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Sabale U, Karamousouli E, Popovic L, Krasznai ZT, Harrop D, Meiwald A, Hughes R, Weston G, Bencina G. The indirect costs of human papillomavirus-related cancer in Central and Eastern Europe: years of life lost and productivity costs. J Med Econ 2024; 27:1-8. [PMID: 38638098 DOI: 10.1080/13696998.2024.2341572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Human papilloma virus (HPV) is a common cause of several types of cancer, including head and neck (oral cavity, pharynx, oropharynx, hypopharynx, nasopharynx, and larynx), cervical, vulval, vaginal, anal, and penile cancers. As HPV vaccines are available, there is potential to prevent HPV-related disease burden and related costs. METHOD A model was developed for nine Central Eastern European (CEE) countries (Bulgaria, Croatia, Czechia, Hungary, Poland, Romania, Serbia, Slovakia, Slovenia). This model considered cancer patients who died from 11 HPV-related cancers (oropharynx, oral cavity, nasopharynx, hypopharynx, pharynx, anal, larynx, vulval, vaginal, cervical, and penile) in 2019. Due to data limitations, Bulgaria only included four cancer types. The model estimated the number of HPV-related deaths and years of life lost (YLL) based on published HPV-attributable fractions. YLL was adjusted with labor force participation, retirement age and then multiplied by mean annual earnings, discounted at a 3% annual rate to calculate the present value of future lost productivity (PVFLP). RESULTS In 2019, there were 6,832 deaths attributable to HPV cancers resulting in 107,846 YLL in the nine CEE countries. PVFLP related to HPV cancers was estimated to be €46 M in Romania, €37 M in Poland, €19 M in Hungary, €15 M in Czechia, €12 M in Croatia, €10 M in Serbia, €9 M in Slovakia, €7 M in Bulgaria and €4 M in Slovenia. CONCLUSIONS There is a high disease burden of HPV-related cancer-related deaths in the CEE region, with a large economic impact to society due to substantial productivity losses. It is critical to implement and reinforce public health measures with the aim to reduce the incidence of HPV-related diseases, and the subsequent premature cancer deaths. Improving HPV screening and increasing vaccination programs, in both male and female populations, could help reduce this burden.
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Affiliation(s)
- Ugne Sabale
- Center for Observational and Real-World Evidence (CORE), MSD, Vilnius, Lithuania
| | | | - Lazar Popovic
- Faculty of Medicine, Oncology Institute of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Zoárd Tibor Krasznai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | - Goran Bencina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
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Pinsent A, Weston G, Adams EJ, Linley W, Hawkins N, Schwenkglenks M, Hamlyn-Williams C, Toward T. Determining the Relationship Between Seizure-Free Days and Other Predictors of Quality of Life in Patients with Dravet Syndrome and Their Carers from FFA Registration Studies. Neurol Ther 2023; 12:1593-1606. [PMID: 37328668 PMCID: PMC10444918 DOI: 10.1007/s40120-023-00510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023] Open
Abstract
INTRODUCTION Dravet syndrome (DS) is a rare, lifelong epileptic encephalopathy characterised by frequent and severe seizures associated with premature mortality. Typically diagnosed in infancy, patients also experience progressive behavioural, motor-function and cognitive decline. Twenty percent of patients do not reach adulthood. Quality of life (QoL) is impaired for both patients and their carers. Reducing convulsive seizure frequency, increasing convulsive seizure-free days (SFDs) and improving patient/carer QoL are primary treatment goals in DS. This study explored the relationship between SFDs and patients' and carers' QoL to inform a cost-utility analysis of fenfluramine (FFA). METHODS In FFA registration studies, patients (or their carer proxies) completed the Paediatric QoL inventory (PedsQL). These data were mapped to EuroQol-5 Dimensions Youth version (EQ-5D-Y) to provide patient utilities. Carer utilities were collected using EQ-5D-5L and mapped to EQ-5D-3L to align patient and carer QoL on the same scale. Linear mixed-effects and panel regression models were tested and Hausman tests identified the most appropriate approach for each group. On this basis, a linear mixed-effects regression model was used to examine the relationships between patient EQ-5D-Y and clinically relevant variables (age, frequency of SFDs per 28 days, motor impairments and treatment dose). A linear panel regression model examined the relationship between SFDs and carer QoL. RESULTS After adjustment for age and underlying comorbidities, the patient regression model showed that SFDs per 28 days was a significant predictor of QoL. Each additional patient-SFD increased utility by 0.005 (p < 0.001). The carer linear panel model also showed that increasing SFDs per 28 days was a significant predictor of improved QoL. Each additional SFD increased carer utility by 0.014 (p < 0.001). CONCLUSION This regression framework highlights that SFDs are significantly correlated with both patients' and carers' QoL. Treatment with effective antiseizure medications that increase SFDs directly improves QoL for patients and their carers.
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Affiliation(s)
- Amy Pinsent
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK
| | - Georgie Weston
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK
| | - Elisabeth J Adams
- Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK.
