1
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Karukonda P, Czito B, Duffy E, Uronis H, D'Amico T, Niedzwiecki D, Willett CG, Palta M. Pembrolizumab, Radiotherapy, and Chemotherapy in Neoadjuvant Treatment of Malignant Esophago-Gastric Diseases (PROCEED): Assessment of Pathologic Response in a Prospective, Phase II Single-Arm Trial. Int J Radiat Oncol Biol Phys 2023; 117:S12. [PMID: 37784310 DOI: 10.1016/j.ijrobp.2023.06.226] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A standard treatment paradigm for locally advanced, resectable, non-metastatic esophageal or gastric adenocarcinomas (EGA) is neoadjuvant chemoradiation (CRT) followed by surgical resection. Historical pathologic complete response (pCR) rate after CRT with carboplatin/paclitaxel per the CROSS trial was 23%. The efficacy of immune checkpoint inhibition in the adjuvant setting has since been demonstrated in this patient population. The primary objective of this trial was to investigate whether neoadjuvant CRT combined with pembrolizumab improves pCR compared to the historical control of CRT alone. MATERIALS/METHODS Single-institution, prospective phase II trial (NCT03064490) evaluating the efficacy and safety of neoadjuvant pembrolizumab combined with CRT followed by adjuvant pembrolizumab in patients with locally advanced operable EGA. CRT (45 Gy in 25 fractions with concurrent, weekly carboplatin [AUC 2] and paclitaxel [50mg/m2 of BSA]) with three cycles of pembrolizumab were administered as neoadjuvant therapy. Patients also received three cycles of adjuvant pembrolizumab after surgical resection. Baseline characteristics were collected. Pathologic response was scored from 0-3 based on tumor regression grading (TRG), with 0 indicating a complete response, 1 indicating marked response (<10% residual disease), 2 indicating partial response, and 3 indicating poor or no response. The percentage of patients with pCR and major pathologic response (MPR, score of 0-1) are described. RESULTS Accrual of this trial is now complete, with 35 patients with cT2-3N0-2M0 EGA enrolled from 10/10/2017-10/07/2022. 89% of enrolled patients are male, and 94% are white. 97% of patients have an esophageal primary. One patient withdrew from the study prior to completing neoadjuvant therapy due to a severe drug reaction. Two other patients did not undergo surgery, one due to preference and the other due to development of metastatic disease. Of 32 remaining eligible patients, 28 have completed neoadjuvant therapy and surgical resection to date. 100% of patients underwent IMRT/VMAT. 27/28 (97%) patients underwent R0 resection. 10/28 (35.7%: 95% CI: 17%, 53%) patients achieved a pCR, and 14/28 (50%: 95% CI: 31%, 68%) patients achieved an MPR. CONCLUSION Patients undergoing neoadjuvant CRT combined with pembrolizumab for EGA experienced a higher rate of pCR/MPR compared to historical controls treated with CRT alone. This phase II trial demonstrates the efficacy of this treatment paradigm, which warrants assessment in future prospective studies.
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Affiliation(s)
- P Karukonda
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - B Czito
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - E Duffy
- Duke University Medical Center, Durham, NC
| | - H Uronis
- Duke University Medical Center, Durham, NC
| | - T D'Amico
- Duke University Medical Center, Durham, NC
| | | | - C G Willett
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
| | - M Palta
- Duke University Medical Center, Department of Radiation Oncology, Durham, NC
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Manis AD, Cook-Snyder DR, Duffy E, Osmani WA, Eilbes M, Dillard M, Palygin O, Staruschenko A, Hodges MR. Repeated seizures lead to progressive ventilatory dysfunction in SS Kcnj16-/- rats. J Appl Physiol (1985) 2023; 135:872-885. [PMID: 37535709 PMCID: PMC10642517 DOI: 10.1152/japplphysiol.00072.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023] Open
Abstract
Patients with uncontrolled epilepsy experience repeated seizures putting them at increased risk for sudden unexpected death in epilepsy (SUDEP). Data from human patients have led to the hypothesis that SUDEP results from severe cardiorespiratory suppression after a seizure, which may involve pathological deficiencies in the brainstem serotonin (5-HT) system. Rats with a genomic Kcnj16 mutation (SSKcnj16-/- rats) are susceptible to sound-induced generalized tonic-clonic seizures (GTCS) which, when repeated once daily for up to 10 days (10-day seizure protocol), increased mortality, particularly in male rats. Here, we test the hypothesis that repeated seizures across the 10-day protocol will cause a progressive ventilatory dysfunction due to time-dependent 5-HT deficiency. Initial severe seizures led to ictal and postictal apneas and transient decreases in breathing frequency, ventilatory drive, breath-to-breath variability, and brief hypoventilation. These seizure-induced effects on ventilation were exacerbated with increasing seizures and ventilatory chemoreflexes became further impaired after repeated seizures. Tissue analyses of key brainstem regions controlling breathing showed time-dependent 5-HT system suppression and increased immunoreactivity for IBA-1 (microglial marker) without changes in overall cell counts at 3, 7, and 10 days of seizures. Fluoxetine treatment in SSKcnj16-/- rats prevented repeated seizure-induced progressive respiratory suppression but failed to prevent seizure-related mortality. We conclude that repeated seizures cause a progressive compromise of ventilatory control in the immediate postictal period largely mediated by serotonin system suppression in brainstem regions of respiratory control. However, other unknown factors contribute to overall survival following repeated seizures in this model.NEW & NOTEWORTHY This study demonstrated that repeated seizures in a novel rat model (SSKcnj16-/- rats) caused a progressively greater ventilatory dysfunction in the immediate postictal period associated with brainstem serotonin (5-HT) suppression. Augmenting brain 5-HT with a selective serotonin reuptake inhibitor prevented the progressive ventilatory dysfunction induced by repeated seizures but failed to prevent seizure-related mortality, suggesting that repeated seizures may lead to cardiorespiratory suppression and failure through multiple mechanisms.
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Affiliation(s)
- Anna D Manis
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Denise R Cook-Snyder
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Erin Duffy
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Wasif A Osmani
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Melissa Eilbes
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Matthew Dillard
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Oleg Palygin
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Alexander Staruschenko
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Department of Molecular Pharmacology & Physiology, University of South Florida, Tampa, Florida, United States
- James A. Haley Veterans' Hospital, Tampa, Florida, United States
| | - Matthew R Hodges
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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3
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Adler L, Ly B, Duffy E, Hannick K, Hall M, Trish E. Ground Ambulance Billing And Prices Differ By Ownership Structure. Health Aff (Millwood) 2023; 42:227-236. [PMID: 36652633 DOI: 10.1377/hlthaff.2022.00738] [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: 01/20/2023]
Abstract
The No Surprises Act prohibits most surprise billing but notably does not apply to ground ambulance services. In this study we created a novel data set that identifies the ownership structure of ground ambulance organizations to compare pricing and billing between private- and public-sector ambulances, with a specific focus on organizations owned by private equity or publicly traded companies. Overall, we found that 28 percent of commercially insured emergency ground ambulance transports during the period 2014-17 resulted in a potential surprise bill. Our analysis illustrates that being transported by a private-sector ambulance in an emergency comes with substantially higher allowed amounts, patient cost sharing, and potential surprise bills compared with being transported by a public-sector ambulance. Further, allowed amounts and cost sharing tended to be higher for private equity- or publicly traded company-owned ambulances than other private-sector ambulances. These findings highlight substantial patient liability and important differences in pricing and billing patterns between public- and private-sector ground ambulance organizations.
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Affiliation(s)
- Loren Adler
- Loren Adler , Brookings Institution, Washington, D.C
| | - Bich Ly
- Bich Ly, University of Southern California, Los Angeles, California
| | - Erin Duffy
- Erin Duffy, University of Southern California
| | | | - Mark Hall
- Mark Hall, Wake Forest University, Winston-Salem, North Carolina
| | - Erin Trish
- Erin Trish, University of Southern California
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Lin E, Ly B, Duffy E, Trish E. Medicare Advantage Plans Pay Large Markups To Consolidated Dialysis Organizations. Health Aff (Millwood) 2022; 41:1107-1116. [PMID: 35914212 DOI: 10.1377/hlthaff.2021.02009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The 21st Century Cures Act of 2016 lifted regulations prohibiting Medicare Advantage (MA) enrollment after patients initiate dialysis, starting in 2021, and early reports indicate increased MA enrollment among such patients. Large shifts into Medicare Advantage could disrupt the market because the consolidated dialysis industry can negotiate payment from MA plans that is higher than that for fee-for-service Medicare. For three large insurers representing 48 percent of the 2016-17 MA market, we found that MA plans paid 27 percent more than fee-for-service Medicare. Larger dialysis center chains commanded higher markups. Virtually all facilities of the two largest chains were in network, suggesting that they leverage their market power into all-or-nothing negotiations with plans. Policy makers should consider regulations that limit market consolidation among dialysis providers, as well as their ability to exercise that power in the MA market.
