 in 10 of whom were also on additional agents) and 19% were on sulfonylurea (8 in 10 of whom were on additional agents excluding insulin). Patterns of HbA1c over 2 years were stable for 44%, variable in 19%, rising in 12% and improved in 8%. The 13% initially considered at increased hypoglycaemic risk based on HbA1c measures alone had worse renal function and were more frequently anaemic (both p<0.0005), and 83% were treated with insulin and/or sulfonylureas. Hypoglycaemia hospital admissions were low with 10 people admitted over the study period. There was a reduction in age with increasing quintiles of HbA1c, and those with HbA1c >75 mmol/mol (9.0%) were youngest (mean age 68 years, p<0.001).Conclusions: The majority of people with diabetes and CKD are elderly and managed in primary care, with anaemia in 31%, potentially affecting HbA1c interpretation. Iatrogenic hypoglycaemic risk was identified in 10%, with suboptimal glycaemic control (HbA1c >9% (75 mmol/mol)) through under-treatment in 9%. This study uncovered unmet clinical need, requiring both escalation and de-escalation of glycaemic therapies.
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Malanchini G, Del Corral M, De Filippo P, Ferrari P, Solomon A, Krepp J. Cardiac arrhythmias and In-hospital mortality amongst patients with takotsubo cardiomyopathy: A retrospective study in an Italian population. IJC Heart & Vasculature 2020; 31:100608. [PMID: 32923578 PMCID: PMC7475186 DOI: 10.1016/j.ijcha.2020.100608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 01/14/2023]
Abstract
Takotsubo cardiomyopathy was more common in women and the mortality rate was 2.2%. Ventricular arrhythmias were the strongest predictor of mortality. Age was associated with increased mortality in women with takotsubo cardiomyopathy.
Background Methods Results Conclusion
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Abstract
In the 25 years since the hypothesis was first described, therapeutic use of inhibitors of dipeptidyl peptidase-4 (DPP-4i) as a novel approach to the treatment of type 2 diabetes has become established widely, with several compounds now available to exemplify the class. Although the clinical profiles of members of the DPP-4i class have been reviewed extensively, the underlying pragmatic small molecular design and pharmaceutical properties of these agents have seldom been addressed in the context of establishment of the class as treatments for type 2 diabetes. Among the reasons contributing to the wide acceptance of DPP-4i as oral anti-hyperglycaemic therapy are: (i) the endocrine basis of their pharmacology; (ii) their chemical 'simplicity' and low molecular mass; (iii) their pharmacological selectivity for their target mechanism of action; (iv) the nature of physiologically relevant substrates for the enzyme; (v) their relative ease of formulation into tablets; (vi) their efficacy as glucose-lowering agents; (vii) their absorption, distribution, metabolism and elimination profiles; and (viii) their limited tolerability issues.
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Affiliation(s)
- R. D. Carr
- Merck Sharp & Dohme UKLondonUK
- Hatter Cardiovascular InstituteUniversity College LondonLondonUK
- School of Biomedical SciencesUlster UniversityColeraineUK
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Hendrix SB, Soininen H, van Hees AMJ, Ellison N, Visser PJ, Solomon A, Attali A, Blennow K, Kivipelto M, Hartmann T. Alzheimer's Disease Composite Score: A Post-Hoc Analysis Using Data from the LipiDiDiet Trial in Prodromal Alzheimer's Disease. J Prev Alzheimers Dis 2020; 6:232-236. [PMID: 31686094 DOI: 10.14283/jpad.2019.33] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As research evolves in prodromal AD, the need to validate sufficiently sensitive outcome measures, e.g. the Alzheimer's Disease Composite Score (ADCOMS) is clear. In the LipiDiDiet randomized trial in prodromal AD, cognitive decline in the study population was much less than expected in the timeframe studied. While the primary composite endpoint was insufficiently sensitive to detect a difference in the modified intention to treat population, the per-protocol population showed less decline in the active than the control group, indicating better treatment effects with regular product intake. These results were further strengthened by significant benefits on secondary endpoints of cognition and function, and brain atrophy. The present post-hoc analysis investigated whether ADCOMS could detect a difference between groups in the LipiDiDiet population (138 active, 140 control). The estimated mean change in ADCOMS from baseline (standard error) was 0.085 (0.018) in the active and 0.133 (0.018) in the control group; estimated mean treatment difference -0.048 (95% confidence intervals -0.090, -0.007; p=0.023), or 36% less decline in the active group. This suggests ADCOMS identified the cognitive and functional benefits observed previously, confirming the sensitivity of this composite measure.