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Bencina G, Chami N, Hughes R, Weston G, Baxter C, Salomonsson S, Demedts I. Indirect Costs Due to Lung Cancer-Related Premature Mortality in Four European Countries. Adv Ther 2023; 40:3056-3069. [PMID: 37195488 PMCID: PMC10189212 DOI: 10.1007/s12325-023-02509-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/28/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Lung cancer accounts for approximately 20% of all cancer-related deaths and for the loss of 3.2 million disability-adjusted life years (DALYs) annually across Europe. The present study investigated the productivity losses resulting from premature deaths due to lung cancer in four European countries. METHODS The human capital approach (HCA) was used to estimate indirect cost of productivity losses due to premature death due to lung cancer (ICD-10 codes C33-34 malignant neoplasm of trachea, bronchus, and lung) in Belgium, the Netherlands, Norway, and Poland. Years of productive life lost (YPLL) and present value of future lost productivity (PVFLP) were calculated using national age-specific mortality, wages, and employment rates. Data were sourced from the World Health Organization, Eurostat, and the World Bank. RESULTS In 2019, there were 41,468 lung cancer deaths in the included countries resulting in 59,246 YPLL and more than €981 million in productivity losses due to premature mortality. From 2010 to 2015, the PVFLP of lung cancer decreased by 14% in Belgium, 13% in the Netherlands, 33% in Norway, and 19% in Poland. From 2015 to 2019, the PVFLP of lung cancer decreased by 26% in Belgium, 27% in the Netherlands, 14% in Norway, and 38% in Poland. CONCLUSION The results from this study illustrate a decreasing trend in productivity costs of premature mortality due to lung cancer, as illustrated by the decreasing PVFLP between 2010 and 2019. This trend could be driven by a shift in the distribution of deaths towards older age groups due to advancements in the preventative and treatment landscape. These results provide an economic measure of the lung cancer burden which may assist decision-makers in allocating scarce resources amongst competing priorities in the included countries.
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Affiliation(s)
- Goran Bencina
- Center for Observational and Real-World Evidence, MSD Spain, Madrid, Spain
| | | | | | | | | | - Stina Salomonsson
- MSD, Center for Observational and Real-World Evidence, Stockholm, Sweden
| | - Ingel Demedts
- Department of Pulmonary Diseases, AZ Delta, Roeselare, Belgium
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Bencina G, Chami N, Hughes R, Weston G, Baxter C, Salomonsson S. Assessing the impact of kidney cancer-related premature mortality and productivity loss in Greece and Portugal. Expert Rev Pharmacoecon Outcomes Res 2023; 23:391-398. [PMID: 36857504 DOI: 10.1080/14737167.2023.2180356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE In 2018, 371,750 people were diagnosed with kidney cancer globally, constituting 2.2% of all cancer diagnoses. Since 2010, the number of kidney cancer deaths in Europe have decreased in people under 65. However, this is not the case in Greece and Portugal. This study estimated the mortality and lost productivity due to premature mortality from kidney cancer in Greece and Portugal. METHODS Years of life lost (YLL) and present value of future lost productivity (PVFLP) due to kidney cancer mortality (ICD-10 code: C64 - Malignant neoplasm of kidney, except renal pelvis) were calculated using the human capital approach. Age-specific mortality, mean earnings, and labor force participation rates were used in these calculations. RESULTS In 2019, there were 564 and 454 kidney cancer deaths in Greece and Portugal, respectively, resulting in 5,871 (3,636 in males and 2,234 in females) and 5,397 (3,100 in males and 2,297 in females) YLL, respectively. YPLL and annual PVFLP were estimated to be 1,326 and €14.8 M in Greece and 1,278 and €11.8 M in Portugal, respectively. CONCLUSION YLL and PVFLP due to kidney cancer mortality are substantial in Greece and Portugal. These results provide new evidence to assist decision-makers in allocating resources to reduce cancer burden.
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Affiliation(s)
- Goran Bencina
- Center for Observational and Real-World Evidence, MSD, Spain, Madrid
| | | | | | | | | | - Stina Salomonsson
- MSD, Center for Observational and Real-World Evidence, Stockholm, Sweden
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Bencina G, Chami N, Hughes R, Weston G, Baxter C, Maciejczyk A, Popovic L, Karamousouli E, Salomonsson S. Breast cancer-related mortality in Central and Eastern Europe: years of life lost and productivity costs. J Med Econ 2023; 26:254-261. [PMID: 36756852 DOI: 10.1080/13696998.2023.2169497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Breast cancer (BC) poses a public health challenge as the most commonly diagnosed cancer among women globally. While BC mortality has declined across Europe in the past three decades, an opposite trend has been reported in some transitional European countries. This analysis estimates the mortality burden and the cost of lost productivity due to BC deaths in nine Central and Eastern Europe (CEE) countries: Bulgaria, Croatia, Czech Republic, Hungary, Poland, Romania, Serbia, Slovakia, and Slovenia, that have defied the favorable cancer mortality trends. These estimates may provide relevant evidence to aid decision-makers in the prioritization of BC-targeted policies. METHODS The human capital approach (HCA) was used to estimate years of life lost (YLL) and productivity losses due to premature death from BC (ICD-10 code: C50 Malignant neoplasm of breast). YLL and present value of future lost productivity (PVFLP) were calculated using age and gender-specific mortality, wages, and employment rates. Data were sourced from the World Health Organization (WHO), Eurostat, and the World Bank. RESULTS In 2019, there were 19,726 BC deaths in the nine CEE countries. This study estimated BC deaths resulted in 267,184 YLL. Annual PVFLP was estimated to be €85 M in Poland, €46 M in Romania, €39 M in Hungary, €21 M in Slovakia, €18 M in Serbia, €16 M in Czech Republic, €15 M in Bulgaria, €13 M in Croatia, and €7 M in Slovenia. CONCLUSION Premature death from BC leads to substantial YLL and productivity losses. Lost productivity costs due to premature BC-related mortality exceeded €259 million in 2019 alone. The data modeled provide important evidence toward resource allocation priorities for BC prevention, screening, and treatment that could potentially decrease productivity losses. Careful consideration should be given to BC-specific policies, such as surveillance programs and the availability of new treatments in CEE countries to decrease the medical and financial burden of the disease.