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Affiliation(s)
- Eugene Lin
- Eugene Lin , University of Southern California, Los Angeles, California
| | - Bich Ly
- Bich Ly, University of Southern California
| | - Erin Duffy
- Erin Duffy, University of Southern California
| | - Erin Trish
- Erin Trish, University of Southern California
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5
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Mouradian GC, Liu P, Nakagawa P, Duffy E, Gomez Vargas J, Balapattabi K, Grobe JL, Sigmund CD, Hodges MR. Patch-to-Seq and Transcriptomic Analyses Yield Molecular Markers of Functionally Distinct Brainstem Serotonin Neurons. Front Synaptic Neurosci 2022; 14:910820. [PMID: 35844900 PMCID: PMC9280690 DOI: 10.3389/fnsyn.2022.910820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 01/22/2023] Open
Abstract
Acute regulation of CO2 and pH homeostasis requires sensory feedback from peripheral (carotid body) and central (central) CO2/pH sensitive cells - so called respiratory chemoreceptors. Subsets of brainstem serotonin (5-HT) neurons in the medullary raphe are CO2 sensitive or insensitive based on differences in embryonic origin, suggesting these functionally distinct subpopulations may have unique transcriptional profiles. Here, we used Patch-to-Seq to determine if the CO2 responses in brainstem 5-HT neurons could be correlated to unique transcriptional profiles and/or unique molecular markers and pathways. First, firing rate changes with hypercapnic acidosis were measured in fluorescently labeled 5-HT neurons in acute brainstem slices from transgenic, Dahl SS (SSMcwi) rats expressing T2/ePet-eGFP transgene in Pet-1 expressing (serotonin) neurons (SS ePet1-eGFP rats). Subsequently, the transcriptomic and pathway profiles of CO2 sensitive and insensitive 5-HT neurons were determined and compared by single cell RNA (scRNAseq) and bioinformatic analyses. Low baseline firing rates were a distinguishing feature of CO2 sensitive 5-HT neurons. scRNAseq of these recorded neurons revealed 166 differentially expressed genes among CO2 sensitive and insensitive 5-HT neurons. Pathway analyses yielded novel predicted upstream regulators, including the transcription factor Egr2 and Leptin. Additional bioinformatic analyses identified 6 candidate gene markers of CO2 sensitive 5-HT neurons, and 2 selected candidate genes (CD46 and Iba57) were both expressed in 5-HT neurons determined via in situ mRNA hybridization. Together, these data provide novel insights into the transcriptional control of cellular chemoreception and provide unbiased candidate gene markers of CO2 sensitive 5-HT neurons. Methodologically, these data highlight the utility of the patch-to-seq technique in enabling the linkage of gene expression to specific functions, like CO2 chemoreception, in a single cell to identify potential mechanisms underlying functional differences in otherwise similar cell types.
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Affiliation(s)
- Gary C. Mouradian
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States,*Correspondence: Gary C. Mouradian Jr.,
| | - Pengyuan Liu
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Pablo Nakagawa
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Erin Duffy
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Javier Gomez Vargas
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kirthikaa Balapattabi
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Justin L. Grobe
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, United States,Comprehensive Rodent Metabolic Phenotyping Core, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Curt D. Sigmund
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States,Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Matthew R. Hodges
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, United States,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, United States
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Osmani WA, Duffy E, Manis A, Rohde N, Mouradian G, Forster H, Staruschenko A, Hodges MR. Single Nuclear RNA Sequencing Reveals Activation of Neuroinflammation Within the Pre‐Bötzinger Complex Following Repeated Seizures. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3667] [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: 11/11/2022]
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7
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Finnegan M, Duffy E, Morrin A. The determination of skin surface pH via the skin volatile emission using wearable colorimetric sensors. Sensing and Bio-Sensing Research 2022. [DOI: 10.1016/j.sbsr.2022.100473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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8
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Srivastava A, Thirupathirajan VAR, Duffy E. 318 Adapting Surgical Intercalation Teaching to The Pandemic – A Novel Near-Peer Educational Model for Intercalating Medical Students. Br J Surg 2021. [PMCID: PMC8524548 DOI: 10.1093/bjs/znab259.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The COVID-19 pandemic has reduced medical student exposure to traditional formats of surgical teaching, thereby irrefutably altering surgical education for the foreseeable future. The pandemic has compounded the preliminarily reported disconnect intercalating students experience, as well as depriving students of opportunities for surgical exposure. The aim of our study is to devise an innovative near-peer system to supplement surgical teaching and guidance for the ‘Surgical Sciences’ Intercalated BSc offered at University College London, hence promoting surgical education.
Method
Past students (preceding two cohorts) were competitively recruited, termed mentors. Each student was paired with a mentor for one-to-one guidance. Mentors and programme directors formulated surgical, module-specific, virtual tutorials (Zoom). Mentees were surveyed using predesigned Google Forms to gauge subjective utility. Likert Scales (0-10) were used for quantitative analysis and free-text fields for further commentary.
Results
Mentors and programme directors devised 8 module-specific, surgical tutorials over term 1, spaced on average at every 1.5 weeks. A statistically significant increase in confidence reported per taught module, from 5.85±1.16 to 7.85±0.93 (P < 0.0001), was observed. Mentees report an overall recommendation of 93.19% that all tutorials be rerun for the upcoming cohort. 75% of mentees predict their designated mentors will be ‘very useful’ in their surgical education.
Conclusions
A novel model of near-peer education for surgical intercalation studies has been successfully established, whereby students receive valuable education and guidance from mentors with relevant surgical experiences. Students report significant utility in this programme, which can be a constant in otherwise turbulent times for surgical education.
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Affiliation(s)
- A Srivastava
- School of Medicine, University College London (UCL), London, United Kingdom
| | | | - E Duffy
- School of Medicine, University College London (UCL), London, United Kingdom
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O'Mahony L, Duffy E, Mc Ginnity M, Balmer F, Duffy I. NSAIDs and Renal Impairment: Deprescribing Chronic NSAID use in General Practice. Ir Med J 2021; 114:431. [PMID: 35863072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim NSAIDs are high-risk medicines that can commonly cause adverse renal effects. Recent evidence suggests a rise in the number of patients with acute and chronic renal disease. The aim of this audit is to determine our de-prescribing rate of chronic NSAID use in an Irish general practice. Methods We reviewed NSAID-containing drug prescriptions that were issued over a three month period in 2018. A description analysis was performed to ascertain for the frequency and type of NSAIDs prescribed. An educational session was delivered to clinicians to encourage de-prescribing of NSAIDs if deemed clinically appropriate. Results Fifty-one NSAID-containing prescriptions were identified. Thirty-six (71%) patients, who were prescribed a regular NSAID, were aged between 71-85 years. Meloxicam was used the most (31%), whilst the preferred NSAIDs (naproxen and ibuprofen) were used least (18%). A 37% improvement in de-prescribing of chronic NSAIDs was achieved upon re-auditing. Conclusion NSAIDs are commonly implicated in inappropriate prescribing. Clinicians are encouraged to practice de-prescribing at every opportunity. Recent evidence suggests that pharmacy-led educational interventions can further assist de-prescribing of inappropriate medicines. Thus, a close collaboration between physicians and pharmacists is encouraged to further maximise quality of prescribing and patient care.
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Affiliation(s)
- L O'Mahony
- GP Registrar, North East Training Scheme, ICGP
| | - E Duffy
- Swan Park Surgery, Monaghan, Co. Monaghan
| | | | - F Balmer
- Swan Park Surgery, Monaghan, Co. Monaghan
| | - I Duffy
- Swan Park Surgery, Monaghan, Co. Monaghan
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10
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McCurdy S, Duffy E, Hickman M, Halasohoris S, Zumbrun SD. Efficacy of Delafloxacin against the Biothreat Pathogen Burkholderia pseudomallei. Antimicrob Agents Chemother 2021; 65:e0073621. [PMID: 34339266 PMCID: PMC8448139 DOI: 10.1128/aac.00736-21] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/17/2021] [Indexed: 11/20/2022] Open
Abstract
The in vitro activity and in vivo efficacy of delafloxacin were evaluated against the causative pathogen of melioidosis, Burkholderia pseudomallei. Delafloxacin MICs were determined by broth microdilution according to CLSI guidelines for 30 isolates of B. pseudomallei. The in vivo efficacy of delafloxacin was studied at a range of doses in a postexposure prophylaxis (PEP) murine model of melioidosis. Delafloxacin was active in vitro against B. pseudomallei (MIC90, 1 μg/ml). When the mice were dosed with 50 mg/kg body weight and 80 mg/kg body weight delafloxacin at both 16 and 24 h, greater survival was observed (90% to 100% survival) than with the 30-mg/kg-dosed mice (70% survival). All delafloxacin-treated cohorts contained no detectable B. pseudomallei in the spleens at the end of the study. This contrasts with ceftazidime 16- and 24-h administration, which had 40% and 20% survival, respectively. Complete clearance of infection was observed for most but not all surviving cohorts administered ceftazidime. In the mouse model of infection, survival curves for delafloxacin- and ceftazidime-treated animals at treatment start times of 16 and 24 h were statistically significant (P values of <0.0001). Estimated daily delafloxacin exposures in the B. pseudomallei murine aerosol study were similar to daily human exposures with the approved twice a day (BID) intravenous (i.v.) (300 mg) or oral (450 mg) dosing regimens. Based on its in vitro and in vivo activity, its safety, and its tolerability profile, delafloxacin may offer an attractive treatment option as PEP or eradication therapy for B. pseudomallei. Evaluation in other in vivo infection models for B. pseudomallei should be considered.
