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Hech B, Knych H, Desprez I, Weiner D, Ambros B. Pharmacokinetics of hydrorphone hydrochloride after intravenous and subcutaneous administration in ferrets (Mustela putorius furo). Vet Anaesth Analg 2024; 51:152-159. [PMID: 38158281 DOI: 10.1016/j.vaa.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To determine the pharmacokinetic profile of hydromorphone 0.2 mg kg-1 administered by the intravenous (IV) and subcutaneous (SC) route in ferrets. STUDY DESIGN Randomized, crossover study. ANIMALS A group of eight adult ferrets weighting (mean ± standard deviation) 1.02 ± 0.22 kg. METHODS Hydromorphone hydrochloride 0.2 mg kg-1 was administered IV or SC with a washout period of 7 days. Blood samples were collected from a jugular catheter before administration of hydromorphone and at 5, 10, 15, 20, 30, 45, 60, 90, 120, 240, 360, 480 and 720 minutes after hydromorphone administration. Plasma hydromorphone concentrations were determined by liquid chromatography/tandem mass spectrometry. Data were analyzed using a non-linear mixed effects model. RESULTS The hydromorphone effective half-life was (t1/2) 45 min-1. Systemic clearance (Cls) and the volume of distribution (Vdss) following IV administration were 84.8 mL kg-1 min-1 and 5.59 L kg-1, respectively. The maximum observed plasma concentration was 59.53 ± 14.02 ng mL-1 within 10 minutes following SC administration. The SC bioavailability was 102.0%. CONCLUSIONS AND CLINICAL RELEVANCE Administration of IV and SC hydromorphone (0.2 mg kg-1) was characterized by a high clearance, short terminal half-life and large volume of distribution. Hydromorphone plasma concentrations remained greater than 2 ng mL-1 for 2 hours in most ferrets, a threshold reported to provide antinociceptive effects in other species. Hydromorphone was well absorbed following SC injection, providing an alternative administration route for clinical use in ferrets.
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Affiliation(s)
- Bruna Hech
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Heather Knych
- KL Maddy Equine Analytical Pharmacology Lab, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Isabelle Desprez
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Barbara Ambros
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Bansal N, Weiner D, Sarnak M. Cardiovascular-Kidney-Metabolic Health Syndrome: What Does the American Heart Association Framework Mean for Nephrology? J Am Soc Nephrol 2024:00001751-990000000-00253. [PMID: 38421033 DOI: 10.1681/asn.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Nisha Bansal
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Daniel Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Mark Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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3
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Balevic SJ, Weiner D, Hornik CP, Cohen-Wolkowiez M, Gonzalez D, Wang X, Xu M, Abdel-Rahman SZ, Rytting E. Indomethacin Pharmacokinetics and Pharmacodynamics in Pregnancies With Preterm Labor: The Need for Dose-Ranging Trials. J Clin Pharmacol 2024. [PMID: 38315120 DOI: 10.1002/jcph.2412] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
The use of indomethacin to delay delivery in preterm labor (PTL) is widely accepted; however, the optimal dosage of indomethacin in pregnancy is unknown. Here, we perform population pharmacokinetic (PK) and pharmacodynamic (PD) analyses, characterize the plasma disposition of indomethacin in pregnant women with PTL, and relate indomethacin exposure to delayed delivery and maternal/neonatal safety. We analyzed plasma and urine samples collected from a multicenter, prospective, opportunistic PK/PD study of indomethacin in pregnant women 12-32 weeks gestation admitted with PTL. Ninety-four participants with 639 plasma concentrations for indomethacin were included in the analysis. The final population PK (popPK) model for indomethacin was a 2-compartment structural model with first-order absorption and elimination and a covariate effect of body mass index on apparent oral clearance. We observed a 21%-60% increase in apparent oral clearance observed during pregnancy. There was no clear association between indomethacin exposure and maternal or neonatal safety outcomes, or with the magnitude of delayed delivery; however, 96.7% of women treated with indomethacin had a delivery that was delayed at least 48 hours. Given the changes to indomethacin apparent oral clearance during pregnancy, and the lack of relationship between indomethacin exposure and safety, dose-finding studies of indomethacin in pregnant women with PTL may help clarify the most safe and efficacious dosage and duration of indomethacin.
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Affiliation(s)
- Stephen J Balevic
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Daniel Weiner
- Department of Medicine, Duke University, Durham, NC, USA
| | - Christoph P Hornik
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Daniel Gonzalez
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Xiaoming Wang
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Meixiang Xu
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Sherif Z Abdel-Rahman
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Erik Rytting
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
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Powell JR, Al Qaraghuli F, Fiedler-Kelly J, Gonzalez D, Weiner D. Dabigatran Dosing Proposal for Adults With Atrial Fibrillation: Stress-Testing Renal Function Range in Real World Patients. Clin Pharmacol Ther 2023; 114:362-370. [PMID: 37026424 DOI: 10.1002/cpt.2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023]
Abstract
Dabigatran is the first of four direct-acting oral anticoagulants approved to prevent stroke in adult patients with atrial fibrillation using a fixed two-dose scheme compared with warfarin dosing adjusted to a prothrombin time range associated with optimal risk reduction in stroke and serious bleeding. The pivotal phase III trial found dabigatran, depending on dose, is superior to warfarin in stroke reduction and similar in bleeding risk while also showing dabigatran efficacy and safety correlate with steady-state plasma concentrations. Because the relationship between dabigatran dose and plasma concentration is highly variable, a previously developed population pharmacokinetic model of over 9,000 clinical trial patients was used as a basis for simulations comparing the performance of dosing via the drug label to other proposed doses and regimens. Assessment of dosing regimen performance was based on simulations of trough plasma levels within the therapeutic concentration range of 75-150 ng/mL over a renal function range of 15-250 mL/min creatinine clearance, representing extremes for real-world patients. An improved regimen that best achieves this therapeutic range was identified, requiring five different dosing schedules, corresponding to specified renal function ranges, compared with the two approved in the label. The discussion focuses on how this information could better inform patient outcomes and future dabigatran development.
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Affiliation(s)
- J Robert Powell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Weiner
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Begishev IA, Dorrer C, Bahk SW, Bucht S, Feng C, Guardalben MJ, Jeon C, Mileham C, Roides RG, Spilatro M, Webb B, Weiner D, Zuegel JD, Bromage J. Final amplifier of an ultra-intense all-OPCPA system with 13-J output signal energy and 41% pump-to-signal conversion efficiency. Opt Express 2023; 31:24785-24795. [PMID: 37475297 DOI: 10.1364/oe.492745] [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] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/17/2023] [Indexed: 07/22/2023]
Abstract
Optical parametric chirped-pulse amplification (OPCPA) using high-energy Nd:glass lasers has the potential to produce ultra-intense pulses (>1023 W/cm2). We report on the performance of the final high-efficiency amplifier in an OPCPA system based on large-aperture (63 × 63-mm2) partially deuterated potassium dihydrogen phosphate (DKDP) crystals. The seed beam (180-nm bandwidth, 110 mJ) was provided by the preceding OPCPA stages. A maximum pump-to-signal conversion efficiency of 41% and signal energy up to 13 J were achieved with a 52-mm-long DKDP crystal due to the flattop super-Gaussian pump beam profile and flat-in-time pulse shape.
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Silberzweig J, Wu S, Sinclair M, Watson T, Welder N, Concepcion D, Yee J, Speed F, Cukor D, Schiller B, Weiner D. Response to COVID-19: The Outpatient Dialysis Setting. Clin J Am Soc Nephrol 2023; 18:01277230-990000000-00061. [PMID: 36795086 PMCID: PMC10356158 DOI: 10.2215/cjn.0000000000000091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jeffrey Silberzweig
- Division of Nephrology, Weill Medical College of Cornell University, New York, New York
- The Rogosin Institute, New York, New York
| | - Sylvia Wu
- Division of Nephrology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Matthew Sinclair
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Nancy Welder
- DaVita Inc, Regulatory Affairs, Denver, Colorado
| | - Danilo Concepcion
- Providence St Joseph Heritage Medical Group, Renal Services, Orange, California
| | - Jerry Yee
- Internal Medicine/Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Felicia Speed
- Social Work Services, Fresenius Medical Care North America, Waltham, Massachusetts
| | - Daniel Cukor
- Behavioral Health, The Rogosin Institute, New York, New York
| | - Brigitte Schiller
- Medical Affairs, Satellite Healthcare, San Jose, California
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Daniel Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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Knych HK, Weiner D, Harrison L, McKemie DS. Pharmacokinetics and pharmacodynamics of intra-articular isoflupredone following administration to horses with lipopolysaccharide-induced synovitis. BMC Vet Res 2022; 18:436. [PMID: 36514067 PMCID: PMC9746120 DOI: 10.1186/s12917-022-03537-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Intra-articular corticosteroids, such as isoflupredone acetate, are commonly used in the treatment of joint inflammation, especially in performance horses. Following administration in a non-inflamed joints blood concentrations of isoflupredone were low and detectable for only a short period of time post-administration compared to synovial fluid concentrations. For some drugs, inflammation can affect pharmacokinetics, therefore, the goal of the current study was to describe the pharmacokinetics of isoflupredone acetate following intra-articular administration using a model of acute synovitis. Secondarily, pharmacodynamic effects, including effects on joint circumference, joint flexion, and lameness following intra-articular administration of isoflupredone acetate in the experimental model were described. METHODS Sixteen horses received a single intra-articular dose of 8 mg of isoflupredone acetate or saline 12 h post-administration of lipopolysaccharide. Blood and urine samples were collected up to 72 h and synovial fluid for 28 days post-administration, drug concentrations determined by liquid chromatography- mass spectrometry and pharmacokinetic analysis performed. Joint circumference, maximum angle of pain free joint flexion and lameness were evaluated prior to and post-treatment. RESULTS The maximum isoflupredone plasma concentration was 2.45 ± 0.61 ng/mL at 2.5 ± 0.75 h and concentrations were less than the limit of quantitation by 72 h. Isoflupredone was below detectable concentrations in urine by 72 h post-administration in all horses and no longer detectable in synovial fluid by 96 h post-administration. Joint circumference was significantly decreased in the isoflupredone treatment group compared to the saline group at 24 and 48 h post drug administration. Pain free joint flexion was significantly different between the saline and isoflupredone treatment groups on day 4 post-treatment. CONCLUSIONS Synovial fluid concentrations and maximum plasma concentrations of isoflupredone differed slightly between the current study and a previous one describing administration into a non-inflamed joint, however, the detection time of isoflupredone in blood was comparable. Effects of isoflupredone on joint circumference and degree of pain free joint flexion suggest a short duration of effect with respect to alleviation of lipopolysaccharide induced synovitis, however, results of this study support future studies of the anti-inflammatory effects of intra-articular isoflupredone acetate.
