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Ogaz D, Enayat Q, Brown JRG, Phillips D, Wilkie R, Jayes D, Reid D, Hughes G, Mercer CH, Saunders J, Mohammed H. Mpox Diagnosis, Behavioral Risk Modification, and Vaccination Uptake among Gay, Bisexual, and Other Men Who Have Sex with Men, United Kingdom, 2022. Emerg Infect Dis 2024; 30:916-925. [PMID: 38573160 PMCID: PMC11060451 DOI: 10.3201/eid3005.230676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November-December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%-72%; 601/875) and was 92% (95% CI 89%-94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.
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Testard C, Shergold C, Acevedo-Ithier A, Hart J, Bernau A, Negron-Del Valle JE, Phillips D, Watowich MM, Sanguinetti-Scheck JI, Montague MJ, Snyder-Mackler N, Higham JP, Platt ML, Brent L. Natural disaster alters the adaptive benefits of sociality in a primate. bioRxiv 2024:2023.07.17.549328. [PMID: 37503170 PMCID: PMC10370068 DOI: 10.1101/2023.07.17.549328] [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] [Indexed: 07/29/2023]
Abstract
Weather-related disasters can radically alter ecosystems. When disaster-driven ecological damage persists, the selective pressures exerted on individuals can change, eventually leading to phenotypic adjustments. For group-living animals, social relationships are believed to help individuals cope with environmental challenges and may be a critical mechanism enabling adaptation to ecosystems degraded by disasters. Yet, whether natural disasters alter selective pressures on patterns of social interactions and whether group-living animals can, as a result, adaptively change their social relationships remains untested. Here, we leveraged unique data collected on rhesus macaques from 5 years before to 5 years after a category 4 hurricane, leading to persistent deforestation which exacerbated monkeys' exposure to intense heat. In response, macaques increased tolerance for and decreased aggression toward other monkeys, facilitating access to scarce shade critical for thermoregulation. Social tolerance predicted individual survival for 5 years after the hurricane, but not before it, revealing a clear shift in the adaptive function of social relationships in this population. We demonstrate that an extreme climatic event altered selection on sociality and triggered substantial and persistent changes in the social structure of a primate species. Our findings unveil the function and adaptive flexibility of social relationships in degraded ecosystems and identify natural disasters as potential evolutionary drivers of sociality. One-Sentence Summary Testard et al. show that a natural disaster altered selection on sociality in group-living primates triggering persistent changes in their social structure.
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Barlow GL, Schürch CM, Bhate SS, Phillips D, Young A, Dong S, Martinez HA, Kaber G, Nagy N, Ramachandran S, Meng J, Korpos E, Bluestone JA, Nolan GP, Bollyky PL. The Extra-Islet Pancreas Supports Autoimmunity in Human Type 1 Diabetes. medRxiv 2023:2023.03.15.23287145. [PMID: 36993739 PMCID: PMC10055577 DOI: 10.1101/2023.03.15.23287145] [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] [Indexed: 06/19/2023]
Abstract
In autoimmune Type 1 diabetes (T1D), immune cells progressively infiltrate and destroy the islets of Langerhans - islands of endocrine tissue dispersed throughout the pancreas. However, it is unclear how this process, called 'insulitis', develops and progresses within this organ. Here, using highly multiplexed CO-Detection by indEXing (CODEX) tissue imaging and cadaveric pancreas samples from pre-T1D, T1D, and non-T1D donors, we examine pseudotemporal-spatial patterns of insulitis and exocrine inflammation within large pancreatic tissue sections. We identify four sub-states of insulitis characterized by CD8 + T cells at different stages of activation. We further find that exocrine compartments of pancreatic lobules affected by insulitis have distinct cellularity, suggesting that extra-islet factors may make particular lobules permissive to disease. Finally, we identify "staging areas" - immature tertiary lymphoid structures away from islets where CD8 + T cells appear to assemble before they navigate to islets. Together, these data implicate the extra-islet pancreas in autoimmune insulitis, greatly expanding the boundaries of T1D pathogenesis.
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Peto T, Evans RN, Reeves BC, Harding S, Madhusudhan S, Lotery A, Downes S, Balaskas K, Bailey CC, Foss A, Ghanchi F, Yang Y, Phillips D, Rogers CA, Muldrew A, Hamill B, Chakravarthy U. Long-term Retinal Morphology and Functional Associations in Treated Neovascular Age-Related Macular Degeneration: Findings from the Inhibition of VEGF in Age-Related Choroidal Neovascularisation Trial. Ophthalmol Retina 2022; 6:664-675. [PMID: 35314388 DOI: 10.1016/j.oret.2022.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To describe the frequency of long-term morphologic features and their relationships with visual function in participants who exited the Inhibition of VEGF in Age-Related Choroidal Neovascularisation (IVAN; ISRCTN92166560) trial. DESIGN Multicenter cohort study up to 7 years after enrollment. PARTICIPANTS Patients enrolled in the IVAN trial, excluding participants who died or withdrew during the trial. METHODS Multimodal fundus images, best-corrected visual acuity (BCVA), and low-luminance visual acuity (LLVA) were obtained for a subset of 199 participants who attended a research visit. Clinical sites (n = 20) also provided all visual acuity and clinical information from usual care records for 532 participants and submitted the most recent color, OCT, and other fundus images for 468 participants to a reading center. MAIN OUTCOME MEASURES Assessed the following from the most recent images: intralesional macular atrophy (ILMA) within the footprint of the neovascular lesion; hyperreflective material (HRM); intraretinal fluid (IRF); subretinal fluid (SRF); pigment epithelial detachment (PED); and disorganized retinal outer layers (DROLs). Cross-sectional relationships between morphologic features and BCVA/LLVA were estimated. RESULTS Intralesional macular atrophy was present in 31.8% of the study eyes at IVAN exit (mean follow-up, 1.96 years) and 89.5% at the most recent imaging visit (mean follow-up, 6.18 years). Hyperreflective material, IRF, SRF, PED, and DROLs were present in 78.8%, 47.7%, 7.6%, 94.5%, and 55% of the study eyes, respectively. In the subset with complete imaging data, in eyes without DROL, the BCVA was worst in the thinnest outer fovea tertile (thinnest minus middle and thickest tertiles, -19.7 and -19.5 letters, respectively), whereas in eyes with DROL, the BCVA was worst in the thickest (thinnest and middle tertiles minus thickest, 12.5 and 12.2, respectively). Regression models showed that the presence of ILMA and HRM was independently associated with BCVA (22 letters worse [95% confidence interval {CI}, -11.2 to -32.8; P < 0.001] and 9.8 letters worse [95% CI, -0.1 to -19.4; P = 0.047], respectively). Subretinal fluid and foveal PED were associated with better BCVA (5.9 letters [95% CI, -7.9 to 19.7; P = 0.399] and 6.4 letters [95% CI, -1.1 to 14.0; P = 0.094], respectively). The model with LLVA was similar. A sensitivity analysis involving the entire eligible cohort yielded similar estimates. CONCLUSIONS Macular atrophy and HRM were common after 7 years of follow-up and strongly associated with visual outcomes.
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Affiliation(s)
- Tunde Peto
- Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland
| | - Rebecca N Evans
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Barnaby C Reeves
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Simon Harding
- Department of Eye and Vision Science, University of Liverpool and St Paul's Eye Unit, Liverpool University Hospitals National Health Service Foundation Trust, Members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Savita Madhusudhan
- Department of Eye and Vision Science, University of Liverpool and St Paul's Eye Unit, Liverpool University Hospitals National Health Service Foundation Trust, Members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Andrew Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Susan Downes
- University Hospitals National Health Service Trust, Oxford, United Kingdom
| | - Konstantinos Balaskas
- Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Clare C Bailey
- Department of Ophthalmology, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
| | - Alexander Foss
- Department of Ophthalmology, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Faruque Ghanchi
- Department of Ophthalmology, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom
| | - Yit Yang
- Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton National Health Service Trust, Wolverhampton, United Kingdom
| | - Dawn Phillips
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Chris A Rogers
- Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alyson Muldrew
- Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland
| | - Barbra Hamill
- Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland
| | - Usha Chakravarthy
- Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland.
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Pollack B, Popiel P, Drugge E, Bibi M, Pollack S, Friedman R, Alishahian L, Bielawski A, Sacks A, Lebron K, Phillips D, Rubino S, Toaff M, Khan R, Khan E, Marioutina M, Gorgy M, Grimes C. Impact of permanent versus absorbable suture in vaginal suspension surgery for apical pelvic organ prolapse. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.135] [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: 11/24/2022]
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Tabrah J, Wilson N, Phillips D, Bohning D. What is the diagnostic accuracy of digital rectal examination for detecting cauda equina compression? A systematic review and meta-analysis. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Leiro B, Phillips D, Duiker M, Harmatz P, Charles S. Mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome): defining and measuring functional impacts in pediatric patients. Orphanet J Rare Dis 2021; 16:500. [PMID: 34857033 PMCID: PMC8638175 DOI: 10.1186/s13023-021-02113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research about pediatric patients' perspective on mucopolysaccharidosis type VI (MPS VI) and its impact on daily life is limited. We aimed to identify the disease concepts of interest that most impact function and day-to-day life of pediatric patients with MPS VI, and to consider clinical outcome assessments (COAs) that may potentially measure meaningful improvements in these concepts. METHODS Potential focus group participants were identified by the National MPS Society (USA) and invited to participate if they self-reported a clinician-provided diagnosis of MPS VI and were 4 to 18 years, receiving enzyme replacement therapy (ERT), and available to attend a 1-day focus group with their caregiver in Dallas, TX, USA. The focus group consisted of a series of polling and open-ended concept elicitation questions and a cognitive debriefing session. The discussion was audio recorded, transcribed verbatim, and analyzed to identify disease concepts of interest and functional impacts most relevant to participants. RESULTS Overall, caregivers (n = 9) and patients with MPS VI (n = 9) endorsed that although their children/they receive ERT, residual symptoms exist and impact health-related quality of life. The key disease concepts of interest identified were impaired mobility, upper extremity and fine motor deficits, pain, and fatigue. Pain was unanimously reported by all patients across many areas of the body and impacted daily activity. Key disease concepts were mapped to a selection of pediatric COAs including generic measures such as PROMIS®, PODCI, CHAQ, and PedsQL™. Caregivers endorsed the relevance of PODCI and PROMIS Upper Extremity, Mobility, and Pain items and all patients completed the NIH Toolbox Pegboard Dexterity Test. Additional COAs that aligned with the disease concepts included range of motion, the 2- and 6-min walk tests, timed stair climbs, Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition, grip strength, pain visual analog scale, and the Faces Pain Scale-Revised. CONCLUSION An MPS VI focus group of pediatric patients and their caregivers identified impaired mobility, upper extremity and fine motor deficits, pain, and fatigue as key disease concepts of interest. These disease concepts were mapped to existing pediatric COAs, which were provided to the group for endorsement of their relevance.
