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Rogers G. Care to Ease the Slope? Differences in Canadian and Californian Medical Assistance in Dying Laws. Am J Bioeth 2023; 23:113-115. [PMID: 37879022 DOI: 10.1080/15265161.2023.2256266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- G Rogers
- Institute for Religion & Critical Inquiry, Australian Catholic University
- Queensland Bioethics Centre, Australian Catholic University
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Evans S, Klas A, Mikocka-Walus A, German B, Rogers G, Ling M, Fernando J, Kothe E, Westrupp E. "Poison" or "protection"? A mixed methods exploration of Australian parents' COVID-19 vaccination intentions. J Psychosom Res 2021; 150:110626. [PMID: 34583017 PMCID: PMC8503786 DOI: 10.1016/j.jpsychores.2021.110626] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 05/21/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The success of COVID-19 vaccination programs relies on community attitudes, yet little is known about parents' views. We aimed to explore the reasons behind Australian parents' vaccine intentions for themselves and for their children. METHOD This mixed methods study relates to Wave 13 (January 2021) of a longitudinal study of Australian parents' experiences during COVID-19 and contained 1094 participants (83% mothers). We used multinomial logistic regression to understand demographic predictors of vaccine intention, and a descriptive template thematic analysis to analyse open-ended questions about parents' reasons for vaccine intentions for themselves and their children. RESULTS 64% of Australian parents intend on vaccination, 26% are unsure and 9% intend to decline; 48% intend to vaccinate their children, 38% are unsure, and 14% intend to decline. Relative to those intending to vaccinate, parents unsure (OR = -0.63, 95% CI: 0.46, -0.84, p = .002) or not intending (OR = -0.41, 95% CI: 0.24, 0.67 p < .001) to vaccinate were more likely to have lower trust in doctors. Similar predictors emerged for parents who did not intend to vaccinate their children (OR = 0.47, 95% CI: 0.31, 0.70, p < .001). Qualitative data indicated that many parents had not made a firm decision, including a lack of alignment between intentions and reasons. For example, parents who said 'yes' to vaccination, often then expressed hesitance and a focus on risks in their written response. Reasons for hesitancy for themselves included concerns about testing, side effects, and long-term outcomes. Similar themes were present for children, but parents expressed a strong desire to protect their children, and an eagerness for health information. CONCLUSION Based on prior research and the themes identified here, a multipronged campaign that includes education/promotion, good access to vaccines and role models, is likely to support parents to make informed decisions regarding COVID-19 vaccination.
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Affiliation(s)
- S. Evans
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Corresponding author at: School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
| | - A. Klas
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - A. Mikocka-Walus
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - B. German
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - G.D. Rogers
- School of Medicine, Deakin University, Victoria, Australia
| | - M. Ling
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - J.W. Fernando
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia
| | - E. Kothe
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Deakin University, Misinformation Lab, School of Psychology, Victoria, Australia
| | - E.M. Westrupp
- Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Victoria, Australia,Department of Paediatrics, University of Melbourne, Victoria, Australia,Judith Lumley Centre, La Trobe University, Victoria, Australia
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Barrett T, Khwaja A, Carmona C, Martinez Y, Nicholas H, Rogers G, Wierzbicki AS, Lewington AJP. Acute kidney injury: prevention, detection, and management. Summary of updated NICE guidance for adults receiving iodine-based contrast media. Clin Radiol 2020; 76:193-199. [PMID: 33390251 DOI: 10.1016/j.crad.2020.08.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
The National Institute for Health and Care Excellence (NICE) has recently updated the guideline for Acute kidney injury: prevention, detection and management (NG148), providing new recommendations on preventing acute kidney injury (AKI) in adults receiving intravenous iodine-based contrast media. The association between intravenous iodinated contrast media and AKI is controversial, particularly with widespread use of iso-osmolar agents. Associations between contrast media administration and AKI are largely based on observational studies, with inherent heterogeneity in patient populations, definitions applied, and timing of laboratory investigations. In an attempt to mitigate risk, kidney protection has typically been employed using intravenous volume expansion and/or oral acetylcysteine. Such interventions are in widespread use, despite lacking high-quality evidence of benefit. In the non-emergency setting, glomerular filtration rate (GFR) measurements should be obtained within the preceding 3 months before offering intravenous iodine-based contrast media. In the acute setting, adults should also have their risk of AKI assessed before offering intravenous iodine-based contrast media; however, this should not delay emergency imaging. Based on the evidence available from randomised controlled trials, the NICE committee recommends that oral hydration should be encouraged in adults at increased risk of AKI and that volume expansion with intravenous V fluids should only be considered for inpatients at particularly high risk.
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Affiliation(s)
- T Barrett
- Department of Radiology, Addenbrooke's Hospital and the University of Cambridge, Cambridge CB2 0QQ, UK.
| | - A Khwaja
- Renal Department, Sheffield Kidney Institute, Northern General Hospital, Sheffield S5 7AU, UK
| | - C Carmona
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - Y Martinez
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - H Nicholas
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - G Rogers
- National Institute for Health & Clinical Excellence, Level 1, City Tower, Piccadilly Gardens, Manchester M1 4BT, UK
| | - A S Wierzbicki
- Department of Chemical Pathology, Guy's & St. Thomas' Hospitals, London, UK
| | - A J P Lewington
- Renal Department, St. James's University Hospital, Beckett Street Leeds, LS9 7TF, UK
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Schadendorf D, Hauschild A, Fosko S, Zloty D, Labeille B, Grob J, Puig S, Makrutzki M, Gilberg F, Hong A, Dréno B, Rogers G, Kunstfeld R. Quality‐of‐life analysis with intermittent vismodegib regimens in patients with multiple basal cell carcinomas: patient‐reported outcomes from the MIKIE study. J Eur Acad Dermatol Venereol 2020; 34:e526-e529. [DOI: 10.1111/jdv.16446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - A. Hauschild
- University Hospital Schleswig‐Holstein Kiel Germany
| | - S. Fosko
- Saint Louis University Medical School St. Louis MO USA
| | - D. Zloty
- University of British Columbia Vancouver BC Canada
| | - B. Labeille
- University Hospital of Saint‐Etienne Saint‐Priest‐en‐Jarez France
| | - J.‐J. Grob
- Aix‐Marseille University Marseille France
- Timone Hospital Marseille France
| | - S. Puig
- Hospital Clinic de Barcelona University of BarcelonaIDIBAPS (Institut d’Investigacions Biomediques August Pi i Sunyer) Barcelona Spain
- Centro de Investigación Biomedica en Red de Enfermedades Raras (CIBER ER) Barcelona Spain
| | | | - F. Gilberg
- F. Hoffmann‐La Roche Ltd Basel Switzerland
| | - A. Hong
- Genentech, Inc. South San Francisco CA USA
| | | | - G. Rogers
- Tufts University School of Medicine Boston MA USA
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Rosenthal Gelman C, Ghesquiere A, Rogers G, Williams L, Notto A. Elder Abuse, Mistreatment, and Interventions. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - G Rogers
- Brookdale Center for Healthy Aging
| | - L Williams
- Texas Department of Family and Protective Services
| | - A Notto
- Texas Department of Family and Protective Services
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Scott TM, Rogers G, Weiner DE, Livingston K, Selhub J, Jacques PF, Rosenberg IH, Troen AM. B-Vitamin Therapy for Kidney Transplant Recipients Lowers Homocysteine and Improves Selective Cognitive Outcomes in the Randomized FAVORIT Ancillary Cognitive Trial. J Prev Alzheimers Dis 2018; 4:174-182. [PMID: 29182708 DOI: 10.14283/jpad.2017.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Objectives: Elevated plasma total homocysteine (tHcy) is associated with increased risk of cardiovascular disease, stroke and dementia. Results of clinical trials using B-vitamins to reduce the cognitive risks attributed to tHcy have been inconsistent. The high prevalence of both hyperhomocysteinemia and cognitive impairment among kidney transplant recipients makes them an important population in which to evaluate the effect of lowering homocysteine on cognitive function. We therefore evaluated whether B-vitamin therapy to lower tHcy would prevent cognitive-decline in a cohort of stable kidney transplant recipients. DESIGN The study was a longitudinal ancillary of the FAVORIT trial, a randomized, placebo-controlled multi-site trial of high-dose B vitamins to reduce cardiovascular and cerebrovascular events in clinically stable kidney transplant recipients with elevated tHcy. PARTICIPANTS 584 participants from 18 sites across North America. INTERVENTION The intervention consisted of a daily multivitamin containing high-doses of folate (5.0 mg), vitamin B12 (1.0 mg) and vitamin B6 (50 mg). The placebo consisted of a daily multi-vitamin containing no folate and recommended daily allowances of vitamins B12 and B6 (0 mg folate; 2.0 µg vitamin B12; 1.4 mg vitamin B6). MEASUREMENTS Annual neuropsychological assessment for up to 5 years (mean 3.3 years) using a standardized test battery. Efficacy was analyzed on an intention-to-treat basis using end-of-trial data. Subgroup analyses included stratification for baseline plasma B-vitamin and tHcy concentrations. RESULTS At baseline, cognitive impairment was common with 61% of participants falling more than one standard deviation below published norms for at least one cognitive test. Fewer than 1% of participants had insufficient plasma folate < 5 ng/ml or vitamin B12 < 148 pmol/L. However, 44.6% had plasma B6 concentrations < 30 nmol/L. At follow-up, processing speed and memory scores were modestly but significantly better in the B-vitamin supplement group than in controls (p≤0.05). There was no interaction between baseline tHcy, B-vitamin status and treatment on the cognitive outcomes. CONCLUSIONS High-dose B-vitamin supplementation provided modest cognitive benefit for kidney transplant recipients with elevated baseline tHcy. Since nearly all participants were folate and vitamin B12 sufficient at baseline, the potential cognitive benefits of folate and B12 supplementation in individuals with poor B-vitamin status remains to be determined.
