1
|
Hrubesz G, Dwyer K, McIsaac DI, Sood MM, Clark E, Douketis J, Carrier M, Shaw JR. Perioperative management of apixaban in patients with advanced CKD undergoing a planned invasive procedure. Blood Adv 2024; 8:732-735. [PMID: 38181766 PMCID: PMC10847030 DOI: 10.1182/bloodadvances.2023012380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Gabriella Hrubesz
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kevin Dwyer
- Analytics, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Daniel I. McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Manish M. Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Edward Clark
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Marc Carrier
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Joseph R. Shaw
- Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| |
Collapse
|
2
|
Kitamura M, Dasgupta A, Henricks J, Parikh SV, Nadasdy T, Clark E, Bazan JA, Satoskar AA. Clinicopathological differences between Bartonella and other bacterial endocarditis-related glomerulonephritis - our experience and a pooled analysis. Front Nephrol 2024; 3:1322741. [PMID: 38288381 PMCID: PMC10823370 DOI: 10.3389/fneph.2023.1322741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024]
Abstract
Background Although Staphylococcus aureus is the leading cause of acute infective endocarditis (IE) in adults, Bartonella spp. has concomitantly emerged as the leading cause of "blood culture-negative IE" (BCNE). Pre-disposing factors, clinical presentation and kidney biopsy findings in Bartonella IE-associated glomerulonephritis (GN) show subtle differences and some unique features relative to other bacterial infection-related GNs. We highlight these features along with key diagnostic clues and management approach in Bartonella IE-associated GN. Methods We conducted a pooled analysis of 89 cases of Bartonella IE-associated GN (54 published case reports and case series; 18 published conference abstracts identified using an English literature search of several commonly used literature search modalities); and four unpublished cases from our institution. Results Bartonella henselae and Bartonella quintana are the most commonly implicated species causing IE in humans. Subacute presentation, affecting damaged native and/or prosthetic heart valves, high titer anti-neutrophil cytoplasmic antibodies (ANCA), mainly proteinase-3 (PR-3) specificity, fastidious nature and lack of positive blood cultures of these Gram-negative bacilli, a higher frequency of focal glomerular crescents compared to other bacterial infection-related GNs are some of the salient features of Bartonella IE-associated GN. C3-dominant, but frequent C1q and IgM immunofluorescence staining is seen on biopsy. A "full-house" immunofluorescence staining pattern is also described but can be seen in IE -associated GN due to other bacteria as well. Non-specific generalized symptoms, cytopenia, heart failure and other organ damage due to embolic phenomena are the highlights on clinical presentation needing a multi-disciplinary approach for management. Awareness of the updated modified Duke criteria for IE, a high index of suspicion for underlying infection despite negative microbiologic cultures, history of exposure to animals, particularly infected cats, and use of send-out serologic tests for Bartonella spp. early in the course of management can help in early diagnosis and initiation of appropriate treatment. Conclusion Diagnosis of IE-associated GN can be challenging particularly with BCNE. The number of Bartonella IE-associated GN cases in a single institution tends to be less than IE due to gram positive cocci, however Bartonella is currently the leading cause of BCNE. We provide a much-needed discussion on this topic.
Collapse
Affiliation(s)
- Mineaki Kitamura
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Alana Dasgupta
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jonathan Henricks
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Samir V. Parikh
- Department of Internal Medicine, Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tibor Nadasdy
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Edward Clark
- Department of Internal Medicine, St. Vincent Hospital, Erie, PA, United States
| | - Jose A. Bazan
- Department of Internal Medicine, Division of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Anjali A. Satoskar
- Department of Pathology, Division of Renal and Transplant Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| |
Collapse
|
3
|
Farfan Ruiz AC, Malick R, Rhodes E, Clark E, Hundemer G, Karaboyas A, Robinson B, Pecoits R, Sood MM. Adverse Gastrointestinal Events With Sodium Polystyrene Sulfonate Use in Patients on Maintenance Hemodialysis: An International Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231172405. [PMID: 37359984 PMCID: PMC10288443 DOI: 10.1177/20543581231172405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/19/2023] [Indexed: 06/28/2023] Open
Abstract
Background There are concerns regarding the gastrointestinal (GI) safety of sodium polystyrene sulfonate (SPS), a medication commonly used in the management of hyperkalemia. Objective To compare the risk of GI adverse events among users versus non-users of SPS in patients on maintenance hemodialysis. Design International prospective cohort study. Setting Seventeen countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] phase 2-6 from 2002 to 2018). Patients 50 147 adults on maintenance hemodialysis. Measurements An adverse GI event defined by a GI hospitalization or GI fatality with SPS prescription compared with no SPS prescription. Methods Overlap propensity score-weighted Cox models. Results Sodium polystyrene sulfonate prescription was present in 13.4% of patients and ranged from 0.42% (Turkey) to 20.6% (Sweden) with 12.5% use in Canada. A total of 935 (1.9%) adverse GI events (140 [2.1%] with SPS, 795 [1.9%] with no SPS; absolute risk difference 0.2%) occurred. The weighted hazard ratio (HR) of a GI event was not elevated with SPS use compared with non-use (HR = 0.93, 95% confidence interval = 0.83-1.6). The results were consistent when examining fatal GI events and/or GI hospitalization separately. Limitations Sodium polystyrene sulfonate dose and duration were unknown. Conclusions Sodium polystyrene sulfonate use in patients on hemodialysis was not associated with a higher risk of an adverse GI event. Our findings suggest that SPS use is safe in an international cohort of maintenance hemodialysis patients.
Collapse
Affiliation(s)
- Ana Cecilia Farfan Ruiz
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Ranjeeta Malick
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Emily Rhodes
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada
| | - Edward Clark
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Greg Hundemer
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | | | | | | | - Manish M. Sood
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| |
Collapse
|
4
|
Poole K, Chappell D, Brown J, Clark E, Fleming J, Shepstone L, Turmezei T, Wagner A, Willoughby K, Kaptoge S. OP0243 OSTEOPOROSIS CASE-FINDING IN PEOPLE UNDERGOING ROUTINE DIAGNOSTIC CT SCANS ALMOST TRIPLED THE RATE OF OSTEOPOROSIS TREATMENT AT 12 MONTHS. A RANDOMISED, MULTI-CENTRE FEASIBILITY STUDY USING WAITING ROOM FRAX, OPPORTUNISTIC CT BONE DENSITY AND VERTEBRAL FRACTURE ASSESSMENT VERSUS USUAL CARE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundUp to 40% of all diagnostic computed tomography (CT) scans include views of the spine or hips. Among older people, osteoporosis or vertebral fractures have been found in 30% of such CT scans. Our ‘PHOENIX’ intervention repurposes CT scans taken for other reasons to identify fractures and measure bone density as an ‘added extra’. Early detection and treatment of osteoporosis in CT-attending patients could improve health outcomes.ObjectivesTo determine the feasibility and efficacy of PHOENIX versus usual care in a multi-centre, randomised, pragmatic study conducted in Eastern England involving our Cambridge Specialist Hospital ‘hub’ and four regional General Hospital ‘spokes’.MethodsWomen ≥65 and men ≥75 years attending for routine diagnostic CT scans were invited to participate via a novel consent form incorporating FRAX Fracture Risk Assessment questions. After calculating their FRAX 10-year risk score, higher risk patients were block randomised (1:1:1) to Group 1) PHOENIX intervention, 2) Active Control, where the GP was sent the patients’ FRAX answers only, or 3) Usual Care where data were only analysed after 13 months had elapsed. The CT scans of high FRAX risk patients in Group 1 were retrieved by the Cambridge team using NHS Connecting for Health (Burnbank, UK). The team performed vertebral fracture assessment and measured bone density using QCT Pro (Mindways, USA). They added patient-specific treatment and investigation management advice from ‘drop down’ menus before results were reviewed by a physician, authorised and sent to general practitioners (GPs). Baseline CT scans from groups 2 and 3 were assessed in the same way after 13 months to ensure no patient with osteoporosis/fractures was neglected long term. Assuming 25% attrition, the study was powered to find a superior osteoporosis treatment rate in Group 1 (estimated 20%) versus 16% (Active Control) and 5% (Usual Care). Co-primary feasibility endpoints were the ability to a) randomise 375 patients within 10 months and b) retain 75% of survivors able to complete a 1-year bone health outcome questionnaire. Secondary outcomes included osteoporosis/vertebral fracture identification rates and osteoporosis treatment rates. Stakeholder acceptability and economic aspects will be reported separately.ResultsFrom 1828 invites, 595 participants consented to participate of whom 213 were excluded due to ‘low’ FRAX score. Mortality at 12 months was 20%. Both feasibility objectives were achieved: 1) 382 people were randomised within 10 months; 2) 84.4% of survivors at 1 year (95%CI: 80.5, 88.3) were successfully followed-up. Groups were well matched at baseline. The average age of 375 patients (334 female, 41 male) was 75.2 years (74.6, 75.9). Osteoporosis of the hip/spine was present in 41% of 362 analysable CT scans. From the 264 spines that were suitable for VFA, 20% (n=53) were found to have vertebral fractures, with 8.3% having multiple vertebral fractures (n=22). Osteoporosis treatment was reported in 8.5% of Usual Care group (2.9, 14.2) and 24.2% (15.4, 33.0) of PHOENIX group participants, while in the Active Control group (FRAX only) it was 18.8% (10.9, 26.6 p=0.021). In the PHOENIX group, a recommendation to treat was sent to 50 patients’ GPs at baseline. Only 18 of the 50 patients (36%) were found to be taking osteoporosis treatment 12 months after this advice was sent.ConclusionOsteoporosis treatment rates were almost tripled by screening patients attending for routine diagnostic CT scans with waiting room FRAX, CT-bone densitometry and vertebral fracture analysis.AcknowledgementsThis project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0816-20027) and by the Cambridge NIHR Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Funding is in place to 31.03.2022. Three individuals, Mr Jeremy Dearling, Mrs Tessa Plume and Dr Ann Frost joined our trial group as PPI representatives; they were specifically involved in patient documentation design (particularly the PHOENIX pack, informed consent form which facilitated consent without having a researcher present) and contributed to suggestions for increasing patient recruitment and follow up.Disclosure of InterestsNone declared