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Affiliation(s)
- S B Hendrix
- Suzanne B Hendrix, Pentara Corporation, 2180 Claybourne Avenue, Salt Lake City, UT 84109 USA. ; Phone: +1 (801) 898-7241
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Winocour PH, Moore-Haines K, Sullivan K, Currie A, Solomon A, Hardy D. Holistic review of people with diabetes and chronic kidney disease reveals important multimorbidity and unmet clinical need: The ENHIDE diabetes renal telehealth pilot study. Clin Med (Lond) 2020; 20:133-138. [PMID: 32165438 PMCID: PMC7081804 DOI: 10.7861/clinmed.2019-0418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Diabetes and kidney disease commonly coexist and management is complex given frequent additional comorbidity. The East and North Herts Institute of Diabetes and Endocrinology (ENHIDE) renal diabetes telehealth project examined the feasibility of data extraction from primary care records for virtual consultant review as a prelude to a telehealth case-based discussion with primary care teams. Data extraction identified 2,356 cases from 16 general practices, of which 14 took part in a skype telehealth case-based discussion session. The service was well received by primary care as a workable means of delivering patient care. In addition, significant unmet clinical needs were identified with opportunities to empower patient self-management of acute metabolic and foot issues, and better coordination of care between specialist diabetes and renal teams. The increasing clinical burden in all care settings and the commitment in the NHS plan for wider use of digital healthcare and streamlining of outpatient care highlight the need for service reconfiguration.
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Kolarich A, Tanavde V, Solomon A, Georgiades C, Hong K. Abstract No. 546 Portal vein embolization with and without locoregional therapy and post-hepatectomy complication risk: a National Surgery Quality Improvement Program analysis. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.607] [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: 10/25/2022] Open
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Kolarich A, Ishaque T, Solomon A, Ruck J, Massie A, Segev D, Georgiades C, Hong K, Garonzik-Wang J. 3:00 PM Abstract No. 298 Ablation versus chemoembolization in patients with hepatocellular carcinoma awaiting liver transplant: an analysis of the Scientific Registry of Transplant Recipients Database. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.351] [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: 11/28/2022] Open
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Solomon A, Kolarich A, Zhou A, Hoyer M, England R, Moreland A, Fabre M, Holly B. 3:27 PM Abstract No. 102 Infectious complications and postprocedural antibiotics following initial percutaneous biliary drainage for patients with endoscopically placed stents. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.131] [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: 11/30/2022] Open
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Khoo S, Lyons G, Solomon A, Oddy S, Halsall D, Chatterjee K, Moran C. Familial dysalbuminemic hyperthyroxinemia confounding management of coexistent autoimmune thyroid disease. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190161. [PMID: 32101523 PMCID: PMC7077549 DOI: 10.1530/edm-19-0161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/07/2020] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Familial dysalbuminemic hyperthyroxinemia (FDH) is a cause of discordant thyroid function tests (TFTs), due to interference in free T4 assays, caused by the mutant albumin. The coexistence of thyroid disease and FDH can further complicate diagnosis and potentially result in inappropriate management. We describe a case of both Hashimoto's thyroiditis and Graves' disease occurring on a background of FDH. A 42-year-old lady with longstanding autoimmune hypothyroidism was treated with thyroxine but in varying dosage, because TFTs, showing high Free T4 (FT4) and normal TSH levels, were discordant. Discontinuation of thyroxine led to marked TSH rise but with normal FT4 levels. She then developed Graves' disease and thyroid ophthalmopathy, with markedly elevated FT4 (62.7 pmol/L), suppressed TSH (<0.03 mU/L) and positive anti-TSH receptor antibody levels. However, propylthiouracil treatment even in low dosage (100 mg daily) resulted in profound hypothyroidism (TSH: 138 mU/L; FT4: 4.8 pmol/L), prompting its discontinuation and recommencement of thyroxine. The presence of discordant thyroid hormone measurements from two different methods suggested analytical interference. Elevated circulating total T4 (TT4), (227 nmol/L; NR: 69-141) but normal thyroxine binding globulin (TBG) (19.2 µg/mL; NR: 14.0-31.0) levels, together with increased binding of patient's serum to radiolabelled T4, suggested FDH, and ALB sequencing confirmed a causal albumin variant (R218H). This case highlights difficulty ascertaining true thyroid status in patients with autoimmune thyroid disease and coexisting FDH. Early recognition of FDH as a cause for discordant TFTs may improve patient management. LEARNING POINTS The typical biochemical features of familial dysalbuminemic hyperthyroxinemia (FDH) are (genuinely) raised total and (spuriously) raised free T4 concentrations due to enhanced binding of the mutant albumin to thyroid hormones, with normal TBG and TSH concentrations. Given the high prevalence of autoimmune thyroid disease, it is not surprising that assay interference from coexisting FDH may lead to discordant thyroid function tests confounding diagnosis and resulting in inappropriate therapy. Discrepant thyroid hormone measurements using two different immunoassay methods should alert to the possibility of laboratory analytical interference. The diagnosis of FDH is suspected if there is a similar abnormal familial pattern of TFTs and increased binding of radiolabelled 125I-T4 to the patient's serum, and can be confirmed by ALB gene sequencing. When autoimmune thyroid disease coexists with FDH, TSH levels are the most reliable biochemical marker of thyroid status. Measurement of FT4 using equilibrium dialysis or ultrafiltration are more reliable but less readily available.