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Affiliation(s)
- T M Scott
- Prof. Aron M. Troen, Director, Nutrition and Brain Health Laboratory, Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O. Box 12, Rehovot 76100, Israel, Phone ++972-54-8820420, E-mail:
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Stockwell R, Leong L, Wheeler N, Bryant J, Wood M, Sherrard L, Thomson R, Rogers G, Wainwright C, Parkhill J, Floto R, Bell S. P058 Prevalence of shared Mycobacterium abscessus complex (MABSC) in the Queensland cystic fibrosis population. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30355-2] [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: 10/14/2022]
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Fischer D, Kelleher D, Rogers G. Standardized Patient Simulation in a Didactic Program Utilizing Dietetic Interns as Actors. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gelman C, Ghesquiere A, Halarewicz A, Rogers G. OPENING THE DOOR: A TRAINING PROMOTING ENGAGEMENT SKILLS IN ADULT PROTECTIVE SERVICES WORKERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C.R. Gelman
- Silberman School of Social Work, Hunter College, New York, New York,
- Silberman Center of Excellence in Diverse Aging, New York, New York,
| | - A. Ghesquiere
- Brookdale Center for Healthy Aging, New York, New York
| | - A. Halarewicz
- Silberman School of Social Work, Hunter College, New York, New York,
| | - G. Rogers
- Brookdale Center for Healthy Aging, New York, New York
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Rogers G. Microbiota composition and disease severity in bronchiectasis. Pneumologie 2016. [DOI: 10.1055/s-0036-1592243] [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: 10/20/2022]
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Schadendorf D, Hauschild A, Fosko S, Zloty D, Labeille B, Grob J, Puig S, Makrutzki M, Templeton I, Rogers G, Dreno B, Kunstfeld R. Evaluation of the pharmacokinetic (PK) profile of vismodegib (VISMO) in patients (pts) with multiple basal cell carcinomas (BCCs) across two intermittent treatment regimens in the MIKIE study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw379.46] [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: 11/12/2022] Open
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Abstract
CASE HISTORY A herd of Holstein, Jersey, or Holstein-Jersey cross lactating cattle of mixed ages presented with a sudden drop in milk yield in 94/678 cows on 3 October 2014 (Day 0). The herd was located in Gretna in the Derwent Valley (Tasmania, Australia) and had been grazing dryland pasture. CLINICAL FINDINGS On Day 0 the cows variably showed recumbency, peracute photosensitisation, inflamed coronary bands, conjunctival erythema, periauricular oedema, distress indicated by kicking at the flank, bruxism, discomfort, weight shifting, vocalisation indicating pain and depression. Blood samples collected on Day 4 from five clinically affected cows showed high activities of aspartate aminotransferase, glutamate dehydrogenase and gamma-glutamyl transferase. Morbidity, based on the number of treated cases within 72 hours of clinical onset, was estimated at 165/678 cows (24.3%). Mortality over the first 30 days was 19/678 cows (2.8%). PATHOLOGICAL FINDINGS Necropsies of two cows on Day 4 showed marked distension of the gall bladder and extensive icterus. Necropsies of another two cows on Day 5 showed enlarged livers with severe damage and oedema of the distal abomasum. Severe ulcerative abomasal gastritis was present in both cows. Hepatic histopathology was consistent with chronic cholangiohepatitis. MYCOTOXICOLOGY Fifty-five different mycotoxins were detected from a barley grass (Hordeum murinum) sample from the presumably contaminated pasture. Concentrations of B-trichothecenes, fumonisins, and zearalenone metabolites from this sample were remarkably high. The leaf smut, Jamesdicksonia dactylidis, that has not been previously reported in Tasmania, was identified from the sample of barley grass, but it is not known whether the smut can produce toxins. DIAGNOSIS Probably an undescribed peracute mycotoxicosis associated with the ingestion of contaminated dryland pasture. CLINICAL RELEVANCE A definitive diagnosis could not be reached in this case of acute photosensitisation and mortality in dairy cattle grazing possibly contaminated dryland pasture. The findings differed from both facial eczema and acute bovine liver disease, suggesting an undescribed mycotoxicosis.
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Affiliation(s)
- H M Golder
- a Scibus , 2 Broughton St, PO Box 660, Camden , NSW 2570 , Australia
| | - N Moss
- a Scibus , 2 Broughton St, PO Box 660, Camden , NSW 2570 , Australia
| | - G Rogers
- b Dairy Systems , 6745 Lyell Highway, Ouse 7140 , TAS , Australia
| | - B Jackson
- c Department of Primary Industries Parks Water and Environment , Biosecurity Tasmania , PO Box 46, Kings Meadows , TAS , Australia
| | - N Gannon
- d Biomin Australia Pty Ltd , Level 4, 56 Clarence St, Sydney 2000 , NSW , Australia
| | - Ptw Wong
- e Plant Breeding Institute , The University of Sydney , 107 Cobbitty Rd, Cobbitty 2570 , NSW , Australia
| | - I J Lean
- a Scibus , 2 Broughton St, PO Box 660, Camden , NSW 2570 , Australia
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Gladstone GR, Stern SA, Ennico K, Olkin CB, Weaver HA, Young LA, Summers ME, Strobel DF, Hinson DP, Kammer JA, Parker AH, Steffl AJ, Linscott IR, Parker JW, Cheng AF, Slater DC, Versteeg MH, Greathouse TK, Retherford KD, Throop H, Cunningham NJ, Woods WW, Singer KN, Tsang CCC, Schindhelm E, Lisse CM, Wong ML, Yung YL, Zhu X, Curdt W, Lavvas P, Young EF, Tyler GL, Bagenal F, Grundy WM, McKinnon WB, Moore JM, Spencer JR, Andert T, Andrews J, Banks M, Bauer B, Bauman J, Barnouin OS, Bedini P, Beisser K, Beyer RA, Bhaskaran S, Binzel RP, Birath E, Bird M, Bogan DJ, Bowman A, Bray VJ, Brozovic M, Bryan C, Buckley MR, Buie MW, Buratti BJ, Bushman SS, Calloway A, Carcich B, Conard S, Conrad CA, Cook JC, Cruikshank DP, Custodio OS, Ore CMD, Deboy C, Dischner ZJB, Dumont P, Earle AM, Elliott HA, Ercol J, Ernst CM, Finley T, Flanigan SH, Fountain G, Freeze MJ, Green JL, Guo Y, Hahn M, Hamilton DP, Hamilton SA, Hanley J, Harch A, Hart HM, Hersman CB, Hill A, Hill ME, Holdridge ME, Horanyi M, Howard AD, Howett CJA, Jackman C, Jacobson RA, Jennings DE, Kang HK, Kaufmann DE, Kollmann P, Krimigis SM, Kusnierkiewicz D, Lauer TR, Lee JE, Lindstrom KL, Lunsford AW, Mallder VA, Martin N, McComas DJ, McNutt RL, Mehoke D, Mehoke T, Melin ED, Mutchler M, Nelson D, Nimmo F, Nunez JI, Ocampo A, Owen WM, Paetzold M, Page B, Pelletier F, Peterson J, Pinkine N, Piquette M, Porter SB, Protopapa S, Redfern J, Reitsema HJ, Reuter DC, Roberts JH, Robbins SJ, Rogers G, Rose D, Runyon K, Ryschkewitsch MG, Schenk P, Sepan B, Showalter MR, Soluri M, Stanbridge D, Stryk T, Szalay JR, Tapley M, Taylor A, Taylor H, Umurhan OM, Verbiscer AJ, Versteeg MH, Vincent M, Webbert R, Weidner S, Weigle GE, White OL, Whittenburg K, Williams BG, Williams K, Williams S, Zangari AM, Zirnstein E. The atmosphere of Pluto as observed by New Horizons. Science 2016; 351:aad8866. [PMID: 26989258 DOI: 10.1126/science.aad8866] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- G. Randall Gladstone
- Southwest Research Institute, San Antonio, TX 78238, USA
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - S. Alan Stern
- Southwest Research Institute, Boulder, CO 80302, USA
| | - Kimberly Ennico
- National Aeronautics and Space Administration, Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | | | - Harold A. Weaver
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | | | - David P. Hinson
- Search for Extraterrestrial Intelligence Institute, Mountain View, CA 94043, USA
| | | | | | | | | | | | - Andrew F. Cheng
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | | | - Kurt D. Retherford
- Southwest Research Institute, San Antonio, TX 78238, USA
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Henry Throop
- The Johns Hopkins University, Baltimore, MD 21218, USA
| | | | | | | | | | | | - Carey M. Lisse
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - Yuk L. Yung
- California Institute of Technology, Pasadena, CA 91125, USA
| | - Xun Zhu
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - Werner Curdt
- Max-Planck-Institut für Sonnensystemforschung, 37191 Katlenburg-Lindau, Germany
| | - Panayotis Lavvas
- Groupe de Spectroscopie Moléculaire et Atmosphérique, Université Reims Champagne-Ardenne, 51687 Reims, France
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Dudziak J, Bolton N, McNeil G, Paul V, Raithatha A, Rogers G, Booker K, Lima E, Jeanrenaud P, Sim K, Wong C, Mohammed A, Mahendran V, Welters I, Tridente A. The fice course and qualification - experience from the cheshire and merseyside group. Intensive Care Med Exp 2015. [PMCID: PMC4798501 DOI: 10.1186/2197-425x-3-s1-a610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Stern SA, Bagenal F, Ennico K, Gladstone GR, Grundy WM, McKinnon WB, Moore JM, Olkin CB, Spencer JR, Weaver HA, Young LA, Andert T, Andrews J, Banks M, Bauer B, Bauman J, Barnouin OS, Bedini P, Beisser K, Beyer RA, Bhaskaran S, Binzel RP, Birath E, Bird M, Bogan DJ, Bowman A, Bray VJ, Brozovic M, Bryan C, Buckley MR, Buie MW, Buratti BJ, Bushman SS, Calloway A, Carcich B, Cheng AF, Conard S, Conrad CA, Cook JC, Cruikshank DP, Custodio OS, Dalle Ore CM, Deboy C, Dischner ZJB, Dumont P, Earle AM, Elliott HA, Ercol J, Ernst CM, Finley T, Flanigan SH, Fountain G, Freeze MJ, Greathouse T, Green JL, Guo Y, Hahn M, Hamilton DP, Hamilton SA, Hanley J, Harch A, Hart HM, Hersman CB, Hill A, Hill ME, Hinson DP, Holdridge ME, Horanyi M, Howard AD, Howett CJA, Jackman C, Jacobson RA, Jennings DE, Kammer JA, Kang HK, Kaufmann DE, Kollmann P, Krimigis SM, Kusnierkiewicz D, Lauer TR, Lee JE, Lindstrom KL, Linscott IR, Lisse CM, Lunsford AW, Mallder VA, Martin N, McComas DJ, McNutt RL, Mehoke D, Mehoke T, Melin ED, Mutchler M, Nelson D, Nimmo F, Nunez JI, Ocampo A, Owen WM, Paetzold M, Page B, Parker AH, Parker JW, Pelletier F, Peterson J, Pinkine N, Piquette M, Porter SB, Protopapa S, Redfern J, Reitsema HJ, Reuter DC, Roberts JH, Robbins SJ, Rogers G, Rose D, Runyon K, Retherford KD, Ryschkewitsch MG, Schenk P, Schindhelm E, Sepan B, Showalter MR, Singer KN, Soluri M, Stanbridge D, Steffl AJ, Strobel DF, Stryk T, Summers ME, Szalay JR, Tapley M, Taylor A, Taylor H, Throop HB, Tsang CCC, Tyler GL, Umurhan OM, Verbiscer AJ, Versteeg MH, Vincent M, Webbert R, Weidner S, Weigle GE, White OL, Whittenburg K, Williams BG, Williams K, Williams S, Woods WW, Zangari AM, Zirnstein E. The Pluto system: Initial results from its exploration by New Horizons. Science 2015; 350:aad1815. [DOI: 10.1126/science.aad1815] [Citation(s) in RCA: 367] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- S. A. Stern
- Southwest Research Institute, Boulder, CO 80302, USA
| | - F. Bagenal
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - K. Ennico
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | | | | | - W. B. McKinnon
- Department of Earth and Planetary Sciences, Washington University, St. Louis, MO 63130, USA
| | - J. M. Moore
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - C. B. Olkin
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J. R. Spencer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H. A. Weaver