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Affiliation(s)
- Goran Bencina
- Center for Observational and Real-World Evidence, MSD Spain, Madrid, Spain
| | | | | | | | | | - Adam Maciejczyk
- Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
- Department of Radiotherapy, Lower Silesian Oncology, Pulmonology and Haematology Center, Wroclaw, Poland
| | - Lazar Popovic
- Oncology Institute of Vojvodina, Faculty of Medicine, University Novi Sad, Novi Sad, Serbia
| | | | - Stina Salomonsson
- MSD, Center for Observational and Real-World Evidence, Stockholm, Sweden
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Jameel A, Meiwald A, Bain P, Patel N, Nandi D, Jones B, Weston G, Adams EJ, Gedroyc W. The cost-effectiveness of unilateral magnetic resonance-guided focused ultrasound in comparison with unilateral deep brain stimulation for the treatment of medically refractory essential tremor in England. Br J Radiol 2022; 95:20220137. [PMID: 36125247 PMCID: PMC9733625 DOI: 10.1259/bjr.20220137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/01/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aims to ascertain the cost-effectiveness of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of medically refractory Essential Tremor (mrET) in England. Essential Tremor (ET) is the most common movement disorder affecting approximately 1 million in the UK causing considerable societal impact affecting patients, carers and the wider healthservice. Medical treatment has mixed efficacy, with approximately 25-55% of ET medication refractory. Deep brain stimulation (DBS) is a proven neurosurgical treatment; however, the risks of surgery and anaesthesia mean some patients are ineligible. MRgFUS is an emerging noninvasive technique that causes tremor suppression by thermal ablation of tremor-sensitive brain tissue. Several international clinical trials have demonstrated MRgFUS is safe and clinically effective; however, to-date no cost-effectiveness study has been performed in Europe. METHODS A Markov model was used to assess two subpopulations of mrET - those eligible and those ineligible for neurosurgery - in the context specific to England and its healthcare system. For those eligible for neurosurgery, MRgFUS was compared to DBS, the current standard treatment. For those ineligible for neurosurgery, MRgFUS was compared to treatment with medication alone. The model calculated the Incremental cost-effectiveness ratio (ICER) with appropriate sensitivity and scenario analyses. RESULTS For those eligible for neurosurgery: In the model base case, the MRgFUS was economically dominant compared to DBS; MRgFUS was less costly (£19,779 vs £62,348) and more effective generating 0.03 additional quality-adjusted life-years (QALYs) per patient (3.71 vs 3.68) over the 5-year time horizon.For those ineligible for neurosurgery: In the model base case, MRgFUS cost over £16,000 per patient more than medication alone (£19,779 vs £62,348) but yielded 0.77 additional QALYs per patient(3.71 vs 2.95), producing an incremental cost-effectiveness ratio (ICER) of £20,851 per QALY. This ICER of £20,851 per QALY falls within the National Institute for Clinical Excellence's (NICE) willingness to pay threshold (WTP) of 20,000-30,000 demonstrating the cost-effectiveness profile of MRgFUS. CONCLUSION This study demonstrates the favourable cost-effectiveness profile of MRgFUS for the treatment of mrET in England; in both patients suitable and not suitable for neurosurgery. ADVANCES IN KNOWLEDGE The introduction of MRgFUS as a widely available ET treatment in UK is currently undergoing the necessary stages of regulatory approval. As the first European study, these favourable cost-effectiveness outcomes (notably the model base case ICER falling within NICE's WTP) can provide a basis for future commissioning of brain MRgFUS treatments in the UK, Europe and globally.