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Affiliation(s)
- Serena Khoo
- Wellcome-MRC Institute of Metabolic ScienceUniversity of Cambridge, Cambridge, UK
| | - Greta Lyons
- Wellcome-MRC Institute of Metabolic ScienceUniversity of Cambridge, Cambridge, UK
| | - Andrew Solomon
- Department of Medicine and EndocrinologyLister Hospital, Stevenage, UK
| | - Susan Oddy
- Department of Clinical BiochemistryAddenbrooke’s Hospital, Cambridge, UK
| | - David Halsall
- Department of Clinical BiochemistryAddenbrooke’s Hospital, Cambridge, UK
| | - Krishna Chatterjee
- Wellcome-MRC Institute of Metabolic ScienceUniversity of Cambridge, Cambridge, UK
| | - Carla Moran
- Wellcome-MRC Institute of Metabolic ScienceUniversity of Cambridge, Cambridge, UK
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Iwamoto N, Schwartz CJ, Jochim B, Raju P K, Feizollah P, Napierala JL, Severt T, Tegegn SN, Solomon A, Zhao S, Lam H, Wangjam TN, Kumarappan V, Carnes KD, Ben-Itzhak I, Wells E. Strong-field control of H 3 + production from methanol dications: Selecting between local and extended formation mechanisms. J Chem Phys 2020; 152:054302. [PMID: 32035476 DOI: 10.1063/1.5129946] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Using the CD3OH isotopologue of methanol, the ratio of D2H+ to D3 + formation is manipulated by changing the characteristics of the intense femtosecond laser pulse. Detection of D2H+ indicates a formation process involving two hydrogen atoms from the methyl side of the molecule and a proton from the hydroxyl side, while detection of D3 + indicates local formation involving only the methyl group. Both mechanisms are thought to involve a neutral D2 moiety. An adaptive control strategy that employs image-based feedback to guide the learning algorithm results in an enhancement of the D2H+/D3 + ratio by a factor of approximately two. The optimized pulses have secondary structures 110-210 fs after the main pulse and result in photofragments that have different kinetic energy release distributions than those produced from near transform limited pulses. Systematic changes to the linear chirp and higher order dispersion terms of the laser pulse are compared to the results obtained with the optimized pulse shapes.
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Affiliation(s)
- Naoki Iwamoto
- Department of Physics, Augustana University, Sioux Falls, South Dakota 57197, USA
| | - Charles J Schwartz
- Department of Physics, Augustana University, Sioux Falls, South Dakota 57197, USA
| | - Bethany Jochim
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - Kanaka Raju P
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - Peyman Feizollah
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - J L Napierala
- Department of Physics, Augustana University, Sioux Falls, South Dakota 57197, USA
| | - T Severt
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - S N Tegegn
- Department of Physics, Augustana University, Sioux Falls, South Dakota 57197, USA
| | - A Solomon
- Department of Physics, Augustana University, Sioux Falls, South Dakota 57197, USA
| | - S Zhao
- Department of Physics, Augustana University, Sioux Falls, South Dakota 57197, USA
| | - Huynh Lam
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - Tomthin Nganba Wangjam
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - V Kumarappan
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - K D Carnes
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - I Ben-Itzhak
- J.R. Macdonald Laboratory, Department of Physics, Kansas State University, Manhattan, Kansas 66506, USA
| | - E Wells
- Department of Physics, Augustana University, Sioux Falls, South Dakota 57197, USA
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Col N, Alvarez E, Springmann V, Ionete C, Berrios Morales I, Solomon A, Kutz C, Griffin C, Tierman B, Livingston T, Patel M, van Leeuwen D, Ngo L, Pbert L. A Novel Tool to Improve Shared Decision Making and Adherence in Multiple Sclerosis: Development and Preliminary Testing. MDM Policy Pract 2019; 4:2381468319879134. [PMID: 31667351 PMCID: PMC6798166 DOI: 10.1177/2381468319879134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 08/29/2019] [Indexed: 01/18/2023] Open
Abstract
Background. Most people with multiple sclerosis (MS) want to be
involved in medical decision making about disease-modifying therapies (DMTs),
but new approaches are needed to overcome barriers to participation.
