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McClymont E, Atkinson A, Albert A, Av-Gay G, Andrade J, Barrett J, Bogler T, Boucoiran I, Castillo E, D'Souza R, El-Chaâr D, Fadel S, Fell DB, Korchinski I, Kuret V, Ogilvie G, Poliquin V, Sadarangani M, Scott H, Snelgrove JW, Tunde-Byass M, Money D. Reactogenicity, pregnancy outcomes, and SARS-CoV-2 infection following COVID-19 vaccination during pregnancy in Canada: A national prospective cohort study. Vaccine 2023; 41:7183-7191. [PMID: 37865598 DOI: 10.1016/j.vaccine.2023.10.032] [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: 06/21/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To describe self-reported reactogenicity, pregnancy outcomes, and SARS-CoV-2 infection following COVID-19 vaccination during pregnancy. DESIGN National, prospective cohort study. SETTING Participants across Canada were enrolled from July 2021 until June 2022. POPULATION Individuals pregnant during the COVID-19 pandemic, regardless of vaccination status, were included. METHODS The Canadian COVID-19 Vaccine Registry for Pregnant and Lactating Individuals (COVERED) was advertised through traditional and social media. Surveys were administered at baseline, following each vaccine dose if vaccinated, pregnancy conclusion, and every two months for 14 months. Changes to pregnancy or vaccination status, SARS-CoV-2 infections, or significant health events were recorded. MAIN OUTCOME MEASURES Reactogenicity (local and systemic adverse events, and serious adverse events) within 1 week post-vaccination, pregnancy and neonatal outcomes, and subsequent SARS-CoV-2 infection. RESULTS Among 2868 participants who received 1-2 doses of a COVID-19 vaccine during pregnancy, adverse events described included: headache (19.5-33.9%), nausea (4.8-13.8%), fever (2.7-10.2%), and myalgia (33.4-42.2%). Reactogenicity was highest after the 2nd dose of vaccine in pregnancy. Compared to 1660 unvaccinated participants, there were no statistically significant differences in adverse pregnancy or infant outcomes, aside from an increased risk of NICU admission ≥ 24 h among the unvaccinated group. During follow-up, there was a higher rate of participant-reported SARS-CoV-2 infection in the unvaccinated compared to the vaccinated group (18[47.4%] vs. 786[27.3%]). CONCLUSIONS Participant-reported reactogenicity was similar to reports from non-pregnant adults. There was no increase in adverse pregnancy and birth outcomes among vaccinated vs. unvaccinated participants and lower rates of SARS-CoV-2 infection were reported in vaccinated participants. TWEETABLE ABSTRACT No significant increase in adverse pregnancy or infant outcomes among vaccinated versus unvaccinated pregnant women in Canada.
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Affiliation(s)
- E McClymont
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | - A Atkinson
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | - A Albert
- Women's Health Research Institute, Vancouver, Canada
| | - G Av-Gay
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | - J Andrade
- Women's Health Research Institute, Vancouver, Canada
| | - J Barrett
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada
| | - T Bogler
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - I Boucoiran
- Department of Obstetrics & Gynecology and School of Public Health, Université de Montréal, Montreal, Canada
| | - E Castillo
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Canada
| | - R D'Souza
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | - D El-Chaâr
- Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Canada
| | - S Fadel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - D B Fell
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - I Korchinski
- Women's Health Research Institute, Vancouver, Canada
| | - V Kuret
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Canada
| | - G Ogilvie
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - V Poliquin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Manitoba, Winnipeg, Canada
| | - M Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
| | - H Scott
- Department of Obstetrics & Gynecology, Dalhousie University, Halifax, Canada
| | - J W Snelgrove
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | - M Tunde-Byass
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Canada
| | - D Money
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada; Women's Health Research Institute, Vancouver, Canada.
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Caley LR, Jarosz-Griffiths HH, Smith L, Gale L, Barrett J, Kinsey L, Davey V, Nash M, Jones AM, Whitehouse JL, Shimmin D, Floto RA, White H, Peckham DG. Body mass index and nutritional intake following Elexacaftor/Tezacaftor/Ivacaftor modulator therapy in adults with cystic fibrosis. J Cyst Fibros 2023; 22:1002-1009. [PMID: 37422432 DOI: 10.1016/j.jcf.2023.06.010] [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] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Elexacaftor/Tezacaftor/Ivacaftor (ETI) modulator therapy is often associated with increased body mass index (BMI) in people with cystic fibrosis (CF). This is thought to reflect improved clinical stability and increased appetite and nutritional intake. We explored the change in BMI and nutritional intake following ETI modulator therapy in adults with CF. METHODS Dietary intake, measured with myfood24®, and BMI were collected from adults with CF at baseline and follow-up as part of an observational study. Changes in BMI and nutritional intake in participants who commenced ETI therapy between time points were assessed. To contextualize findings, we also assessed changes in BMI and nutritional intake between study points in a group on no modulators. RESULTS In the pre and post ETI threapy group (n = 40), BMI significantly increased from 23.0 kg/m2 (IQR 21.4, 25.3) at baseline to 24.6 kg/m2 (IQR 23.0, 26.7) at follow-up (p<0.001), with a median of 68 weeks between time points (range 20-94 weeks) and median duration of ETI therapy was 23 weeks (range 7-72 weeks). There was a significant decrease in energy intake from 2551 kcal/day (IQR 2107, 3115) to 2153 kcal/day (IQR 1648, 2606), p<0.001. In the no modulator group (n = 10), BMI and energy intake did not significantly change between time points (p>0.05), a median of 28 weeks apart (range 20-76 weeks). CONCLUSIONS These findings tentatively suggest that the increase in BMI with ETI therapy may not simply be attributable to an increase in oral intake. Further exploration into the underlying aetiology of weight gain with ETI therapy is needed.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - L Smith
- Leeds Institute of Health Sciences, University Hospital, University of Leeds, UK
| | - L Gale
- Cambridge Centre for Lung Infection, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - J Barrett
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - L Kinsey
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - V Davey
- Dietetic Department, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - M Nash
- North East Essex Community Services, East Suffolk and North Essex NHS Foundation Trust, UK
| | - A M Jones
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - J L Whitehouse
- West Midlands Regional Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, UK
| | - D Shimmin
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R A Floto
- Cambridge Centre for Lung Infection, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - H White
- Leeds Beckett University, Nutrition, Health & Environment, Leeds, UK
| | - D G Peckham
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Chung R, Xu Z, Arnold M, Stevens D, Keogh R, Barrett J, Harrison H, Pennells L, Kim LG, DiAngelantonio E, Paige E, Usher-Smith JA, Wood AM. Prioritising cardiovascular disease risk assessment to high risk individuals based on primary care records. PLoS One 2023; 18:e0292240. [PMID: 37773956 PMCID: PMC10540947 DOI: 10.1371/journal.pone.0292240] [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: 02/23/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE To provide quantitative evidence for systematically prioritising individuals for full formal cardiovascular disease (CVD) risk assessment using primary care records with a novel tool (eHEART) with age- and sex- specific risk thresholds. METHODS AND ANALYSIS eHEART was derived using landmark Cox models for incident CVD with repeated measures of conventional CVD risk predictors in 1,642,498 individuals from the Clinical Practice Research Datalink. Using 119,137 individuals from UK Biobank, we modelled the implications of initiating guideline-recommended statin therapy using eHEART with age- and sex-specific prioritisation thresholds corresponding to 5% false negative rates to prioritise adults aged 40-69 years in a population in England for invitation to a formal CVD risk assessment. RESULTS Formal CVD risk assessment on all adults would identify 76% and 49% of future CVD events amongst men and women respectively, and 93 (95% CI: 90, 95) men and 279 (95% CI: 259, 297) women would need to be screened (NNS) to prevent one CVD event. In contrast, if eHEART was first used to prioritise individuals for formal CVD risk assessment, we would identify 73% and 47% of future events amongst men and women respectively, and a NNS of 75 (95% CI: 72, 77) men and 162 (95% CI: 150, 172) women. Replacing the age- and sex-specific prioritisation thresholds with a 10% threshold identify around 10% less events. CONCLUSIONS The use of prioritisation tools with age- and sex-specific thresholds could lead to more efficient CVD assessment programmes with only small reductions in effectiveness at preventing new CVD events.
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Affiliation(s)
- Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Zhe Xu
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Matthew Arnold
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - David Stevens
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Keogh
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology & Population Health, London, United Kingdom
| | - Jessica Barrett
- Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Hannah Harrison
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Lois G. Kim
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele DiAngelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Juliet A. Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- Cambridge Centre of Artificial Intelligence in Medicine, Cambridge, United Kingdom
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Chung R, Xu Z, Arnold M, Ip S, Harrison H, Barrett J, Pennells L, Kim LG, Di Angelantonio E, Paige E, Ritchie SC, Inouye M, Usher‐Smith JA, Wood AM. Using Polygenic Risk Scores for Prioritizing Individuals at Greatest Need of a Cardiovascular Disease Risk Assessment. J Am Heart Assoc 2023; 12:e029296. [PMID: 37489768 PMCID: PMC7614905 DOI: 10.1161/jaha.122.029296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
Background The aim of this study was to provide quantitative evidence of the use of polygenic risk scores for systematically identifying individuals for invitation for full formal cardiovascular disease (CVD) risk assessment. Methods and Results A total of 108 685 participants aged 40 to 69 years, with measured biomarkers, linked primary care records, and genetic data in UK Biobank were used for model derivation and population health modeling. Prioritization tools using age, polygenic risk scores for coronary artery disease and stroke, and conventional risk factors for CVD available within longitudinal primary care records were derived using sex-specific Cox models. We modeled the implications of initiating guideline-recommended statin therapy after prioritizing individuals for invitation to a formal CVD risk assessment. If primary care records were used to prioritize individuals for formal risk assessment using age- and sex-specific thresholds corresponding to 5% false-negative rates, then the numbers of men and women needed to be screened to prevent 1 CVD event are 149 and 280, respectively. In contrast, adding polygenic risk scores to both prioritization and formal assessments, and selecting thresholds to capture the same number of events, resulted in a number needed to screen of 116 for men and 180 for women. Conclusions Using both polygenic risk scores and primary care records to prioritize individuals at highest risk of a CVD event for a formal CVD risk assessment can efficiently prioritize those who need interventions the most than using primary care records alone. This could lead to better allocation of resources by reducing the number of risk assessments in primary care while still preventing the same number of CVD events.
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Affiliation(s)
- Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Zhe Xu
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Matthew Arnold
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Hannah Harrison
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Jessica Barrett
- Medical Research Council Biostatistics UnitUniversity of CambridgeUnited Kingdom
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Lois G. Kim
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Ellie Paige
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraAustralia
- The George Institute for Global HealthUNSW SydneyAustralia
| | - Scott C. Ritchie
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Michael Inouye
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- The George Institute for Global HealthUNSW SydneyAustralia
- Cambridge Baker Systems Genomics InitiativeBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Juliet A. Usher‐Smith
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- Cambridge Centre of Artificial Intelligence in MedicineUniversity of CambridgeUnited Kingdom
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Verma R, Chandarana M, Barrett J, Anandadas C, Sundara Rajan S. Post-mastectomy radiotherapy for women with early breast cancer and one to three positive lymph nodes. Cochrane Database Syst Rev 2023; 6:CD014463. [PMID: 37327075 PMCID: PMC10275354 DOI: 10.1002/14651858.cd014463.pub2] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Continual improvement in adjuvant therapies has resulted in a better prognosis for women diagnosed with breast cancer. A surrogate marker used to detect the spread of disease after treatment of breast cancer is local and regional recurrence. The risk of local and regional recurrence after mastectomy increases with the number of axillary lymph nodes affected by cancer. There is a consensus to use radiotherapy as an adjuvant treatment after mastectomy (postmastectomy radiotherapy (PMRT)) in women diagnosed with breast cancer and found to have disease in four or more positive axillary lymph nodes. Despite data showing almost double the risk of local and regional recurrence in women treated with mastectomy and found to have one to three positive lymph nodes, there is a lack of international consensus on the use of PMRT in this group. OBJECTIVES To assess the effects of PMRT in women diagnosed with early breast cancer and found to have one to three positive axillary lymph nodes. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov up to 24 September 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs). The inclusion criteria included women diagnosed with breast cancer treated with simple or modified radical mastectomy and axillary surgery (sentinel lymph node biopsy (SLNB) alone or those undergoing axillary lymph node clearance with or without prior SLNB). We included only women receiving PMRT using X-rays (electron and photon radiation), and we defined the radiotherapy dose to reflect what is currently being recommended (i.e. 40 Gray (Gy) to 50 Gy in 15 to 25/28 fractions in 3 to 5 weeks. The included studies did not administer any boost to the tumour bed. In this review, we excluded studies using neoadjuvant chemotherapy as a supportive treatment before surgery. DATA COLLECTION AND ANALYSIS We used Covidence to screen records. We collected data on tumour characteristics, adjuvant treatments and the outcomes of local and regional recurrence, overall survival, disease-free survival, time to progression, short- and long-term adverse events and quality of life. We reported on time-to-event outcome measures using the hazard ratio (HR) and subdistribution HR. We used Cochrane's risk of bias tool (RoB 1), and we presented overall certainty of the evidence using the GRADE approach. MAIN RESULTS The RCTs included in this review were subgroup analyses of original RCTs conducted in the 1980s to assess the effectiveness of PMRT. Hence, the type and duration of adjuvant systemic treatments used in the studies included in this review were suboptimal compared to the current standard of care. The review involved three RCTs with a total of 829 women diagnosed with breast cancer and low-volume axillary disease. Amongst the included studies, only a single study pertained to the modern-day radiotherapy practice. The results from this one study showed a reduction of local and regional recurrence (HR 0.20, 95% confidence interval (CI) 0.13 to 0.33, 1 study, 522 women; low-certainty evidence) and improvement in overall survival with PMRT (HR 0.76, 95% CI 0.60 to 0.97, 1 study, 522 women; moderate-certainty evidence). One of the other studies using radiotherapy techniques that do not reflect modern-day practice reported on disease-free survival in women with low-volume axillary disease (subdistribution HR 0.63, 95% CI 0.41 to 0.96, 1 study, 173 women). None of the included studies reported on PMRT side effects or quality-of-life outcome measures. AUTHORS' CONCLUSIONS Based on one study, the use of PMRT in women diagnosed with breast cancer and low-volume axillary disease indicated a reduction in locoregional recurrence and an improvement in survival. There is a need for more research to be conducted using modern-day radiotherapy equipment and methods to support and supplement the review findings.