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Affiliation(s)
| | - Anne Meiwald
- UK Aquarius Population Health Limited, London, United Kingdom
| | - Peter Bain
- Division of Brain Sciences, Imperial College London, London, United Kingdom
| | - Neekhil Patel
- Department of Neurosciences, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dipankar Nandi
- Department of Neurosciences, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Brynmor Jones
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Georgie Weston
- UK Aquarius Population Health Limited, London, United Kingdom
| | | | - Wladyslaw Gedroyc
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
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Bencina G, Chami N, Hughes R, Weston G, Golusiński PJ. Lost productivity due to head and neck cancer mortality in Hungary, Poland, and Romania. J Cancer Policy 2022; 34:100366. [DOI: 10.1016/j.jcpo.2022.100366] [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] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
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Bencina G, Chami N, Hughes R, Weston G, Baxter C, Salomonsson S, Demedts I. 1351P Indirect costs due to lung cancer-related premature mortality in four European countries. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1483] [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: 11/01/2022] Open
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Meiwald A, Gara-Adams R, Rowlandson A, Ma Y, Watz H, Ichinose M, Scullion J, Wilkinson T, Bhutani M, Weston G, Adams EJ. Qualitative Validation of COPD Evidenced Care Pathways in Japan, Canada, England, and Germany: Common Barriers to Optimal COPD Care. Int J Chron Obstruct Pulmon Dis 2022; 17:1507-1521. [PMID: 35801119 PMCID: PMC9255283 DOI: 10.2147/copd.s360983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. A comprehensive and detailed understanding of COPD care pathways from pre-diagnosis to acute care is required to understand the common barriers to optimal COPD care across diverse health systems. Methods Country-specific COPD care pathways were created for four high-income countries using international recommendations and country-specific guidelines, then populated with published epidemiological, clinical, and economic data. To refine and validate the pathways, semi-structured interviews using pre-prepared discussion guides and country-specific pathway maps were held with twenty-four primary and secondary care respiratory healthcare professionals. Thematic analysis was then performed on the interview transcripts. Results The COPD care pathway showed broad consistency across the countries. Three key themes relating to barriers in optimal COPD management were identified across the countries: journey to diagnosis, treatment, and the impact of COVID-19. Common barriers included presentation to healthcare with advanced COPD, low COPD consideration, and sub-optimal acute and chronic disease management. COVID-19 has negatively impacted disease management across the pathway but presents opportunities to retain virtual consultations. Structural factors such as insurance and short duration of appointments also impacted the diagnosis and management of COPD. Conclusion COPD is an important public health issue that needs urgent prioritization. The use of Evidenced Care Pathways with decision-makers can facilitate evidence-based decision making on interventions and policies to improve care and outcomes for patients and reduce unnecessary resource use and associated costs for the healthcare provider/payer.
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Affiliation(s)
| | | | | | - Yixuan Ma
- Aquarius Population Health, London, UK
| | - Henrik Watz
- Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Schleswig-Holstein, Germany
| | | | | | - Tom Wilkinson
- Faculty of Medicine, Southampton University, Southampton, Hampshire, UK
- Respiratory and Allergy, NIHR Southampton Biomedical Research Centre, Southampton, Hampshire, UK
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Elisabeth J Adams
- Aquarius Population Health, London, UK
- Correspondence: Elisabeth J Adams, Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK, Tel +44 (0)207 993 2930, Email
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Li X, Muston D, Ramakrishnan K, Black C, Hughes R, Weston G, Lucherini S. Budget Impact of Keytruda for the Treatment of Patients with Recurrent or Metastatic (R/M) and Locally Advanced (LA) Cutaneous Squamous Cell Carcinoma (cSCC) in the United States. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Huntington S, Weston G, Adams E. Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services. Ther Adv Infect Dis 2021; 8:20499361211061645. [PMID: 34881023 PMCID: PMC8647227 DOI: 10.1177/20499361211061645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/29/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) compared to laboratory-based testing. Methods Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables data were collected by clinic staff prior to and following introduction of the POCT. Results SHSs selected patient groups for whom the CT/NG POCT would be used. Testing and treatment process data were collected for 225 patients (n = 118 POC; n = 107 standard). The percentage of patients receiving unnecessary CT treatment was 5% (5/95) and 13% (12/93) for POC and standard care respectively. The average CT/NG pathway cost varied and was on average £61.55 for POC and £50.88 for standard care. For the two SHSs where the POCT was used during a patient's visit, for standard and POC respectively, the average time to CT treatment was 10.0 and 0.0 days and to NG treatment, 0.3 and 0.0 days. Conclusion Use of a 30-minute POCT at three SHSs yielded clinical benefits by reducing time to treatment and unnecessary CT treatment.
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Ganz-Lord FA, Segal KR, Gendlina I, Rinke ML, Weston G. SARS-CoV-2 exposures among healthcare workers in New York City. Occup Med (Lond) 2021; 72:248-251. [PMID: 35604310 PMCID: PMC8690118 DOI: 10.1093/occmed/kqab166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a significant impact on hospitals, including the occupational health departments in charge of handling healthcare worker (HCW) staffing during high rates of exposure and infection of HCWs. HCWs who were exposed to a patient or community member infected with SARS-CoV-2 were required to isolate from work for a minimum of 14 days from the date of exposure.
Aims
This study was aimed to assess the relative risk of SARS-CoV-2 infection following different types of workplace and community exposures.
Methods
We analyzed the details of workplace and community exposures of HCWs to SARS-CoV-2 at Montefiore Medical Center in New York between 22 June 2020 and 22 November 2020.
Results
Of 562 HCW SARS-CoV-2 exposures analyzed, 218 were from the community and 345 were from the workplace. Twenty-nine per cent of community exposures resulted in infection, which was significantly greater than workplace exposure infection (2%). Household community exposures resulted in a larger frequency of infection than non-household community exposures. Of the seven infections after workplace exposures, five had qualifying exposures to a co-worker and two were exposed to an infected patient during a non-aerosolized procedure.
Conclusions
HCW exposure to SARS-CoV-2 continues to present staffing challenges to healthcare systems. Even with deviations from standard personal protective equipment protocol, workplace exposures resulted in low frequencies of infection. In our study, the primary source of HCW infection was exposure in the community. Our findings support investing in efforts to educate around continued masking and social distancing in the community in addition to interventions targeted at addressing vaccine hesitancy.