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Affiliation(s)
| | - Erin Duffy
- Melinta Therapeutics, Morristown, New Jersey, USA
| | - Mark Hickman
- Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (JPEO-CBRND), Joint Product Manager CBRN Medical, Frederick, Maryland, USA
| | - Stephanie Halasohoris
- U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland, USA
| | - Steven D. Zumbrun
- U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID), Frederick, Maryland, USA
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Manis A, Duffy E, Cook‐Snyder D, Staruschenko A, Hodges M. Repeated Seizure Exposure in the SS
Kcnj16‐/‐
Rat Causes Progressive Respiratory Suppression and Associated Brainstem Pathology. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03360] [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: 11/11/2022]
Affiliation(s)
- Anna Manis
- PhysiologyMedical College of WisconsinMilwaukeeWI
| | - Erin Duffy
- PhysiologyMedical College of WisconsinMilwaukeeWI
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12
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Dillard M, Duffy E, Hodges M. Effects of Serotonin Terminal Lesions in the Retrotrapezoid Nucleus on Ventilatory Chemoreflexes. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04669] [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: 11/11/2022]
Affiliation(s)
- Matt Dillard
- PhysiologyMedical College of WisconsinWauwatosaWI
| | - Erin Duffy
- PhysiologyMedical College of WisconsinWauwatosaWI
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13
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Osmani W, Duffy E, Manis A, Mouradian G, Forster H, Staruschenko A, Hodges M. Single Nuclear RNA Sequencing Reveals Activation of Neuroinflammation Within the Pre‐Bötzinger Complex Following Repeated Seizures. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02780] [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: 11/11/2022]
Affiliation(s)
- Wasif Osmani
- PhysiologyMedical College of WisconsinMilwaukeeWI
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14
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Mouradian G, Duffy E, Liu P, Gomez‐Vargas J, Hodges M. Patch‐to‐Seq Reveals Unique Transcriptomic Profiles of Chemosensitive Serotonergic Neurons. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04448] [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: 11/11/2022]
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15
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Chartock BL, Adler L, Ly B, Duffy E, Trish E. Arbitration Over Out-Of-Network Medical Bills: Evidence From New Jersey Payment Disputes. Health Aff (Millwood) 2021; 40:130-137. [PMID: 33400578 DOI: 10.1377/hlthaff.2020.00217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2018 New Jersey implemented a final-offer arbitration system to resolve payment disputes between insurers and out-of-network providers over surprise medical bills. Similar proposals are being considered by Congress and other states. In this article we examine how arbitration decisions compare with other relevant provider payment amounts by linking administrative data from New Jersey arbitration cases to Medicare and commercial insurance claims data. We find that decisions track closely with one of the metrics that arbitrators are shown-the eightieth percentile of provider charges-with the median decision being 5.7 times prevailing in-network rates for the same services. It is not a foregone conclusion that arbitrators will select winning offers based on proximity to this target, although our findings suggest that it is a strong anchor. The amount that providers can expect to receive through the arbitration process also affects their bargaining leverage with insurers, which could affect in-network negotiated rates more broadly. Therefore, basing arbitration decisions or a payment standard on unilaterally set provider-billed charges appears likely to increase health care costs relative to other surprise billing solutions and perversely incentivizes providers to inflate their charges over time.
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Affiliation(s)
- Benjamin L Chartock
- Benjamin L. Chartock is a PhD student in the Health Care Management Department at the Wharton School and an associate fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania, in Philadelphia, Pennsylvania
| | - Loren Adler
- Loren Adler is associate director of the University of Southern California (USC)-Brookings Schaeffer Initiative for Health Policy at the Brookings Institution, in Washington, D.C
| | - Bich Ly
- Bich Ly is a research programmer at the Leonard D. Schaeffer Center for Health Policy and Economics at USC, in Los Angeles, California
| | - Erin Duffy
- Erin Duffy is a postdoctoral fellow at the Leonard D. Schaeffer Center for Health Policy and Economics at USC
| | - Erin Trish
- Erin Trish is the associate director of the Leonard D. Schaeffer Center for Health Policy and Economics and an assistant professor of pharmaceutical and health economics in the School of Pharmacy, both at USC
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Affiliation(s)
| | | | - E. Duffy
- RAND Corporation Santa Monica CA United States
| | - L. Wolf
- Pennsylvania State University State College PA United States
| | - C. Buttorff
- RAND Corporation Santa Monica CA United States
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Das M, Luik A, Shepherd E, Sulkin M, Laughner J, Duffy E, Oesterlein T, Meyer C, Jais P, Duchateau J, Yue A, Ullah W, Garcia-Bolao I. 664Local catheter impedance drop during pulmonary vein isolation predicts conduction block in patients with paroxysmal atrial fibrillation: initial results of the LOCALIZE clinical trial. Europace 2020. [DOI: 10.1093/europace/euaa162.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Boston Scientific
Background
Radiofrequency (RF) catheter ablation for pulmonary vein isolation (PVI) requires resistively heating cardiac tissue to create conduction block. Creation of an RF lesion results in an impedance drop and the magnitude of this drop depends on the temperature and amount of myocardium being heated. Pre-clinical and clinical evaluation of an advanced local impedance (LI) metric found that greater LI drops were indicative of more effective lesion formation.
Purpose
To evaluate whether LI drop is associated with conduction block after first pass encirclement of the PVs in patients with paroxysmal AF.
Methods
LOCALIZE is an ongoing, single-arm, multi-center clinical trial (clinicaltrials.gov NCT03232645). LOCALIZE consists of an index PVI procedure (results presented here) and a 3-month follow-up mapping procedure. In the index procedure, electroanatomical maps of the left atrium were created and ipsilateral PVs were divided into 8 anatomical segments (n = 16 per patient). PVI was performed using point-by-point ablation with blinding of operators to LI. Following initial encirclement and a 20-minute wait period, coronary sinus-paced electroanatomical maps were created to identify gaps within anatomical segments. Gaps were annotated on the map and subsequently ablated. Mean LI drop within each segment was calculated offline as an estimate of regional RF energy delivery (Figure - Left). The diagnostic accuracy of LI drop for predicting segment block was assessed using receiver operating characteristic (ROC) analysis in segments with inter-lesion spacing ≤6mm.
Results
Forty-seven patients with paroxysmal AF underwent PVI at 5 centers (age 62 ± 11 years, male 55.3%). All patients left the index procedure with all PVs isolated. When blinded to LI (n = 3,064 ablations), median baseline LI was 106 (IQR: 97-115) Ω and median LI drop was 18.4 (12.7-24.9) Ω. After first pass encirclement, blocked segments had a significantly larger LI drop (20.2 [14.6-26.0] Ω) than segments with gaps (10.6 [6.9-15.1] Ω, p < 0.01, Figure - Right). The association between LI drop and block was further evaluated along anatomical anterior/posterior wall thickness differences. Anterior block segments were found to have significantly larger LI drops (21.0 [15.9-27.2] Ω) than posterior block segments (16.6 [12.7-23.7] Ω, p < 0.01). ROC analysis of segments with inter-lesion spacing ≤6mm identified optimal LI cut-off values of 16Ω in anterior segments and 11Ω posteriorly, which had positive predictive values for conduction block of 95.6% and 96.7%, respectively.
Conclusions
The magnitude of LI drop is predictive of acute PVI segment conduction block in patients with paroxysmal AF. The thinner posterior wall required smaller LI drops for block compared to the thicker anterior wall. With inter-lesion spacing of ≤6mm, reaching a LI drop of ≥16Ω anteriorly and ≥11Ω posteriorly was highly predictive of acute segment block in de novo PVI.