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Affiliation(s)
- Rashmi Verma
- Breast Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, UK
| | | | - Jessica Barrett
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Carmel Anandadas
- Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
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Mota BS, Bevilacqua JLB, Barrett J, Ricci MD, Munhoz AM, Filassi JR, Baracat EC, Riera R. Skin-sparing mastectomy for the treatment of breast cancer. Cochrane Database Syst Rev 2023; 3:CD010993. [PMID: 36972145 PMCID: PMC10042433 DOI: 10.1002/14651858.cd010993.pub2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Skin-sparing mastectomy (SSM) is a surgical technique that aims to maximize skin preservation, facilitate breast reconstruction, and improve cosmetic outcomes. Despite its use in clinical practice, the benefits and harms related to SSM are not well established. OBJECTIVES To assess the effectiveness and safety of skin-sparing mastectomy for the treatment of breast cancer. SEARCH METHODS We searched Cochrane Breast Cancer's Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov on 9 August 2019. SELECTION CRITERIA Randomized controlled trials (RCTs), quasi-randomized or non-randomized studies (cohort and case-control) comparing SSM to conventional mastectomy for treating ductal carcinoma in situ (DCIS) or invasive breast cancer. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. The primary outcome was overall survival. Secondary outcomes were local recurrence free-survival, adverse events (including overall complications, breast reconstruction loss, skin necrosis, infection and hemorrhage), cosmetic results, and quality of life. We performed a descriptive analysis and meta-analysis of the data. MAIN RESULTS We found no RCTs or quasi-RCTs. We included two prospective cohort studies and twelve retrospective cohort studies. These studies included 12,211 participants involving 12,283 surgeries (3183 SSM and 9100 conventional mastectomies). It was not possible to perform a meta-analysis for overall survival and local recurrence free-survival due to clinical heterogeneity across studies and a lack of data to calculate hazard ratios (HR). Based on one study, the evidence suggests that SSM may not reduce overall survival for participants with DCIS tumors (HR 0.41, 95% CI 0.17 to 1.02; P = 0.06; 399 participants; very low-certainty evidence) or for participants with invasive carcinoma (HR 0.81, 95% CI 0.48 to 1.38; P = 0.44; 907 participants; very low-certainty evidence). For local recurrence-free survival, meta-analysis was not possible, due to high risk of bias in nine of the ten studies that measured this outcome. Informal visual examination of effect sizes from nine studies suggested the size of the HR may be similar between groups. Based on one study that adjusted for confounders, SSM may not reduce local recurrence-free survival (HR 0.82, 95% CI 0.47 to 1.42; P = 0.48; 5690 participants; very low-certainty evidence). The effect of SSM on overall complications is unclear (RR 1.55, 95% CI 0.97 to 2.46; P = 0.07, I2 = 88%; 4 studies, 677 participants; very low-certainty evidence). Skin-sparing mastectomy may not reduce the risk of breast reconstruction loss (RR 1.79, 95% CI 0.31 to 10.35; P = 0.52; 3 studies, 475 participants; very low-certainty evidence), skin necrosis (RR 1.15, 95% CI 0.62 to 2.12; P = 0.22, I2 = 33%; 4 studies, 677 participants; very low-certainty evidence), local infection (RR 2.04, 95% CI 0.03 to 142.71; P = 0.74, I2 = 88%; 2 studies, 371 participants; very low-certainty evidence), nor hemorrhage (RR 1.23, 95% CI 0.47 to 3.27; P = 0.67, I2 = 0%; 4 studies, 677 participants; very low-certainty evidence). We downgraded the certainty of the evidence due to the risk of bias, imprecision, and inconsistency among the studies. There were no data available on the following outcomes: systemic surgical complications, local complications, explantation of implant/expander, hematoma, seroma, rehospitalization, skin necrosis with revisional surgery, and capsular contracture of the implant. It was not possible to perform a meta-analysis for cosmetic and quality of life outcomes due to a lack of data. One study performed an evaluation of aesthetic outcome after SSM: 77.7% of participants with immediate breast reconstruction had an overall aesthetic result of excellent or good versus 87% of participants with delayed breast reconstruction. AUTHORS' CONCLUSIONS Based on very low-certainty evidence from observational studies, it was not possible to draw definitive conclusions on the effectiveness and safety of SSM for breast cancer treatment. The decision for this technique of breast surgery for treatment of DCIS or invasive breast cancer must be individualized and shared between the physician and the patient while considering the potential risks and benefits of available surgical options.
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Affiliation(s)
- Bruna S Mota
- Department of Obstetrics and Gynecology, Instituto do Câncer do Estado de São Paulo (ICESP/FMUSP), São Paulo, Brazil
| | | | - Jessica Barrett
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Marcos Desidério Ricci
- Department of Obstetrics and Gynecology, Instituto do Câncer do Estado de São Paulo (ICESP/FMUSP), São Paulo, Brazil
| | - Alexandre M Munhoz
- Plastic Surgery, Instituto do Câncer do Estado de São Paulo - ICESP, São Paulo, Brazil
| | - José Roberto Filassi
- Department of Obstetrics and Gynecology, Instituto do Câncer do Estado de São Paulo (ICESP/FMUSP), São Paulo, Brazil
| | - Edmund Chada Baracat
- Department of Obstetrics and Gynecology, Instituto do Câncer do Estado de São Paulo (ICESP/FMUSP), São Paulo, Brazil
| | - Rachel Riera
- Cochrane Affiliate Rio de Janeiro, Cochrane, Petrópolis, Brazil
- Center of Health Technology Asessment, Hospital Sírio-Libanês, São Paulo, Brazil
- Núcleo de Ensino e Pesquisa em Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde (NEP-Sbeats), Universidade Federal de São Paulo, São Paulo, Brazil
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Caley LR, Zagoya C, Duckstein F, White H, Shimmin D, Jones AM, Barrett J, Whitehouse JL, Floto RA, Mainz JG, Peckham DG. Diabetes is associated with increased burden of gastrointestinal symptoms in adults with cystic fibrosis. J Cyst Fibros 2023; 22:275-281. [PMID: 36710099 DOI: 10.1016/j.jcf.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/09/2022] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Individuals with diabetes mellitus (DM) are known to frequently experience gastrointestinal (GI) symptoms. In contrast, the impact of cystic fibrosis-related diabetes (CFRD) on accentuating GI symptoms in people with cystic fibrosis (pwCF) is unknown. We sought to examine this. METHODS Abdominal symptoms were measured using the validated CF-specific GI symptom questionnaire - CFAbd-Score© - as part of a multicentre cohort study in pancreatic insufficient adults with CF, not on cystic fibrosis transmembrane conductance regulator (CFTR) modulators. The CFAbd-Score total score (0-100pts), its 5 domains, alongside nine specific GI symptoms associated with DM, were compared between the CFRD and non-CFRD groups. RESULTS 27 (31%) and 61 (69%) participants with CF were recruited in the CFRD and non-CFRD groups respectively. Total CFAbd-Score and the two domains: gastroesophageal reflux disease and disorders of appetite were significantly higher in the CFRD group compared to the non-CFRD group (p<0.05), with the mean total CFAbd-Score being 25.4 ± 2.5 and 18.4 ± 1.5 in the CFRD and non-CFRD groups respectively. Among the nine GI symptoms commonly reported as elevated in DM, bloating and nausea were significantly more common in individuals with CFRD compared to those without (p<0.05). CONCLUSIONS Individuals with CFRD overall, have a higher GI symptom burden, according to CFAbd-Scores. Specifically, they experience significantly more bloating and nausea. Close monitoring and further research is needed to better understand and manage GI symptoms in this group.
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Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research at St James's University Hospital, University of Leeds, Leeds, United Kingdom.
| | - C Zagoya
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - F Duckstein
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - H White
- Nutrition, Health & Environment, Leeds Beckett University, Leeds, United Kingdom
| | - D Shimmin
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A M Jones
- Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, United Kingdom
| | - J Barrett
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, United Kingdom
| | - J L Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS, Foundation Trust, Birmingham, United Kingdom
| | - R A Floto
- MRC-Laboratory of Molecular Biology, Molecular Immunity Unit, University of Cambridge Department of Medicine, Cambridge, United Kingdom; Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, United Kingdom
| | - J G Mainz
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany; Faculty of Health Sciences Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Germany
| | - D G Peckham
- Leeds Institute of Medical Research at St James's University Hospital, University of Leeds, Leeds, United Kingdom; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Nichols L, Taverner T, Crowe F, Richardson S, Yau C, Kiddle S, Kirk P, Barrett J, Nirantharakumar K, Griffin S, Edwards D, Marshall T. In simulated data and health records, latent class analysis was the optimum multimorbidity clustering algorithm. J Clin Epidemiol 2022; 152:164-175. [PMID: 36228971 PMCID: PMC7613854 DOI: 10.1016/j.jclinepi.2022.10.011] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the reproducibility and validity of latent class analysis (LCA) and hierarchical cluster analysis (HCA), multiple correspondence analysis followed by k-means (MCA-kmeans) and k-means (kmeans) for multimorbidity clustering. METHODS We first investigated clustering algorithms in simulated datasets with 26 diseases of varying prevalence in predetermined clusters, comparing the derived clusters to known clusters using the adjusted Rand Index (aRI). We then them investigated the medical records of male patients, aged 65 to 84 years from 50 UK general practices, with 49 long-term health conditions. We compared within cluster morbidity profiles using the Pearson correlation coefficient and assessed cluster stability using in 400 bootstrap samples. RESULTS In the simulated datasets, the closest agreement (largest aRI) to known clusters was with LCA and then MCA-kmeans algorithms. In the medical records dataset, all four algorithms identified one cluster of 20-25% of the dataset with about 82% of the same patients across all four algorithms. LCA and MCA-kmeans both found a second cluster of 7% of the dataset. Other clusters were found by only one algorithm. LCA and MCA-kmeans clustering gave the most similar partitioning (aRI 0.54). CONCLUSION LCA achieved higher aRI than other clustering algorithms.
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Affiliation(s)
- Linda Nichols
- Research Fellow, Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | - Tom Taverner
- Research Fellow, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Francesca Crowe
- Lecturer in Epidemiology and Health Informatics, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Sylvia Richardson
- Emeritus Director, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Christopher Yau
- Professor of Artificial Intelligence, Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Steven Kiddle
- Director, Health Data Science, AstraZeneca, 1 Francis Crick Avenue, Cambridge, Biomedical Campus, Cambridge, CB2 0AA, UK
| | - Paul Kirk
- MRC Investigator, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Jessica Barrett
- MRC Investigator, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Krishnarajah Nirantharakumar
- Professor of Public Health and Health Informatics, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Simon Griffin
- Professor of General Practice, Primary Care Unit, Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN, UK
| | - Duncan Edwards
- Senior Clinical Research Associate, Primary Care Unit, Primary Care Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Tom Marshall
- Professor of Public Health and Primary Care, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK.
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Shaikh M, Dawson A, Gazala W, Zeng P, Barrett J, Nichols A. O3.2 Loss of LRP1B expression drives chemo and radiation resistance in HPV-positive head and neck cancer. Oral Oncol 2022. [DOI: 10.1016/j.oraloncology.2022.106176] [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: 11/11/2022]
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McCormick E, Brown J, Barrett J, Campbell C, Creer D, Cropley I, Lowe D, Moores R, Lipman M. Cutaneous adverse drug reactions to fixed-dose combination treatments for TB. Int J Tuberc Lung Dis 2022; 26:886-887. [PMID: 35996277 DOI: 10.5588/ijtld.22.0202] [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: 11/10/2022] Open
Affiliation(s)
- E McCormick
- North Central London Tuberculosis Service, Whittington Hospital NHS Trust, London, UK
| | - J Brown
- Department of Respiratory Medicine, University College London, Royal Free Campus, London, 6UCL Respiratory, University College London, London, UK
| | - J Barrett
- North Central London Tuberculosis Service, Whittington Hospital NHS Trust, London, UK
| | - C Campbell
- North Central London Tuberculosis Service, Whittington Hospital NHS Trust, London, UK
| | - D Creer
- Department of Respiratory Medicine, University College London, Royal Free Campus, London, 6UCL Respiratory, University College London, London, UK
| | - I Cropley
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, University College London, Royal Free Campus, London, 6UCL Respiratory, University College London, London, UK
| | - D Lowe
- Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK, Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UK
| | - R Moores
- Department of Infectious Diseases, Royal Free London NHS Foundation Trust, London, University College London, Royal Free Campus, London, 6UCL Respiratory, University College London, London, UK
| | - M Lipman
- Department of Respiratory Medicine, University College London, Royal Free Campus, London, 6UCL Respiratory, University College London, London, UK, UCL Respiratory, University College London, London, UK
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Xu Z, Arnold M, Sun L, Stevens D, Chung R, Ip S, Barrett J, Kaptoge S, Pennells L, Di Angelantonio E, Wood AM. Incremental value of risk factor variability for cardiovascular risk prediction in individuals with type 2 diabetes: results from UK primary care electronic health records. Int J Epidemiol 2022; 51:1813-1823. [PMID: 35776101 PMCID: PMC9749723 DOI: 10.1093/ije/dyac140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/17/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) risk prediction models for individuals with type 2 diabetes are important tools to guide intensification of interventions for CVD prevention. We aimed to assess the added value of incorporating risk factors variability in CVD risk prediction for people with type 2 diabetes. METHODS We used electronic health records (EHRs) data from 83 910 adults with type 2 diabetes but without pre-existing CVD from the UK Clinical Practice Research Datalink for 2004-2017. Using a landmark-modelling approach, we developed and validated sex-specific Cox models, incorporating conventional predictors and trajectories plus variability of systolic blood pressure (SBP), total and high-density lipoprotein (HDL) cholesterol, and glycated haemoglobin (HbA1c). Such models were compared against simpler models using single last observed values or means. RESULTS The standard deviations (SDs) of SBP, HDL cholesterol and HbA1c were associated with higher CVD risk (P < 0.05). Models incorporating trajectories and variability of continuous predictors demonstrated improvement in risk discrimination (C-index = 0.659, 95% CI: 0.654-0.663) as compared with using last observed values (C-index = 0.651, 95% CI: 0.646-0.656) or means (C-index = 0.650, 95% CI: 0.645-0.655). Inclusion of SDs of SBP yielded the greatest improvement in discrimination (C-index increase = 0.005, 95% CI: 0.004-0.007) in comparison to incorporating SDs of total cholesterol (C-index increase = 0.002, 95% CI: 0.000-0.003), HbA1c (C-index increase = 0.002, 95% CI: 0.000-0.003) or HDL cholesterol (C-index increase= 0.003, 95% CI: 0.002-0.005). CONCLUSION Incorporating variability of predictors from EHRs provides a modest improvement in CVD risk discrimination for individuals with type 2 diabetes. Given that repeat measures are readily available in EHRs especially for regularly monitored patients with diabetes, this improvement could easily be achieved.