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Affiliation(s)
- F A Ganz-Lord
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Occupational Health Services COVID-19 Response, Montefiore Medical Center, Bronx, NY 10467, USA
| | - K R Segal
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - I Gendlina
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Infection Prevention and Control, Montefiore Medical Center, Bronx, NY 10467, USA
| | - M L Rinke
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Occupational Health Services COVID-19 Response, Montefiore Medical Center, Bronx, NY 10467, USA
- Division of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY 10467, USA
| | - G Weston
- Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
- Infection Prevention and Control, Montefiore Medical Center, Bronx, NY 10467, USA
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Weston G, Dombrowski C, Steben M, Popadiuk C, Bentley J, Adams EJ. A health economic model to estimate the costs and benefits of an mRNA vs DNA high-risk HPV assay in a hypothetical HPV primary screening algorithm in Ontario, Canada. Prev Med Rep 2021; 23:101448. [PMID: 34381664 PMCID: PMC8334715 DOI: 10.1016/j.pmedr.2021.101448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 01/07/2023] Open
Abstract
Using an mRNA HPV test in cervical screening can reduce costs and avoid procedures. This could benefit both the healthcare system and women by optimizing resource use. These results can inform choices in cervical screening programs in Canada.
This study models the impact of using two different types of high-risk (HR) human papillomavirus (HPV) tests: mRNA (Aptima) and DNA (Hybrid Capture 2) as part of a hypothetical primary HPV screening program in Ontario, Canada. Outcomes were the costs of the screening program, and number of colposcopies, HPV tests and cytology tests. Results were estimated for one cohort going through the screening algorithm. A decision tree model was adapted from a published UK study, with inputs drawn from published Canadian data for the probabilities through the model, costs, demographic, and screening data from Ontario. Sensitivity and scenario analyses explored uncertainty in the model inputs and assumptions. Results indicated that screening using an mRNA test could yield cost savings of CAD $4,007,266 (95% credibility interval [CI]: −7,866,251 – 8,035) compared to using a DNA test, with 10,639 (95% CI: 10,170 – 11,094) fewer women undergoing unnecessary colposcopies, and reductions in unnecessary HR-HPV and cytology tests. The HR-HPV test comprised the largest percentage of the costs saved, and the probability of being HPV positive in the first year had the biggest impact on results. These results indicate that the choice of HR-HPV test is important when implementing a primary HPV screening program to avoid unnecessary resource use and cost, which will benefit both women and healthcare providers.
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Affiliation(s)
- Georgie Weston
- Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK
| | | | - Marc Steben
- School of Public Health, Université de Montréal, Montréal, QC H3N 1X9, Canada
| | - Catherine Popadiuk
- Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, NL A1B 3V6, Canada
| | - James Bentley
- Nova Scotia Health Authority, Room 5006, Dickson Building, QEII Health Sciences Centre, 5820, University Avenue, Halifax, NS B3H 2Y9, Canada
| | - Elisabeth J Adams
- Aquarius Population Health, Unit 29 Tileyard Studios, London N7 9AH, UK
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Harding-Esch EM, Huntington SE, Harvey MJ, Weston G, Broad CE, Adams EJ, Sadiq ST. Antimicrobial resistance point-of-care testing for gonorrhoea treatment regimens: cost-effectiveness and impact on ceftriaxone use of five hypothetical strategies compared with standard care in England sexual health clinics. ACTA ACUST UNITED AC 2021; 25. [PMID: 33124553 PMCID: PMC7596918 DOI: 10.2807/1560-7917.es.2020.25.43.1900402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Widespread ceftriaxone antimicrobial resistance (AMR) threatens Neisseria gonorrhoeae (NG) treatment, with few alternatives available. AMR point-of-care tests (AMR POCT) may enable alternative treatments, including abandoned regimens, sparing ceftriaxone use. We assessed cost-effectiveness of five hypothetical AMR POCT strategies: A-C included a second antibiotic alongside ceftriaxone; and D and E consisted of a single antibiotic alternative, compared with standard care (SC: ceftriaxone and azithromycin). Aim Assess costs and effectiveness of AMR POCT strategies that optimise NG treatment and reduce ceftriaxone use. Methods The five AMR POCT treatment strategies were compared using a decision tree model simulating 38,870 NG-diagnosed England sexual health clinic (SHC) attendees; A micro-costing approach, representing cost to the SHC (for 2015/16), was employed. Primary outcomes were: total costs; percentage of patients given optimal treatment (regimens curing NG, without AMR); percentage of patients given non-ceftriaxone optimal treatment; cost-effectiveness (cost per optimal treatment gained). Results All strategies cost more than SC. Strategy B (azithromycin and ciprofloxacin (azithromycin preferred); dual therapy) avoided most suboptimal treatments (n = 48) but cost most to implement (GBP 4,093,844 (EUR 5,474,656)). Strategy D (azithromycin AMR POCT; monotherapy) was most cost-effective for both cost per optimal treatments gained (GBP 414.67 (EUR 554.53)) and per ceftriaxone-sparing treatment (GBP 11.29 (EUR 15.09)) but with treatment failures (n = 34) and suboptimal treatments (n = 706). Conclusions AMR POCT may enable improved antibiotic stewardship, but require net health system investment. A small reduction in test cost would enable monotherapy AMR POCT strategies to be cost-saving.
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Affiliation(s)
- Emma M Harding-Esch
- National Infection Service, Public Health England, London, United Kingdom.,Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | | | | | | | - Claire E Broad
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | | | - S Tariq Sadiq
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom.,National Infection Service, Public Health England, London, United Kingdom.,Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
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Huntington S, Weston G, Seedat F, Marshall J, Bailey H, Tebruegge M, Ahmed I, Turner K, Adams E. Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis. BMJ Open 2020; 10:e038505. [PMID: 33444184 PMCID: PMC7678359 DOI: 10.1136/bmjopen-2020-038505] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women. DESIGN A decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results. SETTING UK antenatal screening programme. POPULATION Hypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses. RESULTS Base case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494. CONCLUSIONS Universal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.