Objectives. We sought to develop a shared decision-making
(SDM) tool for MS DMTs, evaluate patient and provider responses to the tool, and
address challenges encountered during development to guide a future trial.
Methods. We created a patient-centered design process
informed by image theory to develop the MS-SUPPORT SDM tool. Development
included semistructured interviews and alpha and beta testing with MS patients
and providers. Beta testing assessed dissemination and clinical integration
strategies, decision-making processes, communication, and adherence. Patients
evaluated the tool before and after a clinic visit. Results.
MS-SUPPORT combines self-assessment with tailored feedback to help patients
identify their treatment goals and preferences, correct misperceptions, frame
decisions, and promote adherence. MS-SUPPORT generates a personal summary of
their responses that patients can share with their provider to facilitate
communication. Alpha testing (14 patients) identified areas needing improvement,
resulting in reorganization and shortening of the tool. MS-SUPPORT was highly
rated in beta testing (15 patients, 4 providers) on patient-provider
communication, patient preparation, adherence, and other endpoints.
Dissemination through both patient and provider networks appeared feasible. All
patient testers wanted to share the summary report with their provider, but only
60% did. Limitations. Small sample size, no comparison group.
Conclusions. The development process resulted in a
patient-centered SDM tool for MS that may facilitate patient involvement in
decision making, help providers understand their patients’ preferences, and
improve adherence, though further testing is needed. Beta testing in real-world
conditions was critical to prepare the tool for future testing and inform the
design of future studies.
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Affiliation(s)
- Nananda Col
- Shared Decision Making Resources, Georgetown, Maine
| | | | | | - Carolina Ionete
- University of Massachusetts Memorial Health Care, Worchester, Massachusetts
| | | | | | - Christen Kutz
- Colorado Springs Neurological Associates, Colorado Springs, Colorado
| | | | | | | | | | | | - Long Ngo
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lori Pbert
- University of Massachusetts Medical School, Worchester, Massachusetts
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Winocour PH, Moore-Haines K, Solomon A, Currie A, Hardy D. ENHIDE telehealth primary care support of adults with diabetes and chronic kidney disease: a pilot study – rationale and study design. Br J Diabetes 2019. [DOI: 10.15277/bjd.2019.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction: Diabetes is considered the main identified cause of end stage renal disease and this combination is becoming more prevalent as populations age and become more obese. Individuals with diabetes and chronic kidney disease (CKD) have additional multi-morbidity and may represent 25–40% of those on diabetes registers in primary care, where the majority receive medical care. The East and North Herts Clinical Commissioning Group (CCG) commissioned the East and North Herts Institute of Diabetes and Endocrinology (ENHIDE) to pilot an innovative approach to the identification and care of this complex cohort in primary care. This paper reports the project design and objectives.Aims: There were five core objectives of the pilot: (1) to examine the feasibility of extraction of comprehensive datasets from primary care diabetes registers; (2) to examine the feasibility of the individualised data utilisation for patient care; (3) to evaluate the practicality and acceptability of primary care of telehealth virtual case-based reviews; (4) to evaluate the extent of unmet clinical need; and (5) to create new sources of information to improve self-management. In addition, three key performance indicators were set for those with CKD: (1) change in any aspect of management in 20%; (2) reduction of admissions and ambulance call outs for hypoglycaemia in 20%; and (3) reductions in admissions with active foot disease by 20%.Study outline: All patients with estimated glomerular filtration rates (eGFR) <60 mL/min and/or urine albumin creatinine ratio (ACR) >10 mg/mmol were to be identified from practice diabetes registers enabling a holistic review of ‘15 pillars of care’. In addition to blood glucose management and review of renal function, this included recording of cardiovascular disease (CVD) and CVD risk factor status, risk of hypoglycaemia, assessment of anaemia, metabolic bone disease, foot and retinal health and hospitalisation.Progress: The project was initiated in December 2016 and data are currently being updated for full analysis. 20 of the 55 general practices in the catchment area of the acute trust agreed to participate in the project, enabling case review of 2,874 cases. This initial phase of the pilot has established that the core principles of the project can be delivered in larger numbers, subject to developing new models of data capture and creation of clinically underpinned care algorithms.