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Affiliation(s)
- Beth Leiro
- Phillips Consulting, Chapel Hill, NC, USA.
| | | | - Melanie Duiker
- Paradigm Biopharmaceuticals Limited, Melbourne, VIC, Australia
| | - Paul Harmatz
- UCSF Benioff Children's Hospital, Oakland, CA, USA
| | - Sharon Charles
- Paradigm Biopharmaceuticals Limited, Melbourne, VIC, Australia
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Balogun M, Millette D, Yip V, Chan SA, Lee P, Gamal N, Hashim N, Phillips D, Walsh M, Trehan P, Hanna-Bashara L, Abdullah A, Wernham A, Tso S. Phenotypic spectrum of serious cutaneous-only adverse event following immunization with COVID-19 vaccines: a multicentre case series and literature review. Clin Exp Dermatol 2021; 47:614-616. [PMID: 34748655 PMCID: PMC8653198 DOI: 10.1111/ced.15003] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 01/26/2023]
Affiliation(s)
- M Balogun
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Millette
- Department of Dermatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - V Yip
- Department of Dermatology, Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - S A Chan
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Lee
- Birmingham Skin Centre, Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Gamal
- Dermatology, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - N Hashim
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Bebington, UK
| | - D Phillips
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Bebington, UK
| | - M Walsh
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - P Trehan
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - L Hanna-Bashara
- Department of Dermatology, St Helens and Knowsley NHS Foundation Trust, Prescot, UK
| | - A Abdullah
- Department of Dermatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - A Wernham
- Department of Dermatology, Walsall Healthcare NHS Foundation Trust, Walsall, UK
| | - S Tso
- Jephson Dermatology Centre, South Warwickshire NHS Foundation Trust, Warwick, UK
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Phillips D, Gumparthy K, Farrar CW, Karumanchery R, Tan BB. Localized Darier disease: three cases of Type 1 segmental mosaicism. Clin Exp Dermatol 2021; 47:167-169. [PMID: 34347305 DOI: 10.1111/ced.14866] [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] [Received: 07/02/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Darier disease (DD) is an autosomal dominant acantholytic dermatosis with an estimated prevalence of 1 in 30 000-100 000. A localized form of DD was first described by Kreibich in 1906 and is thought to account for 10% of all cases. A number of clinical variants have been reported including: unilateral, linear, segmental or zosteriform DD. We present a case series of three patients with localized DD.
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Affiliation(s)
- D Phillips
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, Merseyside, UK
| | - K Gumparthy
- Department of Histopathology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, Merseyside, UK
| | - C W Farrar
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, Merseyside, UK
| | - R Karumanchery
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, Merseyside, UK
| | - B B Tan
- Department of Dermatology, Clatterbridge Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, Merseyside, UK
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Garcia P, Phillips D, Johnson J, Martin K, Randolph LM, Rosenfeld H, Harmatz P. Long-term outcomes of patients with mucopolysaccharidosis VI treated with galsulfase enzyme replacement therapy since infancy. Mol Genet Metab 2021; 133:100-108. [PMID: 33775523 DOI: 10.1016/j.ymgme.2021.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Long-term outcomes of patients with mucopolysaccharidosis (MPS) VI treated with galsulfase enzyme replacement therapy (ERT) since infancy were evaluated. METHODS The study was a multicenter, prospective evaluation using data from infants with MPS VI generated during a phase 4 study (ASB-008; Clinicaltrials.govNCT00299000) and clinical data collected ≥5 years after completion of the study. RESULTS Parents of three subjects from ASB-008 (subjects 1, 2, and 4) provided written informed consent to participate in the follow-up study. One subject was excluded as consent was not provided. Subjects 1, 2, and 4 were aged 0.7, 0.3, and 1.1 years, respectively, at initiation of galsulfase and 10.5, 7.9, and 10.5 years, respectively, at follow-up. All subjects had classical MPS VI based on pre-treatment urinary glycosaminoglycans and the early onset of clinical manifestations. At follow-up, subject 4 had normal stature for age; subjects 1 and 2 had short stature, but height remained around the 90th percentile of growth curves for untreated classical MPS VI. Six-minute walk distance was normal for age/height in subjects 1 (550 m) and 4 (506 m), and reduced for subject 2 (340 m). Subject 2 preserved normal respiratory function, while percent predicted forced vital capacity and forced expiratory volume in 1 s decreased over time in the other subjects. Skeletal dysplasia was already apparent in all subjects at baseline and continued to progress. Cardiac valve disease showed mild progression in subject 1, mild improvement in subject 4, and remained trivial in subject 2. All subjects had considerably reduced pinch and grip strength at follow-up, but functional dexterity was relatively normal for age and there was limited impact on activities of daily living. Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) results showed that subjects 2 and 4 had numerous fine and gross motor competencies. Corneal clouding progressed in all subjects, while progression of hearing impairment was variable. Liver size normalized from baseline in subjects 1 and 4, and remained normal in subject 2. CONCLUSION Very early and continuous ERT appears to slow down the clinical course of MPS VI, as shown by preservation of endurance, functional dexterity, and several fine and gross motor competencies after 7.7-9.8 years of treatment, and less growth impairment or progression of cardiac disease than could be expected based on the patients' classical phenotype. ERT does not seem to prevent progression of skeletal or eye disease in the long term.
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Affiliation(s)
- Paula Garcia
- Hospital Pediátrico de Coimbra, Coimbra, Portugal
| | - Dawn Phillips
- UNC Chapel Hill Division of Physical Therapy, School of Medicine, Chapel Hill, NC, USA
| | - JoAnn Johnson
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Kenneth Martin
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | | | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA.
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McGeechan GJ, Phillips D, Wilson L, Whittaker VJ, O'Neill G, Newbury-Birch D. Correction to: Service Evaluation of an Exercise on Referral Scheme for Adults with Existing Health Conditions in the United Kingdom. Int J Behav Med 2021; 28:840. [PMID: 33880714 DOI: 10.1007/s12529-021-09981-1] [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: 10/21/2022]
Affiliation(s)
- Grant J McGeechan
- School of Health and Social Care, Constantine Building, Teesside University, Borough Road, Middlesbrough, TS1 3BX, UK.
| | - Dawn Phillips
- Public Health Department, County Hall, Durham County Council, Durham, DH1 5UJ, England.,Children, Young People, and Families, North Tyneside Council, The Silverlink North, Cobalt Business Park, Quadrant, Newcastle upon Tyne, NE27 0BY, England
| | - Lynn Wilson
- Public Health Department, County Hall, Durham County Council, Durham, DH1 5UJ, England.,Public Health, Gateshead Council, Civic Centre, Gateshead, NE8 1HH, England
| | - Vicki J Whittaker
- School of Health and Social Care, Constantine Building, Teesside University, Borough Road, Middlesbrough, TS1 3BX, UK
| | - Gillian O'Neill
- Public Health Department, County Hall, Durham County Council, Durham, DH1 5UJ, England
| | - Dorothy Newbury-Birch
- School of Health and Social Care, Constantine Building, Teesside University, Borough Road, Middlesbrough, TS1 3BX, UK
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12
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Duong T, Harding G, Mannix S, Abel C, Phillips D, Alfano LN, Bönnemann CG, Lilien C, Lowes LP, Servais L, Warken-Madelung B, Nieto Bergman S, James ES, Noursalehi M, Prasad S, Rico S, Bilder DA. Use of the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) in X-Linked Myotubular Myopathy: Content Validity and Psychometric Performance. J Neuromuscul Dis 2021; 8:63-77. [PMID: 32925083 PMCID: PMC7902972 DOI: 10.3233/jnd-200479] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
X-linked myotubular myopathy (XLMTM) is a life-threatening, congenital myopathy characterized by extreme hypotonia, weakness, delayed motor milestones, and respiratory failure, often resulting in pediatric mortality. This study evaluated the content validity and psychometric performance of the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders as a measure of neuromuscular functioning in children with X-linked myotubular myopathy. This study was conducted in two phases. Phase I assessed the content validity of the measure for use in an XLMTM pediatric population through: literature review, clinical expert interviews, caregiver interviews, and a modified-Delphi panel among clinicians. Phase II assessed psychometric performance based on the INCEPTUS observational clinical study and the ASPIRO interventional gene therapy study, including tests of reliability (internal consistency, test-retest, and interrater), validity (construct and criterion), and responsiveness based on observational and interventional clinical trial data analyses. Data established construct validity and reliability of the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders among XLMTM patients before administration of resamirigene bilparvovec, and sensitivity to study drug administration as evidenced by the significant post-administration response in ASPIRO. Findings support the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders as an appropriate neuromuscular functioning assessment in a pediatric X-linked myotubular myopathy patient population.