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Affiliation(s)
| | | | - Farah Seedat
- UK National Screening Committee, Public Health England, London, UK
| | - John Marshall
- UK National Screening Committee, Public Health England, London, UK
| | - Heather Bailey
- UCL Institute for Global Health, University College London, London, UK
| | - Marc Tebruegge
- Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK
- Department of Paediatrics, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Katy Turner
- School of Veterinary Science, University of Bristol, Bristol, UK
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Weston G, Dombrowski C, Harvey MJ, Iftner T, Kyrgiou M, Founta C, Adams EJ. Use of the Aptima mRNA high-risk human papillomavirus (HR-HPV) assay compared to a DNA HR-HPV assay in the English cervical screening programme: a decision tree model based economic evaluation. BMJ Open 2020; 10:e031303. [PMID: 32152154 PMCID: PMC7064071 DOI: 10.1136/bmjopen-2019-031303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To estimate the impact of using the Aptima messenger RNA (mRNA) high-risk human papilloma virus (HR-HPV) assay versus a DNA HR-HPV assay in a primary HPV cervical screening programme. DESIGN One hypothetical cohort followed for 3 years through HPV primary cervical screening. SETTING England. PARTICIPANTS A hypothetical cohort of women aged 25-65 years tested in the National Health Service (NHS) Cervical Screening Programme (CSP) for first call or routine recall testing. METHODS A decision tree parameterised with data from the CSP (2017/18) and the HORIZON study. Uncertainty analyses were conducted using data from the FOCAL and GAST studies, other DNA HPV tests in addition to one-way and probabilistic sensitivity and scenarios analyses, to test the robustness of results. INTERVENTIONS Aptima mRNA HR-HPV assay and a DNA HR-HPV assay (cobas 4800 HPV assay). MAIN OUTCOME MEASURES Primary: total colposcopies and total costs for the cohort. Secondary: total HPV and cytology tests, number lost to follow-up. RESULTS At baseline for a population of 2.25 million women, an estimated £15.4 million (95% credibility intervals (CI) £6.5 to 24.1 million) could be saved and 28 009 (95% CI 27 499 to 28 527) unnecessary colposcopies averted if Aptima mRNA assays are used instead of a DNA assay, with 90 605 fewer unnecessary HR-HPV and 253 477 cytology tests performed. These savings are due to a lower number of HPV positive samples in the mRNA arm. When data from other primary HPV screening trials were compared, results indicated that using the Aptima mRNA assay generated cost savings and reduced testing in every scenario. CONCLUSION Using the Aptima mRNA assay versus a DNA assay would almost certainly yield cost savings and reduce unnecessary testing and procedures, benefiting the NHS and women in the CSP.
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Affiliation(s)
| | | | | | - Thomas Iftner
- Department of Medical Virology, University Hospital Tübingen, Tübingen, Germany
| | - Maria Kyrgiou
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Imperial College London, London, UK
- Queen Charlotte's and Chelsea, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Christina Founta
- Department of Gynaecological Oncology, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton, Somerset, UK
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Rajagopal V, Chamberlain S, Weston G. Intrauterine insemination (IUI) in patients with single patent tube. a retrospective review to analyze cancellation rate, pregnancy rate and to improve pretreatment counselling. Fertil Steril 2014. [DOI: 10.1016/j.fertnstert.2014.07.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vollenhoven B, Osianlis T, Weston G, Wan K, Gabbe M. Blastocyst embryo transfer does not increase the rate of monozygotic twinning (MZ) compared with day 2-3 embryo transfer. Fertil Steril 2009. [DOI: 10.1016/j.fertnstert.2009.07.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Dimitriadis E, Paiva P, Manuelpillai U, Weston G, Meehan K, Yap J. 107. INTERLEUKIN 11 AND LEUKEMIA INHIBITORY FACTOR REGULATE CYTOKINE NETWORKS IN HUMAN FIRST TRIMESTER PLACENTA. Reprod Fertil Dev 2009. [DOI: 10.1071/srb09abs107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Inadequate trophoblast invasion is thought to be involved in the pathogenesis of preeclampsia (PE). Shallow trophoblast invasion has been implicated to lead to placental hypoxia and a localised overproduction of pro-inflammatory cytokines. Interleukin (IL) 11 and leukemia inhibitory factor (LIF) are IL6-type cytokines produced at the maternal-fetal interphase and regulate human trophoblast migration/invasion, but their mechanisms of action are unknown. We aimed to determine the effect of hypoxia on human placental IL11/LIF secretion and the effect of IL11/LIF on placental cytokine secretion. As an in vitro model we cultured human first trimester placental villous explants (gestation weeks 7-9) in serum free conditions under either 2% (hypoxia) or 20% oxygen (normoxia) (N=8/gp) for 48h. Medium was assayed for IL11/LIF by ELISA. The effect of IL11/LIF (N=6/gp) on placental explant cytokine secretion (26 cytokines) was analysed using a quantitative multiplex immunoassay. Data was expressed as pg/mg wet weight and then as % change vs control (100%). IL11 secretion from explants was decreased by 76±5% (p<0.01) under hypoxia vs normoxia while LIF secretion did not differ significantly. Under normoxia the most highly abundant cytokines were IL6, IL8 and MCP-1 while moderate levels of G-CSF, CX3CL1, IP-10, and PGDF were present in conditioned medium. IL11 increased IL10 secretion while it decreased G-CSF, TNFa, IL1receptor antagonist (Ra), IL6 and PDGF secretion (p<0.05) vs control. Similarly LIF decreased G-CSF, TNFa, IL1Ra and additionally IL8 secretion (p<0.05) vs control. IL6 and VEGF secretion were increased (p<0.05) while MCP-1 was reduced (p<0.05) by hypoxia vs normoxia. This study identified for the first time that IL11 was reduced by hypoxia and identified a profile of cytokines secreted by placenta. IL11 and LIF regulated similar and unique anti-inflammatory cytokines in first trimester placenta. Whether placental IL11 or LIF is altered in women with PE remains to be elucidated however this study suggests mechanisms of action and confirms the importance of IL11/LIF in placentation.