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - L. A. Young
- Southwest Research Institute, Boulder, CO 80302, USA
| | - T. Andert
- Universität der Bundeswehr München, Neubiberg 85577, Germany
| | - J. Andrews
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M. Banks
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - B. Bauer
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J. Bauman
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - O. S. Barnouin
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - P. Bedini
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - K. Beisser
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - R. A. Beyer
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - S. Bhaskaran
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - R. P. Binzel
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - E. Birath
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M. Bird
- University of Bonn, Bonn D-53113, Germany
| | - D. J. Bogan
- NASA Headquarters (retired), Washington, DC 20546, USA
| | - A. Bowman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - V. J. Bray
- University of Arizona, Tucson, AZ 85721, USA
| | - M. Brozovic
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - C. Bryan
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - M. R. Buckley
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. W. Buie
- Southwest Research Institute, Boulder, CO 80302, USA
| | - B. J. Buratti
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - S. S. Bushman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A. Calloway
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - B. Carcich
- Cornell University, Ithaca, NY 14853, USA
| | - A. F. Cheng
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S. Conard
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C. A. Conrad
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J. C. Cook
- Southwest Research Institute, Boulder, CO 80302, USA
| | - D. P. Cruikshank
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - O. S. Custodio
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C. M. Dalle Ore
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - C. Deboy
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - P. Dumont
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - A. M. Earle
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - H. A. Elliott
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - J. Ercol
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C. M. Ernst
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T. Finley
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S. H. Flanigan
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - G. Fountain
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. J. Freeze
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T. Greathouse
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - J. L. Green
- NASA Headquarters, Washington, DC 20546, USA
| | - Y. Guo
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. Hahn
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Cologne 50931, Germany
| | - D. P. Hamilton
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - S. A. Hamilton
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - J. Hanley
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - A. Harch
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H. M. Hart
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - C. B. Hersman
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A. Hill
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. E. Hill
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D. P. Hinson
- Search for Extraterrestrial Intelligence Institute, Mountain View, CA 94043, USA
| | - M. E. Holdridge
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. Horanyi
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - A. D. Howard
- Department of Environmental Sciences, University of Virginia, Charlottesville, VA 22904, USA
| | | | | | - R. A. Jacobson
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - D. E. Jennings
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - J. A. Kammer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - H. K. Kang
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - P. Kollmann
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S. M. Krimigis
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D. Kusnierkiewicz
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T. R. Lauer
- National Optical Astronomy Observatory, Tucson, AZ 26732, USA
| | - J. E. Lee
- NASA Marshall Space Flight Center, Huntsville, AL 35812, USA
| | - K. L. Lindstrom
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | - C. M. Lisse
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A. W. Lunsford
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - V. A. Mallder
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - N. Martin
- Southwest Research Institute, Boulder, CO 80302, USA
| | - D. J. McComas
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - R. L. McNutt
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D. Mehoke
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - T. Mehoke
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - E. D. Melin
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. Mutchler
- Space Telescope Science Institute, Baltimore, MD 21218, USA
| | - D. Nelson
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - F. Nimmo
- University of California, Santa Cruz, CA 95064, USA
| | - J. I. Nunez
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - A. Ocampo
- NASA Headquarters, Washington, DC 20546, USA
| | - W. M. Owen
- NASA Jet Propulsion Laboratory, La Cañada Flintridge, CA 91011, USA
| | - M. Paetzold
- Rheinisches Institut für Umweltforschung an der Universität zu Köln, Cologne 50931, Germany
| | - B. Page
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - A. H. Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | - J. W. Parker
- Southwest Research Institute, Boulder, CO 80302, USA
| | | | - J. Peterson
- Southwest Research Institute, Boulder, CO 80302, USA
| | - N. Pinkine
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. Piquette
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - S. B. Porter
- Southwest Research Institute, Boulder, CO 80302, USA
| | - S. Protopapa
- Department of Astronomy, University of Maryland, College Park, MD 20742, USA
| | - J. Redfern
- Southwest Research Institute, Boulder, CO 80302, USA
| | | | - D. C. Reuter
- NASA Goddard Space Flight Center, Greenbelt, MD 20771, USA
| | - J. H. Roberts
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S. J. Robbins
- Southwest Research Institute, Boulder, CO 80302, USA
| | - G. Rogers
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - D. Rose
- Southwest Research Institute, Boulder, CO 80302, USA
| | - K. Runyon
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | - P. Schenk
- Lunar and Planetary Institute, Houston, TX 77058, USA
| | - E. Schindhelm
- Southwest Research Institute, Boulder, CO 80302, USA
| | - B. Sepan
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - M. R. Showalter
- Search for Extraterrestrial Intelligence Institute, Mountain View, CA 94043, USA
| | - K. N. Singer
- Southwest Research Institute, Boulder, CO 80302, USA
| | - M. Soluri
- Michael Soluri Photography, New York, NY 10014, USA
| | | | - A. J. Steffl
- Southwest Research Institute, Boulder, CO 80302, USA
| | | | - T. Stryk
- Roane State Community College, Jamestown, TN 38556, USA
| | | | - J. R. Szalay
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO 80303, USA
| | - M. Tapley
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - A. Taylor
- KinetX Aerospace, Tempe, AZ 85284, USA
| | - H. Taylor
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - H. B. Throop
- Planetary Science Institute, Tucson, AZ 85719, USA
| | | | - G. L. Tyler
- Stanford University, Stanford, CA 94305, USA
| | - O. M. Umurhan
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - A. J. Verbiscer
- Department of Astronomy, University of Virginia, Charlottesville, VA 22904, USA
| | - M. H. Versteeg
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - M. Vincent
- Southwest Research Institute, Boulder, CO 80302, USA
| | - R. Webbert
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - S. Weidner
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - G. E. Weigle
- Southwest Research Institute, San Antonio, TX 28510, USA
| | - O. L. White
- National Aeronautics and Space Administration (NASA) Ames Research Center, Space Science Division, Moffett Field, CA 94035, USA
| | - K. Whittenburg
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | | | | | - S. Williams
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD 20723, USA
| | - W. W. Woods
- Stanford University, Stanford, CA 94305, USA
| | - A. M. Zangari
- Southwest Research Institute, Boulder, CO 80302, USA
| | - E. Zirnstein
- Southwest Research Institute, San Antonio, TX 28510, USA
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Lacouture M, Guillen J, Kudchadkar R, Rogers G, Olencki T, Tang J, Yoo S, Dawson K, Mun Y, Sekulic A. 3332 Real-world treatment of vismodegib (VISMO)-related adverse events (AEs) in patients with locally advanced basal cell carcinoma: Report from the RegiSONIC Disease Registry Study. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31850-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Van Zyl LM, Fernandes N, Rogers G, Du Toit N. Primary health eye care knowledge among general practitioners working in the Cape Town metropole. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2011.10874060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- LM Van Zyl
- Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
| | - N Fernandes
- Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
| | - G Rogers
- Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
| | - N Du Toit
- Division of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
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18