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Affiliation(s)
| | | | | | | | | | | | | | - Charlotte Lilien
- MDUK Oxford Neuromuscular Centre, Oxford, United Kingdom.,Institut I-Motion, Institut de Myologie, Paris, France
| | | | - Laurent Servais
- MDUK Oxford Neuromuscular Centre, Oxford, United Kingdom.,Institut I-Motion, Institut de Myologie, Paris, France.,University Hospital Liège & University of La Citadelle, Liège, Belgium
| | | | | | - Emma S James
- Encoded Therapeutics, South San Francisco, CA, USA formerly at Audentes Therapeutics, an Astellas Company, San Francisco, CA, USA
| | | | - Suyash Prasad
- Suyash Prasad Consulting, LLC, San Francisco, CA, USA formerly at Audentes Therapeutics, an Astellas Company, San Francisco, CA, USA
| | - Salvador Rico
- Encoded Therapeutics, South San Francisco, CA, USA formerly at Audentes Therapeutics, an Astellas Company, San Francisco, CA, USA
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Willgoss T, Cassater D, Connor S, Krishnan ML, Miller MT, Dias-Barbosa C, Phillips D, McCormack J, Bird LM, Burdine RD, Claridge S, Bichell TJ. Measuring What Matters to Individuals with Angelman Syndrome and Their Families: Development of a Patient-Centered Disease Concept Model. Child Psychiatry Hum Dev 2021; 52:654-668. [PMID: 32880036 PMCID: PMC8238699 DOI: 10.1007/s10578-020-01051-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Angelman syndrome (AS) is a complex, heterogeneous, and life-long neurodevelopmental disorder. Despite the considerable impact on individuals and caregivers, no disease-modifying treatments are available. To support holistic clinical management and the development of AS-specific outcome measures for clinical studies, we conducted primary and secondary research identifying the impact of symptoms on individuals with AS and their unmet need. This qualitative research adopted a rigorous step-wise approach, aggregating information from published literature, then evaluating it via disease concept elicitation interviews with clinical experts and caregivers. We found that the AS-defining concepts most relevant for treatment included: impaired expressive communication, seizures, maladaptive behavior, cognitive impairment, motor function difficulties, sleep disturbance, and limited self-care abilities. We highlight the relevance of age in experiencing these key AS concepts, and the difference between the perceptions of clinicians and caregivers towards the syndrome. Finally, we outline the impact of AS on individuals, caregivers, and families.
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Affiliation(s)
- Tom Willgoss
- Roche Products Limited, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK.
| | - Daiana Cassater
- grid.417570.00000 0004 0374 1269Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Siobhan Connor
- grid.419227.bRoche Products Limited, Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW UK
| | - Michelle L. Krishnan
- grid.417570.00000 0004 0374 1269Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Meghan T. Miller
- grid.417570.00000 0004 0374 1269Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Dawn Phillips
- grid.410711.20000 0001 1034 1720Division of Physical Therapy, School of Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Julie McCormack
- grid.423257.50000 0004 0510 2209Evidera, Patient-Centered Research, Bethesda, MD USA
| | - Lynne M. Bird
- grid.266100.30000 0001 2107 4242Department of Pediatrics, University of California San Diego, San Diego, CA USA
| | - Rebecca D. Burdine
- grid.16750.350000 0001 2097 5006Department of Molecular Biology, Princeton University, Princeton, NJ USA
| | - Sharon Claridge
- Foundation for Angelman Syndrome Research (FAST), Downers Grove, IL USA
| | - Terry Jo Bichell
- Consortium for Outcome Measures and Biomarkers for Neurodevelopmental Disorders, Nashville, TN USA
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Khoury M, Phillips D, Wood P, Mott W, Stickland M, Boulanger P, Rempel G, Conway J, Mackie A, Khoo N. CARDIAC REHABILITATION IN THE PEDIATRIC FONTAN POPULATION: DEVELOPMENT OF A HOME-BASED HIGH-INTENSITY INTERVAL TRAINING PROGRAM. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.063] [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] Open
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15
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Evans RN, Reeves BC, Phillips D, Muldrew KA, Rogers C, Harding SP, Chakravarthy U. Long-term Visual Outcomes after Release from Protocol in Patients who Participated in the Inhibition of VEGF in Age-related Choroidal Neovascularisation (IVAN) Trial. Ophthalmology 2020; 127:1191-1200. [PMID: 32359843 PMCID: PMC7471837 DOI: 10.1016/j.ophtha.2020.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 02/26/2020] [Accepted: 03/17/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To describe visual outcomes, frequency of treatment and monitoring visits, and anti-vascular endothelial growth factor drugs used in usual care in participants who exited a trial in which treatment for neovascular age-related macular degeneration (nAMD) was initiated with bevacizumab or ranibizumab. DESIGN Multicenter cohort study up to 7 years after trial exit. PARTICIPANTS Patients enrolled in the Inhibition of VEGF in Age-related choroidal Neovascularisation (IVAN) trial; after excluding participants from 2 sites and who died or withdrew during the trial, 537 were included in this follow-up cohort. METHODS Data were collected between May 26, 2016, and August 24, 2017. Distance visual acuity (DVA) (letters read) in both eyes and treatments for nAMD administered to either eye at all usual care visits were extracted from medical records of all participants until the point of data collection (duration of study eye monitoring). MAIN OUTCOME MEASURES Rate of change of DVA during active surveillance of the study eye (study eye monitoring), estimated using a multivariable linear random effects model. Other outcome measures were visit and treatment frequency and switches in anti-vascular endothelial growth factor (VEGF) drug. RESULTS Data were obtained for 99% (532/537) of eligible participants. The median duration of study eye monitoring after IVAN exit was 3.3 years (interquartile range [IQR], 1.3-4.7), and median DVA was 58.0 letters (IQR, 34.0-73.0). Study eye DVA deteriorated by 4.3 (95% confidence interval [CI], 3.7-4.9) letters per year. Injection rate did not influence the rate of change in DVA after adjusting for key covariates. After IVAN exit, 174 participants (32%) received no treatment; 332 of 358 (93%) were treated first with ranibizumab, 78 (23%) of whom switched to aflibercept. The DVA was similar among participants who switched or did not switch at the end of study monitoring. CONCLUSIONS Approximately 5 years after the IVAN study finished, with unprecedented completeness of follow-up for such a trial, the trajectory of functional decline in the study eye was shown to be greater than that previously reported for incomplete trial cohorts. Anti-VEGF injection rates and treatment switches were not important factors in determining visual acuity outcomes.
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Key Words
- ci, confidence interval
- dva, distance visual acuity
- etdrs, early treatment diabetic retinopathy study
- iqr, interquartile range
- ivan, inhibition of vegf in age-related choroidal neovascularisation
- namd, neovascular age-related macular degeneration
- rct, randomized controlled trial
- sd, standard deviation
- va, visual acuity
- vegf, vascular endothelial growth factor
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Affiliation(s)
- Rebecca N Evans
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Dawn Phillips
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Chris Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Simon P Harding
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Usha Chakravarthy
- Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland.
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16
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Phillips D, Hennermann JB, Tylki-Szymanska A, Borgwardt L, Gil-Campos M, Guffon N, Amraoui Y, Geraci S, Ardigò D, Cattaneo F, Lund AM. Use of the Bruininks-Oseretsky test of motor proficiency (BOT-2) to assess efficacy of velmanase alfa as enzyme therapy for alpha-mannosidosis. Mol Genet Metab Rep 2020; 23:100586. [PMID: 32292699 PMCID: PMC7149402 DOI: 10.1016/j.ymgmr.2020.100586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/08/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Alpha-mannosidosis is a rare autosomal recessive lysosomal storage disorder resulting from deficient lysosomal alpha-mannosidase activity. Clinical manifestations include progressive balance disorders, immune deficiency, skeletal abnormalities and cognitive deficits beginning in early childhood. Enzyme replacement therapy with recombinant human alpha-mannosidase (velmanase alfa) is scheduled for clinical development in the US beginning in 2020 and has been approved in the EU for treatment of non-neurological manifestations in cases of mild to moderate disease. This study assessed effects of velmanase alfa on fine and gross motor proficiency in children and adults. Methods Integrated Bruininks-Oseretsky (BOT-2) test of Motor Proficiency data from velmanase alfa clinical trials was stratified by age for 14 adults and 19 children treated for up to 4 years. Results Patients showed global developmental delays at baseline. For the combined adult and pediatric group there was a statistically significant increase (improvement) in BOT-2 total point score of 13% (p = .035, 95% CI 1.0, 25.0) from baseline to last observation. When stratified by pediatric versus adult patients, there was improvement in BOT-2 total point score in patients <18 years (mean percent increase from baseline to last observation 23%) compared to adults (mean decrease of −0.7%). Subtest analysis of individual BOT-2 items captured some improvement following velmanase alfa treatment in pediatric patients. Conclusions There was limited ability to assess the BOT-2 change responses in adults. Pediatric patients showed stability or improvement in scaled scores relative to healthy peers, indicating continued skill acquisition, which may increase independence and contribute to improved patient quality of life. Alpha-mannosidosis patients have global developmental delay, requiring assistance with many activities of daily living. BOT-2 is used to assess improvements in functional capacity in children and young adults. Pediatric patients showed stability or improvement in BOT-2 scaled scores relative to healthy peers, indicating continued skill acquisition.