Collapse
|
5
|
Bennett SE, Gooberman-Hill R, Clark E, Paskins Z, Walsh N, Drew S. POS1514-HPR UNDERSTANDING AND CHARACTERISING PATIENT PATHWAYS TO TREATMENT FOR VERTEBRAL FRACTURES: A QUALITATIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundOsteoporosis involves thinning of the bones, making them more prone to break. The most common osteoporotic fracture is a vertebral fracture (OVF). People with OVFs are at high risk of further fractures. To reduce this risk, guidelines recommend prescription of bone protection therapies to people who have experienced a fracture. However, many patients do not receive diagnosis. Understanding patient pathways to treatment for OVFs will provide information to improve practice and aid in effective identification and management.ObjectivesTo understand and characterise patient pathways to treatment for OVFs.MethodsTwenty-three semi-structured qualitative interviews were conducted with patients aged ≥50 years with diagnosis of OVF. Patients were recruited through two hospitals in England and were purposively sampled to capture variation in pathways to diagnosis, sex, age, comorbidities and other relevant characteristics. Interviews were audio-recorded, transcribed and analysed thematically, with themes transposed onto key stages of the patient pathway.ResultsSeveral factors influenced patient pathways to treatment:Patient appraisal and self-management: Characteristics and attitudes towards back pain impacted treatment-seeking behaviour. Patients who appraised their pain as ‘different’, severe or disruptive, or associated with an injury such as a fall, were more likely to seek help. Limited availability of information about OVFs and risk factors meant most patients did not associate symptoms with a potential OVF. Factors contributing to delayed consultation included the normalisation of back pain and prioritisation of comorbid conditions. Several misappraised their symptoms as a “pulled muscle” or other minor injury. Many adopted strategies to manage pain, including use of painkillers, lying flat or resting. For some, a lack of improvement in symptoms over time, combined with worsening pain, created a ‘tipping point’ in seeking care. There was a moral dimension for some patients who did not want to “bother” healthcare professionals.Healthcare professional appraisal: Differential diagnosis was a barrier to treatment and healthcare professionals interpreted OVF pain as broken ribs, muscular pain, kidney pain or sciatica. GPs tended to instigate watchful waiting, in which patients were asked to re-consult if pain did not improve. Feeling disbelieved caused some patients to become disillusioned and reluctant to re-consult and a small number of patients presented at Accident and Emergency. Those already having treatment for musculoskeletal conditions with access to specialist care, were more likely to receive timely diagnosis.Communication of diagnosis: Patients discussed multiple methods of communication, including written communication and clinical conversations. Several expressed confusion around the use of unfamiliar medical terminology, the implications of OVFs, how many OVFs they had experienced and how they had been identified.Treatment initiation: Bone protection therapies were not consistently prescribed after diagnosis. Patients who were familiar with these therapies were unsure whether treatment should be initiated in primary or secondary care. Patients described how they felt a need to be proactive by arranging appointments and asking for treatment.ConclusionThe study provides novel findings about patient pathways to treatment and will be used to identify targeted solutions to improve management of OVFs. This work addresses stages of the Model of Pathways to Treatment[1] and provides detailed understanding of patients’ experiences of these stages. Further work with healthcare professionals in primary care is underway to identify additional system-level factors that may impact patients’ journeys to treatment.References[1]Scott, S.E., et al., The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol, 2013. 18(1): p. 45-65.AcknowledgementsThis study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) programme NIHR201523. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.Disclosure of InterestsNone declared
Collapse
|
6
|
Khan H, Connolly T, Loh MY, Clark E. Duodenal volvulus: a rare cause of small bowel obstruction. Ann R Coll Surg Engl 2021; 104:e102-e104. [PMID: 34846192 DOI: 10.1308/rcsann.2021.0242] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Small bowel volvulus is a rare but life-threatening emergency. Volvulus of the duodenum is even rarer without the presence of predisposing factors. The clinical presentation is vague, including abdominal pain, nausea and vomiting, prompt diagnosis of volvulus therefore relies heavily on radiographs. The treatment options lie between conservative or surgical management, where the decision is influenced by the patient and their presentation. This case is of a 100-year-old female with an extensive surgical and medical background presenting with signs of small bowel obstruction. With the help of imaging, a rare case of duodenal volvulus was diagnosed but managed conservatively due to the patient's background, age and personal wishes.
Collapse
Affiliation(s)
- H Khan
- Stockport NHS Foundation Trust, UK
| | | | - M-Y Loh
- Stockport NHS Foundation Trust, UK
| | - E Clark
- Stockport NHS Foundation Trust, UK
| |
Collapse
|
7
|
Akbari A, Kunkel E, Bota SE, Harel Z, Le Gal G, Cox C, Hundemer GL, Canney M, Clark E, Massicotte-Azarniouch D, Eddeen AB, Knoll G, Sood MM. Proteinuria and venous thromboembolism in pregnancy: a population-based cohort study. Clin Kidney J 2021; 14:2101-2107. [PMID: 34671466 PMCID: PMC8521786 DOI: 10.1093/ckj/sfaa278] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
Background Pregnancy-associated venous thromboembolism (VTE) is associated with high morbidity and mortality. Identification of risk factors of VTE may lead to improved maternal and foetal outcomes. Proteinuria confers a pro-thrombotic state, however, its association with VTE in pregnancy remains unknown. We set out to assess the association of proteinuria and VTE during pregnancy. Methods We conducted a population-based, retrospective cohort study of all pregnant women (≥16 years of age) with a proteinuria measure within 20 weeks of conception (n = 306 244; mean age 29.8 years) from Ontario, Canada. Proteinuria was defined by any of the following: urine albumin:creatinine ratio ≥3 mg/mmol, urine protein:creatinine ratio ≥5 mg/mmol or urine dipstick proteinuria ≥1. The main outcome measure was a diagnosis of VTE up to 24-weeks post-partum. Results A positive proteinuria measurement occurred in 8508 (2.78%) women and was more common with a history of kidney disease, gestational or non-gestational diabetes mellitus and hypertension. VTE events occurred in 625 (0.20%) individuals, with a higher risk among women with positive proteinuria [32 events (0.38%)] compared with women without proteinuria [593 events (0.20%); inverse probability-weighted risk ratio 1.79 (95% confidence interval 1.25-2.57)]. The association was consistent using a more specific VTE definition, in the post-partum period, in high-risk subgroups (hypertension or diabetes) and when the sample was restricted to women with preserved kidney function. Conclusions The presence of proteinuria in the first 20 weeks of pregnancy is associated with a significantly higher risk of VTE.
Collapse
Affiliation(s)
- Ayub Akbari
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Ziv Harel
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregoire Le Gal
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Conor Cox
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gregory L Hundemer
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mark Canney
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward Clark
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Greg Knoll
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,ICES, Toronto, ON, Canada
| | - Manish M Sood
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,ICES, Toronto, ON, Canada
| |
Collapse
|
8
|
Shannon RJ, Deeks HM, Burfoot E, Clark E, Jones AJ, Mulholland AJ, Glowacki DR. Exploring human-guided strategies for reaction network exploration: Interactive molecular dynamics in virtual reality as a tool for citizen scientists. J Chem Phys 2021; 155:154106. [PMID: 34686059 DOI: 10.1063/5.0062517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The emerging fields of citizen science and gamification reformulate scientific problems as games or puzzles to be solved. Through engaging the wider non-scientific community, significant breakthroughs may be made by analyzing citizen-gathered data. In parallel, recent advances in virtual reality (VR) technology are increasingly being used within a scientific context and the burgeoning field of interactive molecular dynamics in VR (iMD-VR) allows users to interact with dynamical chemistry simulations in real time. Here, we demonstrate the utility of iMD-VR as a medium for gamification of chemistry research tasks. An iMD-VR "game" was designed to encourage users to explore the reactivity of a particular chemical system, and a cohort of 18 participants was recruited to playtest this game as part of a user study. The reaction game encouraged users to experiment with making chemical reactions between a propyne molecule and an OH radical, and "molecular snapshots" from each game session were then compiled and used to map out reaction pathways. The reaction network generated by users was compared to existing literature networks demonstrating that users in VR capture almost all the important reaction pathways. Further comparisons between humans and an algorithmic method for guiding molecular dynamics show that through using citizen science to explore these kinds of chemical problems, new approaches and strategies start to emerge.