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Weston G, Bowker K, Noel A, MacGowan A, Howe R. P1660 The activity of mecillinam vs Enterobacteriaceae resistant to 3rd-generation cephalosporins in Bristol, UK. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- G Weston
- Monash University Department of Obstetrics and Gynaecology, Monash Medical Centre, Clayton, Victoria, Australia
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Abstract
The endometrium is one of the few tissues in the adult where physiological angiogenesis occurs. Studies of endometrial angiogenesis are complicated by the continual changes in tissue growth and regression during the menstrual cycle, and differences between the two different zones of the endometrium--the functionalis and basalis. The mechanisms of angiogenesis in the endometrium may be different to those in solid tumours, requiring a re-evaluation of the relative importance of various angiogenesis promoters and inhibitors. None of the angiogenesis promoters or inhibitors have yet been demonstrated beyond doubt to have a biological role in endometrial angiogenesis in vivo. Thus, the mechanisms, timing and control of angiogenesis in the endometrium are far from being fully understood.
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Affiliation(s)
- G Weston
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Weston G, Cattrall F, Trounson AO, Healy DL. Cloning: its relevance to monozygotic twins. Aust N Z J Obstet Gynaecol 2000; 40:317-25. [PMID: 11065041 DOI: 10.1111/j.1479-828x.2000.tb03342.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Weston
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
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Harris LJ, Desjardins AE, Plattner RD, Nicholson P, Butler G, Young JC, Weston G, Proctor RH, Hohn TM. Possible Role of Trichothecene Mycotoxins in Virulence of Fusarium graminearum on Maize. Plant Dis 1999; 83:954-960. [PMID: 30841080 DOI: 10.1094/pdis.1999.83.10.954] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Trichothecene-producing and -nonproducing Fusarium graminearum strains were tested for their ability to cause Gibberella ear rot in field trials at two locations-Ottawa, Ontario, and Peoria, Illinois-in 1996. Maize ears were inoculated with wild-type or transgenic F. graminearum strains in which the trichothecene biosynthetic pathway had been disabled by the specific disruption of the trichodiene synthase gene and with a derivative revertant strain in which trichothecene production had been restored through recombination. A silk channel inoculation method was employed at both locations. In addition, a kernel puncture inoculation method was used at the Ontario location. Harvested maize ears were analyzed for visual disease severity, grain yield, deoxynivalenol (DON) concentration, and fungal biomass by quantitative polymerase chain reaction (PCR) and/or ergosterol quantitation. There was a significant correlation (r= 0.86) between data obtained from the two different methods of quantifying fungal biomass. The trichothecene-nonproducing strains were still pathogenic but appeared less virulent on maize than the trichothecene-producing progenitor and revertant strains, as assayed by most parameters. This suggests that the trichothecenes may act as virulence factors to enhance the spread of F. graminearum on maize.
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Affiliation(s)
- L J Harris
- Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, Ottawa, Ontario K1A 0C6 Canada
| | - A E Desjardins
- Mycotoxin Research, National Center for Agricultural Utilization Research, USDA/ARS, Peoria, IL 61604
| | - R D Plattner
- Mycotoxin Research, National Center for Agricultural Utilization Research, USDA/ARS, Peoria, IL 61604
| | - P Nicholson
- John Innes Centre, Norwich Research Park, Colney, Norwich NR4 7UH, UK
| | - G Butler
- Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, Ottawa, Ontario K1A 0C6 Canada
| | - J C Young
- Eastern Cereal and Oilseed Research Centre, Agriculture and Agri-Food Canada, Ottawa, Ontario K1A 0C6 Canada
| | - G Weston
- John Innes Centre, Norwich Research Park, Colney, Norwich NR4 7UH, UK
| | - R H Proctor
- Mycotoxin Research, National Center for Agricultural Utilization Research, USDA/ARS, Peoria, IL 61604
| | - T M Hohn
- Mycotoxin Research, National Center for Agricultural Utilization Research, USDA/ARS, Peoria, IL 61604
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Doohan FM, Weston G, Rezanoor HN, Parry DW, Nicholson P. Development and use of a reverse transcription-PCR assay to study expression of Tri5 by Fusarium species in vitro and in planta. Appl Environ Microbiol 1999; 65:3850-4. [PMID: 10473385 PMCID: PMC99710 DOI: 10.1128/aem.65.9.3850-3854.1999] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/1999] [Accepted: 06/16/1999] [Indexed: 11/20/2022] Open
Abstract
The Tri5 gene encodes trichodiene synthase, which catalyzes the first reaction in the trichothecene biosynthetic pathway. In vitro, a direct relationship was observed between Tri5 expression and the increase in deoxynivalenol production over time. We developed a reverse transcription (RT)-PCR assay to quantify Tri5 gene expression in trichothecene-producing strains of Fusarium species. We observed an increase in Tri5 expression following treatment of Fusarium culmorum with fungicides, and we also observed an inverse relationship between Tri5 expression and biomass, as measured by beta-D-glucuronidase activity, during colonization of wheat (cv. Avalon) seedlings by F. culmorum. RT-PCR analysis also showed that for ears of wheat cv. Avalon inoculated with F. culmorum, there were different levels of Tri5 expression in grain and chaff at later growth stages. We used the Tri5-specific primers to develop a PCR assay to detect trichothecene-producing Fusarium species in infected plant material.