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Affiliation(s)
- Heather K. Knych
- grid.27860.3b0000 0004 1936 9684K.L. Maddy Equine Analytical Pharmacology Laboratory, School of Veterinary Medicine, University of California, 620 West Health Science Drive, Davis, CA 95616 USA ,grid.27860.3b0000 0004 1936 9684Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA USA
| | | | | | - Daniel S. McKemie
- grid.27860.3b0000 0004 1936 9684K.L. Maddy Equine Analytical Pharmacology Laboratory, School of Veterinary Medicine, University of California, 620 West Health Science Drive, Davis, CA 95616 USA
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8
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Weiner D, Powell JR, Patterson JH, Tyson R, Gehi A, Moll S, Konicki R, Al Qaraghuli F, Campbell KB, Kashuba AD, Gonzalez D. Leveraging a Previously Published Population Pharmacokinetic Model to Predict Rivaroxaban Exposure in Real-World Patients. J Clin Pharmacol 2022; 62:1518-1527. [PMID: 35808944 PMCID: PMC9669199 DOI: 10.1002/jcph.2122] [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: 04/26/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022]
Abstract
Population pharmacokinetic (PK)/pharmacodynamic models are commonly used to inform drug dosing; however, often real-world patients are not well represented in the clinical trial population. We sought to determine how well dosing recommended in the rivaroxaban drug label results in exposure for real-world patients within a reference area under the concentration-time curve (AUC) range. To accomplish this, we assessed the utility of a prior published rivaroxaban population PK model to predict exposure in real-world patients. We used the model to predict rivaroxaban exposure for 230 real-world patients using 3 methods: (1) using patient phenotype information only, (2) using individual post hoc estimates of clearance from the prior model based on single PK samples of rivaroxaban collected at steady state without refitting of the prior model, and (3) using individual post hoc estimates of clearance from the prior model based on PK samples of rivaroxaban collected at steady state after refitting of the prior model. We compared the results across 3 software packages (NONMEM, Phoenix NLME, and Monolix). We found that while the average patient-assigned dosing per the drug label will likely result in the AUC falling within the reference range, AUC for most individual patients will be outside the reference range. When comparing post hoc estimates, the average pairwise percentage differences were all <10% when comparing the software packages, but individual pairwise estimates varied as much as 50%. This study demonstrates the use of a prior published rivaroxaban population PK model to predict exposure in real-world patients.
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Affiliation(s)
- Daniel Weiner
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J. Robert Powell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J. Herbert Patterson
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Tyson
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anil Gehi
- Division of Cardiology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephan Moll
- Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robyn Konicki
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Angela D.M. Kashuba
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Balevic SJ, Randell R, Weiner D, Beard C, Schanberg LE, Hornik CP, Cohen-Wolkowiez M, Gonzalez D. Pharmacokinetics of hydroxychloroquine in paediatric lupus: data from a novel, direct-to-family clinical trial. Lupus Sci Med 2022; 9:9/1/e000811. [PMID: 36328395 PMCID: PMC9639143 DOI: 10.1136/lupus-2022-000811] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Objective Determine the pharmacokinetics (PK) and exposure–response of hydroxychloroquine (HCQ) and desethylhydroxychloroquine (DHCQ) in paediatric SLE (pSLE). Methods We conducted an exploratory phase 2, direct-to-family trial. Children enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry with a diagnosis of pSLE were eligible if they were receiving HCQ as standard of care for ≥3 months. Biological samples were collected at up to four visits over a 6-month period. At each visit, plasma was obtained to measure the concentrations of HCQ and DHCQ, as well as cytokines. HCQ and DHCQ plasma PK data were analysed using a population PK modelling approach. Results Twenty-five subjects provided a total of 88 plasma concentrations for PK analysis. There was a poor linear fit between HCQ concentrations and total body weight (R2=0.03). There was a decline in both interferon (IFN)-alpha and IFN-gamma with higher concentrations of HCQ and DHCQ. Volume of distribution for HCQ in plasma was higher in children compared with published values in adults (73 000 L vs 44 000 L), but clearance values in children were similar to adults. Conclusions We report the first population PK model for HCQ and DHCQ in children using data from a novel direct-to-family clinical trial. We observed high interindividual variability in HCQ PK and found that weight-based dosing for HCQ is poorly correlated with drug concentrations, suggesting the need to use therapeutic drug monitoring to individualise dosing. Furthermore, our results suggest that the current weight-based dosing paradigm for HCQ may result in suboptimal drug exposures, particularly for children with obesity. Accordingly, additional studies of HCQ are needed in pSLE to determine the optimal drug concentration and dosing to reduce disease activity and improve outcomes. Trial registration number NCT04358302.
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Affiliation(s)
- Stephen J Balevic
- Pediatric Rheumatology, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rachel Randell
- Pediatric Rheumatology, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Daniel Weiner
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claire Beard
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Laura Eve Schanberg
- Pediatric Rheumatology, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kabadi N, Adrian P, Stoeckl C, Sorce A, Sio HW, Bedzyk M, Evans T, Ivancic S, Katz J, Knauer J, Pearcy J, Weiner D, Betti R, Birkel A, Cao D, Johnson MG, Regan SP, Petrasso RD, Frenje J. The phase-2 particle x-ray temporal diagnostic for simultaneous measurement of multiple x-ray and nuclear emission histories from OMEGA implosions (invited). Rev Sci Instrum 2022; 93:103538. [PMID: 36319383 DOI: 10.1063/5.0101648] [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: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Electron-temperature (Te) measurements in implosions provide valuable diagnostic information, as Te is negligibly affected by residual flows and other non-thermal effects unlike ion-temperature inferred from a fusion product spectrum. In OMEGA cryogenic implosions, measurement of Te(t) can be used to investigate effects related to time-resolved hot-spot energy balance. The newly implemented phase-2 Particle X-ray Temporal Diagnostic (PXTD) utilizes four fast-rise (∼15 ps) scintillator-channels with distinct x-ray filtering. Titanium and stepped aluminum filtering were chosen to maximize detector sensitivity in the 10-20 keV range, as it has been shown that these x rays have similar density and temperature weighting to the emitted deuterium-tritium fusion neutrons (DTn) from OMEGA Cryo-DT implosions. High quality data have been collected from warm implosions at OMEGA. These data have been used to infer spatially integrated Te(t) with <10% uncertainty at peak emission. Nuclear and x-ray emission histories are measured with 10 ps relative timing uncertainty for x rays and DTn and 12 ps for x rays and deuterium-He3 protons (D3Hep). A future upgrade to the system will enable spatially integrated Te(t) with 40 ps time-resolution from cryogenic DT implosions.
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Affiliation(s)
- N Kabadi
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - P Adrian
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - C Stoeckl
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - A Sorce
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - H W Sio
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Bedzyk
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - T Evans
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - S Ivancic
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - J Katz
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - J Knauer
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - J Pearcy
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - D Weiner
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - R Betti
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - A Birkel
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - D Cao
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - M Gatu Johnson
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - S P Regan
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - R D Petrasso
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - J Frenje
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
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Weiner D, Ly A, Talluru S, Ambinder R, Rozati S. Clinical outcomes of single-agent chemotherapy in a diverse cohort of patients with recalcitrant cutaneous T-cell lymphoma. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00594-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Talluru S, Weiner D, Ly A, Fazal M, Rozati S. Investigating clinical characteristics and outcomes of CTCL patients with a history of eczema: retrospective review at a single tertiary referral center. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00622-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Talluru S, Weiner D, Singh D, Zeng Z, Connor S, Burns A, Smith K, Rozati S. Single-cell RNA sequencing reveals race-based heterogeneity of malignant T-cells and skin microenvironment in patients with cutaneous T-cell lymphoma. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Balevic SJ, Weiner D, Clowse MEB, Eudy AM, Maharaj AR, Hornik CP, Cohen-Wolkowiez M, Gonzalez D. Hydroxychloroquine PK and exposure-response in pregnancies with lupus: the importance of adherence for neonatal outcomes. Lupus Sci Med 2022; 9:9/1/e000602. [PMID: 34996856 PMCID: PMC8744126 DOI: 10.1136/lupus-2021-000602] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Evaluate the impact of pregnancy physiology and medication non-adherence on serum hydroxychloroquine (HCQ) pharmacokinetics (PK) and exposure-response in SLE. METHODS We conducted a PK analysis using data from two observational pregnancy registries. We enrolled pregnant women with SLE taking HCQ at least 3 months prior to, and throughout pregnancy, and excluded those with multiple gestations. Using the PK model, we conducted dosing simulations and imputed 0%/20%/40%/60% non-adherence to evaluate the impact of adherence versus physiological changes on HCQ concentrations. We compared the effect of pregnancy-average non-adherent concentrations (≤100 ng/mL vs >100 ng/mL) on preterm birth using adjusted logistic regression. RESULTS We enrolled 56 women who had 61 pregnancies. By the third trimester, mean apparent HCQ clearance increased by 59.6%. At a dosage of 400 mg/day, fully adherent patients are expected to have HCQ concentrations ≤100 ng/mL only 0.3% of the time, compared with 24.2% when 60% of doses are missed. Persistently low HCQ concentrations throughout pregnancy were associated with a significantly higher odds of preterm birth, controlling for lupus nephritis and race (OR 11.2; 95% CI 2.3 to 54.2; p=0.003). CONCLUSIONS We observed significant changes in HCQ PK during pregnancy, resulting in a shortening in the drug's half-life by 10 days; however, medication non-adherence had a more pronounced effect on HCQ exposure compared with physiological changes alone. Moreover, pregnant women with non-adherent HCQ concentrations had significantly higher rates of preterm birth. Accordingly, optimising adherence in pregnancy may be more clinically meaningful than adjusting HCQ dosage to account for physiological changes. PK modelling indicates that serum HCQ concentrations ≤100 ng/mL are suggestive of non-adherence regardless of trimester and may help identify pregnancies at risk for poor outcomes.