Collapse
Affiliation(s)
- Robin J Shannon
- School of Chemistry, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Helen M Deeks
- School of Chemistry, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Eleanor Burfoot
- School of Chemistry, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Edward Clark
- School of Chemistry, University of Bristol, Bristol BS8 1TS, United Kingdom
| | - Alex J Jones
- School of Chemistry, University of Bristol, Bristol BS8 1TS, United Kingdom
| | | | - David R Glowacki
- ArtSci Foundation International, 5th floor Mariner House, Bristol, BS1 4QD, United Kingdom
| |
Collapse
|
9
|
Siqueira IF, Clark E, Neil-Sztramko SE, Belita E, Dobbins M. Informing policy on school and daycare operations during COVID-19 with a living rapid evidence review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
To support evidence-informed decision making (EIDM) for safe re-opening and operation of schools and daycares, the National Collaborating Centre for Methods and Tools (NCCMT) has maintained since May 2020 a living rapid review answering the following question: “What is the role of schools and daycares in COVID-19 transmission”. Traditional rapid review methodology was modified for the COVID-19 context. This presentation will describe the global reach and usefulness of this living rapid review.
Methods
Following completion of each update of the living rapid review, findings were disseminated broadly with the aim of informing policy and public health practice. Key dissemination strategies include e-mails to key contacts and a subscriber list; highlight in a monthly newsletter; media outreach; and social media. The review's reach was analyzed using Google Analytics, citation tracking, and qualitative feedback.
Results
Between May 2020 and April 2021, the living review has been updated 14 times. The posted review has been viewed over 5000 times across 46 countries. The review has been cited and indexed in over 40 sources, including key governmental and non-governmental reports and guidelines. The NCCMT has received positive qualitative feedback on the review's value in informing the public health response related to schools and daycares in various jurisdictions across Canada. Key stakeholders have expanded the review's reach organically as they use the evidence in practice and share the review with their networks.
Lessons
Using a living rapid review to continuously provide high-quality synthesized evidence amidst the evolving COVID-19 research literature demonstrates a responsive approach to decision makers' requests for evidence. An emerging challenge is reaching the proper stakeholders responsible for EIDM, particularly during public health emergencies with many competing high-priority questions and decisions to be made.
Key messages
As the evidence landscape changes due to a surge in literature, evidence-informed decision making can be supported by rapid but rigorous syntheses that evaluate quality and emerging recommendations. A long-standing, trusting relationship with decision makers is key to optimizing living rapid review methodology to meet the evidence needs of decision makers despite the changing literature.
Collapse
Affiliation(s)
- IF Siqueira
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - E Clark
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - SE Neil-Sztramko
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - E Belita
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - M Dobbins
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| |
Collapse
|
10
|
Moura I, Spittal W, Clark E, Ewin D, Altringham J, Fumero E, Grada A, Wilcox M, Buckley A. 224 Profiling the effects of acne therapeutics, including the novel narrow-spectrum antibiotic sarecycline, on the human microbiota. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Carlo‐Stella C, Hutchings M, Offner FC, Morschhauser F, Bachy E, Crump M, Sureda A, Iacoboni G, Haioun C, Perez‐Callejo D, Lundberg L, Relf J, Clark E, Carlile D, Piccione E, Belousov A, Humphrey K, Dickinson MJ. GLOFITAMAB STEP‐UP DOSING: UPDATED EFFICACY DATA SHOW HIGH COMPLETE RESPONSE RATES IN HEAVILY PRETREATED RELAPSED/REFRACTORY (R/R) NON‐HODGKIN LYMPHOMA (NHL) PATIENTS. Hematol Oncol 2021. [DOI: 10.1002/hon.15_2879] [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: 11/08/2022]
Affiliation(s)
- C Carlo‐Stella
- Humanitas University and Humanitas Research Hospital Department of Biomedical Sciences Milan Italy
| | - M Hutchings
- Rigshospitalet Department of Hematology and Phase 1 Unit Copenhagen Denmark
| | - F. C Offner
- Universitair Ziekenhuis Gent Department of Hematology Gent Belgium
| | - F Morschhauser
- Hôpital Claude Huriez and Centre Hospitalier Régional Universitaire de Lille Department of Hematology Lille France
| | - E Bachy
- Hospices Civils de Lyon and Université Claude Bernard Department of Hematology Pierre‐Bénite France
| | - M Crump
- Princess Margaret Hospital Department of Medical Oncology Toronto Canada
| | - A Sureda
- Institut Català d'Oncologia Hospitalet IDIBELL, Universitat de Barcelona Department of Clinical Haematology Barcelona Spain
| | - G Iacoboni
- Vall d’Hebron University Hospital Department of Hematology Barcelona Spain
| | - C Haioun
- Hopital Henri Mondor, AP‐HP Lymphoid Malignancies Unit Créteil France
| | - D Perez‐Callejo
- N F. Hoffmann‐La Roche Ltd Clinical Science ‐ Product Development Hematology Basel Switzerland
| | - L Lundberg
- N F. Hoffmann‐La Roche Ltd Clinical Science ‐ Product Development Hematology Basel Switzerland
| | - J Relf
- Roche Products Ltd Clinical Safety ‐ Product Development Safety Welwyn Garden City UK
| | - E Clark
- Roche Products Ltd Product Development Biostatistics Welwyn Garden City UK
| | - D Carlile
- Roche Products Ltd Clinical Pharmacology, Pharma Research and Early Development Welwyn Garden City UK
| | - E Piccione
- Genentech, Inc Oncology Biomarker Development South San Francisco USA
| | - A Belousov
- F. Hoffmann‐La Roche Ltd Product Development Biostatistics Basel Switzerland
| | - K Humphrey
- Roche Products Ltd Clinical Science ‐ Product Development Hematology Welwyn Garden City UK
| | - M. J Dickinson
- The Peter MacCallum Cancer Centre Royal Melbourne Hospital and The University of Melbourne Clinical Haematology Melbourne Australia
| |
Collapse
|
12
|
Harris HC, Buckley AM, Spittal W, Ewin D, Clark E, Altringham J, Bentley K, Moura IB, Wilcox MH, Woodford N, Davies K, Chilton CH. The effect of intestinal microbiota dysbiosis on growth and detection of carbapenemase-producing Enterobacterales within an in vitro gut model. J Hosp Infect 2021; 113:1-9. [PMID: 33932556 DOI: 10.1016/j.jhin.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/18/2021] [Accepted: 04/14/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) can colonize the gut and are of major clinical concern. Identification of CPE colonization is problematic; there is no gold-standard detection method, and the effects of antibiotic exposure and microbiota dysbiosis on detection are unknown. AIM Based on a national survey we selected four CPE screening assays in common use. We used a clinically reflective in vitro model of human gut microbiota to investigate the performance of each test to detect three different CPE strains under different, clinically relevant antibiotic exposures. METHODS Twelve gut models were seeded with a pooled faecal slurry and exposed to CPE either before, after, concomitant with, or in the absence of piperacillin-tazobactam (358 mg/L, 3 × daily, seven days). Total Enterobacterales and CPE populations were enumerated daily. Regular screening for CPE was performed using Cepheid Xpert® Carba-R molecular test, and with Brilliance™ CRE, Colorex™ mSuperCARBA and CHROMID® CARBA SMART agars. FINDINGS Detection of CPE when the microbiota are intact is problematic. Antibiotic exposure disrupts microbiota populations and allows CPE proliferation, increasing detection. The performances of assays varied, particularly with respect to different CPE strains. The Cepheid assay performed better than the three agar methods for detecting a low level of CPE within an intact microbiota, although performance of all screening methods was comparable when CPE populations increased in a disrupted microbiota. CONCLUSION CPE strains differed in their dynamics of colonization in an in vitro gut model and in their subsequent response to antibiotic exposure. This affected detection by molecular and screening methods, which has implications for the sensitivity of CPE screening in healthcare settings.