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Barbero L, Villaseca C, Rogers G, Brown PE. Geochemical and isotopic disequilibrium in crustal melting: An insight from the anatectic granitoids from Toledo, Spain. ACTA ACUST UNITED AC 2012. [DOI: 10.1029/95jb00036] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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Bond M, Rogers G, Peters J, Anderson R, Hoyle M, Miners A, Moxham T, Davis S, Thokala P, Wailoo A, Jeffreys M, Hyde C. The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review and economic model. Health Technol Assess 2012; 16:1-470. [PMID: 22541366 DOI: 10.3310/hta16210] [Citation(s) in RCA: 163] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alzheimer’s disease (AD) is the most commonly occurring form of dementia. It is predominantly a disease of later life, affecting 5% of those over 65 in the UK. OBJECTIVES Review and update guidance to the NHS in England and Wales on the clinical effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine [acetylcholinesterase inhibitors (AChEIs)] and memantine within their licensed indications for the treatment of AD, which was issued in November 2006 (amended September 2007 and August 2009). DATA SOURCES Electronic databases were searched for systematic reviews and/or metaanalyses, randomised controlled trials (RCTs) and ongoing research in November 2009 and updated in March 2010; this updated search revealed no new includable studies. The databases searched included The Cochrane Library (2009 Issue 4, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, PsycINFO, EconLit, ISI Web of Science Databases--Science Citation Index, Conference Proceedings Citation Index, and BIOSIS; the Centre for Reviews and Dissemination (CRD) databases--NHS Economic Evaluation Database, Health Technology Assessment, and Database of Abstracts of Reviews of Effects. REVIEW METHODS The clinical effectiveness systematic review was undertaken following the principles published by the NHS CRD. We included RCTs whose population was people with AD. The intervention and comparators depended on disease severity, measured by the Mini Mental State Examination (MMSE). INTERVENTIONS mild AD (MMSE 21-26)--donepezil, galantamine and rivastigmine; moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine and memantine; severe AD (MMSE < 10)--memantine. Comparators: mild AD (MMSE 21-26)--placebo or best supportive care (BSC); moderate AD (MMSE 10-20)--donepezil, galantamine, rivastigmine, memantine, placebo or BSC; severe AD (MMSE < 10)--placebo or BSC. The outcomes were clinical, global, functional, behavioural, quality of life, adverse events, costs and cost-effectiveness. Where appropriate, data were pooled using pair-wise meta-analysis, multiple outcome measures, metaregression and mixedtreatment comparisons. The decision model was based broadly on the structure of the three-state Markov model described in the previous technology assessment report, based upon time to institutionalisation, parameterised with updated estimates of effectiveness, costs and utilities. RESULTS Notwithstanding the uncertainty of our results, we found in the base case that the AChEIs are probably cost saving at a willingness-to-pay (WTP) of £’30,000 per qualityadjusted life-year (QALY) for people with mild-to-moderate AD. For this class of drugs, there is a > 99% probability that the AChEIs are more cost-effective than BSC. These analyses assume that the AChEIs have no effect on survival. For the AChEIs, in people with mild to moderate AD, the probabilistic sensitivity analyses suggested that donepezil is the most cost-effective, with a 28% probability of being the most cost-effective option at a WTP of £’30,000 per QALY (27% at a WTP of £’20,000 per QALY). In the deterministic results, donepezil dominates the other drugs and BSC, which, along with rivastigmine patches, are associated with greater costs and fewer QALYs. Thus, although galantamine has a slightly cheaper total cost than donepezil (£’69,592 vs £’69,624), the slightly greater QALY gains from donepezil (1.616 vs 1.617) are enough for donepezil to dominate galantamine.The probability that memantine is cost-effective in a moderate to severe cohort compared with BSC at a WTP of £’30,000 per QALY is 38% (and 28% at a WTP of £’20,000 per QALY). The deterministic ICER for memantine is £’32,100 per/QALY and the probabilistic ICER is £’36,700 per/QALY. LIMITATIONS Trials were of 6 months maximum follow-up, lacked reporting of key outcomes, provided no subgroup analyses and used insensitive measures. Searches were limited to English language, The model does not include behavioural symptoms and there is uncertainty about the model structure and parameters. CONCLUSIONS The additional clinical effectiveness evidence identified continues to suggest clinical benefit from the AChEIs in alleviating AD symptoms, although there is debate about the magnitude of the effect. Although there is also new evidence on the effectiveness of memantine, it remains less supportive of this drug’s use than the evidence for AChEIs. The conclusions concerning cost-effectiveness are quite different from the previous assessment. This is because both the changes in effectiveness and costs between drug use and non-drug use underlying the ICERs are very small. This leads to highly uncertain results, which are very sensitive to change. RESEARCH PRIORITIES: RCTs to include mortality, time to institutionalisation and quality of life, powered for subgroup analysis. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- M Bond
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
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Rogers G, Hoyle M, Thompson Coon J, Moxham T, Liu Z, Pitt M, Stein K. Dasatinib and nilotinib for imatinib-resistant or -intolerant chronic myeloid leukaemia: a systematic review and economic evaluation. Health Technol Assess 2012; 16:1-410. [PMID: 22551803 DOI: 10.3310/hta16220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic myeloid leukaemia (CML) is a form of cancer affecting the blood, characterised by excessive proliferation of white blood cells in the bone marrow and circulating blood. In the UK, an estimated 560 new cases of CML are diagnosed each year. OBJECTIVES The purpose of this study was to assess the clinical effectiveness and cost-effectiveness of dasatinib and nilotinib in the treatment of people with imatinib-resistant (ImR) and imatinib-intolerant (ImI) CML. A systematic review of the clinical effectiveness literature, a review of manufacturer submissions and a critique and exploration of manufacturer submissions for accelerated phase and blast crisis CML were carried out and a decision-analytic model was developed to estimate the cost-effectiveness of dasatinib and nilotinib in chronic phase CML. SYSTEMATIC REVIEW METHODS: Key databases were searched for relevant studies from their inception to June 2009 [MEDLINE (including MEDLINE In-Process & Other Non-Indexed Citations), EMBASE, (ISI Web of Science) Conference Proceedings Citation Index and four others]. One reviewer assessed titles and abstracts of studies identified by the search strategy, with a sample checked by a second reviewer. The full text of relevant papers was obtained and screened against the full inclusion criteria independently by two reviewers. Data from included studies were extracted by one reviewer and checked by a second. Clinical effectiveness studies were synthesised through narrative review. ECONOMIC EVALUATION METHODS: Cost-effectiveness analyses reported in manufacturer submissions to the National Institute of Health and Clinical Excellence were critically appraised and summarised narratively. In addition, the models for accelerated phase and blast crisis underwent a more detailed critique and exploration. Two separate decision-analytic models were developed for chronic phase CML, one simulating a cohort of individuals who have shown or developed resistance to normal dose imatinib and one representing individuals who have been unable to continue imatinib treatment owing to adverse events. One-way, multiway and probabilistic sensitivity analyses were performed to explore structural and parameter uncertainty. RESULTS Fifteen studies were included in the systematic review. Chronic phase: effectiveness data were limited but dasatinib and nilotinib appeared efficacious in terms of obtaining cytogenetic response and haematological response in both ImR and ImI populations. In terms of cost-effectiveness, it was extremely difficult to reach any conclusions regarding either agent in the ImR population. All three models (Novartis, PenTAG and Bristol-Myers Squibb) were seriously flawed in one way or another, as a consequence of the paucity of data appropriate to construct robust decision-analytic models. Accelerated and blast crisis: all available data originated from observational single-arm studies and there were considerable and potentially important differences in baseline characteristics which seriously undermined any process for making meaningful comparisons between treatments. Owing to a lack of available clinical data, de novo models of accelerated phase and blast crisis have not been developed. The economic evaluations carried out by the manufacturers of nilotinib and dasatinib were seriously undermined by the absence of evidence on high-dose imatinib in these populations. LIMITATIONS The study has been necessarily constrained by the paucity of available clinical data, the differences in definitions used in the studies and the subsequent impossibility of undertaking a meaningful cost-effectiveness analyses to inform all policy questions. CONCLUSIONS Dasatinib and nilotinib appeared efficacious in terms of obtaining cytogenetic and haematological responses in both ImR and ImI populations. It was difficult to reach any cost-effectiveness conclusions as a consequence of the paucity of the data. Future research should include a three-way, double-blind, randomised clinical trial of dasatinib, nilotinib and high-dose imatinib.
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Affiliation(s)
- G Rogers
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
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Parker HE, Adriaenssens A, Rogers G, Richards P, Koepsell H, Reimann F, Gribble FM. Predominant role of active versus facilitative glucose transport for glucagon-like peptide-1 secretion. Diabetologia 2012; 55:2445-55. [PMID: 22638549 PMCID: PMC3411305 DOI: 10.1007/s00125-012-2585-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/20/2012] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS Several glucose-sensing pathways have been implicated in glucose-triggered secretion of glucagon-like peptide-1 (GLP-1) from intestinal L cells. One involves glucose metabolism and closure of ATP-sensitive K(+) channels, and another exploits the electrogenic nature of Na(+)-coupled glucose transporters (SGLTs). This study aimed to elucidate the role of these distinct mechanisms in glucose-stimulated GLP-1 secretion. METHODS Glucose uptake into L cells (either GLUTag cells or cells in primary cultures, using a new transgenic mouse model combining proglucagon promoter-driven Cre recombinase with a ROSA26tdRFP reporter) was monitored with the FLII(12)Pglu-700 μδ6 glucose sensor. Effects of pharmacological and genetic interference with SGLT1 or facilitative glucose transport (GLUT) on intracellular glucose accumulation and metabolism (measured by NAD(P)H autofluorescence), cytosolic Ca(2+) (monitored with Fura2) and GLP-1 secretion (assayed by ELISA) were assessed. RESULTS L cell glucose uptake was dominated by GLUT-mediated transport, being abolished by phloretin but not phloridzin. NAD(P)H autofluorescence was glucose dependent and enhanced by a glucokinase activator. In GLUTag cells, but not primary L cells, phloretin partially impaired glucose-dependent secretion, and suppressed an amplifying effect of glucose under depolarising high K(+) conditions. The key importance of SGLT1 in GLUTag and primary cells was evident from the impairment of secretion by phloridzin or Sglt1 knockdown and failure of glucose to trigger cytosolic Ca(2+) elevation in primary L cells from Sglt1 knockout mice. CONCLUSIONS/INTERPRETATION SGLT1 acts as the luminal glucose sensor in L cells, but intracellular glucose concentrations are largely determined by GLUT activity. Although L cell glucose metabolism depends partially on glucokinase activity, this plays only a minor role in glucose-stimulated GLP-1 secretion.