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Affiliation(s)
- Zhe Xu
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matthew Arnold
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Luanluan Sun
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - David Stevens
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jessica Barrett
- Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK,British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK,Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK
| | - Angela M Wood
- Corresponding author. Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, CB1 8RN, UK. E-mail:
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MD Yusof MY, Robinson J, Davies V, Wild D, Morgan M, Taylor J, El-Sherbiny Y, Morris D, Liu L, Rawstron A, Buch MH, Plant D, Cordell H, Isaacs J, Bruce IN, Emery P, Barton A, Vyse T, Barrett J, Vital E, Morgan A. OP0190 COMPREHENSIVE GENETIC AND FUNCTIONAL ANALYSES OF Fc GAMMA RECEPTORS EXPLAIN RESPONSE TO RITUXIMAB THERAPY FOR AUTOIMMUNE RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRituximab is widely used to treat rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) but clinical response varies. Efficacy is determined by the efficiency of depletion, which may depend on a variety of Fc gamma receptor (FcγR)-dependent mechanisms. Previous research was limited by complexity of the FCGR locus, not integrating copy number variation with functional SNP, and small sample size.ObjectivesThe study objectives were to assess the effect of the full range of FcγRs variants on depletion, clinical response and functional effect on NK-cell-mediated killing in two rheumatic diseases with a view to personalised B-cell depleting therapies.MethodsA prospective longitudinal cohort study was conducted in 873 patients [RA=611; SLE=262] from four cohorts (BSRBR-RA and BILAG-BR registries, Leeds RA and Leeds SLE Biologics). For RA, the outcome measures were 3C-DAS28CRP and 2C-DAS28CRP at 6 (+/-3) months post-rituximab (adjusted for baseline DAS28). For SLE, major clinical response (MCR) was defined as improvement of active BILAG-2004 domains to grade C/better at 6 months. B-cell depletion was evaluated by highly-sensitive flow cytometry. Qualitative and quantitative polymorphisms for five major FcγRs were measured using a commercial multiplex ligation-dependent probe amplification. Median NK cell FcγRIIIa expression (CD3-CD56+CD16+) and NK-cell degranulation (CD107a) in the presence of rituximab-coated Daudi/Raji B-cell lines were assessed using flow cytometry.ResultsIn RA, for FCGR3A, carriage of V allele (coefficient -0.25 (SE 0.11); p=0.02) and increased copies of V allele (-0.20 (0.09); p=0.02) were associated with greater 2C-DAS28 response. Irrespective of FCGR3A genotype, increased gene copies were associated with a better response. In SLE, 177/262 (67.6%) achieved BILAG response [MCR=34.4%; Partial=33.2%]. MCR was associated with increased copies of FCGR3A-158V allele, OR 1.64 (95% CI 1.12-2.41) and FCGR2C-ORF allele 1.93 (1.09-3.40). Of patients with B-cells data in the combined cohort, 236/413 (57%) achieved complete depletion post-rituximab. Only homozygosity for FCGR3A-158V and increased FCGR3A-158V copy number were associated with increased odds of complete depletion. Patients with complete depletion had higher NK cell FcγRIIIa expression at rituximab initiation than those with incomplete depletion (p=0.04) and this higher expression was associated with improved EULAR response in RA. Moreover, for FCGR3A, degranulation activity was increased in V allele carriers vs FF genotype in the combined cohort; p=0.02.ConclusionFcγRIIIa is the major low affinity FcγR and increased copies of the FCGR3A-158V allele, encoding the allotype with a higher affinity for IgG1, was associated with clinical and biological responses to rituximab in two autoimmune diseases. This was supported by functional data on NK cell-mediated cytotoxicity. In SLE, increased copies of the FCGR2C-ORF allele was also associated with improved response. Our findings indicate that enhancing FcγR-effector functions could improve the next generation of CD20-depleting therapies and genotyping could stratify patients for optimal treatment protocols.ReferencesNoneAcknowledgementsThis research was funded/supported by the joint funding from the Medical Research Council (MRC) and Versus Arthritis of MATURA (grant codes 36661 and MR/K015346/1). MASTERPLANS was funded by the MRC (grant code MR/M01665X/1). The Leeds Biologics Cohort was part funded by programme grants from Versus Arthritis (grant codes 18475 and 18387), the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC) and Diagnostic Evaluation Co-operative and the Ann Wilks Charitable Foundation. The BILAG-BR has received funding support from Lupus UK, and unrestricted grants from Roche and GSK.The functional studies were in part supported through a NIHR/HEFCE Clinical Senior Lectureship and a Versus Arthritis Foundation Fellowship (grant code 19764) to AWM, the Wellcome Trust Institutional Strategic Support Fund to JIR and MYMY (204825/Z/16/Z), NIHR Doctoral Research Fellowship to MYMY (DRF-2014-07-155) and NIHR Clinician Scientist to EMV (CS-2013-13-032). . AWM, INB, JDI and PE were supported by NIHR Senior Investigator awards. Work in JDI’s laboratory is supported by the NIHR Newcastle BRC, the Research Into Inflammatory Arthritis Centre Versus Arthritis, and Rheuma Tolerance for Cure (European Union Innovative Medicines Initiative 2, grant number 777357). INB is funded by the NIHR Manchester BRC.This article/paper/report presents independent research funded/supported by the NIHR Leeds BRC and the NIHR Guy’s and St Thomas’ BRC. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.Disclosure of InterestsMd Yuzaiful Md Yusof: None declared, James Robinson: None declared, Vinny Davies: None declared, Dawn Wild: None declared, Michael Morgan: None declared, John Taylor: None declared, Yasser El-Sherbiny: None declared, David Morris: None declared, Lu Liu: None declared, Andrew Rawstron: None declared, Maya H Buch: None declared, Darren Plant: None declared, Heather Cordell: None declared, John Isaacs: None declared, Ian N. Bruce: None declared, Paul Emery Speakers bureau: Roche, Consultant of: Roche, Grant/research support from: Roche, Anne Barton: None declared, Timothy Vyse: None declared, Jennifer Barrett: None declared, Edward Vital Consultant of: Roche, Grant/research support from: Roche, Ann Morgan Speakers bureau: Roche/Chugai, Consultant of: GSK, Roche, Chugai, AstraZeneka, Regeneron, Sanofi, Vifor, Grant/research support from: Roche, Kiniksa Pharmaceuticals
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William Goodall J, James Patterson B, Barrett J, Colquhoun M, Williamson S, Clayton-Smith A, Koh G, Corrah T. A comparison of tuberculous and bacterial native joint septic arthritis infections in a retrospective cohort: presentation characteristics, outcomes and long term follow up. Clinical Infection in Practice 2022. [DOI: 10.1016/j.clinpr.2022.100138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Barrett J. Why are people still dying from TB in low-burden countries? Int J Tuberc Lung Dis 2022; 26:91-92. [PMID: 35086618 DOI: 10.5588/ijtld.21.0680] [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: 11/10/2022] Open
Affiliation(s)
- J Barrett
- London North West University Healthcare, Harrow, UK
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Jeanselme V, Tom B, Barrett J. Neural Survival Clustering: Non-parametric mixture of neural networks for survival clustering. Proc Mach Learn Res 2022; 174:92-102. [PMID: 35464190 PMCID: PMC7612649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Survival analysis involves the modelling of the times to event. Proposed neural network approaches maximise the predictive performance of traditional survival models at the cost of their interpretability. This impairs their applicability in high stake domains such as medicine. Providing insights into the survival distributions would tackle this issue and advance the medical understanding of diseases. This paper approaches survival analysis as a mixture of neural baselines whereby different baseline cumulative hazard functions are modelled using positive and monotone neural networks. The efficiency of the solution is demonstrated on three datasets while enabling the discovery of new survival phenotypes.
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Affiliation(s)
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, UK
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Jeanselme V, De-Arteaga M, Zhang Z, Barrett J, Tom B. Imputation Strategies Under Clinical Presence: Impact on Algorithmic Fairness. Proc Mach Learn Res 2022; 193:12-34. [PMID: 36601036 PMCID: PMC7614014] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Biases have marked medical history, leading to unequal care affecting marginalised groups. The patterns of missingness in observational data often reflect these group discrepancies, but the algorithmic fairness implications of group-specific missingness are not well understood. Despite its potential impact, imputation is too often an overlooked preprocessing step. When explicitly considered, attention is placed on overall performance, ignoring how this preprocessing can reinforce groupspecific inequities. Our work questions this choice by studying how imputation affects downstream algorithmic fairness. First, we provide a structured view of the relationship between clinical presence mechanisms and groupspecific missingness patterns. Then, through simulations and real-world experiments, we demonstrate that the imputation choice influences marginalised group performance and that no imputation strategy consistently reduces disparities. Importantly, our results show that current practices may endanger health equity as similarly performing imputation strategies at the population level can affect marginalised groups differently. Finally, we propose recommendations for mitigating inequities that may stem from a neglected step of the machine learning pipeline.
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Affiliation(s)
| | - Maria De-Arteaga
- McCombs School of Business, University of Texas at Austin, Austin, USA
| | - Zhe Zhang
- Rady School of Management, University of California, San Diego, USA
| | - Jessica Barrett
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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Xu Z, Arnold M, Stevens D, Kaptoge S, Pennells L, Sweeting MJ, Barrett J, Di Angelantonio E, Wood AM. Prediction of Cardiovascular Disease Risk Accounting for Future Initiation of Statin Treatment. Am J Epidemiol 2021; 190:2000-2014. [PMID: 33595074 PMCID: PMC8485151 DOI: 10.1093/aje/kwab031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease (CVD) risk-prediction models are used to identify high-risk individuals and guide statin initiation. However, these models are usually derived from individuals who might initiate statins during follow-up. We present a simple approach to address statin initiation to predict “statin-naive” CVD risk. We analyzed primary care data (2004–2017) from the UK Clinical Practice Research Datalink for 1,678,727 individuals (aged 40–85 years) without CVD or statin treatment history at study entry. We derived age- and sex-specific prediction models including conventional risk factors and a time-dependent effect of statin initiation constrained to 25% risk reduction (from trial results). We compared predictive performance and measures of public-health impact (e.g., number needed to screen to prevent 1 event) against models ignoring statin initiation. During a median follow-up of 8.9 years, 103,163 individuals developed CVD. In models accounting for (versus ignoring) statin initiation, 10-year CVD risk predictions were slightly higher; predictive performance was moderately improved. However, few individuals were reclassified to a high-risk threshold, resulting in negligible improvements in number needed to screen to prevent 1 event. In conclusion, incorporating statin effects from trial results into risk-prediction models enables statin-naive CVD risk estimation and provides moderate gains in predictive ability but had a limited impact on treatment decision-making under current guidelines in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Angela M Wood
- Correspondence to Dr. Angela M. Wood, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, United Kingdom (e-mail: )
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Verma R, Chandarana M, Barrett J, Anandadas C, Sundara Rajan S. Post-mastectomy radiotherapy for women with early breast cancer and one to three positive lymph nodes. Hippokratia 2021. [DOI: 10.1002/14651858.cd014463] [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: 11/09/2022]
Affiliation(s)
| | | | - Jessica Barrett
- MRC Biostatistics Unit; University of Cambridge; Cambridge UK
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Estave PM, Jacobs ML, Rukstalis M, Goforth J, Stone SN, Choi JA, Barrett J, Douglas HE, Oliver JB, Keating MK, Freischlag JA, O'Brien MC, McEwen S, Strowd RE. Opioid stewardship training during the transition to residency to prepare medical students to recognize and treat opioid use disorder. Subst Abus 2021; 42:1040-1048. [PMID: 34236292 DOI: 10.1080/08897077.2021.1915918] [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: 10/20/2022]
Abstract
Background: With a drastic shortage of addiction medicine specialists-and an ever-growing number of patients with opioid use disorder (OUD)-there is a dire need for more clinicians to feel confident in prevention and management of OUD and obtain a DEA-X waiver to prescribe medications to treat OUD. Here we determine if it is feasible to certify 4th year medical students with DEA-X waiver training as a component of the PROUD (Prevent and Reduce Opioid Use Disorder) curriculum, and if PROUD enhanced preparedness for medical students to manage OUD as interns. Methods: We implemented a sequential mixed-methods IRB approved study to assess feasibility (completing all required components of DEA-X waiver training) and impact of PROUD (measured by knowledge growth, enhancement for residency, and utilization of training during internship). Students completed 11 hours of required OUD training. Quantitative data included pre-/post- knowledge and curriculum satisfaction assessments as well as long-term impact with follow up survey as interns. Qualitative data was collected by survey and semi-structured focus groups. Results: All 120 graduating medical students completed the required components of the curriculum. Knowledge improved on the Provider Clinical Support Services (12.9-17.3, p < 0.0001) and Brief Opioid Overdose Knowledge assessments (10.15-10.81, p < 0.0001). Course satisfaction was high: 90% recommended online modules; 85% recommended training overall. Six qualitative themes emerged: (1) curriculum content was practical, (2) online modules allowed flexibility, (3) in-person seminars ensured authenticity, (4) timing at the transition to residency was optimal, (5) curriculum enhanced awareness and confidence, and (6) training was applicable to future careers. At 3 months, 60% reported using their training during internship; 64% felt more prepared to treat OUD than peers. Conclusions: PROUD trained 4th year medical students in opioid stewardship. As interns, students felt ready to serve as change agents to prevent, diagnose, and treat OUD.