Collapse
Affiliation(s)
- H C Harris
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - A M Buckley
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - W Spittal
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - D Ewin
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - E Clark
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - J Altringham
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - K Bentley
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - I B Moura
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M H Wilcox
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, Leeds, UK
| | - N Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), Reference Unit, Microbiology Services - Colindale, Public Health England, UK
| | - K Davies
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, Leeds, UK
| | - C H Chilton
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| |
Collapse
|
13
|
Magner K, Ilin J, Clark E, King J, Davis A, Hiremath S. POS-039 N-Acetylcysteine and Contrast-induced Acute Kidney Injury: A Systematic Review and Meta-analysis exploring the Heterogeneity, Publication Bias and Small Study effects. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.045] [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
|
14
|
Clark E, Tullo D, Bertone A. Perceptual reasoning skills mediate the relationship between attention and math proficiency in individuals with a neurodevelopmental condition. Res Dev Disabil 2021; 111:103880. [PMID: 33556699 DOI: 10.1016/j.ridd.2021.103880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/19/2020] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND An important component of academic success in typically developing students is the development of math skills, which is associated with attention and perceptual reasoning (PR) skills. For children with a neurodevelopmental condition (NDC), the relationship is confounded by diagnostic-specific cognitive characteristics. Specifically, enhanced PR is specific to individuals with Autism Spectrum Disorder (ASD). AIMS The purpose of this study was to test: (i) a mediation model where PR skills would mediate the relationship between attention and math proficiency for students with an NCD, and (ii) whether this mediation model is moderated by a diagnostic profile. METHODS AND PROCEDURES One hundred and thirty-seven students with an NDC participated in a school-based study examining the effectiveness of using a standardized measure of attention in predicting math capabilities. OUTCOMES AND RESULTS PR mediated the relationship between attention and math proficiency for students diagnosed with an NDC. However, the model was not moderated by diagnostic profile. CONCLUSIONS AND IMPLICATIONS The results of this study provide a better understanding of the roles of higher-level cognitive ability specific to students with NDCs. Additionally, the superior PR skills demonstrated by the ASD sample further supports the research suggesting this population possesses cognitive strengths in this domain.
Collapse
Affiliation(s)
- E Clark
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada.
| | - D Tullo
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada
| | - A Bertone
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada
| |
Collapse
|
15
|
Akbari A, Kunkel E, Bota S, Harel Z, Le Gal G, Cox C, Hundemer G, Canney M, Clark E, Massicotte-Azarinouch D, Eddeen A, Knoll G, Sood M. POS-468 PROTEINURIA AND VENOUS THROMBOEMBOLISM IN PREGNANCY: A POPULATION-BASED COHORT STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
16
|
Magner K, Clark E, Hiremath S. Letter to the editor regarding "Accelerated versus standard initiation of renal replacement therapy for critically ill patients with acute kidney injury: a systematic review and meta-analysis of RCT studies". Crit Care 2021; 25:96. [PMID: 33750433 PMCID: PMC7941718 DOI: 10.1186/s13054-021-03528-2] [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] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Kate Magner
- Faculty of Medicine, The University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada. .,The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H8L6, Canada.
| | - Edward Clark
- Faculty of Medicine, The University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada.,The Ottawa Hospital, Riverside Campus, 1967 Riverside Dr., Ottawa, ON, K1H7W9, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, The University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H8M5, Canada.,The Ottawa Hospital, Riverside Campus, 1967 Riverside Dr., Ottawa, ON, K1H7W9, Canada
| |
Collapse
|
17
|
Patton DE, Pearce CJ, Cartwright M, Smith F, Cadogan CA, Ryan C, Clark E, Francis JJ, Hughes CM. A non-randomised pilot study of the Solutions for Medication Adherence Problems (S-MAP) intervention in community pharmacies to support older adults adhere to multiple medications. Pilot Feasibility Stud 2021; 7:18. [PMID: 33413650 PMCID: PMC7788279 DOI: 10.1186/s40814-020-00762-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Older patients prescribed multiple medications commonly experience difficulties with adherence. High-quality evidence on interventions targeting older patients is lacking. Theory is rarely used to tailor adherence solutions. This study aimed to pilot test a novel intervention, developed using the Theoretical Domains Framework, which guides community pharmacists in identifying adherence barriers and delivering tailored solutions (behaviour change techniques). Key study procedures (e.g. recruitment, data collection) for a future randomised controlled trial (cRCT) were also assessed. METHODS Using purposive sampling, this non-randomised pilot study aimed to recruit 12 community pharmacies (six in Northern Ireland; six in London, England). Pharmacists were trained to deliver the intervention to non-adherent older patients (maximum 10 per pharmacy; target n = 60-120) aged ≥ 65 years (reduced to 50 years due to recruitment challenges) and prescribed ≥ 4 regular medicines. The intervention, guided by an iPad web-application, was delivered over 3-4 face-to-face or telephone sessions, tailored to specific barriers to adherence. We assessed the feasibility of collecting adherence data (primary outcome: self-report and dispensing records), health-related quality of life (HRQOL) and unplanned hospitalisations (secondary outcomes) at baseline and 6-months. The final decision on progressing to a cRCT, using pre-defined 'stop-amend-go' criteria, is presented. RESULTS Fifteen pharmacists from 12 pharmacies were recruited and trained. One pharmacy subsequently dropped out. Sixty patients were recruited (meeting the 'Amend' progression criteria), with 56 receiving the intervention. Adherence barriers were identified for 55 patients (98%) and a wide range of behaviour change solutions delivered (median: 5 per patient). Self-report and dispensing adherence data were available for 37 (61.7%) and 44 (73.3%) patients, respectively. HRQOL data were available for 35 (58.3%) patients. GP-reported and self-reported hospitalisations data were available for 47 (78.3%) and 23 (38.3%) patients, respectively. All progression concepts were met (nine 'Go' and three 'Amend' criteria). CONCLUSION This study demonstrates the feasibility of key study procedures (e.g. pharmacy recruitment) and delivery of a tailored adherence intervention in community pharmacies. However, modifications are required to enhance issues identified with patient recruitment, retention and missing data. A future definitive cRCT will explore the effectiveness of the intervention. TRIAL REGISTRATION ISRCTN, ISRCTN73831533 , Registered 12 January 2018.
Collapse
Affiliation(s)
- D. E. Patton
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - C. J. Pearce
- School of Health Sciences, City University of London, London, UK
| | - M. Cartwright
- School of Health Sciences, City University of London, London, UK
| | - F. Smith
- School of Pharmacy, University College London, London, UK
| | - C. A. Cadogan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C. Ryan
- School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - E. Clark
- School of Health Sciences, City University of London, London, UK
| | - J. J. Francis
- School of Health Sciences, City University of London, London, UK
| | - C. M. Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| |
Collapse
|
18
|
Huang JW, Lahey B, Clarkin OJ, Kong J, Clark E, Kanji S, McCudden C, Akbari A, J W Chow B, Shabana W, Hiremath S. A Systematic Review of the Effect of N-Acetylcysteine on Serum Creatinine and Cystatin C Measurements. Kidney Int Rep 2020; 6:396-403. [PMID: 33615065 PMCID: PMC7879108 DOI: 10.1016/j.ekir.2020.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/03/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction N-acetylcysteine (NAC) is an antioxidant that can regenerate glutathione and is primarily used for acetaminophen overdose. NAC has been tested and used for preventing iatrogenic acute kidney injury or slowing the progression of chronic kidney disease, with mixed results. There are conflicting reports that NAC may artificially lower measured serum creatinine without improving kidney function, potentially by assay interference. Given these mixed results, we conducted a systematic review of the literature to determine whether there is an effect of NAC on kidney function as measured with serum creatinine and cystatin C. Methods A literature search was conducted to identify all study types reporting a change in serum creatinine after NAC administration. The primary outcome was change in serum creatinine after NAC administration. The secondary outcome was a change in cystatin C after NAC administration. Subgroup analyses were conducted to assess effect of creatinine assay (Jaffe vs. non-Jaffe and intravenous vs. oral). Results Six studies with a total of 199 participants were eligible for the systematic review and meta-analysis. There was a small but significant decrease in serum creatinine after NAC administration overall (weighted mean difference [WMD], −2.80 μmol/L [95% confidence interval {CI} −5.6 to 0.0]; P = 0.05). This was greater with non-Jaffe methods (WMD, −3.24 μmol/L [95% CI −6.29 to −0.28]; P = 0.04) than Jaffe (WMD, −0.51 μmol/L [95% CI −7.56 to 6.53]; P = 0.89) and in particular with intravenous (WMD, −31.10 μmol/L [95% CI −58.37 to −3.83]; P = 0.03) compared with oral NAC (WMD, −2.5 μmol/L [95% CI −5.32 to 0.32]; P = 0.08). There was no change in cystatin C after NAC administration. Discussion NAC causes a decrease in serum creatinine but not in cystatin C, suggesting analytic interference rather than an effect on kidney function. Supporting this, the effect was greater with non-Jaffe methods of creatinine estimation. Future studies of NAC should use the Jaffe method of creatinine estimation when kidney outcomes are being reported. Even in clinical settings, the use of an enzymatic assay when high doses of intravenous NAC are being used may result in underdiagnosis or delayed diagnosis of acute kidney injury.
Collapse
Affiliation(s)
- Johnny W Huang
- The Ottawa Hospital, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Brianna Lahey
- University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Owen J Clarkin
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jennifer Kong
- Division of Nephrology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Edward Clark
- The Ottawa Hospital, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- The Ottawa Hospital, Ottawa, Ontario, Canada.,Division of Nephrology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christopher McCudden
- The Ottawa Hospital, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Ayub Akbari
- The Ottawa Hospital, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Wael Shabana
- The Ottawa Hospital, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- The Ottawa Hospital, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada.,Division of Nephrology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
19
|
Hilger C, Clark E, Swiontek K, Chiriac AM, Caimmi DP, Demoly P, Bourrain JL. Anaphylaxis to Bovine Serum Albumin Tissue Adhesive in a Non–Meat-Allergic Patient. J Investig Allergol Clin Immunol 2020; 30:369-371. [DOI: 10.18176/jiaci.0522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Clark E, Snelling S, Beyers J, Howarth C, Neil-Sztramko S, Dobbins M. A new tool to assess community-level evidence to inform public health decision making. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
As public health responds to evolving challenges around the globe, it is critical to draw on community-level evidence to inform decisions on emerging needs. There are existing tools for assessing the quality of research evidence, but none that explicitly focus on quality assessment of evidence from community sources, including local health status and ever-changing community and political preferences and actions.