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Affiliation(s)
- H. E. Parker
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - A. Adriaenssens
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - G. Rogers
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - P. Richards
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - H. Koepsell
- Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany
| | - F. Reimann
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
| | - F. M. Gribble
- Cambridge Institute for Medical Research, Wellcome Trust/MRC Building, Addenbrooke’s Hospital, Box 139, Hills Road, Cambridge, CB2 0XY UK
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22
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Cuthbertson L, Rogers G, Hoffman L, Oliver A, Wing P, Carroll M, Bruce K, Walker A, van der Gast C. 136 Impact of propidium monoazide treatment on CF bacterial community pyrosequencing analysis. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Dzingina M, Stegenga H, Heath M, Jones D, Rogers G, Kleijnen J, Wolff R, Armstrong N, Howdle PD. [Assessment and referral after emergency treatment in suspected anaphylactic reaction: summary of the NICE guideline]. Praxis (Bern 1994) 2012; 101:473-476. [PMID: 22454309 DOI: 10.1024/1661-8157/a000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- M Dzingina
- National Institute for Health and Clincial Excellence, Piccadilly Plaza, Manchester, Grossbritannien
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24
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Kehayias JJ, Ribeiro SML, Skahan A, Itzkowitz L, Dallal G, Rogers G, Khodeir M. Water homeostasis, frailty and cognitive function in the nursing home. J Nutr Health Aging 2012; 16:35-9. [PMID: 22238000 DOI: 10.1007/s12603-011-0079-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE - To develop and test a practical clinical method to assess frailty in nursing homes; - To investigate the relationship between cognitive status of the elderly and the balance between water compartments of their body composition. DESIGN AND SUBJECTS Cross-sectional study, conducted at two nursing homes in Boston-MA. METHODS Body mass and height (Ht) were evaluated to calculate BMI (body mass index, in Kg/m²). The cognitive decline was evaluated based on the scores obtained from the Mini-Mental State Examination (MMSE); The extracellular to total body water ratio (ECW/TBW) was calculated after the analysis of TBW from deuterium and tritium dilution and ECW from bromide dilution. Single-frequency BIA analysis data were investigated for resistance (R) and reactance (Xc), plotted in an R/Ht Xc/Ht graph (vectorial analysis-BIVA). The BIVA results of nursing home residents were compared against the data obtained from the NHANES III study. TBW and ECW values were compared with a group of free-living elderly volunteers. RESULTS The ECW/TBW was significantly higher in nursing home residents than in the free-living individuals. BIVA analysis showed significantly higher Xc/Ht values in the reference subjects. The MMSE did not present a significant correlation with ECW/TBW for either gender. CONCLUSION We proposed the ECW/TBW ratio and BIVA as surrogate methods for the clinical assessment of frailty. We tested successfully both approaches with nursing home patients and free-living volunteers and compared them to a national data base. The advent of new, portable instruments will enable field tests to further validate our proposed "Frailty Factor" in future studies. We found no correlation between frailty and cognitive decline in the nursing home.
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Affiliation(s)
- J J Kehayias
- Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University, Boston, MA 02111, USA.
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Bruhn S, Barrenäs F, Mobini R, Andersson BA, Chavali S, Egan BS, Hovig E, Sandve GK, Langston MA, Rogers G, Wang H, Benson M. Increased expression of IRF4 and ETS1 in CD4+ cells from patients with intermittent allergic rhinitis. Allergy 2012; 67:33-40. [PMID: 21919915 DOI: 10.1111/j.1398-9995.2011.02707.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The transcription factor (TF) IRF4 is involved in the regulation of Th1, Th2, Th9, and Th17 cells, and animal studies have indicated an important role in allergy. However, IRF4 and its target genes have not been examined in human allergy. METHODS IRF4 and its target genes were examined in allergen-challenged CD4(+) cells from patients with IAR, using combined gene expression microarrays and chromatin immunoprecipitation chips (ChIP-chips), computational target prediction, and RNAi knockdowns. RESULTS IRF4 increased in allergen-challenged CD4(+) cells from patients with IAR, and functional studies supported its role in Th2 cell activation. IRF4 ChIP-chip showed that IRF4 regulated a large number of genes relevant to Th cell differentiation. However, neither Th1 nor Th2 cytokines were the direct targets of IRF4. To examine whether IRF4 induced Th2 cytokines via one or more downstream TFs, we combined gene expression microarrays, ChIP-chips, and computational target prediction and found a putative intermediary TF, namely ETS1 in allergen-challenged CD4(+) cells from allergic patients. ETS1 increased significantly in allergen-challenged CD4(+) cells from patients compared to controls. Gene expression microarrays before and after ETS1 RNAi knockdown showed that ETS1 induced Th2 cytokines as well as disease-related pathways. CONCLUSIONS Increased expression of IRF4 in allergen-challenged CD4(+) cells from patients with intermittent allergic rhinitis leads to activation of a complex transcriptional program, including Th2 cytokines.
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Affiliation(s)
- S Bruhn
- The Centre for Individualized Medication, Linköping University Hospital, Linköping, Sweden
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Dzingina M, Stegenga H, Heath M, Jones D, Rogers G, Kleijnen J, Wolff R, Armstrong N, Howdle PD. Assessment and referral after emergency treatment of a suspected anaphylactic episode: summary of NICE guidance. BMJ 2011; 343:d7595. [PMID: 22171344 DOI: 10.1136/bmj.d7595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Dzingina
- National Institute for Health and Clinical Excellence, Piccadilly Plaza, Manchester M1 4BT, UK
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Wang Q, Thompson E, Parsons R, Rogers G, Dunn D. Economic feasibility of converting cow manure to electricity: A case study of the CVPS Cow Power program in Vermont. J Dairy Sci 2011; 94:4937-49. [DOI: 10.3168/jds.2010-4124] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/04/2011] [Indexed: 11/19/2022]
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Laity G, Neuber A, Rogers G, Frank K. System for time resolved spectral studies of pulsed atmospheric discharges in the visible to vacuum ultraviolet range. Rev Sci Instrum 2010; 81:083103. [PMID: 20815599 DOI: 10.1063/1.3478016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Vacuum ultraviolet (VUV) emission is believed to play a major role in the development of plasma streamers in pulsed atmospheric discharges, but detection of VUV light is difficult in pulsed experiments at atmospheric pressures. Since VUV light is absorbed in most standard optical materials as well, careful attention must be given to the selection of the lens and mirror optics used in these studies. Of highest interest is the VUV emission during the initial stage of pulsed atmospheric discharges, which has a typical duration in the nanosecond regime. An experiment was designed to study this fast initial stage of VUV emission coupled with fast optical imaging of streamer propagation, both with temporal resolution on the order of nanoseconds. A repetitive solid-state high voltage pulser was constructed which produces triggered flashover discharges with low jitter and consistent pulse amplitude. VUV emission is captured utilizing both photomultiplier and intensified charge-coupled device detectors during the fast stage of streamer propagation. These results are discussed in context with the streamer formation photographed in the visible wavelength regime with 3 ns exposure time.
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Affiliation(s)
- G Laity
- Department of Electrical and Computer Engineering, Center for Pulsed Power and Power Electronics, Texas Tech University, Lubbock, Texas 79409, USA
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Thompson Coon JS, Liu Z, Hoyle M, Rogers G, Green C, Moxham T, Welch K, Stein K. Reply: SUN vs BEVþIFN in first-line mRCC therapy: no evidence for a statistically significant difference in progression-free survival. Br J Cancer 2010. [PMCID: PMC2813750 DOI: 10.1038/sj.bjc.6605447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ryan C, Kama M, Darcy A, Aleksic E, Mirza T, Chaudhary A, Oelrichs R, Rogers G, Crowe S. HIV type 1 in Fiji is caused by subtypes C and B. AIDS Res Hum Retroviruses 2009; 25:1355-8. [PMID: 20001316 DOI: 10.1089/aid.2009.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The HIV epidemic in Fiji remains largely uncharacterized. By February 2009, there were 294 confirmed cases; the majority occurred among the 20- to 39-year old age group and resulted from heterosexual contact. There are currently no published data concerning HIV subtypes in Fiji. In this study, venous blood samples were collected as dried blood spots from 35 HIV-positive individuals in Fiji. HIV-1 subtype was determined for 27 (77%) samples and the presence of four different subtypes, with multiple introductions of two, was demonstrated. Subtype distribution was as follows: 16 (59%) were subtype C, 9 (33%) were subtype B, 1 (4%) was subtype A, and 1 (4%) was subtype G. Phylogenetic analysis showed a clear segregation of the Fijian subtype C isolates and previously published Papua New Guinea subtype C isolates as well as multiple introductions of subtype B. These findings represent the first HIV-1 subtype data from the Fiji Islands.
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Affiliation(s)
- C.E. Ryan
- Burnet Institute, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | | | | | | | | | | | - R.B. Oelrichs
- Burnet Institute, Melbourne, Australia
- The World Bank, Washington, D.C. 20433
| | | | - S.M. Crowe
- Burnet Institute, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
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Dickens G, Rogers G, Rooney C, Mc Guinness A, Doyle D. An audit of the use of breakaway techniques in a large psychiatric hospital: a replication study. J Psychiatr Ment Health Nurs 2009; 16:777-83. [PMID: 19824971 DOI: 10.1111/j.1365-2850.2009.01449.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This paper describes an audit study of the effectiveness of breakaway training conducted in a specialist inpatient mental health hospital. Breakaway techniques comprise a set of physical skills to help separate or break away from an aggressor in a safe manner, but do not involve the use of restraint. Staff (n= 147) were assessed on their ability to break away from simulations of potentially life-threatening scenarios in a timely manner, and using the techniques taught in annual breakaway or refresher training. We found that only 14% (21/147) of participants correctly used the taught techniques to break away within 10 s. However, 80% of people were able to break away from the scenarios within 10 s but did not use the techniques taught to them. This audit reinforces questions about breakaway training raised in a previous study. It further demonstrates the need for a national curriculum for physical intervention training and development of the evidence base for the content of such training as a priority.
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Affiliation(s)
- G Dickens
- St Andrew's Academic Centre, Kings College London Institute of Psychiatry, UK.