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Affiliation(s)
- Stephen J Balevic
- Department of Pediatrics, Duke University, Durham, North Carolina, USA .,Duke Clinical Research Institute, Durham, North Carolina, USA.,Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Daniel Weiner
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Megan E B Clowse
- Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Amanda M Eudy
- Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Anil R Maharaj
- Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Christoph P Hornik
- Department of Pediatrics, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Miller LM, Kurella Tamura M, Pajewski NM, Rifkin D, Weiner D, Marquine M, Shlipak MG, Ix JH. The Relationship of Kidney Tubule Biomarkers with Brain Imaging in CKD Patients in SPRINT. Kidney360 2021; 3:337-340. [PMID: 35373134 PMCID: PMC8967647 DOI: 10.34067/kid.0007702021] [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] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023]
Abstract
Urine biomarker concentrations reflecting kidney tubule injury and dysfunction were not associated with brain MRI measures.Higher eGFR was associated with lower total brain cerebral blood flow.This is the first evaluation of the relationship of kidney tubule biomarkers with brain imaging by MRI in patients with CKD.
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Affiliation(s)
- Lindsay M. Miller
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, California,Correspondence: Dr. Lindsay M. Miller, Veterans Medical Research Foundation, Room 117B, Building 13, 3350 La Jolla Village Drive #151A, San Diego, CA 92161.
| | - Manjula Kurella Tamura
- Department of Medicine-Nephrology, Stanford University, Palo Alto, California,Geriatric Research Education and Clinical Center, Veterans Affairs, Palo Alto, Palo Alto, California,Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dena Rifkin
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Daniel Weiner
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Maria Marquine
- Department of Medicine and Psychiatry, University of California San Diego, San Diego, California
| | - Michael G. Shlipak
- Division of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California,Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco, San Francisco, California,General Internal Medicine Division, San Francisco Veterans Affairs Healthcare System, San Francisco, California
| | - Joachim H. Ix
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
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16
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Weiner D, Menzaghi F, Wen W, Qian J, Munera C, Bhaduri S. FC 022AN OPEN-LABEL, MULTICENTER STUDY TO EVALUATE THE SAFETY AND EFFECTIVENESS OF INTRAVENOUS DIFELIKEFALIN IN PATIENTS WITH MODERATE-TO-SEVERE CKD–ASSOCIATED PRURITUS UNDERGOING HEMODIALYSIS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab133.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Chronic kidney disease–associated pruritus (CKD-aP) is a common and highly distressing condition in patients undergoing hemodialysis (HD). CKD-aP is associated with sleep disturbances, significant quality-of-life (QoL) impairment, and increased morbidity and mortality. Difelikefalin (DFK) is a selective kappa opioid receptor agonist in development for CKD-aP that has minimal central nervous system penetration. In placebo-controlled phase 3 trials of patients with moderate to severe CKD-aP undergoing HD, intravenous (IV) DFK had an acceptable safety profile and demonstrated significant reductions vs placebo in itch intensity. We report safety and effectiveness outcomes, including itch-related QoL and sleep measures, from a phase 3 open-label study of DFK in patients with moderate to severe CKD-aP.
Method
This multicenter, open-label study conducted in the United States and Europe enrolled patients with moderate to severe CKD-aP (mean baseline 24-hour Worst Itching Intensity Numerical Rating Scale [WI-NRS] score ≥5) undergoing HD for ≥3 months. Patients received IV DFK 0.5 mcg/kg 3 times/week at the end of each HD session for up to 12 weeks. Predefined effectiveness endpoints at week 12 included ≥3-point and ≥4-point improvement in the weekly mean of the 24-hour WI-NRS score (range from 0 [no itching] to 10 [worst itching imaginable]). Change from baseline in QoL at week 12 was assessed using the 5-D itch and Skindex-10, multidimensional itch-related questionnaires validated in CKD-aP (higher scores indicate worse QoL). The proportion of patients with no problems (score of 1) on the skin irritation and self-confidence domains of the EQ-PSO questionnaire was evaluated. Post hoc endpoints included complete resolution in WI-NRS (≥75% of week 12 scores 0 or 1) and Sleep Quality Questionnaire total score assessments (range of possible scores, 0 [did not interfere] to 10 [completely interfered]), including ≥3-point and ≥4-point improvement in weekly mean score and complete resolution (all scores of 0) at week 12. Safety assessments and adverse events (AEs) were evaluated. Data were summarized descriptively.
Results
Among 222 patients who received DFK, 197 (88.7%) completed the study. At baseline, mean ±SD age was 58.1 ±12.8 years and 54.5% of patients were male. Baseline mean ±SD WI-NRS score was 7.6 ±1.3, Sleep Quality score was 6.6 ±2.2, 5-D itch score was 17.1 ±3.5, and Skindex-10 score was 32.9 ±14.3. At week 12, the majority of patients achieved ≥3-point and ≥4-point improvement in WI-NRS (73.7% and 59.3%) and Sleep Quality score (66.0% and 56.7%). Complete resolution of WI-NRS and Sleep Quality score was observed in 29.4% and 19.1% of patients, respectively (Figure). DFK was associated with improvements in mean 5-D itch (−7.1 ±4.3) and Skindex-10 (−21.0 ±15.6) scores at week 12. The proportion of patients reporting no problems in the skin irritation EQ-PSO domain increased from 1.4% at baseline to 28.9% at week 12, and self-confidence EQ-PSO domain scores increased from 63.5% at baseline to 73.2% at week 12. Overall, 64.4% (143/222) of patients reported ≥1 treatment-emergent AE (TEAE). The most commonly reported TEAEs (≥4% of patients) were diarrhea (5.0% [11/222]), nausea (4.5% [10/222]), and hyperkalemia (4.1% [9/222]). Serious TEAEs were reported by 20.3% (45/222) of patients; no serious TEAEs were related to study drug.
Conclusion
In this phase 3 open-label study in patients with moderate to severe CKD-aP undergoing HD, DFK was generally well tolerated with an acceptable safety profile. DFK demonstrated effectiveness based on reduction of itch intensity, and improvements in sleep quality and itch-related QoL at week 12. The majority of patients reported ≥3-point or ≥4-point improvement in WI-NRS and Sleep Quality scores, with some reporting complete resolution. Findings from this open-label study provide insight into the potential real-world effectiveness of DFK in moderate to severe CKD-aP.
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Affiliation(s)
| | | | - Warren Wen
- Cara Therapeutics, Stamford, United States of America
| | - Jenny Qian
- Cara Therapeutics, Stamford, United States of America
| | | | - Sarbani Bhaduri
- Bhaduri Biotech Consulting, El Paso, United States of America
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17
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Weiner D, Fishbane S, Lynn R, Yang Y, Rosenbaum D. FC 077LONG-TERM SAFETY OF TENAPANOR FOR THE CONTROL OF SERUM PHOSPHORUS IN PATIENTS WITH CKD ON DIALYSIS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab123.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Tenapanor, a first-in-class, phosphate absorption inhibitor blocks the paracellular absorption of phosphate in the GI tract by local inhibition of the sodium-hydrogen exchanger (NHE3). It therefore provides a novel, non-binder approach for managing hyperphosphatemia. Tenapanor is dosed as one small pill twice daily. In three pivotal trials, tenapanor met its primary phosphorus-lowering outcome. This report evaluates long-term safety data from the longest of these trials.
Method
This 52-week study consisted of a 26-week, open-label, randomized treatment period with a 12-week placebo-controlled randomized withdrawal period, followed by a 14-week open label safety extension period. Maintenance dialysis patients with serum phosphorus ≥ 6.0 mg/dL and a 1.5 mg/dL increase in serum phosphorus following phosphate binder washout were randomized 3:1 to receive tenapanor 30 mg twice daily or sevelamer carbonate, dosed per package insert. At end of the randomized treatment period all patients in the tenapanor arm were re-randomized 1:1 to either tenapanor or placebo for the randomized withdrawal period followed by tenapanor for the safety extension period. Sevelamer was used as a safety control for comparisons of serious adverse events/hospitalizations to tenapanor.
Results
Tenapanor was generally well tolerated, with diarrhea the only adverse event reported by >5% of patients during the randomized treatment period. Diarrhea was typically mild-to-moderate in severity, transient, and occurred more commonly during the randomized treatment period than the randomized withdrawal or safety extension periods. Rates of serious adverse events leading to hospitalization were higher in patients treated with sevelamer than tenapanor (35.8% vs 24.6%). The highest reported percentages of serious adverse events were infections and infestations (16.1% vs 9.3%) cardiac disorders (8.0% vs 5.7%), respiratory, thoracic and mediastinal disorders (8.8% vs 5.5%), and metabolism and nutritional disorders (7.3% vs 3.6%) for sevelamer and tenapanor, respectively. Adverse events leading to death were higher in patients treated with sevelamer than tenapanor (3.6% vs 2.9%).