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Affiliation(s)
- Dawn Phillips
- UNC Chapel Hill, Division of Physical Therapy, School of Medicine, Chapel Hill, NC, United States of America
- Corresponding author at: 1104 Willow Drive, Chapel Hill, NC 27517, United States of America.
| | - Julia B. Hennermann
- University Medical Centre Mainz, Dept. Pediatric and Adolescent Medicine, Villa Metabolica, Mainz, Germany
| | - Anna Tylki-Szymanska
- Department of Paediatric, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | - Line Borgwardt
- Centre for Inherited Metabolic Diseases, Department of Paediatrics and Department of Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mercedes Gil-Campos
- Metabolism and Pediatric Research Unit, Reina Sofia University Hospital, IMIBIC, University of Cordoba, Unidad de Metabolismo e Investigación Pediátrica, Hospital Universitario Reina Sofía, Universidad de Córdoba, CIBERObn, Córdoba, Spain
| | - Nathalie Guffon
- Reference Center for Inherited Metabolic Diseases, Femme Mere Enfant Hospital, Lyon, France
| | | | | | | | | | - Allan M. Lund
- Centre for Inherited Metabolic Diseases, Department of Paediatrics and Department of Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Whiteman I, Jones A, Selvarajah K, De Silva C, Sathiadas G, Umasankar N, Osmond C, Phillips D, Ragunathan R. 747 Poor Domestic Smoke Ventilation is associated With an Increased Risk of Rheumatic Heart Disease in Sri Lankan Children. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.754] [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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18
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Culliford L, Brierley R, Clout M, Evans R, Maishman R, Phillips D, Tabusa H, Reeves B, Rogers CA. The OMACS-PIL study: a randomised controlled trial within the OMACS observational study. Trials 2019; 20:772. [PMID: 31881927 PMCID: PMC6935214 DOI: 10.1186/s13063-019-3958-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022] Open
Abstract
Background There has been little research to investigate whether the appearance of paper patient information leaflets (PILs) used to describe research studies to potential participants influences their decision to take part. Embedding a study within a trial (SWAT) is an efficient way of answering this type of methodological question. We included a randomised SWAT within a large cohort study, Outcome Monitoring after Cardiac Surgery (OMACS), to address this question. Methods Potential participants for the OMACS study were randomised to receive one of three PILs, which were identical in content but with varying formatting and use of colour: PIL A (enhanced format), PIL B (hybrid format) and PIL C (standard format). Consent to OMACS was the primary outcome. Consent rates using the three different PIL formats were collected and compared. Qualitative feedback on the different formats was obtained from a public and patient involvement (PPI) group. Results For the SWAT, 1517 PILs were sent to potential participants, of whom 640 (42%) consented to take part in OMACS. PIL B had the highest recruitment rate, with 45% of patients consenting to participation; 40% and 41% of patients consented to participation after receiving PILs A and C, respectively. Compared to PIL C, the consent rate was 4% higher with PIL B (45% versus 41%, 95% confidence interval (CI) -2% to + 10%, p = 0.16) and 1% lower with PIL A (40% versus 41%, 95% CI − 7% to + 5%, p = 0.72). Conclusions Consent rates were similar for all three PIL formats. PIL B is being used for the remainder of the host study and will be used to inform the design of PILs for other research studies, as it was the preferred format of the PPI group. Trial registration International Clinical Trials Registry, ISRCTN90204321. Registered on 21 January 2015.
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Affiliation(s)
- Lucy Culliford
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
| | - Rachel Brierley
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Madeleine Clout
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Rebecca Evans
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Rachel Maishman
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Dawn Phillips
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Hana Tabusa
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Barney Reeves
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit Bristol, Bristol Trials Centre, Translational Health Sciences, Bristol Medical School, Level 7 Queens Building (Zone A), Bristol Royal Infirmary, Bristol, BS2 8HW, UK
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Adams DR, Tollinche LE, Yeoh CB, Artman J, Mehta M, Phillips D, Fischer GW, Quinlan JJ, Sakai T. Short-term safety and effectiveness of sugammadex for surgical patients with end-stage renal disease: a two-centre retrospective study. Anaesthesia 2019; 75:348-352. [PMID: 31721151 DOI: 10.1111/anae.14914] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/17/2022]
Abstract
Sugammadex is a novel reversal agent for aminosteroid neuromuscular blocking drugs, especially rocuronium. Given its renal excretion, sugammadex is not recommended for patients with end-stage renal disease; however, reports exist of its use in this group of patients. This two-institutional retrospective observational study aimed to review the safety profile and effectiveness of sugammadex in surgical patients with end-stage renal disease who required pre-operative renal replacement therapy. Adult surgical patients with end-stage renal disease requiring pre-operative renal replacement therapy, who received sugammadex between April 2016 and January 2019, were studied. The primary outcome was the incidence of postoperative tracheal re-intubation within 48 h. The secondary outcome was the incidence of deferred tracheal extubation in the operating theatre. One hundred and fifty-eight patients were identified from 125,653 surgical patients: 48 patients (30%) underwent renal transplantation and 110 (70%) underwent non-renal transplantation procedures. There were 22 instances (14%) of deferred tracheal extubation due to surgical and/or pre-existing medical conditions. Out of the 136 patients who had the tracheal tube removed at the end of the procedure, three patients had their trachea re-intubated within 48 h: two patients developed pulmonary oedema resulting from volume overload; and one patient had worsening sepsis. No incidence of recurrence of neuromuscular blockade was observed. Of note, 24 (18%) patients were found to have incomplete neuromuscular blockade reversal with neostigmine but administration of sugammadex led to successful tracheal extubation. In conclusion, sugammadex appears to be safe and effective in adult patients with end-stage renal disease receiving pre-operative renal replacement therapy.
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Affiliation(s)
- D R Adams
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - L E Tollinche
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C B Yeoh
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Artman
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Mehta
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - D Phillips
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - G W Fischer
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J J Quinlan
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - T Sakai
- Department of Anesthesiology and Peri-operative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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20
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Andersen KF, Buddenhagen CE, Rachkara P, Gibson R, Kalule S, Phillips D, Garrett KA. Modeling Epidemics in Seed Systems and Landscapes To Guide Management Strategies: The Case of Sweet Potato in Northern Uganda. Phytopathology 2019; 109:1519-1532. [PMID: 30785374 PMCID: PMC7779973 DOI: 10.1094/phyto-03-18-0072-r] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 05/29/2023]
Abstract
Seed systems are critical for deployment of improved varieties but also can serve as major conduits for the spread of seedborne pathogens. As in many other epidemic systems, epidemic risk in seed systems often depends on the structure of networks of trade, social interactions, and landscape connectivity. In a case study, we evaluated the structure of an informal sweet potato seed system in the Gulu region of northern Uganda for its vulnerability to the spread of emerging epidemics and its utility for disseminating improved varieties. Seed transaction data were collected by surveying vine sellers weekly during the 2014 growing season. We combined data from these observed seed transactions with estimated dispersal risk based on village-to-village proximity to create a multilayer network or "supranetwork." Both the inverse power law function and negative exponential function, common models for dispersal kernels, were evaluated in a sensitivity analysis/uncertainty quantification across a range of parameters chosen to represent spread based on proximity in the landscape. In a set of simulation experiments, we modeled the introduction of a novel pathogen and evaluated the influence of spread parameters on the selection of villages for surveillance and management. We found that the starting position in the network was critical for epidemic progress and final epidemic outcomes, largely driven by node out-degree. The efficacy of node centrality measures was evaluated for utility in identifying villages in the network to manage and limit disease spread. Node degree often performed as well as other, more complicated centrality measures for the networks where village-to-village spread was modeled by the inverse power law, whereas betweenness centrality was often more effective for negative exponential dispersal. This analysis framework can be applied to provide recommendations for a wide variety of seed systems.[Formula: see text] Copyright © 2019 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.