Abstract Figure. Local impedance drop in de novo PVI
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Affiliation(s)
- M Das
- Freeman Hospital, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - A Luik
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - E Shepherd
- Freeman Hospital, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - M Sulkin
- Boston Scientific, Arden Hills, United States of America
| | - J Laughner
- Boston Scientific, Arden Hills, United States of America
| | - E Duffy
- Boston Scientific, Arden Hills, United States of America
| | - T Oesterlein
- Boston Scientific, Arden Hills, United States of America
| | - C Meyer
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - P Jais
- Hospital Haut Leveque, Bordeaux, France
| | | | - A Yue
- University of Southampton, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - W Ullah
- University of Southampton, Southampton, United Kingdom of Great Britain & Northern Ireland
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Mouradian GC, Duffy E, Liu P, Hodges M. Coupling Electrophysiology with Single Cell RNA Sequencing to Uncover Transcriptional Markers of Chemosensitive Serotonergic Neurons. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.05915] [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: 11/11/2022]
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Osmani W, Duffy E, Manis A, Kasmani M, Khatun A, Mouradian G, Forster H, Hodges M. Single Nuclear Transcriptomes of Raphe Cell Types May be Altered with Repeated Seizures. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.04046] [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: 11/11/2022]
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Dillard M, Duffy E, Cook-Snyder D, Hodges M. Raphe‐Derived Neuromodulators Within the Retrotrapezoid Nucleus (RTN) Modulate Ventilatory Chemoreflexes
In Vivo
. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.03032] [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: 11/11/2022]
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Manis AD, Cook-Snyder D, Duffy E, Staruschenko A, Hodges MR. Evidence of Progressive Brainstem Pathology after Repeated Seizure Exposure in a Novel Rat Model of SUDEP. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.04175] [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: 11/11/2022]
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Rudin RS, Fanta CH, Qureshi N, Duffy E, Edelen MO, Dalal AK, Bates DW. A Clinically Integrated mHealth App and Practice Model for Collecting Patient-Reported Outcomes between Visits for Asthma Patients: Implementation and Feasibility. Appl Clin Inform 2019; 10:783-793. [PMID: 31618782 DOI: 10.1055/s-0039-1697597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Mobile health (mHealth) apps may prove to be useful tools for supporting chronic disease management. We assessed the feasibility of implementing a clinically integrated mHealth app and practice model to facilitate between-visit asthma symptom monitoring as per guidelines and with the help of patient-reported outcomes (PRO). METHODS We implemented the intervention at two pulmonary clinics and conducted a mixed-methods analysis of app usage data and semi-structured interview of patients and clinician participants over a 25-week study period. RESULTS Five physicians, 1 physician's assistant, 1 nurse, and 26 patients participated. Twenty-four patients (92%) were still participating in the intervention at the end of the 25-week study period. On average, each patient participant completed 21 of 25 questionnaires (84% completion rate). Weekly completion rates were higher for participants who were female (88 vs. 73%, p = 0.02) and obtained a bachelor's degree level or higher (94 vs. 74%, p = 0.04). On average, of all questionnaires, including both completed and not completed (25 weekly questionnaires times 26 patient participants), 25% had results severe enough to qualify for a callback from a nurse; however, patients declined this option in roughly half of the cases in which they were offered the option. We identified 6 key themes from an analysis of 21 patients and 5 clinician interviews. From the patient's perspective, these include more awareness of asthma, more connected with provider, and app simplicity. From the clinician's perspective, these include minimal additional work required, facilitating triage, and informing conversations during visits. CONCLUSION Implementation of a clinically integrated mHealth app and practice model can achieve high patient retention and adherence to guideline-recommended asthma symptom monitoring, while minimally burdening clinicians. The intervention has the potential for scaling to primary care and reducing utilization of urgent and emergency care.
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Affiliation(s)
| | - Christopher H Fanta
- Partners Asthma Center, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Nabeel Qureshi
- RAND Corporation, Santa Monica, California, United States
| | - Erin Duffy
- RAND Corporation, Santa Monica, California, United States
| | | | - Anuj K Dalal
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - David W Bates
- Division of General Internal Medicine, Department of Health Policy and Management, Brigham and Women's Hospital, Harvard Chan School of Public Health, Boston, Massachusetts, United States
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Kent C, Marin D, Niedzwiecki D, Stephens S, Duffy E, Malicki M, Abbruzzese J, Uronis H, Blobe G, Blazer D, Czito B, Willett C, Palta M. Imaging & Biomarker Correlates on Outcomes in a Phase II Trial of Neoadjuvant Gemcitabine/Nab-Paclitaxel and Hypofractionated Image-Guided Radiotherapy (HIGRT) in Potentially Resectable Pancreas Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Duffy E, Brassill MJ. Hypercalcaemia due to Hypervitaminosis D in a Self-Supplementing Multiple Sclerosis Patient: A Case Report. Ir Med J 2019; 112:953. [PMID: 31538442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is an increasing literature with regard to vitamin D supplementation in Multiple Sclerosis (MS). We report the case of a 45 year-old male with MS who presented with symptomatic hypercalcaemia secondary to self-supplementation of vitamin D3 purchased online. Treatment was with IV hydration, glucocorticoids, calcitonin and bisphosphonates. This case highlights a lack of consensus guidance regarding safe vitamin D supplementation dosages and the importance of a thorough history with regard to non-prescribed supplements, particularly those easily available online.
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Affiliation(s)
- E Duffy
- South Tipperary General Hospital, Clonmel, Co. Tipperary
| | - M J Brassill
- South Tipperary General Hospital, Clonmel, Co. Tipperary
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Hawkes MF, Duffy E, Joag R, Skeats A, Radwan J, Wedell N, Sharma MD, Hosken DJ, Troscianko J. Sexual selection drives the evolution of male wing interference patterns. Proc Biol Sci 2019; 286:20182850. [PMID: 31138076 DOI: 10.1098/rspb.2018.2850] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The seemingly transparent wings of many insects have recently been found to display unexpected structural coloration. These structural colours (wing interference patterns: WIPs) may be involved in species recognition and mate choice, yet little is known about the evolutionary processes that shape them. Furthermore, to date investigations of WIPs have not fully considered how they are actually perceived by the viewers' colour vision. Here, we use multispectral digital imaging and a model of Drosophila vision to compare WIPs of male and female Drosophila simulans from replicate populations forced to evolve with or without sexual selection for 68 generations. We show that WIPs modelled in Drosophila vision evolve in response to sexual selection and provide evidence that WIPs correlate with male sexual attractiveness. These findings add a new element to the otherwise well-described Drosophila courtship display and confirm that wing colours evolve through sexual selection.
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Affiliation(s)
- M F Hawkes
- 1 Centre for Ecology and Conservation, University of Exeter , Tremough, Penryn TR10 9FE , UK
| | - E Duffy
- 1 Centre for Ecology and Conservation, University of Exeter , Tremough, Penryn TR10 9FE , UK.,2 Institute of Environmental Science, Jagiellonian University , Gronostajowa 7, 30-387 Krakow , Poland
| | - R Joag
- 1 Centre for Ecology and Conservation, University of Exeter , Tremough, Penryn TR10 9FE , UK.,2 Institute of Environmental Science, Jagiellonian University , Gronostajowa 7, 30-387 Krakow , Poland
| | - A Skeats
- 1 Centre for Ecology and Conservation, University of Exeter , Tremough, Penryn TR10 9FE , UK
| | - J Radwan
- 2 Institute of Environmental Science, Jagiellonian University , Gronostajowa 7, 30-387 Krakow , Poland.,3 Evolutionary Biology Group, Faculty of Biology, Adam Mickiewicz University , Umultowska 7, 61-614 Poznan , Poland
| | - N Wedell
- 1 Centre for Ecology and Conservation, University of Exeter , Tremough, Penryn TR10 9FE , UK
| | - M D Sharma
- 1 Centre for Ecology and Conservation, University of Exeter , Tremough, Penryn TR10 9FE , UK
| | - D J Hosken
- 1 Centre for Ecology and Conservation, University of Exeter , Tremough, Penryn TR10 9FE , UK
| | - J Troscianko
- 1 Centre for Ecology and Conservation, University of Exeter , Tremough, Penryn TR10 9FE , UK
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Affiliation(s)
- Jacek Martynow
- Melinta Therapeutics Inc., 300 George Street, New Haven, Connecticut 06511, United States
| | - Roger Hanselmann
- Melinta Therapeutics Inc., 300 George Street, New Haven, Connecticut 06511, United States
| | - Erin Duffy
- Melinta Therapeutics Inc., 300 George Street, New Haven, Connecticut 06511, United States
| | - Ashoke Bhattacharjee
- Melinta Therapeutics Inc., 300 George Street, New Haven, Connecticut 06511, United States
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Geiger CK, Kranz AM, Dick AW, Duffy E, Sorbero M, Stein BD. Delivery of Preventive Oral Health Services by Rurality: A Cross-Sectional Analysis. J Rural Health 2019; 35:3-11. [PMID: 30537073 PMCID: PMC6298795 DOI: 10.1111/jrh.12340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Integrating oral health care into primary care has been promoted as a strategy to increase delivery of preventive oral health services (POHS) to young children, particularly in rural areas where few dentists practice. Using a multistate sample of Medicaid claims, we examined a child's odds of receiving POHS in a medical office by county rurality. METHODS We used 2012-2014 Medicaid Analytic extract claims data for 6,275,456 children younger than 6 years in 39 states that allowed Medicaid payment for POHS in medical offices. We used county-level characteristics from the Area Health Resources Files, including a 3-level measure of county rurality. We used logistic regression to estimate a child's odds of receiving POHS in a medical office by county rurality, while controlling for other patient and county characteristics. FINDINGS POHS in medical offices were received by 7.8% of children. Rates of POHS in medical offices were higher in metropolitan (metro) counties (8.4%) than nonmetro adjacent to metro (5.8%) and nonmetro not adjacent to metro (4.3%). In adjusted analysis, children living in nonmetro not adjacent to metro (OR = 0.79, 95% CI: 0.64-0.99) and adjacent to metro counties (OR = 0.70, 95% CI: 0.59-0.82) were significantly less likely to receive POHS in medical offices than children living in metro counties. CONCLUSIONS In this study of POHS in medical offices among young Medicaid-enrolled children, we found POHS rates were lowest in nonmetro counties. Given barriers to dental care in rural areas, states should take additional steps beyond allowing Medicaid reimbursement to increase delivery of POHS in medical offices.