Conclusion
Among maintenance dialysis patients with hyperphosphatemia, tenapanor, a novel, non-binder, phosphate absorption inhibitor that blocks paracellular absorption of phosphorus with a one tablet twice daily dose, has an acceptable safety profile, and, if approved, may offer a new approach to the treatment of hyperphosphatemia.
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Affiliation(s)
- Daniel Weiner
- Tufts Medical Center, Nephrology, Boston, United States of America
| | - Steven Fishbane
- Northwell Health, Nephrology, Manhasset, United States of America
| | - Robert Lynn
- Kidney Medical Associates, Bronx, United States of America
| | - Yang Yang
- Ardelyx, Inc., Waltham, United States of America
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18
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Kabadi N, Sorce A, Stoeckl C, Sio HW, Adrian P, Bedzyk M, Frenje J, Katz J, Knauer J, Pearcy J, Weiner D, Aguirre BA, Betti R, Birkel A, Cao D, Gatu Johnson M, Patel D, Petrasso RD, Regan SP. A multi-channel x-ray temporal diagnostic for measurement of time-resolved electron temperature in cryogenic deuterium-tritium implosions at OMEGA. Rev Sci Instrum 2021; 92:023507. [PMID: 33648078 DOI: 10.1063/5.0042329] [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: 12/29/2020] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
Electron-temperature (Te) measurements in implosions provide valuable diagnostic information, as Te is unaffected by residual flows and other non-thermal effects unlike ion temperature inferred from a fusion product spectrum. In OMEGA cryogenic implosions, measurement of Te(t) can be used to investigate effects related to time-resolved hot-spot energy balance. The proposed diagnostic utilizes five fast-rise (∼15 ps) scintillator channels with distinct x-ray filtering. Titanium and stepped aluminum filtering were chosen to maximize detector sensitivity in the 10 keV-20 keV range, as it has been shown that these x rays have similar density and temperature weighting to the emitted deuterium-tritium fusion neutrons. Initial data collected using a prototype nosecone on the existing neutron temporal diagnostic demonstrate the validity of this diagnostic technique. The proposed system will be capable of measuring spatially integrated Te(t) with 20 ps time resolution and <10% uncertainty at peak emission in cryogenic DT implosions.
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Affiliation(s)
- N Kabadi
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - A Sorce
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - C Stoeckl
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - H W Sio
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - P Adrian
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - M Bedzyk
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - J Frenje
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - J Katz
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - J Knauer
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - J Pearcy
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - D Weiner
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - B A Aguirre
- Sandia National Laboratories, Albuquerque, New Mexico 87123, USA
| | - R Betti
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - A Birkel
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - D Cao
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - M Gatu Johnson
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - D Patel
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
| | - R D Petrasso
- Massachusetts Institute of Technology Plasma Science and Fusion Center, Cambridge, Massachusetts 02139, USA
| | - S P Regan
- University of Rochester Laboratory for Laser Energetics, Rochester, New York 14623, USA
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19
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Lacson E, Weiner D, Majchrzak K, Puryear W, Hosford J, Palmer A, Runstadler J, Meyer KB, Johnson DS. Prolonged Live SARS-CoV-2 Shedding in a Maintenance Dialysis Patient. Kidney Med 2020; 3:309-311. [PMID: 33521620 PMCID: PMC7834361 DOI: 10.1016/j.xkme.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Eduardo Lacson
- Dialysis Clinic, Inc, Nashville, TN.,Tufts Medical Center and Tufts University School of Medicine, Boston
| | - Daniel Weiner
- Tufts Medical Center and Tufts University School of Medicine, Boston
| | | | - Wendy Puryear
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | | | | | | | - Klemens B Meyer
- Tufts Medical Center and Tufts University School of Medicine, Boston
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20
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Bauer KA, Heimbueger M, Kwiatkowski J, Sampat S, Waxer LJ, Cost EC, Kelly JH, Kobilansky V, Morse SFB, Nelson D, Weiner D, Weselak G, Zou J. Optical characterization of the on-target OMEGA focal spot at high energy using the full-beam in-tank diagnostic. Appl Opt 2020; 59:7994-8002. [PMID: 32976475 DOI: 10.1364/ao.395505] [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] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/09/2020] [Indexed: 06/11/2023]
Abstract
The full-beam in-tank (FBIT) diagnostic has been deployed to directly measure the target-plane beam fluence profile, when operated at high energy, of the OMEGA Laser System at the University of Rochester's Laboratory for Laser Energetics. This paper presents the results of early measurements taken with this diagnostic and discusses an improvement that has overcome performance limitations discovered during the initial testing. The diagnostic gives new insight into the ability of the OMEGA Laser System to provide uniform fluence profiles that are consistent across all 60 beams in the laser. The ultimate goal of the FBIT diagnostic is to allow accurate assessment of the fluence uniformity on a spherical target in 60-beam implosion experiments.
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21
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Powell JR, Cook J, Wang Y, Peck R, Weiner D. Response to "Personalized Dosing = Approved Wide Dose Ranges + Dose Titration". Clin Pharmacol Ther 2020; 109:568. [PMID: 32864732 DOI: 10.1002/cpt.1995] [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] [Received: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022]
Affiliation(s)
- J Robert Powell
- Clinical Pharmacology Consultant, Chapel Hill, North Carolina, USA
| | - Jack Cook
- Clinical Pharmacology, Pfizer Inc, Groton, Connecticut, USA
| | - Yaning Wang
- Office of Clinical Pharmacology, Office of Translational Sciences, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Richard Peck
- Pharma Research & Early Development (pRED), Roche Innovation Center Basel, Basel, Switzerland
| | - Daniel Weiner
- Pharmacometrics Consultant, Chapel Hill, North Carolina, USA
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22
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Nowak KL, Chonchol M, Jovanovich A, You Z, Ambrosius WT, Cho ME, Glasser S, Lash J, Simmons DL, Taylor A, Weiner D, Rastogi A, Oparil S, Supiano MA. Arterial stiffness and kidney disease progression in the systolic blood pressure intervention trial
. Clin Nephrol 2020; 94:26-35. [PMID: 32449678 PMCID: PMC7814777 DOI: 10.5414/cn109982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 06/22/2020] [Indexed: 11/30/2022] Open
Abstract
AIMS Arterial stiffness increases with both advancing age and chronic kidney disease (CKD) and may contribute to kidney function decline, but evidence is inconsistent. We hypothesized that greater baseline arterial stiffness (assessed as pulse pressure (PP) and carotid-femoral pulse-wave velocity CFPWV)) was independently associated with kidney disease progression over the follow-up period (3.8 years) in the Systolic Blood Pressure Intervention Trial (SPRINT). MATERIALS AND METHODS 8,815 SPRINT participants were included in the analysis of PP. 592 adults who participated in a SPRINT ancillary study that measured CFPWV were included in subgroup analyses. Cox proportional hazards analysis was used to examine the association between PP and time to kidney disease progression endpoints: (A) incident estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 in non-CKD participants at baseline; (B) 50% decline in eGFR, initiation of dialysis, or transplant in those with baseline CKD. Mixed model analyses examined the association of baseline PP/CFPWV with follow-up eGFR. RESULTS AND CONCLUSION Mean ± SD age was 68 ± 10 years, baseline PP was 62 ± 14 mmHg, and CFPWV was 10.8 ± 2.7 m/s. In the fully adjusted model, PP ≥ median was associated with an increased hazard of kidney disease progression endpoints (HR: 1.93 (1.43 - 2.61)). The association remained significant in individuals without (2.05 (1.47 - 2.87)) but not with baseline CKD (1.28 (0.55 - 2.65)). In fully adjusted models, higher baseline PP associated with eGFR decline (p < 0.0001 (all, CKD, non-CKD)), but baseline CFPWV did not. Among older adults at high risk for cardiovascular events, baseline PP was associated with kidney disease progression.
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Affiliation(s)
- Kristen L. Nowak
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus
| | - Anna Jovanovich
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus
- Rocky Mountain Regional VA, Aurora, CO
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus
| | - Walter T. Ambrosius
- Department of Biostatistics and Data Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | | | - Debra L. Simmons
- University of Utah, Salt Lake City, UT
- VA Salt Lake City, Salt Lake City, UT
| | - Addison Taylor
- Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX
| | | | - Anjay Rastogi
- David Geffen School of Medicine, University of California, Los Angeles, CA, and
| | | | - Mark A. Supiano
- University of Utah, Salt Lake City, UT
- VA Salt Lake City Geriatric Research, Education and Clinical Center, Salt Lake City, UT, USA
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23
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Peck RW, Weiner D, Cook J, Robert Powell J. A Real-World Evidence Framework for Optimizing Dosing in All Patients With COVID-19. Clin Pharmacol Ther 2020; 108:921-923. [PMID: 32445484 PMCID: PMC7283813 DOI: 10.1002/cpt.1922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/29/2020] [Accepted: 05/17/2020] [Indexed: 11/21/2022]
Abstract
Potential treatments for coronavirus disease 2019 (COVID‐19) are being investigated at unprecedented speed, and successful treatments will rapidly be used in tens or hundreds of thousands of patients. To ensure safe and effective use in all those patents it is essential also to develop, at unprecedented speed, a means to provide frequently updated, optimal dosing information for all patient subgroups. Success will require immediate collaboration between drug developers, academics, and regulators.