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Affiliation(s)
- F M Doohan
- Cereals Department, John Innes Centre, Norwich Research Park, Norwich NR4 7UH, United Kingdom.
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Flanders BS, Kelly JJ, Seifert H, Lopiano D, Aas B, Azizi A, Igo G, Weston G, Whitten C, Wong A, Hynes MV, McClelland J, Bertozzi W, Finn JM, Hyde-Wright CE, Lourie RW, Norum BE, Ulmer P, Berman BL. Empirical density-dependent effective interaction for nucleon-nucleus scattering at 500 MeV. Phys Rev C Nucl Phys 1991; 43:2103-2126. [PMID: 9967263 DOI: 10.1103/physrevc.43.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Kelly JJ, Feldman AE, Flanders BS, Seifert H, Lopiano D, Aas B, Azizi A, Igo G, Weston G, Whitten C, Wong A, Hynes MV, McClelland J, Bertozzi W, Finn JM, Hyde-Wright CE, Lourie RW, Ulmer PE, Norum BE, Berman BL. Effective interaction for 16O(p,p') at Ep=318 MeV. Phys Rev C Nucl Phys 1991; 43:1272-1287. [PMID: 9967167 DOI: 10.1103/physrevc.43.1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
OBJECTIVE To determine the staff required if the rules for airline pilots' hours of work are applied to junior doctors. DESIGN Junior anaesthetists recorded their workload from 1 March 1988 to May 31 1988. SETTING District general hospital. SUBJECTS Two groups of three junior anaesthetists sharing a one in three rota to provide continuous emergency cover. INTERVENTIONS By using the guidelines published by the Civil Aviation Authority in The Avoidance of Excessive Fatigue in Aircrews schedules were drawn up to cover the hours that junior doctors had been on duty. RESULTS Each anaesthetist provided emergency and routine cover for 48-112 (mean 75) hours each week. To cover the work of six junior anaesthetists on an annual basis would require 26 doctors if they were working within the Civil Aviation Authority's guidelines. CONCLUSIONS Junior anaesthetists' hours are much longer than those of airline pilots. Both professions entail considerable periods of monitoring interspersed with episodes of high demands on physical and cognitive skills. Errors induced by fatigue made by anaesthetists and pilots could result in death. The medical profession should define rules similar to those of the aviation authority to prevent junior doctors having to work unsafe numbers of hours.
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Affiliation(s)
- A M Wilson
- Department of Anaesthetics, Northern General Hospital, Sheffield
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30
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Tanaka N, Gazzaly MM, Pauletta G, Aas B, Adams D, Fujisawa H, Greene S, Hasai H, Igo G, Isagawa S, Ishimoto S, Iwatani K, Jones K, Lopiano D, Masaike A, Nishiyama F, Ohashi Y, Okihana A, Okumi S, Sperisen F, Weston G, Whitten C. Spin dependence of pp inelasticities at intermediate energies. Phys Rev C Nucl Phys 1988; 37:2071-2074. [PMID: 9954673 DOI: 10.1103/physrevc.37.2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Weston G. Cardiac Anesthesia, Second Edition. Edited by Kaplan J. A. Published (1987) by Grune and Stratton, Orlando. Pp. 1122; illustrated; indexed. Price $124.5, £92.50. Br J Anaesth 1988. [DOI: 10.1093/bja/60.1.123-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gazzaly MM, Pauletta G, Tanaka N, Aas B, Fujisawa H, Greene S, Hasai H, Isagawa S, Igo G, Ishimoto S, Jones K, Lopiano D, Masaike A, McClelland J, Morris CL, Nishiyama F, Ohashi Y, Okihana A, Santi L, Sperisen F, Weston G, Whitten C. First measurement of the real part of a pp double-spin-flip amplitude. Phys Rev Lett 1987; 58:1084-1087. [PMID: 10034335 DOI: 10.1103/physrevlett.58.1084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Weston G, Strunin L, Amundson GM. Imaging for anaesthetists: a review of the methods and anaesthetic implications of diagnostic imaging techniques. Can Anaesth Soc J 1985; 32:552-61. [PMID: 3899318 DOI: 10.1007/bf03010809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ellis B, Petrow V, Stansfield M, Weston G. 482. Modified steroid hormones. Part XV. A new route to 17α-alkynyl-17β-hydroxy-steroids. ACTA ACUST UNITED AC 1960. [DOI: 10.1039/jr9600002389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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