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Affiliation(s)
- Caroline K. Geiger
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
- Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts
| | | | | | - Erin Duffy
- Pardee RAND Graduate School, Santa Monica, California
| | - Mark Sorbero
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
| | - Bradley D. Stein
- RAND Corporation Pittsburgh, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Abstract
Objective Fluoride varnish (FV) applications among non-dentist primary care providers has increased due to state Medicaid policies. In this study we examine the impact of FV policies on the oral health of publicly insured children aged 2-6 years old. Methods Using three waves of the National Survey of Children's Health (2003, 2007, 2011/12), we used a logistic regression model with state and year fixed effects, adjusting for relevant child characteristics, to examine the association between years since a state implemented a FV policy and the odds of a publicly insured child having very good or excellent teeth. We compared children with public insurance in states with FV policies to children with public insurance in states without FV policies, controlling for the same difference among children with private insurance who were unlikely to be affected by Medicaid FV policies. Results Among 68,890 children aged 2-6 years, 38% had public insurance. Compared to privately insured children, publicly insured children had significantly lower odds of having very good or excellent teeth [odds ratio (OR) 0.70, 95% CI 0.62-0.81]. Publicly insured children in states with FV policies implemented for four or more years had significantly greater odds of having very good or excellent teeth (OR 1.28, 95% CI 1.03-1.60) compared to publicly insured children in states without FV policies. Conclusions for Practice State policies supporting non-dental primary care providers application of FV were associated with improvements in oral health for young children with public insurance.
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Affiliation(s)
| | - Erin Duffy
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Andrew W Dick
- RAND, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA, 02116, USA
| | - Mark Sorbero
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
| | - Richard Gary Rozier
- University of North Carolina Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Bradley D Stein
- RAND, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
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Chowdhury S, Mao J, Martynow J, Zhao H, Duffy E, Wu Y, Thakur V, Sirasani G, Tang Y, Collin F, Sinishtaj S, Bhattacharjee A. Diastereoselective scalable synthesis of 2,6-trans-Piperidines using an aza-Michael reaction. Tetrahedron Lett 2019. [DOI: 10.1016/j.tetlet.2018.12.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rodd H, Kirby J, Duffy E, Porritt J, Morgan A, Prasad S, Baker S, Marshman Z. Children's experiences following a CBT intervention to reduce dental anxiety: one year on. Br Dent J 2018; 225:247-251. [DOI: 10.1038/sj.bdj.2018.540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
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Amin A, Gold MR, Burke MC, Knight BP, Kalbfleisch SJ, Okabe T, Duffy E, Stahl WK, Husby M, Tyler J, Houmsse M, Daoud EG, Hummel JD, Augostini RS, Weiss R. P2930Subcutaneous implantable cardioverter defibrillator position determines success. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Amin
- OhioHealth Heart and Vascular, Cardiac Electrophysiology, Columbus, United States of America
| | - M R Gold
- Medical University of South Carolina, Charleston, United States of America
| | - M C Burke
- CorVita Science Foundation, Chicago, United States of America
| | - B P Knight
- Northwestern University, Chicago, United States of America
| | - S J Kalbfleisch
- The Ohio State University, Columbus, United States of America
| | - T Okabe
- The Ohio State University, Columbus, United States of America
| | - E Duffy
- Boston Scientific, Saint Paul, United States of America
| | - W K Stahl
- Boston Scientific, Saint Paul, United States of America
| | - M Husby
- Boston Scientific, Saint Paul, United States of America
| | - J Tyler
- The Ohio State University, Columbus, United States of America
| | - M Houmsse
- The Ohio State University, Columbus, United States of America
| | - E G Daoud
- The Ohio State University, Columbus, United States of America
| | - J D Hummel
- The Ohio State University, Columbus, United States of America
| | - R S Augostini
- The Ohio State University, Columbus, United States of America
| | - R Weiss
- The Ohio State University, Columbus, United States of America
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Dawe RS, Ferguson J, Ibbotson S, Lawrence L, Paulson S, Duffy E, Cammarata S. Lack of phototoxicity potential with delafloxacin in healthy male and female subjects: comparison to lomefloxacin. Photochem Photobiol Sci 2018; 17:773-780. [PMID: 29721574 DOI: 10.1039/c8pp00019k] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIMS Delafloxacin is a fluoroquinolone antibiotic recently approved by the FDA for treatment of acute bacterial skin and skin structure infections (ABSSSI). Delafloxacin was assessed for phototoxicity potential compared with a known phototoxic fluoroquinolone. METHODS A Phase 1, investigator-blind, placebo/active-controlled, randomized, parallel-group study was conducted in 52 healthy male and female volunteers who received 200 or 400 mg of oral delafloxacin, 400 mg oral lomefloxacin or placebo once daily for 6 days. This study evaluated the photosensitizing potential and possible wavelength dependency of delafloxacin by comparing the response of the skin to ultraviolet A (UVA), ultraviolet B (UVB) and visible radiation prior to and during administration of delafloxacin, lomefloxacin as a positive control, or placebo. Adverse events were monitored throughout the study. RESULTS Forty-seven subjects completed six days of dosing, and no evidence of phototoxicity was seen with delafloxacin. Delafloxacin at 200 and 400 mg day-1 and placebo did not demonstrate differences in percent change from baseline in minimal erythema dose at all tested wavelengths (295-430 nm) by monochromator and solar simulator. Lomefloxacin, the positive control, had statistically significant differences (p < 0.05) at UVA wavelengths of 335 and 365 ± 30 nm 24 hours after radiation exposure (maximum response). The phototoxic index results were significantly higher for lomefloxacin at 335 nm and 365 nm compared to placebo and delafloxacin. CONCLUSIONS 200 and 400 mg of delafloxacin administered for 6 days were well tolerated in healthy adult volunteers. Delafloxacin and placebo failed to demonstrate a phototoxic effect but lomefloxacin, the positive control, demonstrated moderate phototoxicity.
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Affiliation(s)
- R S Dawe
- Photobiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
| | - J Ferguson
- Photobiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
| | - S Ibbotson
- Photobiology Unit, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK
| | - L Lawrence
- Melinta Therapeutics, Inc., Lincolnshire, IL 60069, USA.
| | - S Paulson
- Firma Clinical, Northbrook, IL 60062, USA
| | - E Duffy
- Melinta Therapeutics, Inc., New Haven, CT 06515, USA
| | - S Cammarata
- Melinta Therapeutics, Inc., Lincolnshire, IL 60069, USA.
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Popescu I, Duffy E, Mendelsohn J, Escarce JJ. Racial residential segregation, socioeconomic disparities, and the White-Black survival gap. PLoS One 2018; 13:e0193222. [PMID: 29474451 PMCID: PMC5825109 DOI: 10.1371/journal.pone.0193222] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the association between racial residential segregation, a prominent manifestation of systemic racism, and the White-Black survival gap in a contemporary cohort of adults, and to assess the extent to which socioeconomic inequality explains this association. DESIGN This was a cross sectional study of White and Black men and women aged 35-75 living in 102 large US Core Based Statistical Areas. The main outcome was the White-Black survival gap. We used 2009-2013 CDC mortality data for Black and White men and women to calculate age-, sex- and race adjusted White and Black mortality rates. We measured segregation using the Dissimilarity index, obtained from the Manhattan Institute. We used the 2009-2013 American Community Survey to define indicators of socioeconomic inequality. We estimated the CBSA-level White-Black gap in probability of survival using sequential linear regression models accounting for the CBSA dissimilarity index and race-specific socioeconomic indicators. RESULTS Black men and women had a 14% and 9% lower probability of survival from age 35 to 75 than their white counterparts. Residential segregation was strongly associated with the survival gap, and this relationship was partly, but not fully, explained by socioeconomic inequality. At the lowest observed level of segregation, and with the Black socioeconomic status (SES) assumed to be at the White SES level scenario, the survival gap is essentially eliminated. CONCLUSION White-Black differences in survival remain wide notwithstanding public health efforts to improve life expectancy and initiatives to reduce health disparities. Eliminating racial residential segregation and bringing Black socioeconomic status (SES) to White SES levels would eliminate the White-Black survival gap.