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Affiliation(s)
- K. F. Andersen
- Plant Pathology Department, University of Florida, Gainesville, FL 32611-0680, U.S.A
- Institute for Sustainable Food Systems, University of Florida, Gainesville, FL 32611-0680, U.S.A
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611-0680, U.S.A
| | - C. E. Buddenhagen
- Plant Pathology Department, University of Florida, Gainesville, FL 32611-0680, U.S.A
- Institute for Sustainable Food Systems, University of Florida, Gainesville, FL 32611-0680, U.S.A
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611-0680, U.S.A
| | - P. Rachkara
- Department of Rural Development and Agribusiness, Gulu University, Gulu, Uganda
| | - R. Gibson
- Natural Resource Institute, University of Greenwich, Greenwich, United
| | - S. Kalule
- Department of Rural Development and Agribusiness, Gulu University, Gulu, Uganda
| | - D. Phillips
- Natural Resource Institute, University of Greenwich, Greenwich, United
| | - K. A. Garrett
- Plant Pathology Department, University of Florida, Gainesville, FL 32611-0680, U.S.A
- Institute for Sustainable Food Systems, University of Florida, Gainesville, FL 32611-0680, U.S.A
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32611-0680, U.S.A
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21
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Phillips D, Tomazos IC, Moseley S, L'Italien G, Gomes da Silva H, Lerma Lara S. Reliability and Validity of the 6-Minute Walk Test in Hypophosphatasia. JBMR Plus 2019; 3:e10131. [PMID: 31346563 PMCID: PMC6636775 DOI: 10.1002/jbm4.10131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/09/2018] [Accepted: 11/21/2018] [Indexed: 12/16/2022] Open
Abstract
This investigation evaluated the reliability and validity of the 6‐Minute Walk Test (6MWT) in patients with pediatric hypophosphatasia (HPP). Children (aged 6 to 12 years; n = 11), adolescents (13 to 17 years; n = 4), and adults (18 to 65 years; n = 9) completed the 6MWT at screening and baseline in two clinical studies of asfotase alfa. Test‐retest reliability of the 6MWT, evaluated with Pearson's correlation coefficients (r) for screening versus baseline, was high for children (r = 0.95; p < 0.0001), adolescents (r = 0.81; p = 0.125), and adults (r = 0.94; p = 0.0001). The most conservative minimal clinically important differences, estimated using distribution‐based methods, were 31 m (children and adults) and 43 m (adolescents). In children, the 6MWT correlated significantly with scores on measures of skeletal disease, which included the Radiographic Global Impression of Change scale (r = 0.50; p < 0.0001) and the Rickets Severity Scale (r = −0.78; p < 0.0001), such that distance walked increased as the severity of skeletal disease decreased. Significant (p < 0.0001) correlations with the 6MWT distance walked were also observed for children with scores on parent‐reported measures of disability (r = −0.67), ability to function in activities of daily living (r = 0.71 to 0.77), and parent‐reported measures of pain (r = −0.39). In adolescents and adults, 6MWT distance walked correlated significantly (p < 0.05) with measures of lower extremity function (r = 0.83 and 0.60, respectively), total pain severity (r = −0.41 and −0.36, respectively), and total pain interference (r = −0.41 and −0.49, respectively). Collectively, these data indicate that the 6MWT is a reliable, valid measure of physical functioning in patients with pediatric HPP. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Dawn Phillips
- Division of Physical Therapy Department of Allied Health Sciences University of North Carolina Chapel Hill NC USA
| | | | | | | | | | - Sergio Lerma Lara
- Centro Superior de Estudios Universitarios (CSEU) La Salle Universidad Autónoma de Madrid Madrid Spain.,Hospital Infantil Universitario Niño Jesús Madrid Spain
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22
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Whyte MP, Simmons JH, Moseley S, Fujita KP, Bishop N, Salman NJ, Taylor J, Phillips D, McGinn M, McAlister WH. Asfotase alfa for infants and young children with hypophosphatasia: 7 year outcomes of a single-arm, open-label, phase 2 extension trial. Lancet Diabetes Endocrinol 2019; 7:93-105. [PMID: 30558909 DOI: 10.1016/s2213-8587(18)30307-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Our previous phase 2, open-label study of 11 infants and young children with life-threatening perinatal or infantile hypophosphatasia showed 1 year safety and efficacy of asfotase alfa, an enzyme replacement therapy. We aimed to report the long-term outcomes over approximately 7 years of treatment. METHODS We did a prespecified, end of study, 7 year follow-up of our single-arm, open-label, phase 2 trial in which children aged 3 years or younger with life-threatening perinatal or infantile hypophosphatasia were recruited from ten hospitals (six in the USA, two in the UK, one in Canada, and one in the United Arab Emirates). Patients received asfotase alfa (1 mg/kg three times per week subcutaneously, adjusted to 3 mg/kg three times per week if required) for up to 7 years (primary treatment period plus extension phase) or until the product became commercially available; dosage adjustments were made at each visit according to changes in the patient's weight. The primary objectives of this extension study were to assess the long-term tolerability of asfotase alfa, defined as the number of patients with one or more treatment-emergent adverse events, and skeletal manifestations associated with hypophosphatasia, evaluated using the Radiographic Global Impression of Change (RGI-C) scale (-3 indicating severe worsening, and +3 complete or near-complete healing). Respiratory support, growth, and cognitive and motor functions were also evaluated. All efficacy and safety analyses were done in all patients who received any asfotase alfa (full-analysis population). This study and extension phase are registered with ClinicalTrials.gov, number NCT01205152, and EudraCT, number 2009-009369-32. FINDINGS 11 participants were recruited between Oct 6, 2008, and Dec 4, 2009. Ten patients completed a 6 month treatment period and entered the extension phase; nine received asfotase alfa for at least 6 years and completed the study, with four being treated for more than 7 years. Skeletal healing was sustained over 7 years of treatment; all evaluable patients had RGI-C scores of at least +2 at year 6 (n=9; median score +2·0 [range 2·0-3·0]) and year 7 (n=7; median score +2·3 [2·0-3·0]). No patient who completed the study required respiratory support after year 4. Weight Z scores improved to within normal range from year 3 to study end; length or height Z scores improved but remained below normal. Age-equivalent scores on gross motor, fine motor, and cognitive subscales of the Bayley Scales of Infant and Toddler Development also improved. All 11 patients had at least one treatment-emergent adverse event. The most common adverse events were pyrexia (eight [73%] of 11 patients), upper respiratory tract infection (eight [73%]), craniosynostosis (seven [64%]), and pneumonia (seven [64%]). Serious adverse events related to asfotase alfa occurred in three (27%) patients (severe chronic hepatitis; moderate immediate post-injection reaction; and severe craniosynostosis with severe conductive deafness). INTERPRETATION Patients with perinatal or infantile hypophosphatasia treated with asfotase alfa for up to 7 years showed early, sustained improvements in skeletal mineralisation. Respiratory function, growth, and cognitive and motor function also improved, and asfotase alfa was generally well tolerated. FUNDING Alexion Pharmaceuticals, Inc.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St Louis, MO, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO, USA.
| | - Jill H Simmons
- Vanderbilt University Medical Center, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | | | | | | | | | - John Taylor
- Prevea Health Clinic, Hospital Sisters Health System St Vincent Hospital, Green Bay, WI, USA
| | - Dawn Phillips
- Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
| | | | - William H McAlister
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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23
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Phillips D, Holmes J, Davies R, Geen J, Williams JD, Phillips AO. The influence of socioeconomic status on presentation and outcome of acute kidney injury. QJM 2018; 111:849-857. [PMID: 30137472 DOI: 10.1093/qjmed/hcy180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
AIM Although socioeconomic background is known to impact on the incidence and progression of chronic kidney disease, its influence of on the presentation and outcome for acute kidney injury is not known and is the subject of this study. DESIGN The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients >18 years of age between March 2015 and November 2017. METHODS Socioeconomic classification of patients was derived from the Welsh Index Multiple Deprivation score (WIMD). Patients were grouped according to the WIMD score by their postcode, and the ranked data were categorized into percentiles and correlated with incidence and measures of AKI severity and outcome. RESULTS Date was collected on a total of 57 654 patients. Increased deprivation was associated with higher AKI incidence rates, more episodes of AKI per patient and more severe AKI at presentation. In contrast 90-day mortality was highest in the most affluent areas. Mortality in affluent areas was driven by increased patient age. Corrected for age 90-day mortality was higher in areas of increased deprivation. CONCLUSION This study highlights that AKI incidence presentation and outcomes are adversely affected by social deprivation. Further studies are required to understand the extent to which these differences reflect patient related factors or regional differences in provision and access to care.
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Affiliation(s)
- D Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - J Holmes
- Welsh Renal Clinical Network, Cwm Taf University Health Board, Merthyr, UK
| | - R Davies
- Welsh Renal Clinical Network, Cwm Taf University Health Board, Merthyr, UK
| | - J Geen
- Department of Clinical Biochemistry, Cwm Taf University Health Board, Merthyr, UK
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - J D Williams
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - A O Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
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Arpawong T, Lee J, Phillips D, Prescott C. EARLY CHILDHOOD ADVERSITY AND RECENT STRESS AFFECT RISK FOR DEPRESSIVE SYMPTOMS IN OLDER ADULTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1247] [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
Affiliation(s)
| | - J Lee
- University of Southern California
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Lund AM, Borgwardt L, Cattaneo F, Ardigò D, Geraci S, Gil-Campos M, De Meirleir L, Laroche C, Dolhem P, Cole D, Tylki-Szymanska A, Lopez-Rodriguez M, Guillén-Navarro E, Dali CI, Héron B, Fogh J, Muschol N, Phillips D, Van den Hout JMH, Jones SA, Amraoui Y, Harmatz P, Guffon N. Comprehensive long-term efficacy and safety of recombinant human alpha-mannosidase (velmanase alfa) treatment in patients with alpha-mannosidosis. J Inherit Metab Dis 2018; 41:1225-1233. [PMID: 29725868 PMCID: PMC6326957 DOI: 10.1007/s10545-018-0175-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 03/10/2018] [Accepted: 03/21/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Long-term outcome data provide important insights into the clinical utility of enzyme replacement therapies. Such data are presented for velmanase alfa in the treatment of alpha-mannosidosis (AM). METHODS Patient data (n = 33; 14 adults, 19 paediatric) from the clinical development programme for velmanase alfa were integrated in this prospectively-designed analysis of long-term efficacy and safety. Patients who participated in the phase I/II or phase III trials and were continuing to receive treatment after completion of the trials were invited to participate in a comprehensive evaluation visit to assess long-term outcomes. Primary endpoints were changes in serum oligosaccharide and the 3-minute stair climb test (3MSCT). RESULTS Mean (SD) treatment exposure was 29.3 (15.2) months. Serum oligosaccharide levels were significantly reduced in the overall population at 12 months (mean change: -72.7%, P < 0.001) and remained statistically significant at last observation (-62.8%, P < 0.001). A mean improvement of +9.3% in 3MSCT was observed at 12 months (P = 0.013), which also remained statistically significant at last observation (+13.8%, P = 0.004), with a more pronounced improvement detected in the paediatric subgroup. No treatment-emergent adverse events were reported leading to permanent treatment discontinuation. CONCLUSIONS Patients treated with velmanase alfa experienced improvements in biochemical and functional measures that were maintained for up to 4 years. Long term follow-up is important and further supports the use of velmanase alfa as an effective and well-tolerated treatment for AM. Based on the currently available data set, no baseline characteristic can be predictive of treatment outcome. Early treatment during paediatric age showed better outcome in functional endpoints.
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Affiliation(s)
- Allan M Lund
- Departments of Paediatrics and Adolescent Medicine, Centre for Inherited Metabolic Diseases, Copenhagen, Denmark
- Department of Clinical Genetics, Centre for Inherited Metabolic Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Line Borgwardt
- Departments of Paediatrics and Adolescent Medicine, Centre for Inherited Metabolic Diseases, Copenhagen, Denmark.