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Thompson Coon JS, Liu Z, Hoyle M, Rogers G, Green C, Moxham T, Welch K, Stein K. Sunitinib and bevacizumab for first-line treatment of metastatic renal cell carcinoma: a systematic review and indirect comparison of clinical effectiveness. Br J Cancer 2009; 101:238-43. [PMID: 19568242 PMCID: PMC2720220 DOI: 10.1038/sj.bjc.6605167] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Two new agents have recently been licensed for use in the treatment of metastatic renal cell carcinoma (RCC) in Europe. This paper aims to systematically review the evidence from all available randomised clinical trials of sunitinib and bevacizumab (in combination with interferon-α (IFN-α)) in the treatment of advanced metastatic RCC. Methods: Systematic literature searches were performed in six electronic databases. Bibliographies of included studies were searched for further relevant studies. Individual conference proceedings were searched using their online interfaces. Studies were selected according to the predefined criteria. All randomised clinical trials of sunitinib or bevacizumab in combination with IFN for treating advanced metastatic RCC in accordance with the European licensed indication were included. Study selection, data extraction, validation and quality assessment were performed by two reviewers with disagreements being settled by discussion. The effects of sunitinib and bevacizumab (in combination with IFN-α) on progression-free survival were compared indirectly using Bayesian Markov Chain Monte-Carlo (MCMC) sampling in Win BUGS, with IFN as a common comparator. Results: Three studies were included. Median progression-free survival was significantly prolonged with both interventions (from approximately 5 months to between 8 and 11 months) compared with IFN. Overall survival was also prolonged, compared with IFN, although the published data are not fully mature. Indirect comparison suggests that sunitinib is superior to bevacizumab plus IFN in terms of progression-free survival (hazard ratios 0.796; 95% CI 0.63–1.0; P=0.0272). Conclusion: There is evidence to suggest that treatment with sunitinib and treatment with bevacizumab plus IFN has clinically relevant and statistically significant advantages over treatment with IFN alone in patients with metastatic RCC.
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Affiliation(s)
- J S Thompson Coon
- Peninsula Technology Assessment Group, Peninsula Medical School, Universities of Plymouth and Exeter, Noy Scott House, Barrack Road, Exeter EX2 5DW, UK.
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Rogers G, Elston J, Garside R, Roome C, Taylor R, Younger P, Zawada A, Somerville M. The harmful health effects of recreational ecstasy: a systematic review of observational evidence. Health Technol Assess 2009. [DOI: 10.3310/hta13060] [Citation(s) in RCA: 252] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- G Rogers
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - J Elston
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - R Garside
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - C Roome
- Devon Primary Care Trust, Exeter, UK
| | - R Taylor
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
| | - P Younger
- Exeter Health Library, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A Zawada
- The Agency for Health Technology Assessment in Poland, Warsaw
| | - M Somerville
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, UK
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Main C, Shepherd J, Anderson R, Rogers G, Thompson-Coon J, Liu Z, Hartwell D, Loveman E, Green C, Pitt M, Stein K, Harris P, Frampton GK, Smith M, Takeda A, Price A, Welch K, Somerville M. Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in children under the age of 12 years. Health Technol Assess 2008; 12:1-174, iii-iv. [PMID: 18485272 DOI: 10.3310/hta12200] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the clinical and cost-effectiveness of inhaled corticosteroids (ICS) alone and ICS used in combination with a long-acting beta2 agonist (LABA) in the treatment of chronic asthma in children aged under 12 years. DATA SOURCES Major electronic bibliographic databases, e.g. MEDLINE and EMBASE, were searched up to February/March 2006 (and updated again in October 2006). REVIEW METHODS A systematic review of clinical and cost-effectiveness studies and economic analyses were carried out. A flexible framework was used to allow different types of economic analyses as appropriate, with either a cost comparison or cost-consequence comparison conducted. RESULTS Of 5175 records identified through systematic literature searching, 34 records describing 25 studies were included (16 were fully published randomised controlled trials, six were systematic reviews, and three were post-2004 conference abstracts). The most frequently reported relevant outcomes in the 16 RCTs were peak expiratory flow rate (13 trials), FEV1 (13 trials), symptoms (13 trials), adverse events or exacerbations (13 trials), use of rescue medication (12 trials), markers of adrenal function (e.g. blood or urine cortisol concentrations) (13 trials), height and/or growth rate (seven trials) and markers of bone metabolism (two trials). In the trials that compared low-dose ICS versus ICS and high-dose ICS versus ICS, no consistent significant differences or patterns in differential treatment effect among the outcomes were evident. Where differences were statistically significant at high doses, such as for lung function and growth, they favoured formoterol fumarate (FF), but this was generally in studies that did not compare the ICS at the accepted clinically equivalent doses. Differences between the drugs in impact on adrenal suppression were only significant in two studies. At doses of 200, 400 and 800 microg/day, beclometasone dipropionate (BDP) appears to be the current cheapest ICS product both with the inclusion and exclusion of chlorofluorocarbon (CFC)-propelled products. In the trials comparing ICS at a higher dose with ICS and LABA in combination, most outcomes favoured the combined inhaler. Only the combination inhaler, Seretide Evohaler, is slightly cheaper than the weighted mean cost of all types of ICS at increased dose except BDP 400 microg/day (including CFC-propelled products). Both the combination inhalers, Seretide Accuhaler and Symbicort Turbohaler, are more expensive than the weighted mean cost for all types of ICS at a two-fold increased dose. Compared with the lowest cost preparation for each ICS drug, all the combination inhalers are always more expensive than the ICS products at increased dose. CONCLUSIONS The limited evidence available indicates that there are no consistent significant differences in effectiveness between the three ICS licensed for use in children at either low or high dose. BDP CFC-propelled products are often the cheapest ICS currently available at both low and high dose, and may remain so even when CFC-propelled products are excluded. Exclusion of CFC-propelled products increases the mean annual cost of all budesonide (BUD) and BDP, while the overall cost differences between the comparators diminish. There is very limited evidence available for the efficacy and safety of ICS and LABAs in children. From this limited evidence, there appear to be no significant clinical differences in effects between the use of a combination inhaler versus the same drugs in separate inhalers. There is a lack of evidence comparing ICS at a higher dose with ICS and LABA in combination and comparing the combination products with each other. In the absence of any evidence concerning the effectiveness of ICS at higher dose with ICS and LABA, a cost-consequence analysis gives mixed results. There are potential cost savings with the use of combination inhalers compared to separate inhalers. At present prices, the BUD/FF combination is more expensive than those containing FP/SAL, but it is not known whether there are clinically significant differences between them. A scoping review is required to assess the requirements for additional primary research on the clinical effectiveness of treatment for asthma in children under 5 years old. Such a review could also usefully include all treatment options, pharmacological and non-pharmacological, for asthma. A direct head-to-head trial that compares the two combination therapies of FP/SAL and BUD/FF is warranted, and it is important to assess whether the addition of a LABA to a lower dose of ICS could potentially be as effective as an increased dose of ICS alone, but also be steroid sparing. There is also a need for the long-term adverse events associated with ICS use to be assessed systematically. Future trials of treatment for chronic asthma in children should aim to standardise further the way in which outcome measures are defined. There should be a greater focus on patient-centred outcomes to provide a more meaningful estimation of the impact of treatment on asthma control. Methods of reporting also require standardisation.