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Hardy D, Winocour P, Moore-Haines K, Currie A, Solomon A, Renshaw C. ENHIDE telehealth primary care support of adults with diabetes and chronic kidney disease. Future Healthc J 2019; 6:143. [PMID: 31363659 PMCID: PMC6616706 DOI: 10.7861/futurehosp.6-1-s143] [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: 11/27/2022]
Affiliation(s)
- Dawn Hardy
- Diabetes and Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Peter Winocour
- Diabetes and Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Karen Moore-Haines
- Diabetes and Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Anne Currie
- Diabetes and Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Andrew Solomon
- Diabetes and Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - Claire Renshaw
- Diabetes and Endocrinology, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
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Winocour PH, Solomon A, Currie A, Hardy D, Moore-Haines K, Renshaw C. ENHIDE telehealth support for 148 disengaged young adults with type 1 diabetes: a pilot study – rationale and study design. Br J Diabetes 2018. [DOI: 10.15277/bjd.2018.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Disengaged young adults with type 1 diabetes are vulnerable to poor health outcomes. Potentially 20% of those aged 16–30 years could be included in this category. East and North Herts Clinical Commissioning Group (CCG) commissioned the East and North Herts Institute of Diabetes and Endocrinology (ENHIDE) to pilot an innovative model of care in August 2016. Young adults aged 16–30 were offered an alternative model of tailored care, with access to a young adult support worker and specialist nurse. Inclusion in the project was based on fulfilling at least one of the following criteria:Acute admission with diabetic ketoacidosis or hypoglycaemiaNon-attendance for retinal screeningNon-attendance at clinics on at least two consecutive occasionsPersistent HbA1c levels >75 mmol/molNon-attendance for routine laboratory measures of glycaemia and renal functionMultidisciplinary team review stating need for more flexible careWe invited 148 young adults to participate in the project. Of these, 118 have been recruited after the initial contact, markedly exceeding the 10% take-up rate set by the CCG. The project will evaluate changes in emergency admissions, attendance for routine biochemical tests and retinal screening, changes in glycaemic control and quality of life measures at 6 and 12 months after entry to the project
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Grando A, Manataki A, Furniss SK, Duncan B, Solomon A, Kaufman D, Hirn S, Sunday R, Bouchereau J, Doebbeling B, Burton MM, Poterack KA, Miksch T, Helmers RA. Multi-Method Study of Electronic Health Records Workflows. AMIA Annu Symp Proc 2018; 2018:498-507. [PMID: 30815090 PMCID: PMC6371265] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
EHRs transform work practices in ways that enhance or impede the quality of care. There is a need for in-depth analysis of EHR workflows, particularly in complex clinical environments. We investigated EHR-basedpre-operative workflows by combining findings from 18 interviews, 7 days of observations, and process mining of EHR interactions from 31 personnel caring for 375 patients at one tertiary referral center. We provided high-definition descriptions of workflows and personnel roles. One third (32.2%) of the time with each patient was spent interacting with the EHR and 4.2% using paper-based artifacts. We also mined personnel social networks validating observed personnel's EHR-interactions. When comparing workflows between two similar pre-operative settings at different hospitals, we found significant differences in physical organization, patient workflow, roles, use of EHR, social networks and time efficiency. This study informs Mayo Clinic's enterprise-wide conversion to a single EHR and will guide before and after workflow comparisons.
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Affiliation(s)
- Adela Grando
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Areti Manataki
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Stephanie K Furniss
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Benjamin Duncan
- Department of Biomedical Informatics, Arizona State University, AZ, US
| | - Andrew Solomon
- Department of Biomedical Informatics, Arizona State University, AZ, US
| | - David Kaufman
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Sarah Hirn
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Robert Sunday
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Joanne Bouchereau
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Brad Doebbeling
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
- School for the Science of Healthcare Delivery, Arizona State University, AZ, US
| | - Matthew M Burton
- Department of Biomedical Informatics, Arizona State University, AZ, US
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | | | - Tim Miksch
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
| | - Richard A Helmers
- Office of Information and Knowledge Management, Mayo Clinic, Rochester, MN, US
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Dworkin JD, Sati P, Solomon A, Pham DL, Watts R, Martin ML, Ontaneda D, Schindler MK, Reich DS, Shinohara RT. Automated Integration of Multimodal MRI for the Probabilistic Detection of the Central Vein Sign in White Matter Lesions. AJNR Am J Neuroradiol 2018; 39:1806-1813. [PMID: 30213803 DOI: 10.3174/ajnr.a5765] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/25/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE The central vein sign is a promising MR imaging diagnostic biomarker for multiple sclerosis. Recent studies have demonstrated that patients with MS have higher proportions of white matter lesions with the central vein sign compared with those with diseases that mimic MS on MR imaging. However, the clinical application of the central vein sign as a biomarker is limited by interrater differences in the adjudication of the central vein sign as well as the time burden required for the determination of the central vein sign for each lesion in a patient's full MR imaging scan. In this study, we present an automated technique for the detection of the central vein sign in white matter lesions. MATERIALS AND METHODS Using multimodal MR imaging, the proposed method derives a central vein sign probability, πij, for each lesion, as well as a patient-level central vein sign biomarker, ψi. The method is probabilistic in nature, allows site-specific lesion segmentation methods, and is potentially robust to intersite variability. The proposed algorithm was tested on imaging acquired at the University of Vermont in 16 participants who have MS and 15 participants who do not. RESULTS By means of the proposed automated technique, participants with MS were found to have significantly higher values of ψ than those without MS (ψMS = 0.55 ± 0.18; ψnon-MS = 0.31 ± 0.12; P < .001). The algorithm was also found to show strong discriminative ability between patients with and without MS, with an area under the curve of 0.88. CONCLUSIONS The current study presents the first fully automated method for detecting the central vein sign in white matter lesions and demonstrates promising performance in a sample of patients with and without MS.