Methods
The National Collaborating Centre for Methods and Tools (NCCMT) in Canada has developed new tools, called Quality Assessment of Community Evidence (QACE), to help public health decision makers assess the quality of community evidence. The QACE tools were drafted through extensive review of existing frameworks, tools and measures for appraising population health and community evidence, and diverse key informants. We identified three consistent themes that became the core dimensions in these tools. By using the QACE tools, practitioners can answer the question: “Is the quality of this evidence about local context, community needs and political preferences good enough to influence decision making?”
Results
The QACE tools provide probing questions for each of three dimensions: relevant, trustworthy and equity-informed. Supplementary resources help users delve more deeply into different aspects of quality assessment. The QACE tools are intended for public health practitioners who provide and use evidence to support or make decisions about public health practice and policy, including public health practitioners, senior leaders, policy makers and funders.
Conclusions
The QACE tool is a new addition to the public health toolbox for evidence-informed decision making, providing questions to ask about evidence from community sources. By using the tool as part of a decision-making process, public health practitioners can be assured that their decisions are based on the best-available evidence for their communities.
Key messages
The new Quality Assessment of Community Evidence (QACE) tools fill the gap in assessing quality of community-level evidence for public health decision-makers. Community evidence, including local health status and needs and community and political preferences and actions, should be assessed for quality in three critical domains.
Collapse
Affiliation(s)
- E Clark
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - S Snelling
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - J Beyers
- Jo Beyers Consulting, Thessalon, Canada
| | - C Howarth
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - S Neil-Sztramko
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - M Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| |
Collapse
|
21
|
Clark E, Neil-Sztramko S, Dobbins M. Enhancing partnerships and collaboration in times of change. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
In 2019, the government of the Canadian province of Ontario announced major changes to the structure, governance and funding of public health services. Throughout these changes, publicly funded local and regional public health organizations are still expected to provide effective, evidence-informed programming to their communities. The National Collaborating Centre for Methods and Tools (NCCMT) has facilitated collaborations to support Ontario public health through this transition.
Description of the problem
In order to support evidence-informed public health in Ontario during this transition, the NCCMT reached out to current and potential partners, within and beyond the public health sector for a multidisciplinary approach. We conducted a needs assessment for an evidence review repository, which would allow public health practitioners to share and build upon each other's work. Finally, demonstrating the value of public health to policymakers can be inherently challenging as the return on investment in public health is often very long term. We partnered with health units in varying capacities to find and synthesize evidence to advocate for continued investment in public health.
Results
This initiative has provided important lessons in developing and maintaining strong partnerships. Looking beyond the public health sector can establish mutually beneficial partners and allies in other disciplines. A key finding was the need to establish infrastructure to support collaboration and resource sharing. Finally, we learned that big picture questions like demonstrating the value of public health require many different perspectives, inputs and areas of expertise.
Lessons
Through this initiative, we have developed a multidisciplinary, collaborative approach to supporting evidence-informed public health through times of major restructuring. This approach can be applied to future changes to public health on smaller or larger scales, or within other geographic regions.
Key messages
Multidisciplinary approaches can support collaboration, unity and advocacy in times of change. Establishing infrastructure to support collaboration and sharing of resources is valuable.
Collapse
Affiliation(s)
- E Clark
- Enhancing partnerships and collaboration in times of change, McMaster University, Hamilton, Canada
| | - S Neil-Sztramko
- Enhancing partnerships and collaboration in times of change, McMaster University, Hamilton, Canada
| | - M Dobbins
- Enhancing partnerships and collaboration in times of change, McMaster University, Hamilton, Canada
| |
Collapse
|
22
|
Huddle C, Hirsch H, Kasay C, Beverley M, Mochel J, Clark E, Sharry B. Better Nutrition, Better Care: An Initiative to Improve Early Identification and Intervention of Malnutrition in Pediatric Oncology and BMT Patients. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
23
|
Clark E, Neil-Sztramko S, Dobbins M. The NCCMT’s dynamic model for evidence-informed public health. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
It is well accepted that public health decision makers should use the best available research evidence in their decision-making process. However, research evidence alone is insufficient to inform public health decision making.
Description of the problem
As new challenges to public health emerge, there can be a paucity of high quality research evidence to inform decisions on new topics. Public health decision makers must combine various sources of evidence with their public health expertise to make evidence-informed decisions. The National Collaborating Centre for Methods and Tools (NCCMT) has developed a model which combines research evidence with other critical sources of evidence that can help guide decision makers in evidence-informed decision making.
Results
The NCCMT's model for evidence-informed public health combines findings from research evidence with local data and context, community and political preferences and actions and evidence on available resources. The model has been widely used across Canada and worldwide, and has been integrated into many public health organizations' decision-making processes. The model is also used for teaching an evidence-informed public health approach in Masters of Public Health programs around the globe. The model provides a structured approach to integrating evidence from several critical sources into public health decision making. Use of the model helps ensure that important research, contextual and preference information is sought and incorporated.
Lessons
Next steps for the model include development of a tool to facilitate synthesis of evidence across all four domains. Although Indigenous knowledges are relevant for public health decision making and should be considered as part of a complete assessment the current model does not capture Indigenous knowledges.
Key messages
Decision making in public health requires integrating the best available evidence, including research findings, local data and context, community and political preferences and available resources. The NCCMT’s model for evidence-informed public health provides a structured approach to integrating evidence from several critical sources into public health decision making.
Collapse
Affiliation(s)
- E Clark
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - S Neil-Sztramko
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - M Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| |
Collapse
|
24
|
Sriperumbuduri S, Clark E, Biyani M, Ruzicka M. High Anion Gap Metabolic Acidosis on Continuous Renal Replacement Therapy. Kidney Int Rep 2020; 5:1833-1835. [PMID: 33102978 PMCID: PMC7569678 DOI: 10.1016/j.ekir.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/09/2020] [Accepted: 07/14/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Sriram Sriperumbuduri
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Clark
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohan Biyani
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Marcel Ruzicka
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
25
|
Mintoff D, Camilleri L, Aquilina S, Boffa MJ, Clark E, Scerri L. Prevalence of hidradenitis suppurativa in Malta: comparison with established epidemiological data. Clin Exp Dermatol 2020; 45:758-759. [PMID: 32367586 DOI: 10.1111/ced.14271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 01/02/2023]
Affiliation(s)
- D Mintoff
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| | - L Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - S Aquilina
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| | - M J Boffa
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| | - E Clark
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| | - L Scerri
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| |
Collapse
|
26
|
Oloko A, Talreja H, Davis A, McCormick B, Clark E, Akbari A, Kong J, Hiremath S. Does Iodinated Contrast Affect Residual Renal Function in Dialysis Patients? A Systematic Review and Meta-Analysis. Nephron Clin Pract 2020; 144:176-184. [DOI: 10.1159/000505576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
|
27
|
Patton DE, Francis JJ, Clark E, Smith F, Cadogan CA, Ryan C, Hughes CM. A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: study protocol. Pilot Feasibility Stud 2019; 5:116. [PMID: 31719999 PMCID: PMC6806512 DOI: 10.1186/s40814-019-0506-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/18/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022] Open
Abstract
Background Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory (‘a systematic way of understanding events or situations’) can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3–4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient’s underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention’s mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients’ adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration This study is registered at ISRCTN: 10.1186/ISRCTN73831533
Collapse
Affiliation(s)
- D E Patton
- 1School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
| | - J J Francis
- 2School of Health Sciences, City University of London, London, UK
| | - E Clark
- 2School of Health Sciences, City University of London, London, UK
| | - F Smith
- 3School of Pharmacy, University College London, London, UK
| | - C A Cadogan
- 4School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C Ryan
- 5School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - C M Hughes
- 1School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
| |
Collapse
|
28
|
Ballas L, Aron M, Xiong Y, McCarthy S, Phuong C, Sali A, Chen M, Clark E, Tsao-Wei D, Dorff T, Bhanvadia S, Magliocco A, Daneshmand S. Can Bladder Cancer Biomarkers from Patients Undergoing Cystectomy Predict the Need for Adjuvant Radiotherapy? Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
29
|
Wang C, Hiremath S, Sikora L, Sood MM, Kong J, Clark E. Outpatient kidney recovery after acute kidney injury requiring dialysis: a systematic review protocol. Syst Rev 2019; 8:214. [PMID: 31439026 PMCID: PMC6706935 DOI: 10.1186/s13643-019-1134-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/13/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute kidney injury requiring dialysis (AKI-D) during hospitalization is associated with both in-hospital and post-discharge mortality. Its incidence has risen over time in Canada and the USA. While the majority of AKI-D will recover to dialysis independence at the time of hospital discharge, 10-30% will transition to outpatient dialysis. The risk factors that determine dialysis independence after AKI-D and its optimal outpatient management remain unclear. Eliciting prognostic predictors of kidney recovery in patients who remain on dialysis after hospital discharge will guide subsequent clinical decision making. The objective of this study is to assess the association between patient- and treatment-related factors with short- and long-term outcomes in patients who remained dialysis-dependent after hospitalization with AKI-D. METHODS A literature search in EMBASE, MEDLINE, and PubMed will be performed based on pre-specified criteria. There are no restrictions on language and publication dates. The supplemental search will include manual scan of bibliographies of eligible studies and grey literature assessment. Pre-specified criteria will be used to select eligible studies. Relevant data will be extracted and quality assessments performed per validated tools. Qualitative data synthesis will be performed to reflect directions of associations. Meta-analysis will be formed if two or more studies with similar prognostic factors, outcomes, and adequate quality are identified. Strength of association will be quantified as odds ratios. Reporting of this review will be guided by recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. DISCUSSION This systematic review aims to synthesize association between modifiable and non-modifiable prognostic factors with renal outcomes in AKI-D patients who remain dialysis-dependent after hospital discharge. Our findings will help inform the development of evidence-based management and guide long-term treatment planning for AKI-D patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019127394 .