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Affiliation(s)
- C Main
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK
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Shepherd J, Rogers G, Anderson R, Main C, Thompson-Coon J, Hartwell D, Liu Z, Loveman E, Green C, Pitt M, Stein K, Harris P, Frampton GK, Smith M, Takeda A, Price A, Welch K, Somerville M. Systematic review and economic analysis of the comparative effectiveness of different inhaled corticosteroids and their usage with long-acting beta2 agonists for the treatment of chronic asthma in adults and children aged 12 years and over. Health Technol Assess 2008; 12:iii-iv, 1-360. [PMID: 18485271 DOI: 10.3310/hta12190] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To assess the clinical and cost-effectiveness of inhaled corticosteroids (ICS) alone and ICS used in combination with a long-acting beta2 agonist (LABA) in the treatment of chronic asthma in adults and children aged over 12 years. DATA SOURCES Major electronic bibliographic databases, e.g. MEDLINE and EMBASE, were searched up to February/March 2006 (and updated again in October 2006). REVIEW METHODS A systematic review of clinical and cost-effectiveness studies was conducted. Cost comparison and cost-consequence analyses were performed where appropriate. RESULTS The assessment of clinical effectiveness was based on the 67 randomised controlled trials selected from the 5175 reports identified through the systematic literature search. The most frequently reported relevant outcomes were lung function, symptoms, use of rescue medication and adverse events. The trials varied considerably. In the trials that compared low-dose ICS versus ICS and high-dose ICS versus ICS, there were few significant differences in clinical effectiveness, although a few of the trials had assessed non-inferiority between the comparators rather than superiority. At doses of 400, 800 and 'high-level' doses of 1500 or 1600 microg/day, beclometasone dipropionate (BDP) appears to be the current cheapest ICS product both with the inclusion and exclusion of chlorofluorocarbon (CFC)-propelled products. A significant treatment benefit for combination ICS/LABA therapy across a range of outcomes compared with ICS alone was identified [when the ICS was double the accepted clinically equivalent dose of the ICS in the combination inhaler, and dry powder inhalers (DPIS) were used to deliver the drugs]. When a formoterol fumarate (FF)/salmeterol (SAL) combination inhaler and a budesonide (BUD)/FF combination inhaler were each compared with their constituent drugs delivered in separate inhalers, there were very few statistically significant differences between the treatments across the various efficacy outcomes and the rate of adverse events. Combination inhalers were more often cheaper than doubling the dose of ICS alone. However, the costs were highly variable and dependent on both the dose required and the preparation used in the trials. The estimated mean annual cost of FP/SAL combination varied from being 94 pounds cheaper to 109 pounds more expensive than the alternative of BUD at a higher dose. The BUD/FF combination varied from being 163 pounds cheaper to 66 pounds more expensive than the higher dose of either BUD or FP. When the combination inhalers were compared to each other, the results were mixed, with the FP/SAL combination significantly superior on some outcomes and the BUD/FF combination superior on others; however, meta-analysis showed that there were no significant differences between the two treatments in the rate of adverse events. Taking an ICS with a LABA as either of the two currently available combination products, FP/SAL and BUD/FF, is usually cheaper than taking the relevant constituent drugs in separate inhalers. At very high doses of BUD (1600 microg/day), however, the BUD/FF combination inhaler can be up to 156 pounds more expensive than having the same drugs in separate inhalers. In terms of the relative costs associated with taking one of the combination inhalers, at low dose (400 microg BUD or 200 microg FP/day) the cheapest combination inhaler is FP/SAL as a pressurised metered dose inhaler (pMDI) (Seretide Evohaler). However, this is only slightly cheaper than using BUD/FF as a DPI (Symbicort Turbohaler). At higher dose levels (800 microg BUD or 500 microg FP/day) FP/SAL as either pMDI aerosol (Seretide Evohaler) or a DPI (Seretide Accuhaler) is the cheapest combination product available, but again only slightly cheaper than the DPI BUD/FF combination (Symbicort Turbohaler). It should be highlighted, however, that the three head-to-head trials that compared the effects of FP/SAL with BUD/FF used the FP/SAL DPI combination inhaler, Seretide Accuhaler. CONCLUSIONS The evidence indicates that there are few consistent significant differences in effects between the five ICS licensed for use in adults and adolescents over the age of 12 years, at either low or high dose. On average, BDP products currently tend to be the cheapest ICS available and tend to remain so as the daily ICS dose required increases. There is evidence that the addition of a LABA to an ICS is potentially more clinically effective than doubling the dose of ICS alone, although consistent significant differences between the two treatment strategies are not observed for all outcome measures. The cost differences between combination therapy compared with ICS monotherapy are highly variable and dependent on the dose required and the particular preparations used. For the combination therapies of ICS/LABA there are potential cost savings with the use of combination inhalers compared with separate inhalers, with few differences between the two treatment strategies in terms of effects. The only exception to this cost saving is with BUD/FF at doses higher than 1200 microg/day, where separate inhaler devices can become equivalent to or cheaper than combination inhalers. Neither of the two combination inhalers (FP/SAL or BUD/FF) is consistently superior in terms of treatment effect. A comparison of the costs associated with each combination therapy indicates that at low dose FP/SAL delivered via a pMDI is currently the cheapest combination inhaler but only marginally cheaper than BUD/FF delivered as a DPI. At higher doses, both the FP/SAL combination inhalers (PMDI and DPI) are marginally cheaper than BUD/FF (DPI). Future trials of treatment for chronic asthma should standardise the way in which outcome measures are defined and measured, with a greater focus on patient-centred outcomes. For informing future cost-utility and cost-effectiveness analyses from a UK NHS perspective, there is a need for longitudinal studies that comprehensively track the care pathways followed when people experience asthma exacerbations of different severity. Further research synthesis, quantifying the adverse effects of the different ICS, is required for treatment choices by patients and clinicians to be fully informed.
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Affiliation(s)
- J Shepherd
- Southampton Health Technology Assessments Centre, Wessex Institute for Health Research and Development , University of Southampton, UK
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Rogers G, Stressmann F, Carroll M, Bruce K. Analysis of fungal-bacterial community interactions in cystic fibrosis airway secretions. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60189-7] [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: 10/22/2022]
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Rogers G. "This house believes that only general practitioners with a specialist interest in epilepsy should be treating the condition". Pract Neurol 2008; 8:138-40. [DOI: 10.1136/jnnp.2008.148056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fuentes S, Rogers G, Jobling J, Conroy J, Camus C, Dalton M, Mercenaro L. A SOIL-PLANT-ATMOSPHERE APPROACH TO EVALUATE THE EFFECT OF IRRIGATION/FERTIGATION STRATEGY ON GRAPEVINE WATER AND NUTRIENT UPTAKE, GRAPE QUALITY AND YIELD. ACTA ACUST UNITED AC 2008. [DOI: 10.17660/actahortic.2008.792.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Jackson S, Ryder S, Cramp M, Stein K. Surveillance of cirrhosis for hepatocellular carcinoma: a cost-utility analysis. Br J Cancer 2008; 98:1166-75. [PMID: 18382459 PMCID: PMC2359641 DOI: 10.1038/sj.bjc.6604301] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Using a decision-analytic model, we evaluated the effectiveness and cost-effectiveness of surveillance for hepatocellular carcinoma (HCC) in individuals with cirrhosis. Separate cohorts with cirrhosis due to alcoholic liver disease, hepatitis B and hepatitis C were simulated. Results were also combined to approximate a mixed aetiology population. Comparisons were made between a variety of surveillance algorithms using α-foetoprotein (AFP) assay and/or ultrasound at 6- and 12-monthly intervals. Parameter estimates were obtained from comprehensive literature reviews. Uncertainty was explored using one-way and probabilistic sensitivity analyses. In the mixed aetiology cohort, 6-monthly AFP+ultrasound was predicted to be the most effective strategy. The model estimates that, compared with no surveillance, this strategy may triple the number of people with operable tumours at diagnosis and almost halve the number of people who die from HCC. The cheapest strategy employed triage with annual AFP (incremental cost-effectiveness ratio (ICER): £20 700 per quality-adjusted life-year (QALY) gained). At a willingness-to-pay threshold of £30 000 per QALY the most cost-effective strategy used triage with 6-monthly AFP (ICER: £27 600 per QALY gained). The addition of ultrasound to this strategy increased the ICER to £60 100 per QALY gained. Surveillance appears most cost-effective in individuals with hepatitis B-related cirrhosis, potentially due to younger age at diagnosis of cirrhosis. Our results suggest that, in a UK NHS context, surveillance of individuals with cirrhosis for HCC should be considered effective and cost-effective. The economic efficiency of different surveillance strategies is predicted to vary markedly according to cirrhosis aetiology.
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Affiliation(s)
- J Thompson Coon
- Peninsula Technology Assessment Group (PenTAG), Peninsula College of Medicine and Denistry, (Universities of Plymouth and Exeter), Noy Scott House, Barrack Road, Exeter EX2 5DW, UK.
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De Vries A, Overton M, Fetrow J, Leslie K, Eicker S, Rogers G. Exploring the impact of sexed semen on the structure of the dairy industry. J Dairy Sci 2008; 91:847-56. [PMID: 18218773 DOI: 10.3168/jds.2007-0536] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Widespread commercial application of sexed semen is expected within the next decade because of continued improvements in fertility of sexed semen and sorting capacity. The objective of this study was to explore the potential impact of widespread application of sexed semen on the structure of the dairy industry in the United States. Historically, female offspring from all heifers and cows were needed to produce enough dairy replacement heifers to replace culled cows. The use of sexed semen allows for a decoupling of breeding decisions necessary to obtain an adequate supply of dairy replacement heifers from those needed to achieve pregnancies needed to start new lactations. Application of sexed semen allows dairy producers to select among their herds' potential dams and produce dairy replacement heifers from only the genetically superior animals. The rate of genetic progress is expected to increase, but not more than 15% of the rate of gain accomplished through sire selection achieved through conventional (nonsexed) artificial insemination breeding. The supply of dairy replacement heifers is expected to grow to meet and temporarily exceed current demand, resulting in reduced prices for dairy replacement heifers. Consequently, herd turnover rates are expected to increase slightly, and herd expansions may accelerate. The rate of consolidation of dairy farms is expected to increase. Widespread application of sexed semen may temporarily increase the supply of milk, which would result in lower milk prices. The cost of milk production will be reduced as well. Many breeding options exist for the genetically poorer cows in the herd. The optimal breeding mix depends on the value of the various kinds of calves that could be produced. More crossbred calves for beef production may be produced; however, a market for these crossbred calves is not well established. Increased specialization is expected with more dairy producers deciding not to raise their own heifers but to purchase replacements. Other dairy farms might specialize in producing genetically superior dairy replacement heifers for sale. Depending on the value of calves not raised for replacements, artificial insemination organizations might market beef conventional semen or beef male sexed semen to dairy farms. The use of sexed semen should lower the cost of progeny-testing programs and embryo transfer and enhance the value of genetic markers. Eventually, the economic benefits from the use of sexed semen will be passed on to consumers.
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Affiliation(s)
- A De Vries
- Department of Animal Sciences, University of Florida, Gainesville, FL 32611, USA.