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Affiliation(s)
| | | | - Margaret Rukstalis
- University of South Carolina School of Medicine and VAMC, Columbia, SC, USA
| | - Jon Goforth
- Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Shane N Stone
- Department of Physician Medicine and Rehabilitation, McGaw Medical Center, Northwestern University, Chicago, IL, USA
| | | | | | - Heather E Douglas
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Jennifer B Oliver
- Department of Anesthesia, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Michelle K Keating
- Department of Family Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Julie A Freischlag
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Mary Claire O'Brien
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Sara McEwen
- Governor's Institute on Substance Abuse, Raleigh, NC, USA
| | - Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC, USA
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20
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Cani AK, Dolce EM, Darga EP, Hu K, Brown M, Liu CJ, Pierce J, Bradbury K, Aung K, Schiavon G, Carroll D, Carr TH, Klinowska T, Lindemann J, Marshall G, Rowlands V, Harrington EA, Barrett J, Armstrong A, Baird R, Hamilton E, Im SA, Jhaveri K, Patel MR, Dive C, Tomlins SA, Udager AM, Hayes DF, Paoletti C. Abstract 3143: Monitoring circulating tumor cell (CTC) and circulating tumor DNA (ctDNA) genomic alterations in ER positive (POS)/HER2 negative (NEG) advanced breast cancer during endocrine therapy: correlative study of AZD9496 oral SERD phase I trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: The vast majority of advanced ER POS breast cancers eventually cease responding to endocrine (ET) and other therapies leading to evolution of lethal disease. However, timely monitoring of the molecular events associated with response/progression in tissue biopsies is logistically difficult. The use of liquid biopsies, such as CTC and ctDNA, in this context has been of recent interest.
Patients and Methods: Individual CTC and ctDNA were obtained at different time points from patients with advanced ER POS/HER2 NEG breast cancer enrolled in a Phase I trial of AZD9496, an oral selective estrogen receptor degrader (SERD) ET. The CTC, purified using tandem CellSearch®/DepArray™ technologies, were genomically profiled by DNA single cell next generation sequencing (scNGS). Plasma ctDNA was isolated from blood collected in Streck BCT tubes. Genomic profiling was performed by targeted gene panel scNGS for CTC and ddPCR for ERα gene (ESR1) mutations in ctDNA.
Results: 123 high-quality CTCs from 12 patients profiled by scNGS showed 100% concordance with ctDNA in detection of driver ESR1 somatic mutations. CTC scNGS additionally revealed extensive intra-patient heterogeneity of driver alterations, that would have been unresolvable by bulk ctDNA profiling, including separate subclonal CTC populations emerging within the same patient. ScNGS revealed potential opportunities for targeted therapies in 73% of patients, directed at alterations in PIK3CA, FGFR2, KIT and BRAF, at times present as 2 or more targets in the same or different cell populations. In one patient, an emergent, distinct, BRAF p.V600E targetable alteration was detected in a subpopulation of CTCs collected at the progression time point but not at baseline.
Conclusion: Serial monitoring of CTC and ctDNA genomic alterations is feasible and should enable real-time tracking of response/progression, tumor evolution and opportunities for precision medicine interventions.
Citation Format: Andi K. Cani, Emily M. Dolce, Elizabeth P. Darga, Kevin Hu, Martha Brown, Chia-Jen Liu, Jackie Pierce, Kieran Bradbury, Kimberly Aung, Gaia Schiavon, Danielle Carroll, T. H. Carr, Teresa Klinowska, Justin Lindemann, Gayle Marshall, Vicky Rowlands, Elizabeth A. Harrington, J. Barrett, Anne Armstrong, Richard Baird, Erika Hamilton, Seock-Ah Im, Komal Jhaveri, Manish R. Patel, Caroline Dive, Scott A. Tomlins, Aaron M. Udager, Daniel F. Hayes, Costanza Paoletti. Monitoring circulating tumor cell (CTC) and circulating tumor DNA (ctDNA) genomic alterations in ER positive (POS)/HER2 negative (NEG) advanced breast cancer during endocrine therapy: correlative study of AZD9496 oral SERD phase I trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 3143.
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Affiliation(s)
| | | | | | - Kevin Hu
- 1University of Michigan, Ann Arbor, MI
| | | | | | - Jackie Pierce
- 2CRUK Manchester Institute, Manchester, United Kingdom
| | | | | | | | | | - T. H. Carr
- 3AstraZeneca plc, Cambridge, United Kingdom
| | | | | | | | | | | | | | | | - Richard Baird
- 6Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Erika Hamilton
- 7Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
| | - Seock-Ah Im
- 8Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Komal Jhaveri
- 9Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manish R. Patel
- 10Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, FL
| | - Caroline Dive
- 2CRUK Manchester Institute, Manchester, United Kingdom
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21
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Higgins AM, Neto AS, Bailey M, Barrett J, Bellomo R, Cooper DJ, Gabbe BJ, Linke N, Myles PS, Paton M, Philpot S, Shulman M, Young M, Hodgson CL. Predictors of death and new disability after critical illness: a multicentre prospective cohort study. Intensive Care Med 2021; 47:772-781. [PMID: 34089063 DOI: 10.1007/s00134-021-06438-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to determine the prevalence and predictors of death or new disability following critical illness. METHODS Prospective, multicentre cohort study conducted in six metropolitan intensive care units (ICU). Participants were adults admitted to the ICU who received more than 24 h of mechanical ventilation. The primary outcome was death or new disability at 6 months, with new disability defined by a 10% increase in the WHODAS 2.0. RESULTS Of 628 patients with the primary outcome available (median age of 62 [49-71] years, 379 [61.0%] had a medical admission and 370 (58.9%) died or developed new disability by 6 months. Independent predictors of death or new disability included age [OR 1.02 (1.01-1.03), P = 0.001], higher severity of illness (APACHE III) [OR 1.02 (1.01-1.03), P < 0.001] and admission diagnosis. Compared to patients with a surgical admission diagnosis, patients with a cardiac arrest [OR (95% CI) 4.06 (1.89-8.68), P < 0.001], sepsis [OR (95% CI) 2.43 (1.32-4.47), P = 0.004], or trauma [OR (95% CI) 6.24 (3.07-12.71), P < 0.001] diagnosis had higher odds of death or new disability, while patients with a lung transplant [OR (95% CI) 0.21 (0.07-0.58), P = 0.003] diagnosis had lower odds. A model including these three variables had good calibration (Brier score 0.20) and acceptable discriminative power with an area under the receiver operating characteristic curve of 0.76 (95% CI 0.72-0.80). CONCLUSION Less than half of all patients mechanically ventilated for more than 24 h were alive and free of new disability at 6 months after admission to ICU. A model including age, illness severity and admission diagnosis has acceptable discriminative ability to predict death or new disability at 6 months.
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Affiliation(s)
- A M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - A Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.,Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - M Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - J Barrett
- Intensive Care Unit, Epworth Healthcare, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - R Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - D J Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - B J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - N Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - P S Myles
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Anaesthesiology and Perioperative Medicine, The Alfred, Melbourne, VIC, Australia
| | - M Paton
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Physiotherapy, Monash Health, Melbourne, VIC, Australia
| | - S Philpot
- Intensive Care Unit, Cabrini Health, Melbourne, VIC, Australia
| | - M Shulman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Anaesthesiology and Perioperative Medicine, The Alfred, Melbourne, VIC, Australia
| | - M Young
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - C L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia. .,Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
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22
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Malley T, Jackman J, Manderson S, Saldana Pena L, Evans E, Barrett J, Soni A, Luqmani R. POS0152-HPR REMOTE CLINICAL MANAGEMENT: INCORPORATING ELECTRONIC ASSESSMENT OF PATIENTS WITH RHEUMATIC DISEASES INTO STANDARD CLINICAL PATHWAYS DURING THE COVID-19 PANDEMIC: A PILOT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Many patients with rheumatic disease require immunosuppressive medication putting them at high risk of COVID-19 infection. Reduced staffing in rheumatology due to redeployment to COVID-19 work, limited out patient capacity and patient vulnerability have had a major impact on our ability to review our patients to assess their condition and treatment (by face-to-face, video or telephone consultations). Novel strategies are essential to safely and effectively treat patients with rheumatic disease whilst minimising their risk of exposure to COVID-19 infection.Objectives:The objective was to develop a digital solution to help deliver safe, efficient and effective care for patients with rheumatic diseases. The aim was to produce a system that allowed us to integrate data recorded directly by patients with information held in our electronic health records to provide a virtual review of care.Methods:An online questionnaire was used to collect clinical information, including validated disease activity measures, to conduct a remote assessment in 175 patients awaiting follow-up appointments. This assessment was integrated within our electronic health records (EHR). The questionnaire contained measures of disease activity (DAS28 or BASDAI); patient reported outcomes; patient preferences regarding the urgency and type of appointment; any recent problems or changes in medication. This information was imported into a database for clinician review, together with previous clinical records and results of relevant investigations, to inform clinical decisions and to decide on the safest and most appropriate timing for follow-up. Report letters were sent to the patient and their primary care providers.Results:Of the 175 patients (149 with RA and 26 with AS), 108 patients (89/149 [60%] with RA [mean age=64; female=65%] and 19/26 [73%] with AS [mean age=45; female=54%]) submitted responses over a 6-week period based on which clinical decisions were made. The mean questionnaire completion time was 19 minutes for RA responders and 16 minutes for AS responders. Non responders (67/175 [mean age=61; female=63%]) remained on our list of patients awaiting follow-up arrangements to be made. Sixty-nine responders (64%) had stable disease therefore did not require any changes to their treatment and were offered an appointment within the next 6 months, of whom 12 (11%) requested face-to-face follow-up. Of the remaining 39 – with less stable disease – requiring more rapid follow-up assessment, 22 patients (56%) required a face-to-face consultation to consider treatment change. So far 9 of these patients have had follow-up, of whom 6 necessitated treatment escalation (Methotrexate increase n=2; anti-inflammatory increase n=2; intramuscular steroid n=1; anti-TNF escalation n=1). Thirty-nine patients (36%) provided feedback on the process of completing the questionnaire, 85% of whom used a mobile phone and the remainder used a computer or tablet. The majority (70%) found it “extremely easy” or “somewhat easy” to complete; remaining responses: “neutral” 20%, “somewhat difficult” 10%, “extremely difficult” 0%.Conclusion:We have created and tested a system of remote clinical management for patients with RA and AS. Amongst the 108 responders, just 31% required a face-to-face appointment, with treatment changes made accordingly. With a backlog of 3,800 awaiting allocation to follow-up appointments, remote clinical management will allow us to safely and efficiently prioritise patients requiring urgent follow-up for treatment optimisation. We will integrate this system into our standard care pathway beyond the COVID-19 pandemic to streamline our service, deliver effective care and provide evidence to support the use of costly biologic drugs.1 We plan to investigate the barriers for non-responders.References:[1]Holroyd CR, Seth R, Bukhari M, et al. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis. Rheumatology. 2019; 58 (2): e3–e42.Disclosure of Interests:Tamir Malley: None declared, John Jackman: None declared, Sarah Manderson: None declared, Larissa Saldana Pena Grant/research support from: Pfizer’s Global Medical Grants program, Ellie Evans: None declared, Joe Barrett Grant/research support from: Pfizer’s Global Medical Grants program, Anushka Soni Grant/research support from: Pfizer’s Global Medical Grants program, Raashid Luqmani Grant/research support from: Pfizer’s Global Medical Grants program
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23
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Morgan C, Barrett J, Brown A, Coughlan C, Subbarao S, Abbara A, John L, Martin L, Lynn W, Russell G, Kon OM. Respiratory samples to diagnose tuberculosis in the absence of chest x-ray abnormalities. Respir Med 2021; 185:106488. [PMID: 34102593 DOI: 10.1016/j.rmed.2021.106488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/28/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The World Health Organisation states that the chest x-ray (CXR) has a 'high sensitivity for pulmonary tuberculosis (TB)' [1] and as such, is relied on worldwide as the cornerstone of screening for active pulmonary TB (pTB). METHOD This is a retrospective analysis of plain chest radiographs and microbiological yield in all patients who were diagnosed with pTB or intra-thoracic nodal tuberculosis (ITLN) in two London NHS Trusts. RESULTS Between 2011 and 2017 8% of those diagnosed with pTB and 32% with ITLN TB had normal CXR appearances in the 6 weeks preceding diagnosis. DISCUSSION Pulmomary TB was diagnosed in an additional 51 people based on CT scan and 43 people based on respiratory samples. ITLN TB was also diagnosed in a further 20 people using CT but only an extra 3 people from standard respiratory sampling. Our data suggests that CT imaging and respiratory samples should be sent on all suspected cases of pTB and ITLN TB even if the CXR is normal.