Collapse
Affiliation(s)
- Carol Wang
- Department of Medicine, University of Ottawa, CPC 162 737 Parkdale Avenue, Ottawa, Ontario K1Y 1 J8 Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, The Ottawa Hospital – Riverside Campus, 1967 Riverside Drive, Ottawa, Ontario K1H 7 W9 Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8 M5 Canada
| | - Manish M. Sood
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, The Ottawa Hospital – Riverside Campus, 1967 Riverside Drive, Ottawa, Ontario K1H 7 W9 Canada
| | - Jennifer Kong
- Division of Nephrology, Ottawa Hospital Research Institute, The Ottawa Hospital, 1967 Riverside Drive, Ottawa, Ontario K1H 7 W9 Canada
| | - Edward Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, The Ottawa Hospital – Riverside Campus, 1967 Riverside Drive, Ottawa, Ontario K1H 7 W9 Canada
| |
Collapse
|
30
|
Sriperumbuduri S, Clark E, Hiremath S. New Insights Into Mechanisms of Acute Kidney Injury in Heart Disease. Can J Cardiol 2019; 35:1158-1169. [PMID: 31472814 DOI: 10.1016/j.cjca.2019.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/27/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Acute kidney injury is a frequent occurrence in patients with heart disease, and is associated with higher risk of adverse outcomes, including mortality. In the setting of decompensated heart failure, acute kidney injury can occur from hemodynamic and neurohormonal activation, venous congestion, and nephrotoxic medications. Certain medications, such as loop diuretics, renin angiotensin system blockers, and mineralocorticoid antagonists can seemingly cause acute kidney injury. However, this increase in creatinine level is not always associated with adverse outcomes and should be carefully differentiated so as to allow deliberate continuation of these cardio- and nephroprotective agents. In other settings such as cardiac surgery, acute kidney injury can occur from factors related to the cardiopulmonary bypass, renal hypoperfusion, or other perioperative factors. Last, patients with heart disease commonly undergo imaging procedures that require contrast administration. Contrast can indeed cause acute kidney injury, but these interventional procedures also can result in kidney injury from atheroembolic phenomena. This is well documented by the recent data reporting a higher risk of acute kidney injury from femoral compared with radial access. The advent of biomarkers of kidney injury present an opportunity for early detection, accurate differential diagnosis, as well as potentially designing innovative biomarker-enriched adaptive clinical trials.
Collapse
Affiliation(s)
- Sriram Sriperumbuduri
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Clark
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| |
Collapse
|
31
|
Rooney CM, Sheppard AE, Clark E, Davies K, Hubbard ATM, Sebra R, Crook DW, Walker AS, Wilcox MH, Chilton CH. Dissemination of multiple carbapenem resistance genes in an in vitro gut model simulating the human colon. J Antimicrob Chemother 2019; 74:1876-1883. [DOI: 10.1093/jac/dkz106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/02/2019] [Accepted: 02/25/2019] [Indexed: 01/17/2023] Open
Affiliation(s)
- C M Rooney
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| | - A E Sheppard
- Nuffield Department of Medicine, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, UK
- NIHR Health Protection Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, UK
| | - E Clark
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| | - K Davies
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| | - A T M Hubbard
- Nuffield Department of Medicine, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, UK
| | - R Sebra
- Icahn Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - D W Crook
- Nuffield Department of Medicine, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, UK
- NIHR Health Protection Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, UK
| | - A S Walker
- Nuffield Department of Medicine, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, UK
- NIHR Health Protection Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, UK
| | - M H Wilcox
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| | - C H Chilton
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| |
Collapse
|
32
|
Clark E, Foster Page LA, Larkins K, Leon de la Barra S, Murray Thomson W. Caries-preventive efficacy of a supervised school toothbrushing programme in Northland, New Zealand. Community Dent Health 2019; 36:9-16. [PMID: 30667188 DOI: 10.1922/cdh_4337clark08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Toothbrushing with fluoride toothpaste reduces the incidence of dental caries. OBJECTIVE To evaluate a supervised school toothbrushing programme to reduce dental caries experience in children. BASIC RESEARCH DESIGN Quasi-experimental study. All children had routine dental examinations at baseline using the ICDAS to record dental caries, along with bitewing radiographs. Half of the children were involved in a supervised toothbrushing programme. Examinations were repeated at the end of the school year. CLINICAL SETTING Northland, New Zealand. PARTICIPANTS 335 10-13-year-old New Zealand children with high caries experience. INTERVENTIONS Half of the children participated in the supervised toothbrushing session each school day; the other half had no intervention. MAIN OUTCOME MEASURES Caries increment, determined by comparing the baseline and follow-up status of each tooth surface. RESULTS At baseline, there were 335 children, of whom 240 (71.6%) were followed up. The ICDAS net caries increment for those in the toothbrushing group was a mean of 11.7 surfaces improved; the control group had a mean of 8.6 surfaces which had deteriorated. Caries incidence for those in the toothbrushing group was 7.3%; that for the control group was 71.5%. Multivariate analysis showed that membership of the brushing group was the only statistically significant predictor of a lower net caries increment. CONCLUSION A supervised school toothbrushing programme can reduce caries increment in a population experiencing high levels of dental disease.
Collapse
Affiliation(s)
- E Clark
- Oral Health Service, Northland District Health Board, Whangarei Base Hospital, Private Bag 9742, Whangarei 0148
| | - L A Foster Page
- Associate Professor of Dental Epidemiology and Public Health, Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 647, Dunedin 9054
| | - K Larkins
- Assistant service manager, Oral Health Service, Northland District Health Board, Whangarei Base Hospital, Private Bag 9742, Whangarei 0148
| | - S Leon de la Barra
- Consultant Biostatistician, Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 647, Dunedin 9054
| | - W Murray Thomson
- Professor of Dental Epidemiology and Public Health, Department of Oral Sciences, Faculty of Dentistry, PO Box 647, Dunedin 9054
| |
Collapse
|
33
|
Indorewalla K, Sugarman M, Daley R, Clark E, Scoglio A, O’Connor M. A - 17The Aging Well Through Interaction and Scientific Education (AgeWISE) Program: Examining Changes in Attitudes Toward Cognitive Aging in Older Veterans at Six-Month Follow-Up. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.17] [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: 11/14/2022] Open
|
34
|
|
35
|
Bines J, de Azambuja E, Zardavas D, Procter M, Restuccia E, Viale G, Suter T, Arahmani A, van Dooren V, Clark E, Eng-Wong J, Gelber R, Piccart M, von Minckwitz G, Baselga J. Abstract P1-13-07: Incidence and management of diarrhea with adjuvant pertuzumab and trastuzumab in HER2-Positive breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Diarrhea is the most commonly reported adverse event (AE) on pertuzumab (Ptz) in both early and metastatic breast cancer (BC) settings. We report safety analyses of diarrhea from the large adjuvant APHINTY study in HER2 positive early breast cancer (EBC).
Patients and methods
In this exploratory analysis, the safety population included 2364 patients in the Ptz arm and 2405 in the placebo (Pla) arm. No specific prophylaxis was mandated by the protocol, however early intervention with loperamide as well as fluid and electrolyte replacement was recommended. Diarrhea incidence, severity (NCI-CTCAE v4.0), onset and management were analyzed.
Results
Diarrhea was the most common AE in the Ptz arm (71.3% vs. 45.2% in the Pla arm) and the events were mostly G1. Diarrhea ≥G3 was observed in 9.8% and 3.7% in Ptz and Pla arms, respectively. The highest incidence was reported during administration of HER2 targeted therapy and taxane (61.4% vs. 33.8% with Ptz and Pla, respectively) with a marked decrease observed upon chemotherapy cessation (18.1% vs. 9.2% with Ptz and Pla, respectively). The median time from first targeted treatment to onset of diarrhea during the chemotherapy phase was 7 and 10 days (Ptz/Pla). On average, diarrhea events lasted longer in the Ptz than in the Pla arm (median 8 vs. 6 days). Diarrhea events were more frequent with the administration of docetaxel + carboplatin and targeted agents, irrespective of the severity. Detailed results are reported in Table 1.