- Department of Clinical Genetics, Centre for Inherited Metabolic Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | | | | | | | - Mercedes Gil-Campos
- Unidad de Metabolismo e Investigación Pediátrica, Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, CIBERObn, Córdoba, Spain
| | - Linda De Meirleir
- Paediatric Neurology and Metabolism, Universitair Ziekenhuis, Brussels, Belgium
| | | | | | - Duncan Cole
- Department of Medical Biochemistry and Immunology, University Hospital of Wales, Cardiff, Wales, UK
| | - Anna Tylki-Szymanska
- Department of Paediatric, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Encarna Guillén-Navarro
- Medical Genetics Section, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERER-ISCIII, Madrid, Spain
| | - Christine I Dali
- Departments of Paediatrics and Adolescent Medicine, Centre for Inherited Metabolic Diseases, Copenhagen, Denmark
| | - Bénédicte Héron
- Service de Neuropédiatrie, Centre de Référence des Maladies Lysosomales, and Sorbonne Université, GRC n°19, pathologies Congénitales du Cervelet-LeucoDystrophies, AP-HP, Hôpital Armand Trousseau, F-75012, Paris, France
| | | | - Nicole Muschol
- International Center for Lysosomal Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - J M Hannerieke Van den Hout
- Center for Lysosomal and Metabolic Diseases (department of Pediatrics), Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Simon A Jones
- Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Yasmina Amraoui
- Center for Pediatric and Adolescent Medicine, Villa Metabolica, University Medical Center Mainz, Mainz, Germany
| | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Nathalie Guffon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Femme Mère Enfant, Lyon, France
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Rico S, Bilder D, Duong T, James E, Noursalehi M, Bergman S, Harding G, Mannix S, Phillips D, Abel C, Prasad S. CONGENITAL MYOPATHIES (CNM). Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.166] [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: 11/15/2022]
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Matchan EL, Phillips D, Traine E, Zhu D. Major element data, 40Ar/ 39Ar step-heating and step-crushing data for anorthoclase megacrysts from the Newer Volcanic Province, south-eastern Australia. Data Brief 2018; 19:1847-1851. [PMID: 30229058 PMCID: PMC6141373 DOI: 10.1016/j.dib.2018.06.080] [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] [Received: 04/25/2018] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022] Open
Abstract
We provide the dataset associated with the research article “40Ar/39Ar ages of alkali feldspar xenocrysts constrain the timing of intraplate basaltic volcanism” Matchan et al. [1]. This dataset contains major element data for 15 large anorthoclase xenocrysts (‘megacrysts’) collected from six Pleistocene eruption centres (Mount Leura, Mount Shadwell, Mount Noorat, Mount Franklin, Lake Keilambete and The Anakies (East Cone)) in the basaltic Newer Volcanic Province of south-eastern Australia. It also contains multi-collector (Argus VI) 40Ar/39Ar step-heating for 13 of these anorthoclase megacrysts. 40Ar/39Ar vacuo step-crushing experiment data is also provided for three of these megacrysts.
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Affiliation(s)
- E L Matchan
- School of Earth Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - D Phillips
- School of Earth Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - E Traine
- School of Earth Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - D Zhu
- School of Earth Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
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Borgwardt L, Guffon N, Amraoui Y, Jones SA, De Meirleir L, Lund AM, Gil-Campos M, Van den Hout JMP, Tylki-Szymanska A, Geraci S, Ardigò D, Cattaneo F, Harmatz P, Phillips D. Health Related Quality of Life, Disability, and Pain in Alpha Mannosidosis. Journal of Inborn Errors of Metabolism and Screening 2018. [DOI: 10.1177/2326409818796854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Line Borgwardt
- Centre for Inherited Metabolic Diseases, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nathalie Guffon
- Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Femme Mère Enfant, Lyon, France
| | - Yasmina Amraoui
- University Medical Centre Mainz, Centre for Pediatric and Adolescent Medicine, Villa Metabolica, Mainz, Germany
| | - Simon A. Jones
- Manchester Centre for Genomic Medicine, St. Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Linda De Meirleir
- Paediatric Neurology and Metabolism, Universitair Ziekenhuis, Brussels, Belgium
| | - Allan M. Lund
- Centre for Inherited Metabolic Diseases, Departments of Paediatrics and Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mercedes Gil-Campos
- Unidad de Metabolismo e Investigación Pediátrica, Hospital Reina Sofía, Córdoba, Spain
| | - Johanna M. P. Van den Hout
- Center for Lysosomal and Metabolic Diseases, Erasmus Medical Center—Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Anna Tylki-Szymanska
- Department of Paediatric, Nutrition and Metabolic Diseases, The Children’s Memorial Health Institute, Warsaw, Poland
| | | | | | | | - Paul Harmatz
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA, USA
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Phillips D, Leiro B. Clinical Outcome Assessments: Use of Normative Data in a Pediatric Rare Disease. Value Health 2018; 21:508-514. [PMID: 29753346 DOI: 10.1016/j.jval.2018.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 06/08/2023]
Abstract
Pediatric rare diseases present unique challenges in clinical trial design and in selection of clinical outcome assessments (COAs) used to support claims in medical product labeling. COAs that discriminate level of function relative to a normative sample are particularly important in the pediatric rare disease setting because the literature is often void of natural history data. Pediatric rare disease clinical trials will often include a wide age distribution. Gross and fine motor skills, communication, cognition, and independence in activities of daily living vary by age, and it may be difficult to distinguish between treatment effect and change due to developmental maturation. Asfotase alfa was granted breakthrough therapy designation and subsequently approved for the treatment of hypophosphatasia (HPP; a genetic metabolic musculoskeletal disorder) and is used in this discussion to illustrate COA selection in a pediatric rare disease. Multiple COAs with normative data in HPP clinical trials for asfotase alfa are presented. The assessment instruments included the Bayley Scales of Infant and Toddler Development-Third Edition, the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, the Childhood Health Assessment Questionnaire, the Pediatric Outcomes Data Collection Instrument, handheld dynamometry, the 6-minute walk test, and the Modified Performance-Oriented Mobility Assessment-Gait scale. Multiple end points were required to adequately capture the impact of asfotase alfa treatment on the multiple systems affected in HPP. These data illustrate the importance of using multiple COAs that provide normative data and to use COAs early in the drug development process for rare pediatric disease.
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Affiliation(s)
- Dawn Phillips
- Evidera Inc., Bethesda, MD, USA; UNC Division of Physical Therapy, Chapel Hill, NC, USA.
| | - Beth Leiro
- Physical Therapy Functional Outcomes Consultant and Private Practice Physical Therapist, Chapel Hill, NC, USA
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Lal S, Fowler D, Phillips D, Lillick T, Berg G, Khanna R. Internal Jugular Vein Thrombosis after Subclavian Vein Cannulation: Detection by Computed Tomography. Int J Artif Organs 2018. [DOI: 10.1177/039139888600900408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S.M. Lal
- Departments of Medicine and Radiology University of Missouri Columbia, Missouri, U.S.A
| | - D. Fowler
- Departments of Medicine and Radiology University of Missouri Columbia, Missouri, U.S.A
| | - D. Phillips
- Departments of Medicine and Radiology University of Missouri Columbia, Missouri, U.S.A
| | - T. Lillick
- Departments of Medicine and Radiology University of Missouri Columbia, Missouri, U.S.A
| | - G.G. Berg
- Departments of Medicine and Radiology University of Missouri Columbia, Missouri, U.S.A
| | - R. Khanna
- Departments of Medicine and Radiology University of Missouri Columbia, Missouri, U.S.A
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Phillips D, Griffin D, Przybylski T, Morrison E, Reeves AL, Vallee M, Fujita KP, Madson KL. Development and validation of a modified performance-oriented mobility assessment tool for assessing mobility in children with hypophosphatasia. J Pediatr Rehabil Med 2018; 11:187-192. [PMID: 30223404 PMCID: PMC6294582 DOI: 10.3233/prm-170523] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To modify the Performance-Oriented Mobility Assessment-Gait (POMA-G) subtest and validate this modified POMA-G (mPOMA-G) in children with hypophosphatasia (HPP), a rare metabolic disorder that can manifest with musculoskeletal symptoms that impair mobility and ambulation. METHODS Based on feedback from an expert panel, the POMA-G was modified by removing gait initiation/path assessments and expanding the rating scale for step length/continuity to capture aspects of observational gait analysis relevant to children with HPP. Three trained physical therapists used the mPOMA-G for video-based assessments of gait in 14 children with childhood HPP who participated in a clinical study of asfotase alfa or in a natural history study. Intraclass correlation coefficients (ICCs) were calculated to determine interrater and intrarater agreement. Concurrent validity was evaluated by correlations with other validated assessment tools. RESULTS Across 192 observations from available videos, interrater and intrarater agreement of mPOMA-G scores was significant (ICCs: 0.76 for both; P< 0.001). mPOMA-G scores had strong concurrent validity with the Childhood Health Assessment Questionnaire, Pediatric Outcomes Data Collection Instrument Transfer and Mobility Scale, Sports and Physical Function subscale, and 6-Minute Walk Test (all P⩽ 0.0002). CONCLUSION The mPOMA-G is a reliable and valid measure for detecting clinically significant impairments in children with HPP.