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Affiliation(s)
- Caitlin Morgan
- Imperial College London, London, UK, Tuberculosis Service.
| | - Jessica Barrett
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, London, UK
| | - Aaron Brown
- Imperial College London, London, UK, Tuberculosis Service
| | - Charles Coughlan
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, London, UK
| | | | - Aula Abbara
- Imperial College London, London, UK, Tuberculosis Service
| | - Laurence John
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, London, UK
| | - Laura Martin
- Imperial College London, London, UK, Tuberculosis Service
| | - William Lynn
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, London, UK
| | | | - Onn Min Kon
- Imperial College London, London, UK, Tuberculosis Service
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24
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Yu W, Barrett J, Liu P, Parameswaran A, Chiu ES, Lu CP. Novel evidence of androgen receptor immunoreactivity in skin tunnels of hidradenitis suppurativa: assessment of sex and individual variability. Br J Dermatol 2021; 185:855-858. [PMID: 34047363 DOI: 10.1111/bjd.20520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- W Yu
- The Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA.,Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - J Barrett
- The Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA
| | - P Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - A Parameswaran
- The Ronald O Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - E S Chiu
- The Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA
| | - C P Lu
- The Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, NY, USA.,Department of Cell Biology, New York University School of Medicine, New York, NY, USA
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25
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Hiersch L, Shah BR, Berger H, Geary M, McDonald SD, Murray-Davis B, Guan J, Halperin I, Retnakaran R, Barrett J, Melamed N. DEVELOPING twin-specific 75-g oral glucose tolerance test diagnostic thresholds for gestational diabetes based on the risk of future maternal diabetes: a population-based cohort study. BJOG 2021; 128:1975-1985. [PMID: 34032350 DOI: 10.1111/1471-0528.16773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To develop twin-specific outcome-based oral glucose tolerance test (OGTT) diagnostic thresholds for GDM based on the risk of future maternal type-2 diabetes. DESIGN A population-based retrospective cohort study (2007-2017). SETTING Ontario, Canada. METHODS Nulliparous women with a live singleton (n = 55 361) or twin (n = 1308) birth who underwent testing for gestational diabetes mellitus (GDM) using a 75-g OGTT in Ontario, Canada (2007-2017). We identified the 75-g OGTT thresholds in twin pregnancies that were associated with similar incidence rates of future type-2 diabetes to those associated with the standard OGTT thresholds in singleton pregnancies. RESULTS For any given 75-g OGTT value, the incidence rate of future maternal type-2 diabetes was lower for women with a twin than women with a singleton pregnancy. Using women with a negative OGTT as reference, the risk of future maternal type-2 diabetes in twin pregnancies with a positive OGTT based on the standard OGTT thresholds (9.86 per 1000 person years, adjusted hazard ratio (aHR) 4.79, 95% CI 2.69-8.51) was lower than for singleton pregnancies with a positive OGTT (18.74 per 1000 person years, aHR 8.22, 95% CI 7.38-9.16). The twin-specific OGTT fasting, 1-hour and 2-hour thresholds identified in the current study based on correlation with future maternal type-2 diabetes were 5.8 mmol/l (104 mg/dl), 11.8 mmol/l (213 mg/dl) and 10.4 mmol/l (187 mg/dl), respectively. CONCLUSIONS We identified potential twin-specific OGTT thresholds for GDM that are associated with a similar risk of future type-2 diabetes to that observed in women diagnosed with GDM in singleton pregnancies based on standard OGTT thresholds. TWEETABLE ABSTRACT Potential twin-specific OGTT thresholds for GDM were identified.
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Affiliation(s)
- L Hiersch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.,Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B R Shah
- Department of Medicine and Institute for Health Policy, Management and Evaluation, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Division of Endocrinology, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
| | - H Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - M Geary
- Rotunda Hospital, Dublin, Ireland
| | - S D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - B Murray-Davis
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - J Guan
- ICES, Toronto, ON, Canada
| | - I Halperin
- Department of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - R Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Endocrinology, University of Toronto, Toronto, ON, Canada
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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26
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Yu W, Marohn M, Lin M, Barrett J, Chiu E, Lu C. 030 Defining adaptive and innate immune cell profiles in Hidradenitis Suppurativa at the single cell resolution. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Barrett J, Painter H, Rajgopal A, Keane D, John L, Papineni P, Whittington A. Increase in disseminated TB during the COVID-19 pandemic. Int J Tuberc Lung Dis 2021; 25:160-166. [PMID: 33656432 DOI: 10.5588/ijtld.20.0846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- J Barrett
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, UK
| | - H Painter
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, UK
| | - A Rajgopal
- Faculty of Medicine, Imperial College London, London, UK
| | - D Keane
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, UK
| | - L John
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, UK
| | - P Papineni
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, UK
| | - A Whittington
- Department of Infectious Diseases, London North West University Healthcare NHS Trust, Northwick Park Hospital, London, UK
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28
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McClure ME, Zhu Y, Smith RM, Gopaluni S, Tieu J, Pope T, Kristensen KE, Jayne DRW, Barrett J, Jones RB. Long-term maintenance rituximab for ANCA-associated vasculitis: relapse and infection prediction models. Rheumatology (Oxford) 2021; 60:1491-1501. [PMID: 33141217 PMCID: PMC7937025 DOI: 10.1093/rheumatology/keaa541] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Following a maintenance course of rituximab (RTX) for ANCA-associated vasculitis (AAV), relapses occur on cessation of therapy, and further dosing is considered. This study aimed to develop relapse and infection risk prediction models to help guide decision making regarding extended RTX maintenance therapy. METHODS Patients with a diagnosis of AAV who received 4-8 grams of RTX as maintenance treatment between 2002 and 2018 were included. Both induction and maintenance doses were included; most patients received standard departmental protocol consisting of 2× 1000 mg 2 weeks apart, followed by 1000 mg every 6 months for 2 years. Patients who continued on repeat RTX dosing long-term were excluded. Separate risk prediction models were derived for the outcomes of relapse and infection. RESULTS A total of 147 patients were included in this study with a median follow-up of 63 months [interquartile range (IQR): 34-93]. Relapse: At time of last RTX, the model comprised seven predictors, with a corresponding C-index of 0.54. Discrimination between individuals using this model was not possible; however, discrimination could be achieved by grouping patients into low- and high-risk groups. When the model was applied 12 months post last RTX, the ability to discriminate relapse risk between individuals improved (C-index 0.65), and once again, clear discrimination was observed between patients from low- and high-risk groups. Infection: At time of last RTX, five predictors were retained in the model. The C-index was 0.64 allowing discrimination between low and high risk of infection groups. At 12 months post RTX, the C-index for the model was 0.63. Again, clear separation of patients from two risk groups was observed. CONCLUSION While our models had insufficient power to discriminate risk between individual patients they were able to assign patients into risk groups for both relapse and infection. The ability to identify risk groups may help in decisions regarding the potential benefit of ongoing RTX treatment. However, we caution the use of these prediction models until prospective multi-centre validation studies have been performed.
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Affiliation(s)
- Mark E McClure
- Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Yajing Zhu
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Rona M Smith
- Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Seerapani Gopaluni
- Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Joanna Tieu
- Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Tasneem Pope
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Karl Emil Kristensen
- Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
| | - David R W Jayne
- Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Jessica Barrett
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Rachel B Jones
- Vasculitis and Lupus Clinic, Addenbrooke’s Hospital, Cambridge University Hospitals, Cambridge, UK
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Stratulat V, Melamed N, Barrett J, Nevo O, Hack K, Ronzoni S. Validation of upsilon (Y) zone as pathognomonic ultrasound landmark for chorionicity and amnionicity in triplet pregnancy at any gestational age. Ultrasound Obstet Gynecol 2021; 57:501-503. [PMID: 33258522 DOI: 10.1002/uog.23562] [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] [Received: 09/27/2020] [Revised: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Affiliation(s)
- V Stratulat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Departments of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - O Nevo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - K Hack
- Departments of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - S Ronzoni
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Gupta-Wright A, Macleod CK, Barrett J, Filson SA, Corrah T, Parris V, Sandhu G, Harris M, Tennant R, Vaid N, Takata J, Duraisingham S, Gandy N, Chana H, Whittington A, McGregor A, Papineni P. False-negative RT-PCR for COVID-19 and a diagnostic risk score: a retrospective cohort study among patients admitted to hospital. BMJ Open 2021; 11:e047110. [PMID: 33563629 PMCID: PMC7874904 DOI: 10.1136/bmjopen-2020-047110] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To describe the characteristics and outcomes of patients with a clinical diagnosis of COVID-19 and false-negative SARS-CoV-2 reverse transcription-PCR (RT-PCR), and develop and internally validate a diagnostic risk score to predict risk of COVID-19 (including RT-PCR-negative COVID-19) among medical admissions. DESIGN Retrospective cohort study. SETTING Two hospitals within an acute NHS Trust in London, UK. PARTICIPANTS All patients admitted to medical wards between 2 March and 3 May 2020. OUTCOMES Main outcomes were diagnosis of COVID-19, SARS-CoV-2 RT-PCR results, sensitivity of SARS-CoV-2 RT-PCR and mortality during hospital admission. For the diagnostic risk score, we report discrimination, calibration and diagnostic accuracy of the model and simplified risk score and internal validation. RESULTS 4008 patients were admitted between 2 March and 3 May 2020. 1792 patients (44.8%) were diagnosed with COVID-19, of whom 1391 were SARS-CoV-2 RT-PCR positive and 283 had only negative RT-PCRs. Compared with a clinical reference standard, sensitivity of RT-PCR in hospital patients was 83.1% (95% CI 81.2%-84.8%). Broadly, patients with false-negative RT-PCR COVID-19 and those confirmed by positive PCR had similar demographic and clinical characteristics but lower risk of intensive care unit admission and lower in-hospital mortality (adjusted OR 0.41, 95% CI 0.27-0.61). A simple diagnostic risk score comprising of age, sex, ethnicity, cough, fever or shortness of breath, National Early Warning Score 2, C reactive protein and chest radiograph appearance had moderate discrimination (area under the receiver-operator curve 0.83, 95% CI 0.82 to 0.85), good calibration and was internally validated. CONCLUSION RT-PCR-negative COVID-19 is common and is associated with lower mortality despite similar presentation. Diagnostic risk scores could potentially help triage patients requiring admission but need external validation.