Conclusions
In the curative setting, diarrhea due to Ptz was mild, generally manageable with common antidiarrheals and did not affect patients' ability to receive treatment. The APHINITY findings are consistent with the well-characterized pattern of pertuzumab-related diarrhea across the HER2 BC spectrum.
Diarrhea incidence, severity (NCI-CTCAE v4.0), onset and management Ptz, n=2364Pla, n=2405Incidence and severityTotal number of patients with at least one adverse event$1685 (71.3%)1086 (45.2%)Total number of events$34151792NCI CTC AE Grade (highest grade per patient)!n1683 (71.2%)1085 (45.1%)Grade 1829 (35.1%)690 (28.7%)Grade 2622 (26.3%)305 (12.7%)Grade 3229 (9.7%)90 (3.7%)Grade 43 (0.1%)0Onset and duration$Median time (days) from 1st HER2 targeted treatment to onset (min-max)7 (1 – 358)10 (1 - 384)Median Duration (days) of each event (min-max)8 (1 - 811)6 (1 - 1022)ManagementAntidiarrheals$898 (38.0%)386 (16.0%)Dose modification* of any study drug!210 (8.9%)74 (3.1%)Dose modification* of HER2 targeted treatment!69 (2.9%)18 (0.7%)Discontinuation of any study drug!38 (1.6%)7 (0.3%)Discontinuation of HER2 Targeted treatment!20 (0.8%)2 (<0.1%)$ Based on a basket of preferred terms for diarrhea ! Based only on the preferred term diarrhea * Includes dose reductions (chemotherapy only), delays or interruptions during infusion
Citation Format: Bines J, de Azambuja E, Zardavas D, Procter M, Restuccia E, Viale G, Suter T, Arahmani A, van Dooren V, Clark E, Eng-Wong J, Gelber R, Piccart M, von Minckwitz G, Baselga J. Incidence and management of diarrhea with adjuvant pertuzumab and trastuzumab in HER2-Positive breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-07.
Collapse
Affiliation(s)
- J Bines
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E de Azambuja
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - D Zardavas
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - M Procter
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E Restuccia
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - G Viale
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - T Suter
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - A Arahmani
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - V van Dooren
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E Clark
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - J Eng-Wong
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - R Gelber
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - M Piccart
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - G von Minckwitz
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - J Baselga
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| |
Collapse
|
36
|
Affiliation(s)
- Stephen K Ginn
- Stephen K. Ginn, Psychiatrist, Camden and Islington NHS Foundation Trust, London. Edward Clark, London, UK.
| | - Edward Clark
- Stephen K. Ginn, Psychiatrist, Camden and Islington NHS Foundation Trust, London. Edward Clark, London, UK.
| |
Collapse
|
37
|
Grell WA, Solis-Ramos E, Clark E, Lucon E, Garboczi EJ, Predecki PK, Loftus Z, Kumosa M. Effect of powder oxidation on the impact toughness of electron beam melt Ti-6Al-4V. Acta Mater 2017; 17:123-134. [PMID: 38496266 PMCID: PMC10941301 DOI: 10.1016/j.addma.2017.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Powder quality in additive manufacturing (AM) electron beam melt (EBM) of Ti-6Al-4V components is crucial in determining the critical material properties of the end item. In this study, we report on the effect of powder oxidation on the Charpy impact energy of Ti-6Al-4V parts manufactured using EBM. In addition to oxidation, the effects on impact energy due to hot isostatic pressing (HIP), specimen orientation, and EBM process defects were also investigated. This research has shown that excessive powder oxidation (oxygen mass fraction above 0.25 % and up to 0.46 %) dramatically decreases the impact energy. It was determined that the room temperature impact energy of the parts after excessive oxidation was reduced by about seven times. We also report that HIP post-processing significantly increases the impact toughness, especially for specimens with lower or normal oxygen content. The specimen orientation effect was found to be more significant for low oxidation levels.
Collapse
Affiliation(s)
- W A Grell
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
- Lockheed Martin Space Systems Company, Littleton, CO 80125
| | - E Solis-Ramos
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
| | - E Clark
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
| | - E Lucon
- National Institute of Standards and Technology, Applied Chemicals and Materials Division, Boulder, CO 80305
| | - E J Garboczi
- National Institute of Standards and Technology, Applied Chemicals and Materials Division, Boulder, CO 80305
| | - P K Predecki
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
| | - Z Loftus
- Lockheed Martin Space Systems Company, Littleton, CO 80125
| | - M Kumosa
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
| |
Collapse
|
38
|
Clark E, Daley R, Sugarman M, Scoglio A, O'Connor M. A-03Differential Encoding Strategies Following Cognitive Intervention in Older Adults. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Tomita M, Olewnik A, Ghosh D, Ahrens L, Clark E, Grzebinski K, Haering C. NOVEL ACCURATE APPROACH TOWARD PREDCTING FRAIL OLDER ADULTS’ FALLS WITHIN THREE MONTHS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M.R. Tomita
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| | - A. Olewnik
- Mechanical Engineering, University at Buffalo, Buffalo, New York
| | - D. Ghosh
- Mechanical Engineering, University at Buffalo, Buffalo, New York
| | - L. Ahrens
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| | - E. Clark
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| | - K. Grzebinski
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| | - C. Haering
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| |
Collapse
|
40
|
Clark E, Lumsdaine A, Ekici K, Ruggles A. Computational Investigation of the Thermal-Hydraulic Performance for Twisted Tape Enabled High Heat Flux Components. Fusion Science and Technology 2017. [DOI: 10.1080/15361055.2017.1333823] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E. Clark
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996
| | - A. Lumsdaine
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - K. Ekici
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996
| | - A. Ruggles
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996
| |
Collapse
|
41
|
Collins TA, Hattersley MM, Yates J, Clark E, Mondal M, Mettetal JT. Translational Modeling of Drug-Induced Myelosuppression and Effect of Pretreatment Myelosuppression for AZD5153, a Selective BRD4 Inhibitor. CPT Pharmacometrics Syst Pharmacol 2017; 6:357-364. [PMID: 28378926 PMCID: PMC5488126 DOI: 10.1002/psp4.12194] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/03/2017] [Accepted: 03/22/2017] [Indexed: 01/04/2023]
Abstract
In this work, we evaluate the potential risk of thrombocytopenia in man for a BRD4 inhibitor, AZD5153, based on the platelet count decreases from a Han Wistar rat study. The effects in rat were modeled and used to make clinical predictions for human populations with healthy baseline blood counts. At doses >10 mg, a dose-dependent effect on circulating platelets is expected, with similar predicted changes for both q.d. and b.i.d. dose schedules. These results suggest that at predicted efficacious doses, AZD5153 is likely to have some reductions in the clinical platelet counts, but within the normal range at projected efficacious doses. The model was then extended to incorporate preexisting myelosuppression where bone marrow function is inhibited by acute myeloid leukemia. Under these conditions, duration of platelet count recovery has the potential to be prolonged due to drug-induced myelosuppression.
Collapse
Affiliation(s)
- T A Collins
- Drug Safety and Metabolism, AstraZeneca, Cambridge, UK
| | | | - Jwt Yates
- Oncology iMED, AstraZeneca, Cambridge, UK
| | - E Clark
- Oncology iMED, AstraZeneca, Waltham, Massachusetts, USA
| | - M Mondal
- Drug Safety and Metabolism, AstraZeneca, Waltham, Massachusetts, USA
| | - J T Mettetal
- Drug Safety and Metabolism, AstraZeneca, Waltham, Massachusetts, USA
| |
Collapse
|
42
|
Zhang J, Chan A, Lippa B, Cross JB, Liu C, Yin N, Romero JAC, Lawrence J, Heney R, Herradura P, Goss J, Clark C, Abel C, Zhang Y, Poutsiaka KM, Epie F, Conrad M, Mahamoon A, Nguyen K, Chavan A, Clark E, Li TC, Cheng RK, Wood M, Andersen OA, Brooks M, Kwong J, Barker J, Parr IB, Gu Y, Ryan MD, Coleman S, Metcalf CA. Structure-based discovery of LpxC inhibitors. Bioorg Med Chem Lett 2017; 27:1670-1680. [DOI: 10.1016/j.bmcl.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
|
43
|
Talreja H, Ryan SE, Graham J, Sood MM, Hadziomerovic A, Clark E, Hiremath S. Endoluminal dilatation for embedded hemodialysis catheters: A case-control study of factors associated with embedding and clinical outcomes. PLoS One 2017; 12:e0174061. [PMID: 28346468 PMCID: PMC5367692 DOI: 10.1371/journal.pone.0174061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the increasing frequency of tunneled hemodialysis catheter use there is a parallel increase in the need for removal and/or exchange. A small but significant minority of catheters become embedded or 'stuck' and cannot be removed by traditional means. Management of embedded catheters involves cutting the catheter, burying the retained fragment with a subsequent increased risk of infections and thrombosis. Endoluminal dilatation may provide a potential safe and effective technique for removing embedded catheters, however, to date, there is a paucity of data. OBJECTIVES 1) To determine factors associated with catheters becoming embedded and 2) to determine outcomes associated with endoluminal dilatation. METHODS All patients with endoluminal dilatation for embedded catheters at our institution since Jan. 2010 were included. Patients who had an embedded catheter were matched 1:3 with patients with uncomplicated catheter removal. Baseline patient and catheter characteristics were compared. Outcomes included procedural success and procedure-related infection. Logistic regression models were used to determine factors associated with embedded catheters. RESULTS We matched 15 cases of embedded tunneled catheters with 45 controls. Among patients with embedded catheters, there were no complications with endoluminal dilatation. Factors independently associated with embedded catheters included catheter dwell time (> 2 years) and history of central venous stenosis. CONCLUSION Embedded catheters can be successfully managed by endoluminal dilatation with minimal complications and factors associated with embedding include dwell times > 2 years and/or with a history of central venous stenosis.