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Garside R, Pitt M, Anderson R, Rogers G, Dyer M, Mealing S, Somerville M, Price A, Stein K. The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation. Health Technol Assess 2007; 11:iii-iv, ix-221. [DOI: 10.3310/hta11450] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - K Stein
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK
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Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Cramp M, Jackson S, Ryder S, Price A, Stein K. Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis. Health Technol Assess 2007; 11:1-206. [PMID: 17767898 DOI: 10.3310/hta11340] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness, cost-effectiveness and cost-utility of surveillance of patients with cirrhosis [alcoholic liver disease (ALD)-, hepatitis B (HBV)- and C virus (HCV)-related], using periodic serum alpha-fetoprotein (AFP) testing and/or liver ultrasound examination, to detect hepatocellular carcinoma (HCC), followed by treatment with liver transplantation or resection, where appropriate. DATA SOURCES Electronic databases were searched up to March 2006. REVIEW METHODS A systematic review was carried out using standard methodological guidelines. A computerised decision-analytic model was then developed to compare various surveillance strategies. RESULTS No studies were identified that met the criteria of the systematic review. Based on the assumptions used in the model, the most effective surveillance strategy uses a combination of AFP testing and ultrasound at 6-monthly intervals. Compared with no surveillance, this strategy is estimated to more than triple the number of people with operable HCC tumours at time of diagnosis, and almost halves the number of deaths from HCC. On all effectiveness measures and at both testing frequencies, AFP- and ultrasound-led surveillance strategies are very similar. This may be because test sensitivity was varied according to tumour size, which means that AFP testing is capable of identifying many more small tumours than ultrasound. The best available evidence suggests that AFP tests will detect approximately six times as many small tumours as ultrasound. Increasing the frequency of either test to 6-monthly intervals is more effective than performing combined testing on an annual basis. The undiscounted lifetime cost of the surveillance strategies, including all care and treatment costs, ranges from 40,300 pounds (annual AFP triage) to 42,900 pounds (6-monthly AFP and ultrasound). The equivalent discounted costs are 28,400 pounds and 30,400 pounds. Only a small proportion of these total costs results from the cost of the screening tests. However, screening test costs, and the cost of liver transplants and caring for people post-transplant, accounted for most of the incremental cost differences between alternative surveillance strategies. The results suggest that different surveillance strategies may provide the best value for money in patient groups of different cirrhosis aetiologies. The surveillance of people with HBV-related cirrhosis for HCC provides the best value for money, while surveillance in people with ALD-related cirrhosis provides the poorest value for money. In people with HBV-related cirrhosis, at an assumed maximum willingness to pay (WTP) for a quality-adjusted life-year (QALY) of 30,000 pounds, both the deterministic and probabilistic cost-utility analyses suggest the optimal surveillance strategy would be 6-monthly surveillance with the combination of AFP testing and ultrasound. In contrast, for those with ALD-related cirrhosis, annual screening with AFP as a triage test is the only surveillance strategy that is likely to be considered cost-effective at this WTP. The probabilistic analysis implies that the estimated benefits of a 6-monthly AFP triage strategy will only be worth the cost in those with ALD when society's WTP for a QALY exceeds around 40,000 pounds. For people with HCV-related cirrhosis, the model suggests that the most cost-effective surveillance strategy at a WTP threshold of 30,000 pounds/QALY would be surveillance with a 6-monthly AFP triage strategy. CONCLUSIONS In a mixed-aetiology cohort, the most effective surveillance strategy is to screen each patient with AFP assay and ultrasound imaging on a 6-monthly basis. However, when costs are taken into account it is doubtful whether ultrasound should be routinely offered to those with blood AFP of less than 20 ng/ml, unless policy-makers are prepared to pay over 60,000 pounds per QALY for the benefits achieved. Furthermore, the cost-effectiveness of surveillance for HCC varies considerably depending on the aetiology of cirrhosis; it is much more likely to be cost-effective in those with HBV-related cirrhosis, and much less likely to be cost-effective in those with ALD-related cirrhosis. Further development of the model would help to enable refinement of an optimal screening strategy. Research into the use of contrast-enhanced ultrasound technology for HCC detection would also be valuable, as would research into the epidemiology and natural history of ALD-related cirrhosis. Studies are also needed to investigate the influence of cirrhosis aetiology on tumour AFP expression.
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Affiliation(s)
- J Thompson Coon
- Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Exeter, UK
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Abstract
BACKGROUND The aetiology of maxillary mucosal cysts is uncertain. Chronic rhinosinusitis has been proposed as a probable aetiological explanation for their formation. METHOD We recruited 500 consecutive patients who had undergone computed tomography scanning of the paranasal sinuses for possible chronic sinus disease. We identified 110 (22 per cent) cases of maxillary mucosal cysts. RESULTS Patients' mean age was 42.65 years, with a female to male ratio of 0.69:1 (45:65). The mean cyst size was 14.27 mm, and most were located on the inferior surface of the antrum. Only in two cases did the cyst obstruct the sinus ostium. Of patients with antral cysts, 52.7 per cent had computed tomography evidence of sinus disease, whereas only 41.3 per cent of noncyst (control) patients had sinus pathology. The total Lund-Mackay score was significantly greater in the cyst group (n=390) compared with the noncyst group (Mann-Whitney; p<0.05). CONCLUSION Chronic rhinosinusitis plays an important role in the aetiology of maxillary mucosal cysts.
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Affiliation(s)
- R P S Harar
- Royal National Throat, Nose and Ear Hospital, London, UK.
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Chiu C, Hubbard L, Armstrong J, Rogers G, Jacques P, Chylack L, Hankinson S, Willett W, Taylor A. Dietary glycemic index and carbohydrate in relation to early age-related macular degeneration. Am J Ophthalmol 2006. [DOI: 10.1016/j.ajo.2006.07.011] [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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Leape LL, Rogers G, Hanna D, Griswold P, Federico F, Fenn CA, Bates DW, Kirle L, Clarridge BR. Developing and implementing new safe practices: voluntary adoption through statewide collaboratives. Qual Saf Health Care 2006; 15:289-95. [PMID: 16885255 PMCID: PMC2564013 DOI: 10.1136/qshc.2005.017632] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND Disseminating new safe practices has proved challenging. In a statewide initiative we developed a framework for (1) selecting two safe practices, (2) developing operational details of implementation, (3) enlisting hospitals to participate, and (4) facilitating implementation. METHODS Potential topics were selected by a multistep process to identify candidate practices, review the evidence for efficacy and feasibility, and then select them on the basis of importance, efficacy, feasibility, and impact. A multi-stakeholder advisory group representing all constituencies selected two practices: reconciling medications (RM) and communicating critical test results (CTR). Operational details and strategies for implementation were then developed for each practice using a consensus process of discipline stakeholders led by content experts. Hospital CEOs were solicited to participate by the Massachusetts Hospital Association which made the project a "flagship" initiative. A collaborative model was used to facilitate implementation, following the IHI Model for Improvement. In addition to providing exposure to content and method experts, we gave teams a "toolkit" containing recommendations, a change package, and implementation strategies. Each collaborative met four times over an 18 month period. Results were assessed using the IHI team assessment scale and surveys of teams and hospital leaders. RESULTS Hospital participation rate was high with 88% of hospitals participating in one or both collaboratives. Partial implementation of the practices was achieved by 50% of RM teams and 65% of CTR teams. Full implementation was achieved by 20% of teams for each. CONCLUSIONS Major factors leading to hospital participation included the intrinsic appeal of the practices, access to experts, and the availability of implementation strategies. Team success was correlated with active engagement of a senior administrator, engagement of physicians, increased use of PDSA cycles, and attendance at collaborative meetings. The prior development of subpractices, recommendations and implementation strategies was essential for the hospital teams. These should be well worked out before hospitals are required to implement any guideline.
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Affiliation(s)
- L L Leape
- Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
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Spasenovski T, Rogers G, Caroll M, Bruce K. 116 Characterisation of bacterial community composition in Cystic Fibrosis lung infection using biofilm models. J Cyst Fibros 2006. [DOI: 10.1016/s1569-1993(06)80101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Fuentes S, Conroy J, Kelley G, Rogers G, Collins M. USE OF INFRARED THERMOGRAPHY TO ASSESS SPATIAL AND TEMPORAL VARIABILITY OF STOMATAL CONDUCTANCE OF GRAPEVINES UNDER PARTIAL ROOTZONE DRYING: AN IRRIGATION SCHEDULING APPLICATION. ACTA ACUST UNITED AC 2005. [DOI: 10.17660/actahortic.2005.689.36] [Citation(s) in RCA: 4] [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: 11/17/2022]
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Abstract
The working environment is an important determinant of employee well-being. Previous UK studies report registered nurses' perception of the working environment using the Work Environment Scale (WES), but surprisingly few include data for nurses working in mental health or learning disability settings. One hundred and sixty-one (58.8%) registered nurses working day shifts in five specialist divisions (forensic adult mental health, adolescent mental health, elderly continuing care, adult and adolescent learning disability and brain injury rehabilitation) of a large charitable hospital comprising mostly secure (i.e. 'locked') wards completed the WES. Nurses working in separate clinical divisions differed only on the 'physical comfort' subscale. These results are discussed in the context of previous UK research: this sample of nurses scored differently on a number of subscales, with the working environment characterized by relatively high levels of support, cohesion and managerial control and slightly lower levels of autonomy. It is unclear whether the differences reflect the organizational (i.e. non-NHS) context, or a secure environment effect. Previous studies of mental health nurses are now 10 years old and we present data that may provide a benchmark of perceptions of the working environment held by nurses working in mental health and learning disability settings.
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Affiliation(s)
- G Dickens
- Research Department, St Andrew's Hospital, Northampton, UK.
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Harden LM, Neveling N, Rossouw F, Semple SJ, Marx FE, Rossouw J, Rogers G. The effects of an L-methionine combination supplement on symptoms of upper respiratory tract infections and performance in ultramarathon runners before, during and after ultra-endurance exercise. S Afr j sports med 2004. [DOI: 10.17159/2078-516x/2004/v16i1a188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective. To evaluate whether supplementation with an L-methionine combination would reduce the incidence of upper respiratory tract symptoms (URTS) and improve performance in ultramarathon runners. Design. A double-blind placebo-controlled study. Setting. Twenty-one ultramarathon runners (17 males, 4 females) preparing for participation in an 87.3 km ultramarathon. Interventions. L-methionine combination supplement (L-methionine, vitamin B6, vitamin B12, folic acid and magnesium) or placebo containing potato starch. Main outcome measures. Incidence of URTS was recorded during the runner's preparation for an ultramarathon race (75 days) and recovery from the same (75 days). CD4+, CD8+ cell counts and ratios were measured pre race, immediately post race and 75 days post race. VO2max and endurance fitness (percentage VO2max at 4 mmol-1 lactate concentration) were measured during the preparation for the race. Results. During the preparation period the incidence of URTS was 36% in the supplement group and 80% in the placebo group (p = 0.08). The incidence of URTS during the 3 weeks post race was 27% in the supplement group and 40% in the placebo group (p = 0.65). The CD4+/CD8+ cell ratios were not significantly different between groups. Endurance fitness prior to the race and race times were not significantly different. Conclusions. Although the findings of the current study show that an L-methionine combination supplement did not reduce the incidence of URTS or improve performance in ultramarathon runners, benefits may be found with a more detailed investigation using larger sample sizes and immunosuppressed athletes. South African Journal of Sports Medicine Vol.16(1) 2004: 10-16
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