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Affiliation(s)
- Ankur Gupta-Wright
- Institute for Global Health, University College London, London, UK
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Colin Kenneth Macleod
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Jessica Barrett
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Sarah Ann Filson
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Tumena Corrah
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Victoria Parris
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Gurjinder Sandhu
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Miriam Harris
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Rachel Tennant
- Department of Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Nidhi Vaid
- Department of Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Junko Takata
- Department of Elderly Care, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Sai Duraisingham
- Department of Elderly Care, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Nemi Gandy
- Department of Radiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Harmeet Chana
- Department of Radiology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Ashley Whittington
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Alastair McGregor
- Department of Infectious Diseases, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Padmasayee Papineni
- Department of Infectious Diseases, Ealing Hospital, London North West University Healthcare NHS Trust, London, UK
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Shinar S, Xing W, Pruthi V, Jianping C, Slaghekke F, Groene S, Lopriore E, Lewi L, Couck I, Yinon Y, Batsry L, Raio L, Amylidi-Mohr S, Baud D, Kneuss F, Dekoninck P, Moscou J, Barrett J, Melamed N, Ryan G, Sun L, Van Mieghem T. Outcome of monochorionic twin pregnancy complicated by Type-III selective intrauterine growth restriction. Ultrasound Obstet Gynecol 2021; 57:126-133. [PMID: 33073883 DOI: 10.1002/uog.23515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/15/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Type-III selective intrauterine growth restriction (sIUGR) is associated with a high and unpredictable risk of fetal death and fetal brain injury. The objective of this study was to describe the prospective risk of fetal death and the risk of adverse neonatal outcome in a cohort of twin pregnancies complicated by Type-III sIUGR and treated according to up-to-date guidelines. METHODS We reviewed retrospectively all monochorionic diamniotic twin pregnancies complicated by Type-III sIUGR managed at nine fetal centers over a 12-year period. Higher-order multiple gestations and pregnancies with major fetal anomalies or other monochorionicity-related complications at initial presentation were excluded. Data on fetal and neonatal outcomes were collected and management strategies reviewed. Composite adverse neonatal outcome was defined as neonatal death, invasive ventilation beyond the resuscitation period, culture-proven sepsis, necrotizing enterocolitis requiring treatment, intraventricular hemorrhage Grade > I, retinopathy of prematurity Stage > II or cystic periventricular leukomalacia. The prospective risk of intrauterine death (IUD) and the risk of neonatal complications according to gestational age were evaluated. RESULTS We collected data on 328 pregnancies (656 fetuses). After exclusion of pregnancies that underwent selective reduction (n = 18 (5.5%)), there were 51/620 (8.2%) non-iatrogenic IUDs in 35/310 (11.3%) pregnancies. Single IUD occurred in 19/328 (5.8%) pregnancies and double IUD in 16/328 (4.9%). The prospective risk of non-iatrogenic IUD per fetus declined from 8.1% (95% CI, 5.95-10.26%) at 16 weeks, to less than 2% (95% CI, 0.59-2.79%) after 28.4 weeks and to less than 1% (95% CI, -0.30 to 1.89%) beyond 32.6 weeks. In otherwise uncomplicated pregnancies with Type-III sIUGR, delivery was generally planned at 32 weeks, at which time the risk of composite adverse neonatal outcome was 29.0% (31/107 neonates). In twin pregnancies that continued to 34 weeks, there was a very low risk of IUD (0.7%) and a low risk of composite adverse neonatal outcome (11%). CONCLUSIONS In this cohort of twin pregnancies complicated by Type-III sIUGR and treated at several tertiary fetal centers, the risk of fetal death was lower than that reported previously. Further efforts should be directed at identifying predictors of fetal death and optimal antenatal surveillance strategies to select a cohort of pregnancies that can continue safely beyond 33 weeks' gestation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Shinar
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Xing
- Fetal Medicine Unit &Prenatal Diagnosis Center, Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - V Pruthi
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - C Jianping
- Fetal Medicine Unit &Prenatal Diagnosis Center, Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - F Slaghekke
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Groene
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - I Couck
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Y Yinon
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - L Batsry
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - L Raio
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - S Amylidi-Mohr
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - D Baud
- Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - F Kneuss
- Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - P Dekoninck
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Moscou
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - G Ryan
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - L Sun
- Fetal Medicine Unit &Prenatal Diagnosis Center, Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - T Van Mieghem
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Marsden K, Patel N, Rashid R, Whitehouse J, Barrett J. P176 The benefits of changing to a cystic fibrosis-specific combined fatsoluble vitamin supplement: vitamin status, tablet burden and adherence. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01202-9] [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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McClymont E, Fell D, Albert A, Alton G, Barrett J, El-Chaar D, Harrold J, Krajden M, Lipsky N, Maan E, Malinowski A, Othman M, Raeside A, Ray J, Roberts A, Ryan G, Sadarangani M, Sauve L, van Schalkwyk J, Shah P, Snelgrove J, Sprague A, Ting J, Walker M, Whittle W, Williams C, Yudin M, Zipursky J, Abenhaim H, Boucoiran I, Castillo E, Crane J, Elwood C, Joynt C, Kotaska A, Martel J, Murphy-Kaulbeck L, Poliquin V, Ryan S, Saunders S, Scott H, Money D. Canadian surveillance of COVID-19 in pregnancy: Epidemiology and maternal and infant outcomes. Am J Obstet Gynecol 2020. [PMCID: PMC7683302 DOI: 10.1016/j.ajog.2020.08.137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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VanderMeulen H, Strauss R, Lin Y, McLeod A, Barrett J, Sholzberg M, Callum J. Correction to: The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study. BMC Pregnancy Childbirth 2020; 20:230. [PMID: 32303200 PMCID: PMC7165365 DOI: 10.1186/s12884-020-02932-w] [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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Calvert FL, Deane FP, Barrett J. Supervisees' experiences of a metacommunication intervention in clinical supervision. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12199] [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: 11/28/2022]
Affiliation(s)
- Fiona L. Calvert
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia,
| | - Frank P. Deane
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia,
| | - Jessica Barrett
- Discipline of Clinical Psychology, University of Technology Sydney, Ultimo, New South Wales, Australia,
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Barrett J, Gonsalvez CJ, Shires A. Evidence‐based practice within supervision during psychology practitioner training: A systematic review. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jessica Barrett
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia,
| | - Craig J. Gonsalvez
- School of Social Sciences & Psychology, Western Sydney University, Penrith, New South Wales, Australia,
| | - Alice Shires
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia,
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Melamed N, Murphy K, Barrett J, Asztalos E, McDonald SD, Yoon EW, Shah PS. Benefit of antenatal corticosteroids by year of birth among preterm infants in Canada during 2003-2017: a population-based cohort study. BJOG 2020; 128:521-531. [PMID: 32936996 DOI: 10.1111/1471-0528.16511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the changes in the associations of antenatal corticosteroids (ACS) with neonatal mortality and severe neurological injury over time (2003-17). DESIGN National, population-representative, retrospective cohort study. SETTING Level III neonatal intensive care units participating in the Canadian Neonatal Network. POPULATION All infants born at 230/7 -336/7 weeks of gestation (n = 43 456). METHODS We estimated the associations between exposure to ACS and neonatal outcomes by year of birth. Year of birth was considered both continuously and categorically as three consecutive epochs. MAIN OUTCOME MEASURE Neonatal mortality and severe neurological injury. RESULTS The absolute rates of neonatal mortality and severe neurological injury decreased during the study period in both the ACS and No ACS groups. For infants born at 230/7 -306/7 weeks of gestation, ACS was associated with similar reductions in neonatal mortality across the three epochs (9.0% versus 18.1%, adjusted relative risk [aRR] 0.54, 95% CI 0.47-0.61 in 2003-09; 7.6% versus 19.6%, aRR 0.51, 95% CI 0.44-0.59 in 2010-13; and 7.3% versus 14.5%, aRR 0.56, 95% CI 0.46-0.68 in 2014-17) and in severe neurological injury (13.2% versus 25.8%, aRR 0.57, 95% CI 0.50-0.64 in 2003-09; 7.4% versus 17.4%, aRR 0.53, 95% CI 0.43-0.66 in 2010-14; and 7.2% versus 14.8%, aRR 0.59, 95% CI 0.48-0.74 in 2014-17). CONCLUSION Despite the ongoing improvements in neonatal care of preterm infants, as reflected by the gradual decrease in the absolute rates of neonatal mortality and severe neurological injury, the association of ACS treatment with neonatal mortality and severe neurological injury among extremely preterm infants born at 23-30 weeks of gestation has remained stable throughout the study period of 15 years. TWEETABLE ABSTRACT Despite the gradual decrease in the rates of neonatal mortality and severe neurological injury, antenatal corticosteroids remain an important intervention in the current era of neonatal care.
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Affiliation(s)
- N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - K Murphy
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - E Asztalos
- Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - S D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynaecology, Radiology, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - E W Yoon
- Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - P S Shah
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
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Rosen H, Stratulat V, Aviram A, Melamed N, Barrett J, Glanc P. Mid-trimester cervical consistency index measurement and prediction of preterm birth before 34 and 37 weeks in twin pregnancy. Ultrasound Obstet Gynecol 2020; 56:626-628. [PMID: 31762115 DOI: 10.1002/uog.21927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Affiliation(s)
- H Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - V Stratulat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - A Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - P Glanc
- Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Davis R, Day A, Barrett J, Vanlint A, Andrews JM, Costello SP, Bryant RV. Habitual dietary fibre and prebiotic intake is inadequate in patients with inflammatory bowel disease: findings from a multicentre cross‐sectional study. J Hum Nutr Diet 2020; 34:420-428. [DOI: 10.1111/jhn.12812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023]
Affiliation(s)
- R. Davis
- Inflammatory Bowel Disease Services The Department of Gastroenterology and Hepatology The Queen Elizabeth Hospital Woodville South SA Australia
- Discipline of Nutrition and Dietetics College of Nursing and Health Sciences Flinders University Adelaide SA Australia
| | - A. Day
- Inflammatory Bowel Disease Services The Department of Gastroenterology and Hepatology The Queen Elizabeth Hospital Woodville South SA Australia
- School of Medicine Faculty of Health Sciences University of Adelaide Adelaide SA Australia
| | - J. Barrett
- Department of Gastroenterology Monash University Central Clinical SchoolThe Alfred Centre Melbourne VIC Australia
| | - A. Vanlint
- Inflammatory Bowel Disease Services The Department of Gastroenterology and Hepatology The Queen Elizabeth Hospital Woodville South SA Australia
| | - J. M Andrews
- School of Medicine Faculty of Health Sciences University of Adelaide Adelaide SA Australia
- Inflammatory Bowel Disease Service Department of Gastroenterology and Hepatology Royal Adelaide Hospital Adelaide SA Australia
| | - S. P. Costello
- Inflammatory Bowel Disease Services The Department of Gastroenterology and Hepatology The Queen Elizabeth Hospital Woodville South SA Australia
- School of Medicine Faculty of Health Sciences University of Adelaide Adelaide SA Australia
| | - R. V. Bryant
- Inflammatory Bowel Disease Services The Department of Gastroenterology and Hepatology The Queen Elizabeth Hospital Woodville South SA Australia
- School of Medicine Faculty of Health Sciences University of Adelaide Adelaide SA Australia
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Aviram A, Quaglietta P, Warshafsky C, Zaltz A, Weiner E, Melamed N, Ng E, Barrett J, Ronzoni S. Utility of ultrasound assessment in management of pregnancies with preterm prelabor rupture of membranes. Ultrasound Obstet Gynecol 2020; 55:806-814. [PMID: 31332850 DOI: 10.1002/uog.20403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/20/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the utility of ultrasound markers in the management of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) between 23 + 0 and 33 + 6 weeks' gestation, and to assess the ability of ultrasound markers to predict adverse neonatal outcomes. METHODS This was a retrospective cohort study of all patients with PPROM between 23 + 0 and 33 + 6 weeks' gestation and latency period (PPROM to delivery) > 48 h, who delivered before 34 weeks' gestation at a tertiary referral center between 2005 and 2017. All patients underwent a non-stress test daily and an ultrasound scan twice a week for assessment of amniotic fluid volume, biophysical profile (BPP) and umbilical artery (UA) pulsatility index (PI). In patients with suspected fetal growth restriction, fetal middle cerebral artery (MCA)-PI was also assessed and the cerebroplacental ratio (CPR) calculated. The last ultrasound examination performed prior to delivery was analyzed. We compared the characteristics and outcomes between women who were delivered owing to clinical suspicion of chorioamnionitis and those who were not delivered for this indication. The primary objective was to evaluate the utility of ultrasound in the management of patients with PPROM. The secondary objective was to assess the diagnostic performance of ultrasound markers (BPP score < 6, oligohydramnios, UA-PI > 95th percentile, MCA-PI < 5th percentile, CPR < 5th percentile) for the prediction of composite adverse neonatal outcome, which was defined as the presence of one or more of: perinatal death, respiratory distress syndrome, periventricular leukomalacia, intraventricular hemorrhage Grade 3 or 4, necrotizing enterocolitis, hypoxic ischemic encephalopathy, neonatal sepsis or neonatal seizures. RESULTS A total of 504 women were included in the study, comprising 120 with suspected chorioamnionitis and 384 without. Women with suspected chorioamnionitis, compared with those without, were less likely to be nulliparous (34.2% vs 45.3%; P = 0.03) and more likely to have fever (50.8% vs 2.6%; P < 0.001) and be delivered by Cesarean section (69.2% vs 42.4%; P < 0.001), mainly owing to a history of previous Cesarean section (18.3% vs 9.1%; P = 0.005) and to having non-reassuring fetal heart rate tracings (32.5% vs 14.6%; P < 0.001). No significant differences were found between the two groups with regard to the median amniotic fluid volume, overall BPP score, BPP score < 6, MCA-PI or CPR. Median UA-PI was slightly higher in the suspected-chorioamnionitis group, yet the incidence of UA-PI > 95th percentile was similar between the two groups. There was a higher incidence of composite adverse neonatal outcome in the group with suspected chorioamnionitis than in the group without (78.3% vs 64.3%, respectively; P = 0.004). However, on logistic regression analysis, none of the ultrasound markers evaluated was found to be associated with chorioamnionitis or composite adverse neonatal outcome, and they all had a poor diagnostic performance for the prediction of chorioamnionitis and composite adverse neonatal outcome. CONCLUSIONS Commonly used ultrasound markers in pregnancies complicated by PPROM were similar between women delivered for suspected chorioamnionitis and those delivered for other indications, and performed poorly in predicting composite adverse neonatal outcome. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - P Quaglietta
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - C Warshafsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A Zaltz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Weiner
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Ng
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, affiliated with the Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - S Ronzoni
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, affiliated with the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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VanderMeulen H, Strauss R, Lin Y, McLeod A, Barrett J, Sholzberg M, Callum J. The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study. BMC Pregnancy Childbirth 2020; 20:196. [PMID: 32252681 PMCID: PMC7132873 DOI: 10.1186/s12884-020-02886-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 03/20/2020] [Indexed: 01/20/2023] Open
Abstract
Background Iron deficiency in pregnancy is associated with inferior maternal and fetal outcomes. Postpartum depression, prematurity, intrauterine growth restriction, impaired childhood cognition and transfusion are all sequelae of maternal iron deficiency anemia. Transfusion to women of childbearing age has important consequences including increasing the risk of hemolytic disease of the fetus and newborn with future pregnancies. The relative contribution of iron deficiency to transfusion rates in the peripartum period is unknown. This study aimed to identify the prevalence of iron deficiency and anemia in pregnant women that received peripartum transfusions relative to age-matched non-transfused controls. Methods We performed a retrospective case-control study of all women that were transfused in the peripartum period from January, 2014 to July, 2018. Cases were compared to the next age matched control to deliver at our institution. The primary objective was to determine the proportion of patients with iron deficiency in pregnancy or anemia in pregnancy in cases and controls. Charts were reviewed for predisposing risk factors for iron deficiency, laboratory measures of iron deficiency and anemia, iron supplementation history and maternal and fetal outcomes. Factors associated with peripartum transfusion were analyzed using a multivariate logistic regression. Results 169 of 18, 294 (0.9%) women were transfused in the peripartum period and 64 (44%) of those transfused received 1 unit. Iron deficiency or anemia were present in 103 (71%) transfused women and 74 (51%) control women in pregnancy (OR 2.34, 95% CI: 3.7–18.0). Multivariate analysis identified social work involvement (adjusted OR 4.1, 95% CI: 1.8–10.1), intravenous iron supplementation in pregnancy (adjusted OR 3.8, 95% CI: 1.2–17.4) and delivery by unscheduled cesarean section (adjusted OR 2.8, 95% CI: 1.3–6.2) as significant predictors of peripartum transfusion. Conclusions Pregnant women being followed by a social worker, receiving intravenous iron supplementation in pregnancy or who deliver by unscheduled cesarean section are more likely to receive a red blood cell transfusion. Women with iron deficiency or anemia in pregnancy are at increased risk of peripartum blood transfusions and warrant early and rigorous iron supplementation.