Collapse
Affiliation(s)
- Hari Talreja
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Edward Ryan
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet Graham
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adnan Hadziomerovic
- Department of Medical Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Clark
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| |
Collapse
|
44
|
Miller LM, MacRae JM, Kiaii M, Clark E, Dipchand C, Kappel J, Lok C, Luscombe R, Moist L, Oliver M, Pike P, Hiremath S. Hemodialysis Tunneled Catheter Noninfectious Complications. Can J Kidney Health Dis 2017. [PMID: 28270922 DOI: 10.1177/2054358116669130.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Noninfectious hemodialysis catheter complications include catheter dysfunction, catheter-related thrombus, and central vein stenosis. The definitions, causes, and treatment strategies for catheter dysfunction are reviewed below. Catheter-related thrombus is a less common but serious complication of catheters, requiring catheter removal and systemic anticoagulation. In addition, the risk factors, clinical manifestation, and treatment options for central vein stenosis are outlined.
Collapse
Affiliation(s)
- Lisa M Miller
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jennifer M MacRae
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mercedeh Kiaii
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Edward Clark
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Joanne Kappel
- Faculty of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Charmaine Lok
- Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada
| | - Rick Luscombe
- Department of Nursing, Providence Health Care, Vancouver, British Columbia, Canada
| | - Louise Moist
- Department of Medicine, University of Western Ontario, London, Canada
| | - Matthew Oliver
- Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Pamela Pike
- Department of Medicine, Memorial University, Saint John's, Newfoundland and Labrador, Canada
| | | | | |
Collapse
|
45
|
Timmis J, Alden K, Andrews P, Clark E, Nellis A, Naylor B, Coles M, Kaye P. Building confidence in quantitative systems pharmacology models: An engineer's guide to exploring the rationale in model design and development. CPT Pharmacometrics Syst Pharmacol 2017; 6:156-167. [PMID: 27863172 PMCID: PMC5351409 DOI: 10.1002/psp4.12157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/30/2016] [Accepted: 11/06/2016] [Indexed: 11/11/2022]
Abstract
This tutorial promotes good practice for exploring the rationale of systems pharmacology models. A safety systems engineering inspired notation approach provides much needed rigor and transparency in development and application of models for therapeutic discovery and design of intervention strategies. Structured arguments over a model's development, underpinning biological knowledge, and analyses of model behaviors are constructed to determine the confidence that a model is fit for the purpose for which it will be applied.
Collapse
Affiliation(s)
- J Timmis
- Department of Electronics, The University of York, York, UK.,SimOmics Limited, York, UK
| | - K Alden
- Department of Electronics, The University of York, York, UK
| | | | | | | | - B Naylor
- Department of Electronics, The University of York, York, UK.,SimOmics Limited, York, UK
| | - M Coles
- Centre for Immunology and Infection, Hull York Medical School/University of York, York, UK
| | - P Kaye
- Centre for Immunology and Infection, Hull York Medical School/University of York, York, UK
| |
Collapse
|
46
|
Clark E, Barsuk JH, Karpinski J, McQuillan R. Achieving Procedural Competence during Nephrology Fellowship Training: Current Requirements and Educational Research. Clin J Am Soc Nephrol 2016; 11:2244-2249. [PMID: 27269612 PMCID: PMC5142073 DOI: 10.2215/cjn.08940815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Concerns have previously been raised as to whether training programs are ensuring that nephrology fellows achieve competence in the procedural skills required for independent practice. We sought to review the current requirements for procedural training as well as educational research pertaining to achieving competence in the core nephrology procedures of nontunneled (temporary) hemodialysis catheter insertion and percutaneous kidney biopsy. At this time, there is no universal approach to procedural training and assessment during nephrology fellowship. Nonetheless, simulation-based mastery learning programs have been shown to be effective in improving fellows' skills in nontunneled (temporary) hemodialysis catheter insertion and should be provided by all nephrology training programs. For percutaneous kidney biopsy, the development and evaluation of inexpensive simulators are a promising starting point for future study. Current practice with respect to procedural training during nephrology fellowship remains imperfect; however, the ongoing shift toward competency-based evaluation provides opportunities to refocus on improvement.
Collapse
Affiliation(s)
- Edward Clark
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Jolanta Karpinski
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Rory McQuillan
- Division of Nephrology, University Health Network and The University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
47
|
Vete A, Clark E. Dental clearance unsuccesful: cleidocranial dysplasia diagnosed at a relief of pain clinic. N Z Dent J 2016; 112:122-124. [PMID: 29694758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 55-year-old woman presented to Whangarei Base Hospital Emergency Department with a mandibular swelling adjacent to her unerupted tooth 48. She had never had dental radiographs taken, having had a dental clearance 20 years earlier. She wore full dentures. A panoramic dental radiograph revealed 44 unerupted teeth. Based on the clinical, oral and radiographic examinations a diagnosis of cleidocranial dysplasia (CCD) was confirmed. The patient had not been diagnosed with CCD prior to her hospital visit. Treatment included staged extractions of superficial mandibular supernumeraries and enucleation of the mandibular cyst, attempting to avoid pathological fracture. This would be followed by a six-month review and then annually as required. The case outlines the value of dental radiography in dental practice. Little is known about the prevalence of CCD in New Zealand and this is an area where future research could be conducted.
Collapse
|
48
|
Clark E. Health-related quality of life in older people with osteoporotic vertebral fractures: response to comments by Sani et al. Osteoporos Int 2016; 27:3663. [PMID: 27503174 DOI: 10.1007/s00198-016-3726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- E Clark
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, BS10 5NB, UK.
| |
Collapse
|
49
|
Zhou PP, Clark E, Kapadia MR. A systematic review of presacral extramedullary haematopoiesis: a diagnosis to be considered for presacral masses. Colorectal Dis 2016; 18:1033-1040. [PMID: 27329993 DOI: 10.1111/codi.13427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/20/2016] [Indexed: 02/08/2023]
Abstract
AIM Presacral masses are uncommon and have malignant potential; treatment typically includes surgical excision. However, there are conditions such as extramedullary haematopoiesis (EMH) which are benign. The present study aimed to summarize the presentation of presacral EMH in our institution, to review the literature and to offer management strategies for this rare condition. METHOD The literature was searched for articles related to presacral EMH, and case reports were collected from articles meeting the inclusion criteria. We collected data on patient demographics, diagnostic investigation, management and the results of treatment. RESULTS Thirty-nine patients were included in the systematic review. Initial imaging included computed tomography (CT), magnetic resonance imaging (MRI) or ultrasound (US) suggestive of EMH. Some patients then underwent a technetium scan (n = 7, 18%), biopsy of the presacral lesion (n = 27, 69%) or excision of the entire mass (n = 3, 8%). All patients who underwent technetium scan were confirmed to have EMH, demonstrating enhancement similar to bone marrow. Patients who underwent technetium scan and presacral mass biopsy had concordant results confirming presacral EMH (n = 5, 13%). Data on management were available for 35/39 (90%) with most patients followed by clinical observation (n = 20, 51%). Symptomatic patients were treated with radiotherapy (15%), surgical excision (15%) or hydroxyurea (5%) and blood transfusions (10%). Most (81%, n = 17/21) patients whose outcome was reported remained asymptomatic or experienced pain relief. CONCLUSION Although uncommon, EMH should be considered in the differential diagnosis of a presacral mass. Presacral EMH is a benign condition that can be suspected on CT or MRI and confirmed with technetium scan. Patients may not necessarily need to undergo biopsy to confirm haematopoietic elements. Unlike other presacral masses, patients diagnosed with presacral EMH can be managed by observation. If symptomatic, radiotherapy or surgical excision may be offered.
Collapse
Affiliation(s)
- P P Zhou
- Division of Gastrointestinal, Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - E Clark
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - M R Kapadia
- Division of Gastrointestinal, Minimally Invasive and Bariatric Surgery, Department of Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA.
| |
Collapse
|
50
|
Boscary J, Greuner H, Ehrke G, Böswirth B, Wang Z, Clark E, Lumsdaine A, Tretter J, McGinnis D, Lore J, Ekici K. Prototyping phase of the high heat flux scraper element of Wendelstein 7-X. Fusion Engineering and Design 2016. [DOI: 10.1016/j.fusengdes.2016.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|