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Affiliation(s)
- Dawn Phillips
- Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA.,Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
| | | | | | | | - Amy L Reeves
- Shriners Hospitals for Children, St. Louis, MO, USA
| | - Marc Vallee
- Biostatistics, Alexion Pharmaceuticals, Inc., Boston, MA, USA
| | - Kenji P Fujita
- Clinical Development, Alexion Pharmaceuticals, Inc., Boston, MA, USA
| | - Katherine L Madson
- Shriners Hospitals for Children, St. Louis, MO, USA.,Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
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Affiliation(s)
- J F Fairhead
- Nuffield Department of Surgery, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
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Gomez E, Bishop J, Jackson K, Muram T, Phillips D, Wilhelm S. 434 Treatment with ixekizumab does not interfere with the efficacy of tetanus and pneumococcal vaccines in healthy subjects. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kotit S, Saeed K, Elfaramawy A, Mahmoud H, Phillips D, Yacoub M. P5442Prevalence and prognostic value of echocardiographic screening for RHD in Aswan school children. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5442] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Frank M, Khodadoust M, Chu M, Kohrt H, Advani R, Alizadeh A, Reddy S, Maeda L, Gupta N, Laport G, Meyer E, Miklos D, Negrin R, Rezvani A, Weng W, Sheehan K, Czerwinski D, Faham M, Okada A, Moore H, Phillips D, Wapnir I, Brody J, Levy R. PHASE I/II CLINICAL TRIAL OF AN ACTIVATED WHOLE TUMOR CELL VACCINE FOLLOWED BY TRANSFER OF IMMUNE T CELLS IN PATIENTS WITH MANTLE CELL LYMPHOMA. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M. Frank
- Division of Oncology; Stanford University; Stanford USA
| | - M. Khodadoust
- Division of Oncology; Stanford University; Stanford USA
| | - M. Chu
- Department of Oncology; University of Alberta; Edmonton Canada
| | - H. Kohrt
- Division of Oncology; Stanford University; Stanford USA
| | - R. Advani
- Division of Oncology; Stanford University; Stanford USA
| | - A. Alizadeh
- Division of Oncology; Stanford University; Stanford USA
| | - S. Reddy
- Division of Oncology; Stanford University; Stanford USA
| | - L. Maeda
- Division of Oncology; Stanford University; Stanford USA
| | - N. Gupta
- Division of Oncology; Stanford University; Stanford USA
| | - G. Laport
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - E. Meyer
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - D. Miklos
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - R. Negrin
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - A. Rezvani
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - W. Weng
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - K. Sheehan
- Division of Blood and Marrow Transplantation; Stanford University; Stanford USA
| | - D. Czerwinski
- Division of Oncology; Stanford University; Stanford USA
| | - M. Faham
- Adaptive Biotechnologies, Adaptive Biotechnologies; Seattle USA
| | - A. Okada
- Division of Oncology; Stanford University; Stanford USA
| | - H. Moore
- Division of Oncology; Stanford University; Stanford USA
| | - D. Phillips
- Division of Oncology; Stanford University; Stanford USA
| | - I. Wapnir
- Department of Sugery; Stanford University; Stanford USA
| | - J. Brody
- Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai; New York USA
| | - R. Levy
- Division of Oncology; Stanford University; Stanford USA
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Phillips D, Case LE, Griffin D, Hamilton K, Lara SL, Leiro B, Monfreda J, Westlake E, Kishnani PS. Physical therapy management of infants and children with hypophosphatasia. Mol Genet Metab 2016; 119:14-9. [PMID: 27386757 DOI: 10.1016/j.ymgme.2016.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/20/2016] [Accepted: 06/20/2016] [Indexed: 11/16/2022]
Abstract
Hypophosphatasia (HPP) is a rare inborn error of metabolism resulting in undermineralization of bone and subsequent skeletal abnormalities. The natural history of HPP is characterized by rickets and osteomalacia, increased propensity for bone fracture, early loss of teeth in childhood, and muscle weakness. There is a wide heterogeneity in disease presentation, and the functional impact of the disease can vary from perinatal death to gait abnormalities. Recent clinical trials of enzyme replacement therapy have begun to offer an opportunity for improvement in survival and function. The role of physical therapy in the treatment of the underlying musculoskeletal dysfunction in HPP is underrecognized. It is important for physical therapists to understand the disease characteristics of the natural history of a rare disease like HPP and how the impairment and activity limitations may change in response to medical interventions. An understanding of when and how to intervene is also important in order to optimally impact body function, lessen structural impairment, and facilitate increased functional independence in mobility and activities of daily living. Individualizing treatment to the child's needs, medical fragility, and setting (home/school/hospital), while educating parents, caregivers, and school staff regarding approved activities and therapy frequency, may improve function and development in children with HPP.
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Affiliation(s)
- Dawn Phillips
- University of North Carolina, Division of Physical Therapy, Department of Allied Health Sciences, 1104 Willow Drive, Chapel Hill, NC 27517, USA.
| | - Laura E Case
- Duke University, Division of Physical Therapy, School of Medicine, DUMC 104002, Durham, NC 27708, USA.
| | - Donna Griffin
- Shriners Hospitals for Children, Center for Metabolic Bone Disease and Molecular Research, 4400 Clayton Avenue, St. Louis, MO 63110, USA.
| | - Kim Hamilton
- Health Sciences Centre, 820 Sherbrook Street MS107, Winnipeg, Manitoba R3A 1R9, Canada.
| | - Sergio Lerma Lara
- CSEU La Salle, Autonomous University of Madrid, Niño Jesús Paediatric Hospital, Avenida de Menéndez Pelayo, 65, 28009 Madrid, Spain.
| | - Beth Leiro
- Functional Outcomes Consultant, 401 Holly Lane, Chapel Hill, NC 27517, USA.
| | - Jessica Monfreda
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Elaine Westlake
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; University of California, San Francisco Benioff Children's Hospital, 747 52nd Street, Oakland, CA 94609, USA.
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, 905 S. LaSalle Street, 4th Floor, GSRBI, Box 103856 DUMC, Durham, NC 27710, USA.
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Phillips D, Mitchell EJS, Lea-Langton AR, Parmar KR, Jones JM, Williams A. The use of conservation biomass feedstocks as potential bioenergy resources in the United Kingdom. Bioresour Technol 2016; 212:271-279. [PMID: 27107483 DOI: 10.1016/j.biortech.2016.04.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
A number of countries have introduced energy policies to reduce the emission of carbon dioxide which, in the case of bio-heat, has resulted in increased use of small wood burning stoves and boilers, particularly in Europe. There are issues surrounding the supply of sustainable wood feedstock, prompting a desire to utilise local biomass resources. This includes biomass generated through the management of natural woodlands in nature reserves and conservation areas. These management practices can also extend to other areas, such as raised bog wildernesses and estuary Reed beds. We term the biomass from this resource as conservation biomass. This study is concerned with the viability of this resource as a fuel within the United Kingdom, and combustion tests were carried out using a small domestic stove. It was concluded that there is as much as 500kty(-1) that could be used in this way.
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Affiliation(s)
- D Phillips
- Energy Research Institute, School of Chemical and Process Engineering, The University of Leeds, LS29JT, UK
| | - E J S Mitchell
- Energy Research Institute, School of Chemical and Process Engineering, The University of Leeds, LS29JT, UK
| | - A R Lea-Langton
- School of Mechanical, Aerospace and Civil Engineering, The University of Manchester, Manchester M13 9PL, UK
| | - K R Parmar
- Energy Research Institute, School of Chemical and Process Engineering, The University of Leeds, LS29JT, UK
| | - J M Jones
- Energy Research Institute, School of Chemical and Process Engineering, The University of Leeds, LS29JT, UK
| | - A Williams
- Energy Research Institute, School of Chemical and Process Engineering, The University of Leeds, LS29JT, UK.
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Whyte MP, Madson KL, Phillips D, Reeves AL, McAlister WH, Yakimoski A, Mack KE, Hamilton K, Kagan K, Fujita KP, Thompson DD, Moseley S, Odrljin T, Rockman-Greenberg C. Asfotase alfa therapy for children with hypophosphatasia. JCI Insight 2016; 1:e85971. [PMID: 27699270 DOI: 10.1172/jci.insight.85971] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Hypophosphatasia (HPP) is caused by loss-of-function mutation(s) of the gene that encodes the tissue-nonspecific isoenzyme of alkaline phosphatase (TNSALP). Consequently, cell-surface deficiency of TNSALP phosphohydrolase activity leads to extracellular accumulation of inorganic pyrophosphate, a natural substrate of TNSALP and inhibitor of mineralization. Children with HPP can manifest rickets, skeletal pain, deformity, fracture, muscle weakness, and premature deciduous tooth loss. Asfotase alfa is a recombinant, bone-targeted, human TNSALP injected s.c. to treat HPP. In 2012, we detailed the 1-year efficacy of asfotase alfa therapy for the life-threatening perinatal and infantile forms of HPP. Methods. Here, we evaluated the efficacy and safety of asfotase alfa treatment administered to children 6-12 years of age at baseline who were substantially impaired by HPP. Two radiographic scales quantitated HPP skeletal disease, including comparisons to serial radiographs from similarly affected historical control patients. Results. Twelve children receiving treatment were studied for 5 years. The 6-month primary endpoint was met, showing significant radiographic improvement. Additional significant improvements included patient growth, strength, motor function, agility, and quality of life, which for most patients meant achieving normal values for age- and sex-matched peers that were sustained at 5 years of treatment. For most, pain and disability resolved. Mild to moderate injection-site reactions were common and were sometimes associated with lipohypertrophy. Low anti-asfotase alfa antibody titers were noted in all patients. No evidence emerged for clinically important ectopic calcification or treatment resistance. Conclusions. Asfotase alfa enzyme replacement therapy has substantial and sustained efficacy with a good safety profile for children suffering from HPP. Trial Registration. ClinicalTrials.gov NCT00952484 (https://clinicaltrials.gov/ct2/show/NCT00952484) and NCT01203826 (https://clinicaltrials.gov/ct2/show/NCT01203826). Funding. Alexion Pharmaceuticals Inc. and Shriners Hospitals for Children.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, Missouri, USA.,Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, Missouri, USA
| | - Katherine L Madson
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, Missouri, USA
| | - Dawn Phillips
- University of North Carolina, Division of Physical Therapy, Department of Allied Health Sciences, Chapel Hill, North Carolina, USA
| | - Amy L Reeves
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, Missouri, USA
| | - William H McAlister
- Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Amy Yakimoski
- The University of Manitoba, Faculty of Health Sciences, Department of Pediatrics and Child Health, Winnipeg, Manitoba, Canada
| | - Karen E Mack
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, Missouri, USA
| | | | - Kori Kagan
- Children's Hospital, Winnipeg, Manitoba, Canada
| | - Kenji P Fujita
- Alexion Pharmaceuticals Inc., Cheshire, Connecticut, USA
| | | | - Scott Moseley
- Alexion Pharmaceuticals Inc., Cheshire, Connecticut, USA
| | | | - Cheryl Rockman-Greenberg
- The University of Manitoba, Faculty of Health Sciences, Department of Pediatrics and Child Health, Winnipeg, Manitoba, Canada.,Children's Hospital, Winnipeg, Manitoba, Canada
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Bird E, Cormack I, Rodgers M, Phillips D, Elgalib A. An audit of HIV treatment outcomes in a UK inner city cohort. Int J STD AIDS 2016; 27:1114-1116. [PMID: 27147265 DOI: 10.1177/0956462416649327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/19/2016] [Indexed: 11/16/2022]
Abstract
We describe the demographics and treatment outcomes of a HIV-infected cohort from Croydon University Hospital, London, UK. We showed that the Croydon Cohort had good viral load suppression (98.6% with viral load < 100 copies/ml and 99.0% with viral load < 200 copies/ml) despite being a potentially challenging cohort in a deprived area of London. The viral load outcomes are better than the Public Health England data from 2014 and the latest British HIV Association audit using data from 2009.