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Affiliation(s)
- H VanderMeulen
- Department of Medicine, Division of Hematology, University of Toronto, Toronto, Canada.
| | - R Strauss
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Y Lin
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - A McLeod
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - J Barrett
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - M Sholzberg
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, Toronto, Canada.,Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - J Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada. .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
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Weiner E, Barrett J, Zaltz A, Ram M, Aviram A, Kibel M, Lipworth H, Asztalos E, Melamed N. Amniotic fluid volume at presentation with early preterm prelabor rupture of membranes and association with severe neonatal respiratory morbidity. Ultrasound Obstet Gynecol 2019; 54:767-773. [PMID: 30834608 DOI: 10.1002/uog.20257] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/23/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Amniotic fluid volume (AFV) plays an important role in early fetal lung development, and oligohydramnios in early pregnancy is associated with pulmonary hypoplasia. The aim of this study was to evaluate the association between AFV at the time of presentation with early preterm prelabor rupture of membranes (PPROM) and severe neonatal respiratory morbidity and other adverse pregnancy outcomes. METHODS This was a retrospective study of all women with a singleton pregnancy, admitted to a single tertiary referral center between 2004 and 2014, for expectant management of PPROM at 20 + 0 to 28 + 6 weeks' gestation. The primary exposure was AFV at presentation, classified according to sonographic maximum vertical pocket (MVP) as: normal AFV (> 2 cm), oligohydramnios (≤ 2 cm and > 1 cm) or severe oligohydramnios (≤ 1 cm). The primary outcome was a composite variable of severe respiratory morbidity, defined as either of the following: (1) need for respiratory support in the form of mechanical ventilation using an endotracheal tube for ≥ 72 h and need for surfactant; or (2) bronchopulmonary dysplasia, defined as requirement for oxygen at postmenstrual age of 36 weeks or at the time of transfer to a Level-II facility. Adjusted odds ratios (aOR) and 95% CI for the primary and secondary outcomes were calculated for each AFV-at-presentation group (using normal AFV as the reference), adjusting for gestational age (GA) at PPROM, latency period, birth weight, mode of delivery and chorioamnionitis. RESULTS In total, 580 women were included, of whom 304 (52.4%) had normal AFV, 161 (27.8%) had oligohydramnios and 115 (19.8%) had severe oligohydramnios at presentation. The rates of severe respiratory morbidity were 16.1%, 26.7% and 45.2%, respectively. Compared with normal AFV at presentation, oligohydramnios (aOR, 3.27; 95% CI, 1.84-5.84) and severe oligohydramnios (aOR, 4.11; 95% CI, 2.26-7.56) at presentation were associated independently with severe respiratory morbidity. Other variables that were associated independently with the primary outcome were GA at PPROM (aOR, 0.54; 95% CI, 0.43-0.69), latency period (aOR, 0.94; 95% CI, 0.91-0.98) and Cesarean delivery (aOR, 2.01; 95% CI, 1.21-3.32). CONCLUSIONS In women with early PPROM, AFV at presentation, as assessed by the MVP on ultrasound examination, is associated independently with severe neonatal respiratory morbidity. This information may be taken into consideration when counseling women with early PPROM regarding neonatal outcome and management options. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Weiner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - A Zaltz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - M Ram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Kibel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - H Lipworth
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Asztalos
- Department of Newborn and Developmental Pediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Aker M, Altenmüller K, Arenz M, Babutzka M, Barrett J, Bauer S, Beck M, Beglarian A, Behrens J, Bergmann T, Besserer U, Blaum K, Block F, Bobien S, Bokeloh K, Bonn J, Bornschein B, Bornschein L, Bouquet H, Brunst T, Caldwell TS, La Cascio L, Chilingaryan S, Choi W, Corona TJ, Debowski K, Deffert M, Descher M, Doe PJ, Dragoun O, Drexlin G, Dunmore JA, Dyba S, Edzards F, Eisenblätter L, Eitel K, Ellinger E, Engel R, Enomoto S, Erhard M, Eversheim D, Fedkevych M, Felden A, Fischer S, Flatt B, Formaggio JA, Fränkle FM, Franklin GB, Frankrone H, Friedel F, Fuchs D, Fulst A, Furse D, Gauda K, Gemmeke H, Gil W, Glück F, Görhardt S, Groh S, Grohmann S, Grössle R, Gumbsheimer R, Ha Minh M, Hackenjos M, Hannen V, Harms F, Hartmann J, Haußmann N, Heizmann F, Helbing K, Hickford S, Hilk D, Hillen B, Hillesheimer D, Hinz D, Höhn T, Holzapfel B, Holzmann S, Houdy T, Howe MA, Huber A, James TM, Jansen A, Kaboth A, Karl C, Kazachenko O, Kellerer J, Kernert N, Kippenbrock L, Kleesiek M, Klein M, Köhler C, Köllenberger L, Kopmann A, Korzeczek M, Kosmider A, Kovalík A, Krasch B, Kraus M, Krause H, Kuckert L, Kuffner B, Kunka N, Lasserre T, Le TL, Lebeda O, Leber M, Lehnert B, Letnev J, Leven F, Lichter S, Lobashev VM, Lokhov A, Machatschek M, Malcherek E, Müller K, Mark M, Marsteller A, Martin EL, Melzer C, Menshikov A, Mertens S, Minter LI, Mirz S, Monreal B, Morales Guzmán PI, Müller K, Naumann U, Ndeke W, Neumann H, Niemes S, Noe M, Oblath NS, Ortjohann HW, Osipowicz A, Ostrick B, Otten E, Parno DS, Phillips DG, Plischke P, Pollithy A, Poon AWP, Pouryamout J, Prall M, Priester F, Röllig M, Röttele C, Ranitzsch PCO, Rest O, Rinderspacher R, Robertson RGH, Rodenbeck C, Rohr P, Roll C, Rupp S, Ryšavý M, Sack R, Saenz A, Schäfer P, Schimpf L, Schlösser K, Schlösser M, Schlüter L, Schön H, Schönung K, Schrank M, Schulz B, Schwarz J, Seitz-Moskaliuk H, Seller W, Sibille V, Siegmann D, Skasyrskaya A, Slezák M, Špalek A, Spanier F, Steidl M, Steinbrink N, Sturm M, Suesser M, Sun M, Tcherniakhovski D, Telle HH, Thümmler T, Thorne LA, Titov N, Tkachev I, Trost N, Urban K, Vénos D, Valerius K, VanDevender BA, Vianden R, Vizcaya Hernández AP, Wall BL, Wüstling S, Weber M, Weinheimer C, Weiss C, Welte S, Wendel J, Wierman KJ, Wilkerson JF, Wolf J, Xu W, Yen YR, Zacher M, Zadorozhny S, Zbořil M, Zeller G. Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN. Phys Rev Lett 2019; 123:221802. [PMID: 31868426 DOI: 10.1103/physrevlett.123.221802] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Indexed: 06/10/2023]
Abstract
We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9}) eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation.
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Affiliation(s)
- M Aker
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - K Altenmüller
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- IRFU (DPhP & APC), CEA, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - M Arenz
- Helmholtz-Institut für Strahlen- und Kernphysik, Rheinische Friedrich-Wilhelms-Universität Bonn, Nussallee 14-16, 53115 Bonn, Germany
| | - M Babutzka
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - J Barrett
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
| | - S Bauer
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - M Beck
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
- Institut für Physik, Johannes-Gutenberg-Universität Mainz, 55099 Mainz, Germany
| | - A Beglarian
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - J Behrens
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - T Bergmann
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - U Besserer
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - K Blaum
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - F Block
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - S Bobien
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - K Bokeloh
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - J Bonn
- Institut für Physik, Johannes-Gutenberg-Universität Mainz, 55099 Mainz, Germany
| | - B Bornschein
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - L Bornschein
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - H Bouquet
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - T Brunst
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - T S Caldwell
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - L La Cascio
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - S Chilingaryan
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - W Choi
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - T J Corona
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - K Debowski
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - M Deffert
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - M Descher
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - P J Doe
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - O Dragoun
- Nuclear Physics Institute of the CAS, v. v. i., CZ-250 68 Řež, Czech Republic
| | - G Drexlin
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - J A Dunmore
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - S Dyba
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - F Edzards
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - L Eisenblätter
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - K Eitel
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - E Ellinger
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - R Engel
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - S Enomoto
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - M Erhard
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - D Eversheim
- Helmholtz-Institut für Strahlen- und Kernphysik, Rheinische Friedrich-Wilhelms-Universität Bonn, Nussallee 14-16, 53115 Bonn, Germany
| | - M Fedkevych
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - A Felden
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - S Fischer
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - B Flatt
- Institut für Physik, Johannes-Gutenberg-Universität Mainz, 55099 Mainz, Germany
| | - J A Formaggio
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
| | - F M Fränkle
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - G B Franklin
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - H Frankrone
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - F Friedel
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - D Fuchs
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - A Fulst
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - D Furse
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
| | - K Gauda
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - H Gemmeke
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - W Gil
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - F Glück
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - S Görhardt
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - S Groh
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - S Grohmann
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - R Grössle
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - R Gumbsheimer
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Ha Minh
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - M Hackenjos
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - V Hannen
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - F Harms
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - J Hartmann
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - N Haußmann
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - F Heizmann
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - K Helbing
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - S Hickford
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - D Hilk
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - B Hillen
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - D Hillesheimer
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - D Hinz
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - T Höhn
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - B Holzapfel
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - S Holzmann
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - T Houdy
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - M A Howe
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - A Huber
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - T M James
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - A Jansen
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - A Kaboth
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
| | - C Karl
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - O Kazachenko
- Institute for Nuclear Research of Russian Academy of Sciences, 60th October Anniversary Prospect 7a, 117312 Moscow, Russia
| | - J Kellerer
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - N Kernert
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - L Kippenbrock
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - M Kleesiek
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - M Klein
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - C Köhler
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - L Köllenberger
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - A Kopmann
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Korzeczek
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - A Kosmider
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - A Kovalík
- Nuclear Physics Institute of the CAS, v. v. i., CZ-250 68 Řež, Czech Republic
| | - B Krasch
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Kraus
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - H Krause
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - L Kuckert
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - B Kuffner
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - N Kunka
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - T Lasserre
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- IRFU (DPhP & APC), CEA, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - T L Le
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - O Lebeda
- Nuclear Physics Institute of the CAS, v. v. i., CZ-250 68 Řež, Czech Republic
| | - M Leber
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - B Lehnert
- Institute for Nuclear and Particle Astrophysics and Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J Letnev
- University of Applied Sciences (HFD) Fulda, Leipziger Straße 123, 36037 Fulda, Germany
| | - F Leven
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - S Lichter
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - V M Lobashev
- Institute for Nuclear Research of Russian Academy of Sciences, 60th October Anniversary Prospect 7a, 117312 Moscow, Russia
| | - A Lokhov
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
- Institute for Nuclear Research of Russian Academy of Sciences, 60th October Anniversary Prospect 7a, 117312 Moscow, Russia
| | - M Machatschek
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - E Malcherek
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - K Müller
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Mark
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - A Marsteller
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - E L Martin
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - C Melzer
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - A Menshikov
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - S Mertens
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
- Institute for Nuclear and Particle Astrophysics and Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - L I Minter
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - S Mirz
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - B Monreal
- Department of Physics, Case Western Reserve University, Cleveland, Ohio 44106, USA
| | - P I Morales Guzmán
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - K Müller
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - U Naumann
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - W Ndeke
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstraße 15, 12489 Berlin, Germany
| | - H Neumann
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - S Niemes
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Noe
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - N S Oblath
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
| | - H-W Ortjohann
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - A Osipowicz
- University of Applied Sciences (HFD) Fulda, Leipziger Straße 123, 36037 Fulda, Germany
| | - B Ostrick
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - E Otten
- Institut für Physik, Johannes-Gutenberg-Universität Mainz, 55099 Mainz, Germany
| | - D S Parno
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - D G Phillips
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - P Plischke
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - A Pollithy
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - A W P Poon
- Institute for Nuclear and Particle Astrophysics and Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J Pouryamout
- Department of Physics, Faculty of Mathematics and Natural Sciences, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - M Prall
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - F Priester
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Röllig
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - C Röttele
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - P C-O Ranitzsch
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - O Rest
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - R Rinderspacher
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - R G H Robertson
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - C Rodenbeck
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - P Rohr
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - Ch Roll
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstraße 15, 12489 Berlin, Germany
| | - S Rupp
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - M Ryšavý
- Nuclear Physics Institute of the CAS, v. v. i., CZ-250 68 Řež, Czech Republic
| | - R Sack
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - A Saenz
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstraße 15, 12489 Berlin, Germany
| | - P Schäfer
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - L Schimpf