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Affiliation(s)
- Richard W Peck
- Clinical Pharmacology, Pharma Research & Early Development, Roche Innovation Center, Basel, Switzerland
| | - Daniel Weiner
- Pharmacometrics Consultant, Chapel Hill, North Carolina, USA
| | - Jack Cook
- Clinical Pharmacology, Pfizer Inc, Groton, Connecticut, USA
| | - J Robert Powell
- Clinical Pharmacology Consultant, Chapel Hill, North Carolina, USA
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24
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Knych HK, Weiner D, Arthur RM, Baden R, McKemie DS, Kass PH. Serum concentrations, pharmacokinetic/pharmacodynamic modeling, and effects of dexamethasone on inflammatory mediators following intravenous and oral administration to exercised horses. Drug Test Anal 2020; 12:1087-1101. [PMID: 32436346 DOI: 10.1002/dta.2862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 11/10/2022]
Abstract
Corticosteroids are potent anti-inflammatory drugs and as such are commonly administered to performance and racehorses. The objectives of the current study were to describe blood and urine concentrations and the pharmacokinetics and effects on cortisol and inflammatory mediator concentrations, following intravenous and oral administration to 12 exercised horses. Horses received an intravenous administration of 40 mg of dexamethasone sodium phosphate and 20 mg of dexamethasone tablets with a 4 week washout in between administrations. Blood and urine samples were collected prior to and for up to 96 hours post drug administration. Whole blood samples were collected at various time points and challenged with lipopolysaccharide or calcium ionophore to induce ex vivo synthesis of eicosanoids. The concentrations of dexamethasone and eicosanoids were measured using LC-MS/MS and the concentrations from both routes of administration fit simultaneously using a three-compartment pharmacokinetic model. A turnover model with inhibition of Kin gave an adequate fit to the dexamethasone-cortisol PKPD data. Serum and urine dexamethasone concentrations were at the limit of quantitation at 96 and 48 hours post administration, respectively. The volume of distribution, systemic clearance, and terminal half-life was 0.907 L/kg, 7.89 mL/h/kg, and 1.34 h, respectively. The IC50 for cortisol suppression was 0.007 ng/mL. Stimulation of dexamethasone treated blood with lipopolysaccharide and calcium ionophore resulted in an inhibition of inflammatory biomarker production for a prolonged period of time post drug administration. The results of this study suggest that dexamethasone has a prolonged anti-inflammatory effect following intravenous or oral administration to horses.
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Affiliation(s)
- Heather K Knych
- K.L. Maddy Equine Analytical Pharmacology Laboratory, School of Veterinary Medicine, University of California Davis, CA, USA.,Department of Veterinary Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | | | - Rick M Arthur
- School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Russell Baden
- K.L. Maddy Equine Analytical Pharmacology Laboratory, School of Veterinary Medicine, University of California Davis, CA, USA
| | - Daniel S McKemie
- K.L. Maddy Equine Analytical Pharmacology Laboratory, School of Veterinary Medicine, University of California Davis, CA, USA
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA, USA
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25
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Konicki R, Weiner D, Herbert Patterson J, Gonzalez D, Kashuba A, Cao YC, Gehi AK, Watkins P, Powell JR. Rivaroxaban Precision Dosing Strategy for Real-World Atrial Fibrillation Patients. Clin Transl Sci 2020; 13:777-784. [PMID: 32267996 PMCID: PMC7359950 DOI: 10.1111/cts.12766] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/05/2019] [Accepted: 01/04/2020] [Indexed: 02/04/2023] Open
Abstract
Rivaroxaban is a direct-acting oral anticoagulant approved to prevent strokes in patients with atrial fibrillation. Dosage recommendations are approved for all adult patients to receive either 15 mg or 20 mg once daily depending upon renal function. There are a number of reasons to believe rivaroxaban dosing could be more effective and/or safer for more patients if increased dosing precision is available. Because real-world patients are more diverse than those studied in phase III clinical trials, we evaluated the extremes of creatinine clearance (CrCl) on rivaroxaban clearance using a published population pharmacokinetic model and applying exposure variation limits (±20%) based on published literature. The proposed dosing recommendations are 10 mg once daily (CrCl 15-29 ml/min), 15 mg once daily (CrCl 30-69 ml/min), 10 mg twice daily (CrCl 70-159 ml/min), and 15 mg twice daily (CrCl 160-250 ml/min). These new dosing recommendations should be prospectively tested for predictive accuracy and to assess the impact on AF patient efficacy and safety.
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Affiliation(s)
- Robyn Konicki
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Weiner
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J Herbert Patterson
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Angela Kashuba
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yanguang Carter Cao
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anil K Gehi
- Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul Watkins
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - J Robert Powell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Ramirez-Fort MK, Suarez P, Carrion M, Weiner D, Postl C, Arribas R, Sayyah M, Forta DV, Niaz MJ, Feily A, Lange CS, Fort ZZ, Fort M. Prostatic irradiation-induced sexual dysfunction: A review and multidisciplinary guide to management in the radical radiotherapy era (Part III on Psychosexual Therapy and the Masculine Self-Esteem). Rep Pract Oncol Radiother 2020; 25:625-631. [PMID: 32536830 DOI: 10.1016/j.rpor.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/20/2020] [Indexed: 01/16/2023] Open
Abstract
Psychological morbidity, sexuality, and health/system information have been identified as the highest areas of support needs in patients undergoing management of their prostate cancer (PCa). Management of a patient's sexual function prior to, during and after PCa radiotherapy requires multidisciplinary coordination of care between radiation oncologists, urologists, dermatologists, pharmacists, and psychiatrists. The finale of this three-part review provides a framework for clinicians to better understand the role of mental healthcare providers in the management of sexual toxicities associated with prostatic radiotherapy. The authors recommend that patients be referred for psychological evaluation and possibly to individual, couples or group general or cognitive behavioral sex therapy at the time of their PCa diagnosis, for a more specialized focus on management of sexual toxicities and sexual recovery. The importance and implications of the masculine self-esteem, sexual orientation, gender identification, cultural expectations, relationship status and patient education are reviewed. Well-informed patients tend to have a better quality of life outcomes compared to patients that take on a passive role in their cancer management.
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Affiliation(s)
- Marigdalia K Ramirez-Fort
- Life Sciences, BioFort Corp., Guaynabo, PR, USA
- Urology, Weill Cornell Medicine, New York, NY, USA
- Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, NY, USA
- Physiology and Pathology, San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Paula Suarez
- Physiology and Pathology, San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Margely Carrion
- Physiology and Pathology, San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Daniel Weiner
- Psychiatry, VA New Jersey Healthcare System, Lyons, NJ, USA
- Psychiatry, Robert Wood Johnson UMDNJ Hospital, New Brunswick, NJ, USA
| | - Claire Postl
- Urology, Ohio State University, Columbus, OH, USA
| | - Ricardo Arribas
- Psychiatry, San Juan Bautista School of Medicine, Caguas, PR, USA
| | - Mehdi Sayyah
- Psychiatry, Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Digna V Forta
- Life Sciences, BioFort Corp., Guaynabo, PR, USA
- Dermatology, Hospitales HIMA San Pablo, Bayamon, PR, USA
| | | | - Amir Feily
- Dermatology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Christopher S Lange
- Life Sciences, BioFort Corp., Guaynabo, PR, USA
- Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, NY, USA
| | | | - Migdalia Fort
- Life Sciences, BioFort Corp., Guaynabo, PR, USA
- Psychiatry, VA New Jersey Healthcare System, Lyons, NJ, USA
- Psychiatry, Robert Wood Johnson UMDNJ Hospital, New Brunswick, NJ, USA
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27
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Tyson RJ, Park CC, Powell JR, Patterson JH, Weiner D, Watkins PB, Gonzalez D. Precision Dosing Priority Criteria: Drug, Disease, and Patient Population Variables. Front Pharmacol 2020; 11:420. [PMID: 32390828 PMCID: PMC7188913 DOI: 10.3389/fphar.2020.00420] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
Abstract
The administered dose of a drug modulates whether patients will experience optimal effectiveness, toxicity including death, or no effect at all. Dosing is particularly important for diseases and/or drugs where the drug can decrease severe morbidity or prolong life. Likewise, dosing is important where the drug can cause death or severe morbidity. Since we believe there are many examples where more precise dosing could benefit patients, it is worthwhile to consider how to prioritize drug–disease targets. One key consideration is the quality of information available from which more precise dosing recommendations can be constructed. When a new more precise dosing scheme is created and differs significantly from the approved label, it is important to consider the level of proof necessary to either change the label and/or change clinical practice. The cost and effort needed to provide this proof should also be considered in prioritizing drug–disease precision dosing targets. Although precision dosing is being promoted and has great promise, it is underutilized in many drugs and disease states. Therefore, we believe it is important to consider how more precise dosing is going to be delivered to high priority patients in a timely manner. If better dosing schemes do not change clinical practice resulting in better patient outcomes, then what is the use? This review paper discusses variables to consider when prioritizing precision dosing candidates while highlighting key examples of precision dosing that have been successfully used to improve patient care.