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Affiliation(s)
- Ioana Popescu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States of America
| | - Erin Duffy
- The RAND Corporation, Santa Monica, CA, United States of America
| | | | - José J. Escarce
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States of America
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Chino F, Castellar E, Schild M, Blitzblau R, Georgiade G, Suneja G, Duffy E, Broadwater G, Horton J. Pathologic Response and Acute Toxicity: Planned Interim Analysis of the Phase 2 NeoRT Trial Evaluating Preoperative Single Fraction Partial Breast Radiation Therapy in Early Stage Breast Cancer. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Duffy E, Ritchie S, Metcalfe S, Van Bakel B, Thomas MG. Antibacterials dispensed in the community comprise 85%-95% of total human antibacterial consumption. J Clin Pharm Ther 2017; 43:59-64. [PMID: 28833324 DOI: 10.1111/jcpt.12610] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Interventions intended to slow the emergence and spread of antibacterial resistance through enhanced antimicrobial stewardship will be more effective if informed by an accurate knowledge of current patterns of antibacterial consumption. For example, knowledge of the relative magnitude of community antibacterial consumption in relation to hospital antibacterial consumption within each nation or region should help guide decisions about the relative importance of community and hospital antimicrobial stewardship programmes. It is commonly stated that community antibacterial consumption comprises approximately 80% of total national antibacterial consumption. We aimed to determine this proportion across a large range of nations. METHODS We measured community and hospital antibacterial consumption in New Zealand during 2015, from both reimbursement and purchase data, and compared the New Zealand data with those reported from a large range of other nations during similar time periods. RESULTS AND DISCUSSION Community antibacterial consumption comprised approximately 85%-95% of total antibacterial consumption in all nations for which data were available, and in New Zealand comprised a higher proportion than in any other nation. The proportion of total antibacterial consumption comprised by community consumption was significantly higher in countries with relatively high levels of total antibacterial consumption than in countries with relatively low levels of total antibacterial consumption. WHAT IS NEW AND CONCLUSION The high proportion of total antibacterial consumption comprised by community antibacterial consumption suggests devoting particular attention to improved community antimicrobial stewardship. These results suggest that improving antimicrobial stewardship in the community may provide greater overall benefits in combating antibacterial resistance than improving antimicrobial stewardship in hospitals.
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Affiliation(s)
- E Duffy
- Department of Infectious Disease, Auckland City Hospital, Auckland, New Zealand.,Department of Pharmacy, Auckland City Hospital, Auckland, New Zealand
| | - S Ritchie
- Department of Infectious Disease, Auckland City Hospital, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Metcalfe
- PHARMAC (New Zealand Pharmaceutical Management Agency), Wellington, New Zealand
| | - B Van Bakel
- PHARMAC (New Zealand Pharmaceutical Management Agency), Wellington, New Zealand
| | - M G Thomas
- Department of Infectious Disease, Auckland City Hospital, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Singh JA, Bharat A, Khanna D, Aquino-Beaton C, Persselin JE, Duffy E, Elashoff D, Khanna PP. Health care utilization in patients with gout: a prospective multicenter cohort study. BMC Musculoskelet Disord 2017; 18:233. [PMID: 28569193 PMCID: PMC5452408 DOI: 10.1186/s12891-017-1573-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND All published studies of health care utilization in gout have been cross-sectional to date, and most used a patient-reported diagnosis of gout. Our objective was to assess health care utilization and its predictors in patients with physician-confirmed gout in a prospective cohort study. METHODS In a multi-center prospective cohort study of U.S. veterans with rheumatologist-confirmed gout (N = 186; two centers), we assessed patient self-reported overall and gout-specific health care utilization with the Gout Assessment Questionnaire (GAQ) every 3-months for a 9-month period. Comparisons were made using the student's t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate. Mixed effects Poisson regression was used to assess potential correlates of gout-related health care utilization. RESULTS Mean age was 64.6 years, 98% were men, 13% Hispanic or Latino, 32% were African-American, 6% did not graduate high school, mean serum urate was 8.3 and mean Deyo-Charlson score was 3.1. During the past year, mean gout-related visits were as follows: rheumatologist, 1.5; primary care physician, 2 visits; ≥1 inpatient visits, 7%; ≥1 ER visits, 26%; and urgent care/walk-in visit, 33%. In longitudinal analyses, African-American race and gout flares in the last 3 months were associated with significantly higher rate ratio of gout-related outpatient visits. African-American race and lack of college education were associated with significantly higher rate ratio for gout-related urgent visits and overnight stays. CONCLUSIONS African-American race and recent gout flares were associated with higher outpatient utilization and African-American race and no college education with higher urgent or inpatient utilization. Future studies should examine whether modifiable predictors of utilization can be targeted to reduce healthcare utilization in patients with gout.
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Affiliation(s)
- Jasvinder A Singh
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, Birmingham, 35294, AL, USA. .,Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Aseem Bharat
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA
| | | | | | - Jay E Persselin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Erin Duffy
- University of California, Los Angeles, CA, USA
| | | | - Puja P Khanna
- University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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West R, Gamble J, Kelly J, Milne T, Duffy E, Sidebotham M. Culturally capable and culturally safe: Caseload care for Indigenous women by Indigenous midwifery students. Women Birth 2016; 29:524-530. [DOI: 10.1016/j.wombi.2016.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/29/2016] [Accepted: 05/09/2016] [Indexed: 11/16/2022]
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Singh JA, Bharat A, Khanna D, Aquino-Beaton C, Persselin JE, Duffy E, Elashoff D, Khanna PP. Racial differences in health-related quality of life and functional ability in patients with gout. Rheumatology (Oxford) 2016; 56:103-112. [PMID: 28028159 DOI: 10.1093/rheumatology/kew356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 08/24/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the health-related quality of life (HRQOL) and the functional ability by race in patients with gout. METHODS In a 9-month prospective cohort multicentre study, patients with gout self-reported race, dichotomized as Caucasian or African American (others excluded). We calculated HRQOL/function scores adjusted for age, study site and college education for Short Form-36 (SF-36; generic HRQOL), Gout Impact Scale (GIS; disease-specific HRQOL) and HAQ-disability index (HAQ-DI; functional ability). Longitudinally adjusted scores were computed using multivariable mixed-effect regression models with a random patient effect and fixed sequential visit effect (3-monthly visits). RESULTS Compared with Caucasians (n = 107), African Americans (n = 60) with gout were younger (61.1 vs 67.3 years) and had higher median baseline serum urate (9.0 vs 7.9 mg/dl) (P < 0.01). African Americans with gout had worse HRQOL scores on three SF-36 domains, the mental component summary (MCS) and two of the five GIS scales than Caucasians [mean (se); P ⩽ 0.02 for all]: SF-36 mental health, 39.7 (1.1) vs 45.2 (0.9); SF-36 role emotional, 42.1 (4.2) vs 51.4 (4.2); SF-36 social functioning, 36.0 (1.1) vs 40.0 (0.9) (P = 0.04); SF-36 MCS, 43.2 (3.1) vs 50.0 (3.2); GIS unmet treatment need, 37.6 (1.6) vs 31.5 (1.4); and GIS concern during attacks, 53.3 (3.7) vs 47.4 (3.7). Differences between the respective HAQ-DI total scores were not statistically significant; 0.98 (0.1) vs 0.80 (1.0) (P = 0.11). Racial differences in SF-36 mental health, role emotional and MCS scales exceeded, and for HAQ-DI approached, the minimal clinically important difference thresholds. CONCLUSIONS African Americans with gout have significantly worse HRQOL compared with Caucasians. Further research is necessary in the form of studies targeted at African Americans on how best to improve these outcomes.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center .,Department of Medicine, School of Medicine.,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN
| | - Aseem Bharat
- Department of Medicine, School of Medicine.,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | - Jay E Persselin
- Department of Biostatistics, VA Greater Los Angeles Healthcare System
| | - Erin Duffy
- Department of Medicine, University of California, Los Angeles, CA
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, CA
| | - Puja P Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI.,Department of Medicine, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Kolaitis NA, Duffy E, Zhang A, Lo M, Barba DT, Chen M, Soriano T, Hu J, Nabili V, Saggar R, Sayah DM, DerHovanessian A, Shino MY, Lynch JP, Kubak BM, Ardehali A, Ross DJ, Belperio JA, Elashoff D, Saggar R, Weigt SS. Voriconazole increases the risk for cutaneous squamous cell carcinoma after lung transplantation. Transpl Int 2016; 30:41-48. [PMID: 27678492 DOI: 10.1111/tri.12865] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 05/04/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
Abstract
Lung transplant recipients (LTR) are at high risk of cutaneous squamous cell carcinoma (SCC). Voriconazole exposure after lung transplant has recently been reported as a risk factor for SCC. We sought to study the relationship between fungal prophylaxis with voriconazole and the risk of SCC in sequential cohorts from a single center. We evaluated 400 adult LTR at UCLA between 7/1/2005 and 12/22/2012. On 7/1/2009, our center instituted a protocol switch from targeted to universal antifungal prophylaxis for at least 6 months post-transplant. Using Cox proportional hazards models, time to SCC was compared between targeted (N = 199) and universal (N = 201) prophylaxis cohorts. Cox models were also used to assess SCC risk as a function of time-dependent cumulative exposure to voriconazole and other antifungal agents. The risk of SCC was greater in the universal prophylaxis cohort (HR 2.02, P < 0.01). Voriconazole exposure was greater in the universal prophylaxis cohort, and the cumulative exposure to voriconazole was associated with SCC (HR 1.75, P < 0.01), even after adjustment for other important SCC risk factors. Voriconazole did not increase the risk of advanced tumors. Exposure to other antifungal agents was not associated with SCC. Voriconazole should be used cautiously in this population.