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Affiliation(s)
- E Bird
- Genitourinary Medicine, Croydon University Hospital, London, UK
| | - I Cormack
- Genitourinary Medicine, Croydon University Hospital, London, UK
| | - M Rodgers
- Genitourinary Medicine, Croydon University Hospital, London, UK
| | - D Phillips
- Genitourinary Medicine, Croydon University Hospital, London, UK
| | - A Elgalib
- Genitourinary Medicine, Croydon University Hospital, London, UK
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Phillips D, Griffin D, Przybylski T, Morrison E, Reeves A, Vallee M, Fujita K, Madson K, Whyte M. A modified performance-oriented mobility assessment tool for assessing clinically relevant gait impairments and change in children with hypophosphatasia: development and validation. ACTA ACUST UNITED AC 2015. [DOI: 10.1530/boneabs.4.p136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Phillips D, Griffin D, Przybylski T, Morrison E, Reeves A, Vallee M, Fujita K, Madson K, Whyte M. Gait assessment in children with childhood hypophosphatasia: impairments in muscle strength and physical function. ACTA ACUST UNITED AC 2015. [DOI: 10.1530/boneabs.4.p103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Smith BK, Collins SW, Conlon TJ, Mah CS, Lawson LA, Martin AD, Fuller DD, Cleaver BD, Clément N, Phillips D, Islam S, Dobjia N, Byrne BJ. Phase I/II trial of adeno-associated virus-mediated alpha-glucosidase gene therapy to the diaphragm for chronic respiratory failure in Pompe disease: initial safety and ventilatory outcomes. Hum Gene Ther 2014; 24:630-40. [PMID: 23570273 DOI: 10.1089/hum.2012.250] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pompe disease is an inherited neuromuscular disease caused by deficiency of lysosomal acid alpha-glucosidase (GAA) leading to glycogen accumulation in muscle and motoneurons. Cardiopulmonary failure in infancy leads to early mortality, and GAA enzyme replacement therapy (ERT) results in improved survival, reduction of cardiac hypertrophy, and developmental gains. However, many children have progressive ventilatory insufficiency and need additional support. Preclinical work shows that gene transfer restores phrenic neural activity and corrects ventilatory deficits. Here we present 180-day safety and ventilatory outcomes for five ventilator-dependent children in a phase I/II clinical trial of AAV-mediated GAA gene therapy (rAAV1-hGAA) following intradiaphragmatic delivery. We assessed whether rAAV1-hGAA results in acceptable safety outcomes and detectable functional changes, using general safety measures, immunological studies, and pulmonary functional testing. All subjects required chronic, full-time mechanical ventilation because of respiratory failure that was unresponsive to both ERT and preoperative muscle-conditioning exercises. After receiving a dose of either 1×10(12) vg (n=3) or 5×10(12) vg (n=2) of rAAV1-hGAA, the subjects' unassisted tidal volume was significantly larger (median [interquartile range] 28.8% increase [15.2-35.2], p<0.05). Further, most patients tolerated appreciably longer periods of unassisted breathing (425% increase [103-851], p=0.08). Gene transfer did not improve maximal inspiratory pressure. Expected levels of circulating antibodies and no T-cell-mediated immune responses to the vector (capsids) were observed. One subject demonstrated a slight increase in anti-GAA antibody that was not considered clinically significant. These results indicate that rAAV1-hGAA was safe and may lead to modest improvements in volitional ventilatory performance measures. Evaluation of the next five patients will determine whether earlier intervention can further enhance the functional benefit.
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Affiliation(s)
- Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610-0296, USA
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Dennison L, Morrison L, Lloyd S, Phillips D, Stuart B, Williams S, Bradbury K, Roderick P, Murray E, Michie S, Little P, Yardley L. Does brief telephone support improve engagement with a web-based weight management intervention? Randomized controlled trial. J Med Internet Res 2014; 16:e95. [PMID: 24681761 PMCID: PMC4004138 DOI: 10.2196/jmir.3199] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [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: 12/18/2013] [Revised: 02/25/2014] [Accepted: 03/13/2014] [Indexed: 01/21/2023] Open
Abstract
Background Recent reviews suggest Web-based interventions are promising approaches for weight management but they identify difficulties with suboptimal usage. The literature suggests that offering some degree of human support to website users may boost usage and outcomes. Objective We disseminated the POWeR (“Positive Online Weight Reduction”) Web-based weight management intervention in a community setting. POWeR consisted of weekly online sessions that emphasized self-monitoring, goal-setting, and cognitive/behavioral strategies. Our primary outcome was intervention usage and we investigated whether this was enhanced by the addition of brief telephone coaching. We also explored group differences in short-term self-reported weight loss. Methods Participants were recruited using a range of methods including targeted mailouts, advertisements in the local press, notices on organizational websites, and social media. A total of 786 adults were randomized at an individual level through an online procedure to (1) POWeR only (n=264), (2) POWeR plus coaching (n=247), or (3) a waiting list control group (n=275). Those in the POWeR plus coaching arm were contacted at approximately 7 and 28 days after randomization for short coaching telephone calls aimed at promoting continued usage of the website. Website usage was tracked automatically. Weight was assessed by online self-report. Results Of the 511 participants allocated to the two intervention groups, the median number of POWeR sessions completed was just one (IQR 0-2 for POWeR only, IQR 0-3 for POWeR plus coach). Nonetheless, a substantial minority completed at least the core three sessions of POWeR: 47 participants (17.8%, 47/264) in the POWeR-only arm and 64 participants (25.9%, 64/247) in the POWeR plus coaching arm. Participants in the POWeR plus coaching group persisted with the intervention for longer and were 1.61 times more likely to complete the core three sessions than the POWeR-only group (χ21=4.93; OR 1.61, 95% CI 1.06-2.47; n=511). An intention-to-treat analysis showed between-group differences in weight loss (F2,782=12.421, P<.001). Both intervention groups reported more weight loss than the waiting list control group. Weight loss was slightly, but not significantly, greater in the POWeR plus coaching group. A large proportion of participants assigned to POWeR plus coaching refused phone calls or were not contactable (57.9%, 143/247). Exploratory analyses identified health and sociodemographic differences between those who did and did not engage in coaching when it was made available to them. Users who engaged with coaching used the intervention more and lost more weight than those who did not. Conclusions In common with most Web-based intervention studies, usage of POWeR was suboptimal overall. However, our findings suggest that supplementing Web-based weight management with brief human support could improve usage and outcomes in those who take it up. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 98176068; http://www.controlled-trials.com/ISRCTN98176068 (Archived by WebCite at http://www.webcitation.org/6OKRjM2oy).
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Lee MP, Gibson GM, Phillips D, Padgett MJ, Tassieri M. Dynamic stereo microscopy for studying particle sedimentation. Opt Express 2014; 22:4671-7. [PMID: 24663785 DOI: 10.1364/oe.22.004671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
We demonstrate a new method for measuring the sedimentation of a single colloidal bead by using a combination of optical tweezers and a stereo microscope based on a spatial light modulator. We use optical tweezers to raise a micron-sized silica bead to a fixed height and then release it to observe its 3D motion while it sediments under gravity. This experimental procedure provides two independent measurements of bead diameter and a measure of Faxén's correction, where the motion changes due to presence of the boundary.
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Tandon R, Loebel A, Phillips D, Pikalov A, Hernandez D, Mao Y, Cucchiaro J. EPA-1722 – A double-blind, placebo-controlled, randomized withdrawal study of lurasidone for the maintenance of efficacy in patients with schizophrenia. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78861-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kaynar A, Phillips D, Gomez H, Lischner M, Melhem S, Subramaniam K, Pinsky M. Utility of transesophageal echocardiography in the ICU: a preliminary US perspective. Crit Care 2013. [PMCID: PMC3642394 DOI: 10.1186/cc12120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Leverson J, Souers A, Boghaert E, Phillips D, Park C, Wendt M, Fairbrother W, Humerickhouse R, Roberts A, Elmore S. 69 ABT-199, a Selective Small Molecule Inhibitor of Bcl-2, Exhibits Efficacy in Bcl-2 Dependent Malignancies While Sparing Platelets. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71867-1] [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: 10/27/2022]
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Gill S, Younie S, Rolfo A, Thomas J, Siva S, Fox C, Kron T, Phillips D, Tai K, Foroudi F. Cost Minimisation Analysis: Kilovoltage Imaging with Automated Repositioning Versus Electronic Portal Imaging in Image-guided Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2012; 24:e93-9. [DOI: 10.1016/j.clon.2012.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/23/2012] [Accepted: 04/20/2012] [Indexed: 11/24/2022]
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McMillan ND, Reddin M, Neill MO, Jordan R, Phillips D, Goff D, Nolan J, Harnedy R, Mitchell W, Harkin J, Lawlor V, McMillan LRL. The Tensiograph - A Novel Instrument for the Fingerprinting and Analysis of Multiple Physical Attributes of Beer. Journal of the Institute of Brewing 2012. [DOI: 10.1002/j.2050-0416.2000.tb00051.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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