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Affiliation(s)
- Rachel J Tyson
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christine C Park
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - J Robert Powell
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - J Herbert Patterson
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Weiner
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Paul B Watkins
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Institute for Drug Safety Sciences, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Weiner D, Teuscher NS. Comments on D.A. Noe's papers on noncompartmental pharmacokinetic analysis: Performance characteristics of the adjusted r
2
algorithm for determining the start of the terminal disposition phase and comparison with a simple r
2
algorithm and a visual inspection method https://onlinelibrary.wiley.com/doi/10.1002/pst.1979
and
Criteria for reporting noncompartmental estimates of half‐life and area under the curve extrapolated to infinity https://onlinelibrary.wiley.com/doi/10.1002/pst.1978. Pharm Stat 2020; 19:113-114. [DOI: 10.1002/pst.1999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Daniel Weiner
- Independent drug development consultant, Chapel Hill, NC
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29
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Shea MK, Weiner D, Matuszek G, Booth SL, Kritchevsky S, Cushman M, Barger K. THE ASSOCIATION BETWEEN VITAMIN K STATUS AND CARDIOVASCULAR DISEASE IN OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6846516 DOI: 10.1093/geroni/igz038.2393] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A role for vitamin K in cardiovascular disease (CVD) has been proposed because vitamin K-dependent proteins are present in vascular tissue. We evaluated the association between vitamin K status and incident CVD and mortality in older adults from the Health, Aging, and Body Composition Study (Health ABC), and conducted a replication analysis using the Multi-ethnic Study of Atherosclerosis (MESA). In both cohorts circulating phylloquinone (vitamin K1), measured from baseline fasting blood samples, was categorized as ≤0.5nM, >0.5-≤1.0nM, and >1.0nM. Multivariable Cox proportional hazards models assessed the association between circulating phylloquinone and risk of a composite of CVD and mortality. In Health ABC (n=1246, mean age 74 years, 57% female, 58% Caucasian), over a median 11.5 follow-up years, participants with ≤0.5 nM plasma phylloquinone (n=351) had a 27% higher risk for CVD and mortality compared to those with >1.0nM (n=457) [adjusted hazard ratio (95% confidence interval) (HR(95%CI)): 1.27(1.06-1.52)]. However, the risk for CVD and mortality did not differ between those with >0.5-≤1.0nM (n=438) and with >1.0nM plasma phylloquinone [HR(95%CI): 1.03(0.87-1.52)]. Serum phylloquinone was similarly associated with CVD and mortality in MESA, over a median 12.1 follow-up years (n=764, mean age 62 years, 54% female, 35% Caucasian) [HR(95%CI), compared to those with >1.0nM (n=368): <0.5nM (n=253): 1.54(1.03-2.32); 0.5-≤1.0nM (n=153): 1.23(0.76, 1.98)]. Lower circulating phylloquinone was associated with a higher CVD and mortality risk in two independent cohorts. Additional studies are needed to corroborate our findings and clarify if certain segments of the population can derive cardiovascular benefit from improving vitamin K status.
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Affiliation(s)
- M Kyla Shea
- Tufts University USDA Human Nutrition Research Center on Aging, Boston, Massachusetts, United States
| | - Daniel Weiner
- Tufts Medical Center, Boston, Massachusetts, United States
| | - Gergory Matuszek
- Tufts University USDA Human Nutrition Research Center on Aging, Boston, Massachusetts, United States
| | - Sarah L Booth
- Tufts University USDA Human Nutrition Research Center on Aging, Boston, Massachusetts, United States
| | - Stephen Kritchevsky
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Mary Cushman
- University of Vermont Larner College of Medicine, Burlington, Vermont, United States
| | - Kathryn Barger
- Tufts University USDA Human Nutrition Research Center on Aging, Boston, Massachusetts, United States
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30
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Knych HK, Weiner D, Steinmetz S, Flynn K, McKemie DS. Pharmacokinetics of hydroxyzine and cetirizine following oral administration of hydroxyzine to exercised Thoroughbred horses. J Vet Pharmacol Ther 2019; 42:617-623. [PMID: 31490561 DOI: 10.1111/jvp.12808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/02/2019] [Revised: 06/27/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Abstract
Hydroxyzine is a first-generation antihistamine and cetirizine, a second-generation antihistamine and active metabolite of hydroxyzine. Hydroxyzine is commonly used in performance horses and as such its use in closely regulated; however, there are no published studies suitable for establishing appropriate regulatory recommendations. In the current study, 12 exercised Thoroughbred research horses received a single oral administration of 500 mg of hydroxyzine. Blood and urine samples were collected prior to and up to 96 hr postdrug administration and concentrations of hydroxyzine and cetirizine determined using liquid chromatography-tandem mass spectrometry. A joint parent/metabolite population 2-compartment pharmacokinetic model with first-order absorption and elimination was utilized to describe the pharmacokinetics of both compounds. Serum hydroxyzine and cetirizine concentrations were above the limit of quantitation (0.1 ng/ml) of the assay at 96 hr (the last time point sampled). The terminal half-life was 7.41 and 7.13 hr for hydroxyzine and cetirizine, respectively. Findings from this study suggest that a prolonged withdrawal time should be observed if this compound is used in performance administered to performance horses and is classified as prohibited substance by the applicable regulatory body.
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Affiliation(s)
- Heather K Knych
- K.L. Maddy Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, California.,Department of Veterinary Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, California
| | - Daniel Weiner
- Pharmacometrics Consultant, Chapel Hill, North Carolina
| | - Stacy Steinmetz
- K.L. Maddy Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, California
| | - Katherine Flynn
- California Department of Food and Agriculture, Animal Health Branch, Sacramento, California
| | - Daniel S McKemie
- K.L. Maddy Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, California
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31
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Weiner D. SUN-PO253: Eat to Death – Feeding the Patient at the End of Life – A Holocaust Perspective. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32883-3] [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: 10/26/2022]
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32
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Ratjen F, Davis SD, Stanojevic S, Kronmal RA, Hinckley Stukovsky KD, Jorgensen N, Rosenfeld M, Kerby G, Kopecky C, Anthony M, Mogayzel P, Walker D, Zeglin B, Hoover W, Hathorne H, Slaten K, Dorkin H(H, Fowler R, Fenton C(N, Ulles M, Goetz D, Caci N, Cahill B, Roach C, Retsch-Bogart G, Johnson R, Cunnion R, McColley S, Ward S, Bell E, McPhail G, Keller K, Thornton K, Parsons A, Chmiel J, Schaefer C, Tribout M, Consiglio B, Tribout H, McCoy K, Johnson T, Olson P, Raterman L, Hiatt P, Walker B, Schaap N, Davis M, Davis S, Clem C, Bendy L, Starner T, Lux C, Carver T, Thompson R, Williams A, Schmoll C, Hastings PM, Noe J, Roth L, Kump T, McNamara J, Franck Thompson E, Yousef S, Wezel G(G, Oquendo O, Darling A, Valencia W, Milla C, Zirbes J, Rubenstein R, Donnelly E, Malpass J, Weiner D, Agostini B, Hartigan E, Cornell A, Klein B, Bucher J, Nusbaum P, Rosenfeld M, McNamara S, Genatossio A, Pittman J, Hicks T, Bauer I, Siegel M, Isaac S, Jensen R, Au J, Stanojevic S, Ratjen F, McDonald N, Prentice C, Chilvers M, Richmond M. Inhaled hypertonic saline in preschool children with cystic fibrosis (SHIP): a multicentre, randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine 2019; 7:802-809. [DOI: 10.1016/s2213-2600(19)30187-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 01/25/2023]
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33
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Shea MK, Weiner D, Matuszek G, Booth S, Barger K. A Meta-analysis of Vitamin K Status and Cardiovascular Disease (OR33-01-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz039.or33-01-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Evidence suggests low vitamin K status may be associated with an increased cardiovascular disease (CVD) risk in people with CVD risk factors. The objective of this study was to summarize the association between vitamin K status and CVD, overall and according to baseline CVD risk, by conducting a participant-level meta-analysis using data from the Framingham Offspring Study, the Health, Aging, and Body Composition Study (Health ABC), and the Multi-ethnic Study of Atherosclerosis (MESA).
Methods
Circulating phylloquinone (vitamin K1), measured from baseline fasting blood samples, was categorized as ≤0.5 nM, >0.5 - ≤1.0 nM and >1.0 nM. CVD was defined as confirmed ischemic heart disease, angina, resuscitated cardiac arrest, fatal or non-fatal myocardial infarction or stroke. Multivariable Cox proportional hazards models were used to evaluate the association between circulating phylloquinone and incident CVD overall and stratified according to baseline CVD risk factors.
Results
Among the 3622 participants (mean (SD) baseline age 65 (11), 45% men, 65% white), there were 785 CVD events over a median of 13.0 years. Overall the risk for CVD did not differ significantly according to circulating phylloquinone categories [HR(95%CI) for CVD, compared to plasma phylloquinone >1.0 nM: ≤0.5 nM = 1.15 (0.96–1.38); >0.5 - ≤1.0 nM = 0.99 (0.84–1.18)]. However, lower circulating phylloquinone was associated with higher incident CVD risk in those with diabetes, with a normal BMI, and in women (Table).
Conclusions
Overall, we did not detect any significant differences in CVD risk across circulating phylloquinone categories in community-dwelling adults. However, low circulating phylloquinone was associated with a higher CVD risk among certain sub-groups, but additional studies are needed to clarify if improving vitamin K status will benefit the cardiovascular health of certain segments of the population.
Funding Sources
Supported by NHLBI R21HL133421 and the USDA ARS Cooperative Agreement (58‐1950‐7‐707).
Supporting Tables, Images and/or Graphs
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Broege D, Fochs S, Brent G, Bromage J, Dorrer C, Earley RF, Guardalben MJ, Marozas JA, Roides RG, Sethian J, Wang X, Weiner D, Zweiback J, Zuegel JD. The Dynamic Compression Sector laser: A 100-J UV laser for dynamic compression research. Rev Sci Instrum 2019; 90:053001. [PMID: 31153238 DOI: 10.1063/1.5088049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
The Dynamic Compression Sector (DCS) laser is a 100-J ultraviolet Nd:glass system designed and built by the Laboratory for Laser Energetics for experimental research at the DCS located at the Advanced Photon Source (Argonne National Laboratory). Its purpose is to serve as a shock driver to study materials under extreme dynamic pressures. It was designed to deposit energy within a uniformly illuminated 500-μm spot on target, with additional optics provided to implement spot sizes of 250 and 1000 μm. Designed after larger-scale glass lasers such as OMEGA and the National Ignition Facility, the laser consists of a fiber front end with interferometer-based pulse shaping, a Nd:glass regenerative amplifier, a four-pass rod amplifier, and a 15-cm glass disk amplifier, through which six passes are made in a bowtie geometry. The output is frequency tripled from 1053 to 351 nm by using a pair of type-II phase-matched KDP crystals, with a third to increase conversion bandwidth. The super-Gaussian spot in the far field is achieved with a distributed phase plate and a 1-m aspherical focusing lens. Beam smoothing is achieved by smoothing by spectral dispersion and polarization smoothing, resulting in a root-mean-square variation in intensity on target of ±8.7%.