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Affiliation(s)
- J D Dworkin
- From the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - P Sati
- Translational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - A Solomon
- Departments of Neurological Sciences (A.S.)
| | - D L Pham
- Center for Neuroscience and Regenerative Medicine (D.L.P.), Henry M. Jackson Foundation, Bethesda, Maryland
| | - R Watts
- Radiology (R.W.), Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - M L Martin
- From the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D Ontaneda
- Mellen Center for Multiple Sclerosis Treatment and Research (D.O.), Cleveland Clinic, Cleveland, Ohio
| | - M K Schindler
- Translational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - D S Reich
- Translational Neuroradiology Section (P.S., M.K.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Department of Neurology (D.S.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - R T Shinohara
- From the Department of Biostatistics, Epidemiology, and Informatics (J.D.D., M.L.M., R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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McCaffrey J, Alzahrani T, Mercader M, Solomon A, Tracy C. P6594Rate versus rhythm control in patients with atrial fibrillation and normal to mild left atrial enlargement: insights from the AFFIRM trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6594] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J McCaffrey
- George Washington University School of Medicine and Health Sciences, Washington, United States of America
| | - T Alzahrani
- George Washington University School of Medicine and Health Sciences, Washington, United States of America
| | - M Mercader
- George Washington University School of Medicine and Health Sciences, Washington, United States of America
| | - A Solomon
- George Washington University School of Medicine and Health Sciences, Washington, United States of America
| | - C Tracy
- George Washington University School of Medicine and Health Sciences, Washington, United States of America
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Hooshmand B, Polvikoski T, Kivipelto M, Tanskanen M, Myllykangas L, Mäkelä M, Oinas M, Paetau A, Solomon A. CAIDE Dementia Risk Score, Alzheimer and cerebrovascular pathology: a population-based autopsy study. J Intern Med 2018; 283:597-603. [PMID: 29411449 DOI: 10.1111/joim.12736] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND CAIDE Dementia Risk Score is a tool for estimating dementia risk in the general population. Its longitudinal associations with Alzheimer or vascular neuropathology in the oldest old are not known. AIM To explore the relationship between CAIDE Dementia Risk Score at baseline and neuritic plaques, neurofibrillary tangles, cerebral infarcts and cerebral amyloid angiopathy (CAA) after up to 10-year follow-up in the Vantaa 85 + population. METHODS Study population included 149 participants aged ≥85 years, without dementia at baseline, and with available clinical and autopsy data. Methenamine silver staining was used for β-amyloid and modified Bielschowsky method for neurofibrillary tangles and neuritic plaques. Macroscopic infarcts were identified from cerebral hemispheres, brainstem and cerebellum slices. Standardized methods were used to determine microscopic infarcts, CAA and α-synuclein pathologies. The CAIDE Dementia Risk Score was calculated based on scores for age, sex, BMI, total cholesterol, systolic blood pressure, physical activity and APOEε4 carrier status (range 0-18 points). RESULTS A CAIDE Dementia Risk Score above 11 points was associated with more cerebral infarctions up to 10 years later: OR (95% CI) was 2.10 (1.06-4.16). No associations were found with other neuropathologies. CONCLUSION In a population of elderly aged ≥85 years, higher CAIDE Dementia Risk Score was associated with increased risk of cerebral infarcts.