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Affiliation(s)
| | - Erin Duffy
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Alice Zhang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Michelle Lo
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - David T Barba
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Meng Chen
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Teresa Soriano
- Division of Dermatology, University of California, Los Angeles, CA, USA
| | - Jenny Hu
- Division of Dermatology, University of California, Los Angeles, CA, USA
| | - Vishad Nabili
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Rajeev Saggar
- Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - David M Sayah
- Department of Medicine, University of California, Los Angeles, CA, USA
| | | | - Michael Y Shino
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Joseph P Lynch
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Bernie M Kubak
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Abbas Ardehali
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - David J Ross
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - John A Belperio
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Rajan Saggar
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - S Samuel Weigt
- Department of Medicine, University of California, Los Angeles, CA, USA
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Soge OO, Salipante SJ, No D, Duffy E, Roberts MC. In Vitro Activity of Delafloxacin against Clinical Neisseria gonorrhoeae Isolates and Selection of Gonococcal Delafloxacin Resistance. Antimicrob Agents Chemother 2016; 60:3106-11. [PMID: 26976873 PMCID: PMC4862482 DOI: 10.1128/aac.02798-15] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 11/16/2015] [Accepted: 03/09/2016] [Indexed: 11/20/2022] Open
Abstract
We evaluated the in vitro activity of delafloxacin against a panel of 117 Neisseria gonorrhoeae strains, including 110 clinical isolates collected from 2012 to 2015 and seven reference strains, compared with the activities of seven antimicrobials currently or previously recommended for treatment of gonorrhea. We examined the potential for delafloxacin to select for resistant mutants in ciprofloxacin-susceptible and ciprofloxacin-resistant N. gonorrhoeae We characterized mutations in the gyrA, gyrB, parC, and parE genes and the multidrug-resistant efflux pumps (MtrC-MtrD-MtrE and NorM) by PCR and sequencing and by whole-genome sequencing. The MIC50, MIC90, and MIC ranges of delafloxacin were 0.06 μg/ml, 0.125 μg/ml, and ≤0.001 to 0.25 μg/ml, respectively. The frequency of spontaneous mutation ranged from 10(-7) to <10(-9) The multistep delafloxacin resistance selection of 30 daily passages resulted in stable resistant mutants. There was no obvious cross-resistance to nonfluoroquinolone comparator antimicrobials. A mutant with reduced susceptibility to ciprofloxacin (MIC, 0.25 μg/ml) obtained from the ciprofloxacin-susceptible parental strain had a novel Ser91Tyr alteration in the gyrA gene. We also identified new mutations in the gyrA and/or parC and parE genes and the multidrug-resistant efflux pumps (MtrC-MtrD-MtrE and NorM) of two mutant strains with elevated delafloxacin MICs of 1 μg/ml. Although delafloxacin exhibited potent in vitro activity against N. gonorrhoeae isolates and reference strains with diverse antimicrobial resistance profiles and demonstrated a low tendency to select for spontaneous mutants, it is important to establish the correlation between these excellent in vitro data and treatment outcomes through appropriate randomized controlled clinical trials.
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Affiliation(s)
- Olusegun O Soge
- Neisseria Reference Laboratory, Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Stephen J Salipante
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - David No
- Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Erin Duffy
- Melinta Therapeutics, New Haven, Connecticut, USA
| | - Marilyn C Roberts
- Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington, USA
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Wallace B, Khanna D, Aquino-Beaton C, Singh JA, Duffy E, Elashoff D, Khanna PP. Performance of Gout Impact Scale in a longitudinal observational study of patients with gout. Rheumatology (Oxford) 2016; 55:982-90. [PMID: 26888852 DOI: 10.1093/rheumatology/kew007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 07/28/2015] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The aim was to evaluate the reliability, validity and responsiveness to change of the Gout Impact Scale (GIS), a disease-specific measure of patient-reported outcomes, in a multicentre longitudinal prospective cohort of gout patients. METHODS Subjects completed the GIS, a 24-item instrument with five scales: Concern Overall, Medication Side Effects, Unmet Treatment Need, Well-Being during Attack, and Concern Over Attack. The total GIS score was calculated by averaging the GIS scale scores. HAQ-Disability Index (HAQ-DI), Short Form (SF)-36 physical and mental component summaries (PCS and MCS) and physician and patient gout severity assessments were also completed. Reliability was assessed with Cronbach's α. Baseline GIS scores were compared in subjects with and without gout attacks in the past 3 months using Wilcoxon rank sum tests. Multivariate linear regression was used to evaluate predictors of total GIS. Pearson's correlation coefficients 0.24-0.36 were considered moderate and >0.37 considered large. The effect size for responsiveness to change was interpreted as follows: 0.20-0.49 small, 0.50-0.79 medium and >0.79 large. RESULTS In 147 subjects, reliability was acceptable for total GIS (0.93) and all GIS scales (0.82-0.94) except Medication Side Effects and Unmet Treatment Need. Total GIS and all scales except Medication Side Effects discriminated between subjects with and without recent gout attacks (P < 0.05). Total GIS showed moderate-to-large correlations with HAQ-DI, SF-36 PCS and MCS (0.33-0.46). Improvement in total GIS tracked with improved physician and patient severity scores. Worsening physician severity score and recent gout attack predicted worsening total GIS. CONCLUSION Total GIS score is reliable, valid and responsive to change in patients with gout, and differentiates between subjects with and without recent gout attacks.
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Affiliation(s)
- Beth Wallace
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI
| | - Cleopatra Aquino-Beaton
- Department of Medicine/Division of Rheumatology, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jasvinder A Singh
- Department of Medicine/Division of Rheumatology, University of Alabama and Birmingham VA, Birmingham, AL
| | - Erin Duffy
- University of California Los Angeles Department of Medicine Statistics Core, Los Angeles, CA and
| | - David Elashoff
- University of California Los Angeles Department of Medicine Statistics Core, Los Angeles, CA and
| | - Puja P Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, Department of Medicine/Division of Rheumatology, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
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42
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Kingsley J, Mehra P, Lawrence LE, Henry E, Duffy E, Cammarata SK, Pullman J. A randomized, double-blind, Phase 2 study to evaluate subjective and objective outcomes in patients with acute bacterial skin and skin structure infections treated with delafloxacin, linezolid or vancomycin. J Antimicrob Chemother 2015; 71:821-9. [PMID: 26679243 PMCID: PMC4743703 DOI: 10.1093/jac/dkv411] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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: 08/19/2015] [Accepted: 11/04/2015] [Indexed: 12/21/2022] Open
Abstract
Objectives Delafloxacin is an investigational anionic fluoroquinolone being developed to treat infections caused by Gram-positive and -negative organisms. This clinical trial evaluated the efficacy and safety of delafloxacin in the treatment of acute bacterial skin and skin structure infections (ABSSSIs). Methods In a double-blind, Phase 2 trial, 256 patients were randomized (1 : 1 : 1) to 300 mg of delafloxacin, 600 mg of linezolid or 15 mg/kg vancomycin (actual body weight), each administered intravenously twice daily for 5–14 days. Randomization was stratified by infection category. The primary endpoint was the investigator's assessment of cure, defined as complete resolution of baseline signs and symptoms at follow-up. Secondary endpoints included reductions in the total areas of erythema and induration and assessments of bacterial eradication. This trial has been registered at ClinicalTrials.gov under registration number NCT01283581. Results Cure rates were significantly greater with delafloxacin versus vancomycin (mean difference: −16.3%; 95% CI, −30.3% to −2.3%; P = 0.031); differences were significant for obese patients (BMI ≥30 kg/m2; mean difference: −30.0%; 95% CI, −50.7% to −9.3%; P = 0.009), but not for non-obese patients. Cure rates with delafloxacin and linezolid were similar. Using digital measurement, the percentage decrease in total erythema area was significantly greater with delafloxacin versus vancomycin at follow-up (−96.4% versus −84.5%; P = 0.028). There were no differences in bacterial eradication among the treatment groups. The most frequently reported treatment-emergent adverse events were nausea, diarrhoea and vomiting. Conclusions These data show that delafloxacin is effective in the treatment of ABSSSIs and is well tolerated.