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Affiliation(s)
- D Broege
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - S Fochs
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - G Brent
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - J Bromage
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - C Dorrer
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - R F Earley
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - M J Guardalben
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - J A Marozas
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - R G Roides
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - J Sethian
- Dynamic Compression Sector (DCS), Institute for Shock Physics, Washington State University, Argonne, Illinois 60439, USA
| | - X Wang
- Dynamic Compression Sector (DCS), Institute for Shock Physics, Washington State University, Argonne, Illinois 60439, USA
| | - D Weiner
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
| | - J Zweiback
- Logos Technologies, Fairfax, Virginia 22031, USA
| | - J D Zuegel
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623-1299, USA
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Horsley A, Nissenbaum C, Guglani L, Weiner D. Comment on Comparison of lung clearance index determined by washout of N2 and SF6 in infants and preschool children with cystic fibrosis. J Cyst Fibros 2019; 18:e26-e27. [DOI: 10.1016/j.jcf.2018.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 11/15/2022]
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36
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Hamamoto-Hardman BD, Steffey EP, Weiner D, McKemie DS, Kass P, Knych HK. Pharmacokinetics and selected pharmacodynamics of morphine and its active metabolites in horses after intravenous administration of four doses. J Vet Pharmacol Ther 2019; 42:401-410. [PMID: 30919469 DOI: 10.1111/jvp.12759] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/07/2019] [Accepted: 02/13/2019] [Indexed: 11/28/2022]
Abstract
The objective of the current study was to describe and characterize the pharmacokinetics and selected pharmacodynamic effects of morphine and its two major metabolites in horses following several doses of morphine. A total of ten horses were administered a single intravenous dose of morphine: 0.05, 0.1, 0.2, or 0.5 mg/kg, or saline control. Blood samples were collected up to 72 hr, analyzed for morphine, and metabolites by LC/MS/MS, and pharmacokinetic parameters were determined. Step count, heart rate and rhythm, gastrointestinal borborygmi, fecal output, packed cell volume, and total protein were also assessed. Morphine-3 glucuronide (M3G) was the predominant metabolite detected, with concentrations exceeding those of morphine-6 glucuronide (M6G) at all time points. Maximal concentrations of M3G and M6G ranged from 55.1 to 504 and 6.2 to 28.4 ng/ml, respectively, across dose groups. The initial assessment of morphine pharmacokinetics was done using noncompartmental analysis (NCA). The volume of distribution at steady-state and systemic clearance ranged from 9.40 to 16.9 L/kg and 23.3 to 32.4 ml min-1 kg-1 , respectively. Adverse effects included signs of decreased gastrointestinal motility and increased central nervous excitation. There was a correlation between increasing doses of morphine, increases in M3G concentrations, and adverse effects. Findings from this study support direct administration of purified M3G and M6G to horses to better characterize the pharmacokinetics of morphine and its metabolites and to assess pharmacodynamic activity of these metabolites.
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Affiliation(s)
- Briana D Hamamoto-Hardman
- K.L Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, California
| | - Eugene P Steffey
- K.L Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, California.,Department of Veterinary Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California
| | - Daniel Weiner
- Department of Pharmacotherapy and Experimental Therapeutics, School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Daniel S McKemie
- K.L Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, California
| | - Philip Kass
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - Heather K Knych
- K.L Maddy Equine Analytical Chemistry Laboratory, School of Veterinary Medicine, University of California, Davis, California.,Department of Veterinary Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, California
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Ladin K, Pandya R, Weiner D, Meyer K, Perrone R, Wong J. DIALYSIS DECISION-MAKING WITH ELDERLY PATIENTS: A QUALITATIVE STUDY OF NEPHROLOGISTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1158] [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: 11/14/2022] Open
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Johnson LA, Bozogmehri S, Ishani A, Weiner D, Berry R, Beyth R, Canales M. 0876 Sleep Apnea and Change in Quality of Life Among Veterans with Kidney Disease: A Prospective Cohort Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.875] [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: 11/13/2022] Open
Affiliation(s)
- L A Johnson
- Malcom Randall VA Medical Center, Gainesville, FL
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL
| | - S Bozogmehri
- Malcom Randall VA Medical Center, Gainesville, FL
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL
| | - A Ishani
- Minneapolis VA Medical Center, Minneapolis, MN
- University of Minnesota, Minneapolis, MN
| | - D Weiner
- Malcom Randall VA Medical Center, Gainesville, FL
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL
| | - R Berry
- Malcom Randall VA Medical Center, Gainesville, FL
| | - R Beyth
- Malcom Randall VA Medical Center, Gainesville, FL
| | - M Canales
- Malcom Randall VA Medical Center, Gainesville, FL
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida College of Medicine, Gainesville, FL
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Abraham O, Li JS, Monangai KE, Feathers AM, Weiner D. The pharmacist's role in supporting people living with cystic fibrosis. J Am Pharm Assoc (2003) 2018; 58:246-249. [PMID: 29459095 DOI: 10.1016/j.japh.2018.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/15/2018] [Accepted: 01/20/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To describe the critical need for pharmacists' involvement in outpatient care for people living with cystic fibrosis (CF). DATA SOURCES Not applicable. SUMMARY CF is a pulmonary condition that affects more than 30,000 children and adults in the United States and 70,000 people worldwide. Various complex medication regimens are given to patients with CF, some depending on the type of mutation they have in their CF transmembrane conductance regulator protein. With complex medication regimens and the increased number and variety of treatments that have become available, the medication use burden intensifies for individuals living with CF and their caregivers. Young people living with CF have a particularly difficult time adhering to medications and other therapies as they begin to rely less on their caregivers and assume greater medication management responsibility for their care. Adolescents report low adherence rates from about 40% to 47% for airway clearance methods and even lower for nutritional recommendations, about 16% to 20%. In inpatient settings, pharmacists have been successful in making medication use recommendations that have improved adherence for patients with CF while in the hospital. However, limited research has explored how provision of pharmacist supportive care and patient education in outpatient settings can improve medication adherence and quality of life for people living with CF. CONCLUSION There is potential for provision of outpatient pharmacy clinical services to increase medication adherence and overall quality of care for patients with CF. Higher rates of medication adherence in patients with CF could in turn improve patient outcomes and reduce overall health care costs as a result of fewer rehospitalizations. Pharmacies can implement programs designed to provide comprehensive support services and medication management from pharmacists and staff that are trained in CF care.
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Park M, Katz R, Shlipak MG, Weiner D, Tracy R, Jotwani V, Hughes-Austin J, Gabbai F, Hsu CY, Pfeffer M, Bansal N, Bostom A, Gutierrez O, Sarnak M, Levey A, Ix JH. Urinary Markers of Fibrosis and Risk of Cardiovascular Events and Death in Kidney Transplant Recipients: The FAVORIT Trial. Am J Transplant 2017; 17:2640-2649. [PMID: 28371433 PMCID: PMC5620109 DOI: 10.1111/ajt.14284] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/13/2017] [Accepted: 03/18/2017] [Indexed: 01/25/2023]
Abstract
Cardiovascular risk remains high in kidney transplant recipients (KTRs) despite improved kidney function after transplant. Urinary markers of kidney fibrosis and injury may help to reveal mechanisms of this risk. In a case-cohort study among stable KTRs who participated in the FAVORIT trial, we measured four urinary proteins known to correlate with kidney tubulointerstitial fibrosis on biopsy (urine alpha 1 microglobulin [α1m], monocyte chemoattractant protein-1 [MCP-1], procollagen type I [PINP] and type III [PIIINP] N-terminal amino peptide) and evaluated associations with cardiovascular disease (CVD) events (n = 300) and death (n = 371). In adjusted models, higher urine α1m (hazard ratio [HR] per doubling of biomarker 1.40 [95% confidence interval [CI] 1.21, 1.62]), MCP-1 (HR 1.18 [1.03, 1.36]), and PINP (HR 1.13 [95% CI 1.03, 1.23]) were associated with CVD events. These three markers were also associated with death (HR per doubling α1m 1.51 [95% CI 1.32, 1.72]; MCP-1 1.31 [95% CI 1.13, 1.51]; PINP 1.11 [95% CI 1.03, 1.20]). Higher concentrations of urine α1m, MCP-1, and PINP may identify KTRs at higher risk for CVD events and death. These markers may identify a systemic process of fibrosis involving both the kidney and cardiovascular system, and give new insights into mechanisms linking the kidney with CVD.
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Affiliation(s)
- M Park
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - R Katz
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - M G Shlipak
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California,General Internal Medicine Section, San Francisco Veterans Affairs Hospital, San Francisco, California,Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - D Weiner
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - R Tracy
- Department of Pathology, University of Vermont, Burlington, Vermont
| | - V Jotwani
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - J Hughes-Austin
- Division of Preventive Medicine, Department of Preventive Medicine and Public Health, University of California San Diego, San Diego, California
| | - F Gabbai
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - CY Hsu
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - M Pfeffer
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - N Bansal
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - A Bostom
- Rhode Island Hospital, Providence, Rhode Island
| | - O Gutierrez
- Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - M Sarnak
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - A Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - J H Ix
- Division of Preventive Medicine, Department of Preventive Medicine and Public Health, University of California San Diego, San Diego, California,Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California,Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
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Abstract
The ESRD Quality Incentive Program (QIP) is the first mandatory federal pay for performance program launched on January 1, 2012. The QIP is tied to the ESRD prospective payment system and mandated by the Medicare Improvements for Patients and Providers Act of 2008, which directed the Centers for Medicare and Medicaid Services to expand the payment bundle for renal dialysis services and legislated that payment be tied to quality measures. The QIP links 2% of the payment that a dialysis facility receives for Medicare patients on dialysis to the facility's performance on quality of care measures. Quality measures are evaluated annually for inclusion on the basis of importance, validity, and performance gap. Other quality assessment programs overlap with the QIP; all have substantial effects on provision of care as clinicians, patients, regulators, and dialysis organizations scramble to keep up with the frequent release of wide-ranging regulations. In this review, we provide an overview of quality assessment and quality measures, focusing on the ESRD QIP, its effect on care, and its potential future directions. We conclude that a patient-centered, individualized, and parsimonious approach to quality assessment needs to be maintained to allow the nephrology community to further bridge the quality chasm in dialysis care.