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Affiliation(s)
- B Hooshmand
- Aging Research Center, Karolinska Institute, Stockholm, Sweden.,Department of Neurology, Ulm University Hospital, Ulm, Germany
| | - T Polvikoski
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - M Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Stockholm, Sweden.,Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Geriatrics, Karolinska University Hospital, Stockholm, Sweden.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - M Tanskanen
- Department of Pathology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - L Myllykangas
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Stockholm, Sweden
| | - M Mäkelä
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Stockholm, Sweden
| | - M Oinas
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Stockholm, Sweden
| | - A Paetau
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Stockholm, Sweden
| | - A Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Stockholm, Sweden.,Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.,Department of Geriatrics, Karolinska University Hospital, Stockholm, Sweden
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Lowrence RC, Ramakrishnan A, Sundaramoorthy NS, Shyam A, Mohan V, Subbarao HMV, Ulaganathan V, Raman T, Solomon A, Nagarajan S. Norfloxacin salts of carboxylic acids curtail planktonic and biofilm mode of growth in ESKAPE pathogens. J Appl Microbiol 2018; 124:408-422. [PMID: 29178633 DOI: 10.1111/jam.13651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 09/14/2017] [Accepted: 11/17/2017] [Indexed: 12/19/2022]
Abstract
AIMS To enhance the antimicrobial and antibiofilm activity of norfloxacin against the planktonic and biofilm mode of growth in ESKAPE pathogens using chemically modified norfloxacin salts. METHODS AND RESULTS Antimicrobial testing, synergy testing and time-kill curve analysis were performed to evaluate antibacterial effect of norfloxacin carboxylic acid salts against ESKAPE pathogens. In vivo efficacy to reduce bacterial bioburden was evaluated in zebrafish infection model. Crystal violet assay and live-dead staining were performed to discern antibiofilm effect. Membrane permeability, integrity and molecular docking studies were carried out to ascertain the mechanism of action. The carboxylic acid salts, relative to parent molecule norfloxacin, displayed two- to fourfold reduction in minimum inhibitory concentration against Staphylococcus aureus and Pseudomonas aeruginosa, in addition to displaying potent bacteriostatic effect against certain members of ESKAPE pathogens. In vivo treatments revealed that norfloxacin tartrate (SRIN2) reduced MRSA bioburden by greater than 1 log fold relative to parent molecule in the muscle tissue. In silico docking with gyrA of S. aureus showed increased affinity of SRIN2 towards DNA gyrase. The enhanced antibacterial effect of norfloxacin salts could be partially accounted by altered membrane permeability in S. aureus and perturbed membrane integrity in P. aeruginosa. Antibiofilm studies revealed that SRIN2 (norfloxacin tartrate) and SRIN3 (norfloxacin benzoate) exerted potent antibiofilm effect particularly against Gram-negative ESKAPE pathogens. The impaired colonization of both S. aureus and P. aeruginosa due to improved norfloxacin salts was further supported by live-dead imaging. CONCLUSION Norfloxacin carboxylic acid salts can act as potential alternatives in terms of drug resensitization and reuse. SIGNIFICANCE AND IMPACT OF THE STUDY Our study shows that carboxylic acid salts of norfloxacin could be effectively employed to treat both planktonic- and biofilm-based infections caused by select members of ESKAPE pathogens.
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Affiliation(s)
- R C Lowrence
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India.,Center for Research on Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - A Ramakrishnan
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - N S Sundaramoorthy
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - A Shyam
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - V Mohan
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - H M V Subbarao
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - V Ulaganathan
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - T Raman
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
| | - A Solomon
- Department of Chemistry, School of Engineering, Dayananda Sagar University, Bangalore, Karnataka, India
| | - S Nagarajan
- School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India.,Center for Research on Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA University, Thanjavur, Tamil Nadu, India
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Abstract
Compared with developmental stuttering, adult onset acquired stuttering is rare. However, several case reports describe acquired stuttering and an association with callosal pathology. Interestingly, these cases share a neuroanatomical localisation also demonstrated in developmental stuttering. We present a case of adult onset acquired stuttering associated with inflammatory demyelination within the corpus callosum. This patient's disfluency improved after the initiation of immunomodulatory therapy.
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Affiliation(s)
- Barbara McElwee Decker
- Department of Neurological Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Barry Guitar
- Department of Communication Sciences and Disorders, The University of Vermont, Burlington, Vermont, USA
| | - Andrew Solomon
- Department of Neurological Sciences, University of Vermont Medical Center, Burlington, Vermont, USA
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Solomon A, Kaushal P, Spies J, Caridi T. 4:21 PM Abstract No. 311 Preoperative uterine artery embolization may reduce blood loss during hysterectomy for select uterine leiomyomata. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.345] [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: 10/17/2022] Open
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Solomon A, Borodulin K, Ngandu T, Kivipelto M, Laatikainen T, Kulmala J. Self-rated physical fitness and estimated maximal oxygen uptake in relation to all-cause and cause-specific mortality. Scand J Med Sci Sports 2017; 28:532-540. [PMID: 28543703 DOI: 10.1111/sms.12924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 01/31/2023]
Abstract
This study investigated the longitudinal associations of self-rated physical fitness and estimated maximal oxygen uptake (VO2max) with all-cause and cause-specific mortality. A total of 59 741 participants in the Finnish National FINRISK Study Cohort had data on self-rated physical fitness and covariates. A subsample of 4823 participants had estimated VO2max data. Follow-up ranged from 3 to 38 years. Associations of self-rated physical fitness and VO2max with mortality were analyzed using multivariate Cox proportional hazard models. The study showed that poor self-rated physical fitness was related to all-cause mortality (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.8-2.0) and mortality due to cardiovascular (HR 2.0, 95% CI 1.9-2.2), cerebrovascular (HR 1.9, 95% CI 1.6-2.2) and respiratory diseases (HR 2.1, 95% CI 1.9-2.4), trauma (HR 1.7, 95% CI 1.3-2.0), infections (HR 1.8, 95% CI 1.3-2.7), dementia (HR 1.9, 95% CI 1.6-2.3), and cancer (HR 1.7, 95% CI 1.5-1.9). Coexisting higher age, physical inactivity, male gender, and severe chronic conditions further increased the risk. In men, higher VO2max was associated with a lower risk of lung cancer mortality (HR 0.8, 95% CI 0.7-0.96). Based on the results, self-rated physical fitness reflects a combination of unfavorable biological and lifestyle-related factors, which increase mortality risk. A simple question about perceived physical fitness may reveal at-risk individuals who would benefit from more intensive treatment of chronic conditions and other interventions aiming to promote better fitness and well-being.