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - K Schlösser
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Schlösser
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - L Schlüter
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - H Schön
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - K Schönung
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Max-Planck-Institut für Kernphysik, Saupfercheckweg 1, 69117 Heidelberg, Germany
| | - M Schrank
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - B Schulz
- Institut für Physik, Humboldt-Universität zu Berlin, Newtonstraße 15, 12489 Berlin, Germany
| | - J Schwarz
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - H Seitz-Moskaliuk
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - W Seller
- University of Applied Sciences (HFD) Fulda, Leipziger Straße 123, 36037 Fulda, Germany
| | - V Sibille
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
| | - D Siegmann
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - A Skasyrskaya
- Institute for Nuclear Research of Russian Academy of Sciences, 60th October Anniversary Prospect 7a, 117312 Moscow, Russia
| | - M Slezák
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
- Nuclear Physics Institute of the CAS, v. v. i., CZ-250 68 Řež, Czech Republic
| | - A Špalek
- Nuclear Physics Institute of the CAS, v. v. i., CZ-250 68 Řež, Czech Republic
| | - F Spanier
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Steidl
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - N Steinbrink
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - M Sturm
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Suesser
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Sun
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - D Tcherniakhovski
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - H H Telle
- Departamento de Química Física Aplicada, Universidad Autonoma de Madrid, Campus de Cantoblanco, 28049 Madrid, Spain
| | - T Thümmler
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - L A Thorne
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - N Titov
- Institute for Nuclear Research of Russian Academy of Sciences, 60th October Anniversary Prospect 7a, 117312 Moscow, Russia
| | - I Tkachev
- Institute for Nuclear Research of Russian Academy of Sciences, 60th October Anniversary Prospect 7a, 117312 Moscow, Russia
| | - N Trost
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - K Urban
- Technische Universität München, James-Franck-Straße 1, 85748 Garching, Germany
- Max-Planck-Institut für Physik, Föhringer Ring 6, 80805 München, Germany
| | - D Vénos
- Nuclear Physics Institute of the CAS, v. v. i., CZ-250 68 Řež, Czech Republic
| | - K Valerius
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - B A VanDevender
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - R Vianden
- Helmholtz-Institut für Strahlen- und Kernphysik, Rheinische Friedrich-Wilhelms-Universität Bonn, Nussallee 14-16, 53115 Bonn, Germany
| | - A P Vizcaya Hernández
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - B L Wall
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - S Wüstling
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - M Weber
- Institute for Data Processing and Electronics (IPE), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - C Weinheimer
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - C Weiss
- Project, Process, and Quality Management (PPQ), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - S Welte
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - J Wendel
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
| | - K J Wierman
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J F Wilkerson
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J Wolf
- Institute of Experimental Particle Physics (ETP), Karlsruhe Institute of Technology (KIT), Wolfgang-Gaede-Straße 1, 76131 Karlsruhe, Germany
| | - W Xu
- Laboratory for Nuclear Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
| | - Y-R Yen
- Department of Physics, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - M Zacher
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
| | - S Zadorozhny
- Institute for Nuclear Research of Russian Academy of Sciences, 60th October Anniversary Prospect 7a, 117312 Moscow, Russia
| | - M Zbořil
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, Wilhelm-Klemm-Straße 9, 48149 Münster, Germany
- Nuclear Physics Institute of the CAS, v. v. i., CZ-250 68 Řež, Czech Republic
| | - G Zeller
- Institute for Nuclear Physics (IKP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
- Institute for Technical Physics (ITEP), Karlsruhe Institute of Technology (KIT), Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
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Calvert FL, Deane FP, Barrett J. Improvements in psychologists’ metacommunication self‐efficacy, willingness, and skill following online training and a supervision exercise. J Clin Psychol 2019; 76:1083-1100. [DOI: 10.1002/jclp.22889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Fiona L. Calvert
- School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Frank P. Deane
- School of PsychologyUniversity of Wollongong Wollongong Australia
| | - Jessica Barrett
- Discipline of Clinical PsychologyUniversity of Technology Sydney Ultimo Australia
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Abbara A, Collin SM, Kon OM, Buell K, Sullivan A, Barrett J, Corrah T, McGregor A, Hansel T, John L, Davidson RN. Time to diagnosis of tuberculosis is greater in older patients: a retrospective cohort review. ERJ Open Res 2019; 5:00228-2018. [PMID: 31720296 PMCID: PMC6826249 DOI: 10.1183/23120541.00228-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/29/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Age-related immunosenescence influences the presentation of tuberculosis (TB) in older patients. Here, we explore the clinical and radiological presentation of TB in the elderly and the factors associated with time to treatment for TB. Methods This is a retrospective cohort study comparing the clinical, radiological and demographic characteristics of TB patients aged ≥65 years with TB patients aged 18–64 years in a large cohort of TB patients in the UK. Factors associated with the time to presentation and time to treatment were identified using a multivariable analysis model. Results 1023 patients were included in the analyses: 679 patients aged 18–64 years and 344 patients aged ≥65 years. “Classical” symptoms of TB (cough, haemoptysis, fever, nights sweats and weight loss) were less common among older patients with pulmonary TB (PTB) (p<0.05), but dyspnoea was more common among older patients (p=0.001). Time from presenting in secondary care to starting treatment was shorter in younger compared with older patients: 3 versus 15 days (p=0.001). When adjusted for age, factors associated with shorter time to treatment from symptom onset include sex (male versus female) (hazard ratio (HR) 1.23 (95% CI 1.05–1.46)), UK born (HR 1.23 (95% CI 1.05–1.46)) and HIV (HR 2.07 (95% CI 1.30–3.29)). Only age remained an independent predictor of time to treatment in a multivariable model (HR 0.98 (95% CI 0.98–0.99)). For those with PTB, chest radiography findings showed that cavitation and lymphadenopathy were more common among younger patients (p=0.001). Conclusions Older patients aged ≥65 years with TB had fewer “classical” clinical and radiological presentations of TB, which may explain longer times to starting treatment from symptom onset compared with younger patients aged <65 years. A retrospective UK study in patients with TB shows only age remains an independent predictor of time to treatment in a multivariable model. Older patients have fewer of the “classical” clinical and radiological features of TB compared with younger patients.http://bit.ly/2yHc0OL
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Affiliation(s)
- Aula Abbara
- London North West University Healthcare NHS Trust, London, UK.,Dept of Infection, Imperial College London, London, UK
| | | | - Onn M Kon
- Dept of Infection, Imperial College London, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Kevin Buell
- Dept of Infection, Imperial College London, London, UK
| | - Adam Sullivan
- Dept of Infection, Imperial College London, London, UK
| | - Jessica Barrett
- London North West University Healthcare NHS Trust, London, UK
| | - Tumena Corrah
- London North West University Healthcare NHS Trust, London, UK
| | | | - Trevor Hansel
- Dept of Infection, Imperial College London, London, UK
| | - Laurence John
- London North West University Healthcare NHS Trust, London, UK
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Roden C, Barrett J, Glennon E, Osborne T, Whitehouse J, Rashid R, Nash E. WS09-6 Dietary practices in adults with cystic fibrosis taking CFTR modulator therapies. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30171-7] [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: 11/15/2022]
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Barrett J, Slatter G, Rashid R, Whitehouse J, Nash E. WS09-5 Perception, experience and relationship with food and eating in adults with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Marta GN, Barrett J, Porfirio GJM, Martimbianco ALC, Bevilacqua JLB, Poortmans P, Riera R. Effectiveness of different accelerated partial breast irradiation techniques for the treatment of breast cancer patients: Systematic review using indirect comparisons of randomized clinical trials. Rep Pract Oncol Radiother 2019; 24:165-174. [PMID: 30814916 PMCID: PMC6378667 DOI: 10.1016/j.rpor.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/06/2018] [Accepted: 01/27/2019] [Indexed: 01/27/2023] Open
Abstract
AIM This systematic review was conducted to compare the effectiveness of different accelerated partial breast irradiation (APBI) techniques for the treatment of breast cancer patients. BACKGROUND Numerous (APBI) techniques are available for clinical practice. METHODS AND MATERIALS Systematic review of randomized controlled trials of APBI versus whole breast irradiation (WBI). The data from APBI studies were extracted for the analyses. Indirect comparisons were used to compare different APBI techniques. RESULTS Ten studies fulfilled the inclusion criteria. A total of 4343 patients were included, most of them with tumor stage T1-T2 and N0. Regarding APBI techniques, six trials used external beam radiation therapy; one intraoperative electrons; one intraoperative low-energy photons; one brachytherapy; and one external beam radiation therapy or brachytherapy. The indirect comparisons related to 5-years local control and 5-years overall survival were not significantly different between APBI techniques. CONCLUSIONS Based on indirect comparisons, no differences in clinical outcomes were observed among diverse APBI techniques in published clinical trials that formally compared WBI to APBI. However wide confidence intervals and high risk of inconsistency precluded a sound conclusion. Further head-to-head clinical trials comparing different APBI techniques are required to confirm our findings. Studies comparing different techniques using individual participant data and/or real-life data from population-based studies/registries could also provide more robust results.
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Affiliation(s)
- Gustavo Nader Marta
- Department of Radiation Oncology – Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Sao Paulo, SP 01308-050, Brazil
- Department of Radiology and Oncology – Radiation Oncology Unit. of University of São Paulo, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Rua Dona Adma Jafet, 91, Sao Paulo, 01308-050 SP, Brazil
| | - Jessica Barrett
- MRC Biostatistics Unit, University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom
| | | | | | | | - Philip Poortmans
- Department of Radiation Oncology – Institut Curie, 6 rue d’Ulm, 75248 Paris cedex 05, France
| | - Rachel Riera
- Cochrane Brazil, Rua Borges Lagoa, 564 – Cj 63, Edifício São Paulo, Vila Clementino, São Paulo, SP 04038-000, Brazil
- Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo – Escola Paulista de Medicina (UNIFESP-EPM), Rua Borges Lagoa, 564 – Cj 63, Edifício São Paulo, Vila Clementino, São Paulo, 04038-000 SP, Brazil
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Margarido C, Ferns J, Chin V, Ribeiro T, Nascimento B, Barrett J, Herer E, Halpern S, Andrews L, Ballatyne G, Chapmam M, Gomes J, Callum J. Massive hemorrhage protocol activation in obstetrics: a 5-year quality performance review. Int J Obstet Anesth 2018; 38:37-45. [PMID: 30509680 DOI: 10.1016/j.ijoa.2018.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 04/26/2018] [Revised: 09/24/2018] [Accepted: 10/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND A structured approach to hemorrhagic emergencies in obstetrics has gained popularity with the implementation of massive hemorrhage protocols. The trauma literature suggests that routine quality reviews should be in place to improve patient outcomes. The aim of this study was to develop quality indicators and assess compliance by the clinical team. METHODS A multidisciplinary team set the institutional quality indicators for the massive hemorrhage protocol review. A retrospective review of all obstetrical massive hemorrhage protocol activation events from September 2010 to January 2015 was performed. All protocol events occurred before the creation of the quality indicators. Data were retrieved from patient records. RESULTS There were 17 (0.09%) protocol activations for 19 790 deliveries during the study period. All 17 (100%) patients received at least one unit of red blood cells. Overactivation, defined as the transfusion of <2 units of red blood cells, occurred in two cases (12%). Common causes of non-compliance were: 24% (4/17) temperature monitoring, 18% (3/17) lactate measurement, 41% (7/17) arterial blood gas sampling, and 18% (3/17) hemoglobin maintenance within the target range of 55-95 g/L. Admission to intensive care and peripartum hysterectomy occurred in 12 and 5 cases (71% and 29%), respectively. CONCLUSIONS Suboptimal compliance was found in multiple areas, which may be attributable to the low frequency of activation of our massive haemorrhage protocol in obstetrics. The quality targets identified in this report can act as a basis for other institutions developing quality indicators to evaluate performance.
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Affiliation(s)
- C Margarido
- Department of Obstetrics Anaesthesia, Division of Obstetrical Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - J Ferns
- Department of Obstetrics Anaesthesia, Division of Obstetrical Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - V Chin
- Department of Transfusion Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - T Ribeiro
- Department of Obstetrics Anaesthesia, Division of Obstetrical Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - B Nascimento
- Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J Barrett
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - E Herer
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S Halpern
- Department of Obstetrics Anaesthesia, Division of Obstetrical Anaesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - L Andrews
- Department of Women and Babies, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - G Ballatyne
- Department of Women and Babies, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Chapmam
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J Gomes
- Department of Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - J Callum
- Department of Transfusion Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Paige E, Barrett J, Stevens D, Keogh RH, Sweeting MJ, Nazareth I, Petersen I, Wood AM. Landmark Models for Optimizing the Use of Repeated Measurements of Risk Factors in Electronic Health Records to Predict Future Disease Risk. Am J Epidemiol 2018; 187:1530-1538. [PMID: 29584812 PMCID: PMC6030927 DOI: 10.1093/aje/kwy018] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/13/2022] Open
Abstract
The benefits of using electronic health records (EHRs) for disease risk screening and personalized health-care decisions are being increasingly recognized. Here we present a computationally feasible statistical approach with which to address the methodological challenges involved in utilizing historical repeat measures of multiple risk factors recorded in EHRs to systematically identify patients at high risk of future disease. The approach is principally based on a 2-stage dynamic landmark model. The first stage estimates current risk factor values from all available historical repeat risk factor measurements via landmark-age-specific multivariate linear mixed-effects models with correlated random intercepts, which account for sporadically recorded repeat measures, unobserved data, and measurement errors. The second stage predicts future disease risk from a sex-stratified Cox proportional hazards model, with estimated current risk factor values from the first stage. We exemplify these methods by developing and validating a dynamic 10-year cardiovascular disease risk prediction model using primary-care EHRs for age, diabetes status, hypertension treatment, smoking status, systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol in 41,373 persons from 10 primary-care practices in England and Wales contributing to The Health Improvement Network (1997-2016). Using cross-validation, the model was well-calibrated (Brier score = 0.041, 95% confidence interval: 0.039, 0.042) and had good discrimination (C-index = 0.768, 95% confidence interval: 0.759, 0.777).
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Affiliation(s)
- Ellie Paige
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- National Centre for Epidemiology and Population Health, Research School of Population, The Australian National University, Canberra, Australia
| | - Jessica Barrett
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - David Stevens
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael J Sweeting
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Irwin Nazareth
- Institute of Epidemiology and Health, Research Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Irene Petersen
- Institute of Epidemiology and Health, Research Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Angela M Wood
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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