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Affiliation(s)
- Daniel Weiner
- Department of Medicine, Tufts University, Medford, Massachusetts
| | - Suzanne Watnick
- Department of Medicine, Oregon Health and Science University, Portland, Oregon; and
- Division of Hospital and Specialty Care, Veterans Affairs Portland Health Care System, Portland, Oregon
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Sio H, Frenje JA, Katz J, Stoeckl C, Weiner D, Bedzyk M, Glebov V, Sorce C, Gatu Johnson M, Rinderknecht HG, Zylstra AB, Sangster TC, Regan SP, Kwan T, Le A, Simakov AN, Taitano WT, Chacòn L, Keenan B, Shah R, Sutcliffe G, Petrasso RD. A Particle X-ray Temporal Diagnostic (PXTD) for studies of kinetic, multi-ion effects, and ion-electron equilibration rates in Inertial Confinement Fusion plasmas at OMEGA (invited). Rev Sci Instrum 2016; 87:11D701. [PMID: 27910508 DOI: 10.1063/1.4961552] [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] [Indexed: 06/06/2023]
Abstract
A Particle X-ray Temporal Diagnostic (PXTD) has been implemented on OMEGA for simultaneous time-resolved measurements of several nuclear products as well as the x-ray continuum produced in High Energy Density Plasmas and Inertial Confinement Fusion implosions. The PXTD removes systematic timing uncertainties typically introduced by using multiple instruments, and it has been used to measure DD, DT, D3He, and T3He reaction histories and the emission history of the x-ray core continuum with relative timing uncertainties within ±10-20 ps. This enables, for the first time, accurate and simultaneous measurements of the x-ray emission histories, nuclear reaction histories, their time differences, and measurements of Ti(t) and Te(t) from which an assessment of multiple-ion-fluid effects, kinetic effects during the shock-burn phase, and ion-electron equilibration rates can be made.
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Affiliation(s)
- H Sio
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J A Frenje
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Katz
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - C Stoeckl
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - D Weiner
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - M Bedzyk
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - V Glebov
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - C Sorce
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - M Gatu Johnson
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - H G Rinderknecht
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A B Zylstra
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T C Sangster
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - S P Regan
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - T Kwan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A Le
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A N Simakov
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - W T Taitano
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - L Chacòn
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - B Keenan
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R Shah
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - G Sutcliffe
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R D Petrasso
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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Stoeckl C, Boni R, Ehrne F, Forrest CJ, Glebov VY, Katz J, Lonobile DJ, Magoon J, Regan SP, Shoup MJ, Sorce A, Sorce C, Sangster TC, Weiner D. Neutron temporal diagnostic for high-yield deuterium-tritium cryogenic implosions on OMEGA. Rev Sci Instrum 2016; 87:053501. [PMID: 27250417 DOI: 10.1063/1.4948293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
Abstract
A next-generation neutron temporal diagnostic (NTD) capable of recording high-quality data for the highest anticipated yield cryogenic deuterium-tritium (DT) implosion experiments was recently installed at the Omega Laser Facility. A high-quality measurement of the neutron production width is required to determine the hot-spot pressure achieved in inertial confinement fusion experiments-a key metric in assessing the quality of these implosions. The design of this NTD is based on a fast-rise-time plastic scintillator, which converts the neutron kinetic energy to 350- to 450-nm-wavelength light. The light from the scintillator inside the nose-cone assembly is relayed ∼16 m to a streak camera in a well-shielded location. An ∼200× reduction in neutron background was observed during the first high-yield DT cryogenic implosions compared to the current NTD installation on OMEGA. An impulse response of ∼40 ± 10 ps was measured in a dedicated experiment using hard x-rays from a planar target irradiated with a 10-ps short pulse from the OMEGA EP laser. The measured instrument response includes contributions from the scintillator rise time, optical relay, and streak camera.
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Affiliation(s)
- C Stoeckl
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - R Boni
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - F Ehrne
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - C J Forrest
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - V Yu Glebov
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - J Katz
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - D J Lonobile
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - J Magoon
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - S P Regan
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - M J Shoup
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - A Sorce
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - C Sorce
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - T C Sangster
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
| | - D Weiner
- Laboratory for Laser Energetics, University of Rochester, 250 East River Road, Rochester, New York 14623-1299, USA
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Weiner D, Rifkin D. NKF offers knowledge for all disciplines. Nephrol News Issues 2016; 30:34-35. [PMID: 27169217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Kazmerski TM, Tuchman LK, Borrero S, Weiner D, Pilewski JM, Orenstein DM, Miller E. Cystic fibrosis program directors' attitudes toward sexual and reproductive health in young women with CF. Pediatr Pulmonol 2016; 51:22-7. [PMID: 26551521 DOI: 10.1002/ppul.23321] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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] [Received: 06/19/2015] [Revised: 08/20/2015] [Accepted: 09/14/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Advancements in therapy have led to dramatic increases in the life expectancy of patients with cystic fibrosis (CF). As survival improves, young women with CF will have expectations for their sexual and reproductive health (SRH) futures similar to their counterparts without CF. As they face unique CF-specific SRH concerns, they may rely on CF care providers for disease-specific SRH care provision. The purpose of this study was to investigate the attitudes of CF providers toward female SRH and perceived barriers in the current CF care model. MATERIALS AND METHODS U.S. CF program directors (n = 16) participated in qualitative interviews investigating attitudes and barriers to female CF SRH care. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. RESULTS Participants (nine pediatric, five adult, and two combined) all agreed CF providers have a fundamental role in CF female SRH care. Most respondents named lack of time and patient and provider discomfort as significant barriers to effective SRH communication. Other reported barriers included: lack of training in SRH, family members in the room, low priority of SRH in setting of other CF issues, and lack of adequate rapport with patients. DISCUSSION This is the first study to assess the attitudes and experiences of CF care providers toward SRH discussion and care among female CF patients. Despite their perceived fundamental role in CF female SRH care, CF providers face significant barriers. Investment in provider training is needed to better address the complex SRH needs of young female patients.
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Affiliation(s)
- Traci M Kazmerski
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lisa K Tuchman
- Division of Adolescent and Young Adult Medicine, Children's National Health System, Washington, DC
| | - Sonya Borrero
- Department of Medicine, University of Pittsburgh and VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania
| | - Daniel Weiner
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph M Pilewski
- Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David M Orenstein
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Yang Z, Aggarwal C, Cohen R, Morrow M, Bauml J, Weinstein G, Boyer J, Lee J, Weiner D, Bagarazzi M. Immunotherapy with INO-3112 (HPV16 and HPV18 plasmids + IL-12 DNA) in human papillomavirus (HPV) associated head and neck squamous cell carcinoma (HNSCCa). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv513.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Pattern recognition is a key element in pharmacokinetic data analyses when first selecting a model to be regressed to data. We call this process going from data to insight and it is an important aspect of exploratory data analysis (EDA). But there are very few formal ways or strategies that scientists typically use when the experiment has been done and data collected. This report deals with identifying the properties of a kinetic model by dissecting the pattern that concentration-time data reveal. Pattern recognition is a pivotal activity when modeling kinetic data, because a rigorous strategy is essential for dissecting the determinants behind concentration-time courses. First, we extend a commonly used relationship for calculation of the number of potential model parameters by simultaneously utilizing all concentration-time courses. Then, a set of points to consider are proposed that specifically addresses exploratory data analyses, number of phases in the concentration-time course, baseline behavior, time delays, peak shifts with increasing doses, flip-flop phenomena, saturation, and other potential nonlinearities that an experienced eye catches in the data. Finally, we set up a series of equations related to the patterns. In other words, we look at what causes the shapes that make up the concentration-time course and propose a strategy to construct a model. By practicing pattern recognition, one can significantly improve the quality and timeliness of data analysis and model building. A consequence of this is a better understanding of the complete concentration-time profile.
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Affiliation(s)
- Johan Gabrielsson
- Department of Biomedical Sciences and Veterinary Public Health, SLU, Division of Pharmacology and Toxicology, Box 7028, SE-750 07, Uppsala, Sweden.
| | - Bernd Meibohm
- College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Rm. 444, Memphis, Tennessee, 38163, USA
| | - Daniel Weiner
- , 709 Cambridge Hall Loop, Apex, North Carolina, 27539, USA
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Stallings TL, Aschengrau A, Riefkohl A, Rubio OR, Brooks DR, Weiner D, Amador JJ, Lopez D, Kaufman J, Laws R, Winter M, Applebaum KM. Medical Visits Among Nicaraguan Sugarcane Workers: Uncommon UTI Diagnoses and Subclinical Findings. Ann Epidemiol 2015. [DOI: 10.1016/j.annepidem.2015.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bishop D, Miller I, Weiner D, Guilmette T, Mukand J, Feldmann E, Keitner G, Springate B. Family Intervention: Telephone Tracking (FITT): A Pilot Stroke Outcome Study. Top Stroke Rehabil 2015; 21 Suppl 1:S63-74. [DOI: 10.1310/tsr21s1-s63] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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50
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Miller J, Drew L, Green O, Villella A, Bastos C, Munoz B, Cullen M, Hauck S, Wachi S, Giuliano K, Longo K, Roskelley E, Dobbs W, Garza D, Haeberlein M, Weiner D, Bridges R, Thakerar A, Hutt D, Balch W, Tait B. WS1.3 Enhanced correction of F508del CFTR using drug-like small molecules in combination with correctors and potentiators. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60006-0] [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: 11/16/2022]
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