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Affiliation(s)
- A Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Aging Research Center, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - K Borodulin
- Health Monitoring Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - T Ngandu
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - M Kivipelto
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Aging Research Center, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - T Laatikainen
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Joensuu, Finland.,Hospital District of North Karelia, Joensuu, Finland
| | - J Kulmala
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
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Smyth E, Solomon A, Birrell MA, Smallwood MJ, Winyard PG, Tetley TD, Emerson M. Influence of inflammation and nitric oxide upon platelet aggregation following deposition of diesel exhaust particles in the airways. Br J Pharmacol 2017; 174:2130-2139. [PMID: 28437857 PMCID: PMC5466527 DOI: 10.1111/bph.13831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/07/2017] [Accepted: 04/13/2017] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Exposure to nanoparticulate pollution has been implicated in platelet‐driven thrombotic events such as myocardial infarction. Inflammation and impairment of NO bioavailability have been proposed as potential causative mechanisms. It is unclear, however, whether airways exposure to combustion‐derived nanoparticles such as diesel exhaust particles (DEP) or carbon black (CB) can augment platelet aggregation in vivo and the underlying mechanisms remain undefined. We aimed to investigate the effects of acute lung exposure to DEP and CB on platelet activation and the associated role of inflammation and endothelial‐derived NO. Experimental Approach DEP and CB were intratracheally instilled into wild‐type (WT) and eNOS−/− mice and platelet aggregation was assessed in vivo using an established model of radio‐labelled platelet thromboembolism. The underlying mechanisms were investigated by measuring inflammatory markers, NO metabolites and light transmission aggregometry. Key Results Platelet aggregation in vivo was significantly enhanced in WT and eNOS−/− mice following acute airways exposure to DEP but not CB. CB exposure, but not DEP, was associated with significant increases in pulmonary neutrophils and IL‐6 levels in the bronchoalveolar lavage fluid and plasma of WT mice. Neither DEP nor CB affected plasma nitrate/nitrite concentration and DEP‐induced human platelet aggregation was inhibited by an NO donor. Conclusions and Implications Pulmonary exposure to DEP and subsequent platelet activation may contribute to the reports of increased cardiovascular risk, associated with exposure to airborne pollution, independent of its effects on inflammation or NO bioavailability.
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Affiliation(s)
- E Smyth
- Platelet Biology Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - A Solomon
- Platelet Biology Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - M A Birrell
- Respiratory Pharmacology, National Heart and Lung Institute, Imperial College London, London, UK
| | - M J Smallwood
- Inflammation Research Group, University of Exeter Medical School, Exeter, UK
| | - P G Winyard
- Inflammation Research Group, University of Exeter Medical School, Exeter, UK
| | - T D Tetley
- Lung Cell Biology Group, National Heart and Lung Institute, Imperial College London, London, UK
| | - M Emerson
- Platelet Biology Group, National Heart and Lung Institute, Imperial College London, London, UK
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Strandberg T, Levälahti E, Ngandu T, Solomon A, Kivipelto M, Kivipelto M, Ngandu T, Lehtisalo J, Laatikainen T, Soininen H, Strandberg T, Antikainen R, Jula A, Tuomilehto J, Peltonen M, Levälahti E, Lindström J, Rauramaa R, Pajala S, Hänninen T, Solomon A, Paajanen T, Mangialasche F. Health-related quality of life in a multidomain intervention trial to prevent cognitive decline (FINGER). Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2016.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Affiliation(s)
- Lucy-Anne Frank
- ST4 in Geriatric and Internal Medicine in the Department of Elderly Care, Lister Hospital, Stevenage SG1 4AB
| | - Andrew Solomon
- Consultant Physician in the Department of Endocrinology, Lister Hospital, Stevenage
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