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Affiliation(s)
- Jeff Kingsley
- Columbus Regional Research Institute, 800 Talbotton Road, Columbus, GA 31904, USA
| | - Purvi Mehra
- Artemis Institute for Clinical Research, 770 Washington St., San Diego, CA 92103, USA
| | - Laura E Lawrence
- Melinta Therapeutics, 300 George Street, New Haven, CT 06511, USA
| | - Eugenia Henry
- H2O Clinical, 224 Schilling Circle, Hunt Valley, MD 21031, USA
| | - Erin Duffy
- Melinta Therapeutics, 300 George Street, New Haven, CT 06511, USA
| | - Sue K Cammarata
- Melinta Therapeutics, 300 George Street, New Haven, CT 06511, USA
| | - John Pullman
- Mercury Street Medical Group, PLLC, 300 West Mercury Street, Butte, MT 59701, USA
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Xu Q, Malecka KL, Fink L, Jordan EJ, Duffy E, Kolander S, Peterson JR, Dunbrack RL. Identifying three-dimensional structures of autophosphorylation complexes in crystals of protein kinases. Sci Signal 2015; 8:rs13. [PMID: 26628682 DOI: 10.1126/scisignal.aaa6711] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Protein kinase autophosphorylation is a common regulatory mechanism in cell signaling pathways. Crystal structures of several homomeric protein kinase complexes have a serine, threonine, or tyrosine autophosphorylation site of one kinase monomer located in the active site of another monomer, a structural complex that we call an "autophosphorylation complex." We developed and applied a structural bioinformatics method to identify all such autophosphorylation complexes in x-ray crystallographic structures in the Protein Data Bank (PDB). We identified 15 autophosphorylation complexes in the PDB, of which five complexes had not previously been described in the publications describing the crystal structures. These five complexes consist of tyrosine residues in the N-terminal juxtamembrane regions of colony-stimulating factor 1 receptor (CSF1R, Tyr(561)) and ephrin receptor A2 (EPHA2, Tyr(594)), tyrosine residues in the activation loops of the SRC kinase family member LCK (Tyr(394)) and insulin-like growth factor 1 receptor (IGF1R, Tyr(1166)), and a serine in a nuclear localization signal region of CDC-like kinase 2 (CLK2, Ser(142)). Mutations in the complex interface may alter autophosphorylation activity and contribute to disease; therefore, we mutated residues in the autophosphorylation complex interface of LCK and found that two mutations impaired autophosphorylation (T445V and N446A) and mutation of Pro(447) to Ala, Gly, or Leu increased autophosphorylation. The identified autophosphorylation sites are conserved in many kinases, suggesting that, by homology, these complexes may provide insight into autophosphorylation complex interfaces of kinases that are relevant drug targets.
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Affiliation(s)
- Qifang Xu
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Kimberly L Malecka
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Lauren Fink
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - E Joseph Jordan
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Erin Duffy
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Samuel Kolander
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Jeffrey R Peterson
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Roland L Dunbrack
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Ranganath VK, Ben-Artzi A, Duffy E, Brook J, Taylor M, Choi S, Paulus H, Elashoff DA. Elevated baseline power Doppler discriminates an RA subgroup highly responsive to therapy. Rheumatology (Oxford) 2015; 54:2285-6. [PMID: 26316582 DOI: 10.1093/rheumatology/kev301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Erin Duffy
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA, USA
| | - Jenny Brook
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | - David A Elashoff
- Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA, USA
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Morrissey I, Magnet S, Genet E, Jeandey P, Marra A, Hawser S, Duffy E. Activity of RX-P873, a novel pyrrolocytosine, against Gram-negative bacteria. Int J Antimicrob Agents 2015; 46:352-4. [PMID: 26159867 DOI: 10.1016/j.ijantimicag.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Affiliation(s)
- I Morrissey
- IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland.
| | - S Magnet
- IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland
| | - E Genet
- IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland
| | - P Jeandey
- IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland
| | - A Marra
- Melinta Therapeutics, New Haven, CT, USA
| | - S Hawser
- IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland
| | - E Duffy
- Melinta Therapeutics, New Haven, CT, USA
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Duffy E, He X, Nesterenko EP, Brabazon D, Dey A, Krishnamurthy S, Nesterenko PN, Paull B. Thermally controlled growth of carbon onions within porous graphitic carbon-detonation nanodiamond monolithic composites. RSC Adv 2015. [DOI: 10.1039/c5ra00258c] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The addition of detonation nanodiamond to carbon monolithic composites has improved graphitic nature, pore volume, surface area and thermal conductivity.
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Affiliation(s)
- E. Duffy
- Australian Centre for Research on Separation Science
- School of Physical Sciences
- University of Tasmania
- Hobart
- Australia
| | - X. He
- Irish Separation Science Cluster
- National Centre for Sensor Research
- Dublin City University
- Dublin 9
- Ireland
| | - E. P. Nesterenko
- Irish Separation Science Cluster
- National Centre for Sensor Research
- Dublin City University
- Dublin 9
- Ireland
| | - D. Brabazon
- Irish Separation Science Cluster
- National Centre for Sensor Research
- Dublin City University
- Dublin 9
- Ireland
| | - A. Dey
- Department of Engineering and Innovation
- The Open University
- Milton Keynes MK7 6AA
- UK
| | - S. Krishnamurthy
- Department of Engineering and Innovation
- The Open University
- Milton Keynes MK7 6AA
- UK
| | - P. N. Nesterenko
- Australian Centre for Research on Separation Science
- School of Physical Sciences
- University of Tasmania
- Hobart
- Australia
| | - B. Paull
- Australian Centre for Research on Separation Science
- School of Physical Sciences
- University of Tasmania
- Hobart
- Australia
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Beavis A, Cheema S, Holschneider C, Duffy E, Amneus M. Even high risk women lack knowledge of obesity's impact on risk for endometrial cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.07.044] [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: 10/24/2022]
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Saggar R, Khanna D, Vaidya A, Derhovanessian A, Maranian P, Duffy E, Belperio JA, Weigt SS, Dua S, Shapiro SS, Goldin JG, Abtin F, Lynch JP, Ross DJ, Forfia PR, Saggar R. Changes in right heart haemodynamics and echocardiographic function in an advanced phenotype of pulmonary hypertension and right heart dysfunction associated with pulmonary fibrosis. Thorax 2014; 69:123-9. [PMID: 24431095 DOI: 10.1136/thoraxjnl-2013-204150] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH)-targeted therapy in the setting of pulmonary fibrosis (PF) is controversial; the main clinical concern is worsening of systemic hypoxaemia. We sought to determine the effects of gentle initiation and chronic administration of parenteral treprostinil on right heart function in patients with PF associated with an advanced PH phenotype. METHODS Open-label, prospective analysis of patients with PF-PH referred for lung transplantation (LT). Advanced PH was defined as mean pulmonary artery pressure (mPAP) ≥35 mm Hg. We compared haemodynamics, Doppler echocardiography (DE), oxygenation, dyspnoea and quality of life indices, and 6 min walk distance (6MWD) before and 12 weeks after parenteral treprostinil. RESULTS 15 patients were recruited in the study. After therapy, there were significant improvements in right heart haemodynamics (right atrial pressure (9.5 ± 3.4 vs 6.0 ± 3.7); mPAP (47 ± 8 vs 38.9 ± 13.4); CI (2.3 ± 0.5 vs 2.7 ± 0.6); pulmonary vascular resistance (698 ± 278 vs 496 ± 229); transpulmonary gradient (34.7 ± 8.7 vs 28.5 ± 10.3); mvO2 (65 ± 7.2 vs 70.9 ± 7.4); and stroke volume index (29.2 ± 6.7 vs 33 ± 7.3)) and DE parameters reflecting right heart function (right ventricular (RV) end diastolic area (36.4 ± 5.2 vs 30.9 ± 8.2 cm(2)), left ventricular eccentricity index (1.7 ± 0.6 vs 1.3 ± 0.5), tricuspid annular planar systolic excursion (1.6 ± 0.5 vs 1.9 ± 0.2 cm)). These changes occurred without significant alteration in systemic oxygenation, heart rate, or mean systemic arterial pressure. In addition, improvements were seen in 6MWD (171 ± 93 vs 230 ± 114), 36-Item Short Form Health Survey Mental Component Summary aggregate (38 ± 11 vs 44.2 ± 10.7), University of California, San Diego Shortness of Breath Questionnaire (87 ± 17.1 vs 73.1 ± 21), and brain natriuretic peptide (558 ± 859 vs 228 ± 340). CONCLUSIONS PH-targeted therapy may improve right heart haemodynamics and echocardiographic function without affecting systemic oxygen saturation in an advanced PH phenotype associated with RV dysfunction in the setting of PF.
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Affiliation(s)
- Rajeev Saggar
- Thoracic Transplantation, Heart-Lung Institute, St Joseph Hospital & Medical Center, , Phoenix, Arizona, USA
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Kirkpatrick J, Wang Z, Sampson J, Kelsey C, Allen K, Duffy E, Green S, Cabrera A, Palta M, Yin F. Early Results of a Randomized Trial to Identify an Optimal PTV in Stereotactic Radiosurgery of Brain Metastases. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duffy E, Michel J, Jue J, Erinoff E, Coates V, Mann J, Temin S. P150 Translating Recommendations Into Clinical Decision Support: Cancerlinq Prototype Experience. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.181] [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: 11/03/2022]
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