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Appavu BL, Fox J, Kuwabara M, Burrows BT, Temkit M'H, Adelson PD. Association of Cerebral and Systemic Physiology With Quantitative Electroencephalographic Characteristics of Early Posttraumatic Seizures. J Clin Neurophysiol 2024; 41:257-264. [PMID: 36007060 DOI: 10.1097/wnp.0000000000000965] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Early posttraumatic seizures (EPTS) occur after pediatric traumatic brain injury and have been associated with unfavorable outcomes. We aimed to characterize the relationship among quantitative EEG characteristics of early posttraumatic seizures, cerebral and somatic physiologic measures. METHODS Differences in baseline physiologic, neuroimaging, and demographic characteristics between those with and without early posttraumatic seizures were investigated using Mann-Whitney U test or Fisher exact test. Multivariable dynamic structural equations modeling was used to investigate time series associations between ictal quantitative EEG characteristics with intracranial pressure, arterial blood pressure, heart rate (HR), and cerebral regional oximetry. Quantitative EEG characteristics included amplitude, total power, spectral edge frequency, peak value frequency, complexity, and periodicity. RESULTS Among 72 children, 146 seizures were identified from 19 patients. Early posttraumatic seizures were associated with younger age ( P = 0.0034), increased HR ( P = 0.0018), and increased Glasgow Outcome Scale-Extended scores ( P = 0.0377). Group dynamic structural equations modeling analysis of the first seizure for patients demonstrated that intracranial pressure is negatively associated with spectral edge frequency (standardized regression coefficient -0.12, 99% credible interval [-0.21 to -0.04]), and HR is positively associated with peak value frequency (standardized regression coefficient 0.16, [0.00-0.31]). Among nine patients with seizures arising over the frontal lobe regions, HR was positively associated with peak value frequency (standardized regression coefficient 0.26 [0.02-0.50]) and complexity (standardized regression coefficient 0.14 [0.03-0.26]). Variation in strength and direction of associations was observed between subjects for relationships that were significant during group analysis. CONCLUSIONS Quantitative EEG characteristics of pediatric early posttraumatic seizures are associated with variable changes in cerebral and systemic physiology, with spectral edge frequency negatively associated with intracranial pressure and peak value frequency positively associated with HR.
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Affiliation(s)
- Brian L Appavu
- Department of Neurosciences, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, U.S.A.; and
| | - Jordana Fox
- Department of Neurosciences, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, U.S.A.; and
| | - Michael Kuwabara
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, U.S.A.; and
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - Brian T Burrows
- Department of Neurosciences, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - M 'Hamed Temkit
- Department of Neurosciences, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
| | - Phillip D Adelson
- Department of Neurosciences, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, U.S.A
- Department of Child Health, University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, U.S.A.; and
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Tomaszewski Farias S, Fox J, Dulaney H, Chan M, Namboodiri S, Harvey DJ, Weakley A, Rahman S, Luna C, Beech BF, Campbell L, Schmitter-Edgecombe M. Memory support training and lifestyle modifications to promote healthy aging in persons at risk for Alzheimer's disease: a digital application supported intervention (Brain Boosters). BMC Geriatr 2023; 23:881. [PMID: 38129775 PMCID: PMC10740219 DOI: 10.1186/s12877-023-04574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Evidence-based interventions to protect against cognitive decline among older adults at risk for Alzheimer's disease and related dementias (ADRD) are urgently needed. Rehabilitation approaches to support memory and behavioral/lifestyle interventions are recognized as promising strategies for preserving or improving cognitive health, although few previous interventions have combined both approaches. This paper describes the protocol of the Brain Boosters intervention, which synergistically combines training in compensatory and healthy lifestyle behaviors and supports implementation and tracking of new behaviors with a digital application. METHODS The study utilizes a single-site, single-blinded, randomized controlled design to compare a structured lifestyle and compensatory aid intervention to an education-only self-guided intervention. We plan to enroll 225 community-dwelling adults (25% from underrepresented groups) aged 65 + who endorse subjective cognitive decline (SCD) and low baseline levels of healthy lifestyle behaviors. Both interventions will be administered in group format, consisting of 15 two-hour classes that occur weekly for ten weeks and taper to bi-monthly and monthly, for an intervention duration of 6 months. Participants in both interventions will receive education about a variety of memory support strategies and healthy lifestyle behaviors, focusing on physical and cognitive activity and stress management. The structured intervention will also receive support in adopting new behaviors and tracking set goals aided by the Electronic Memory and Management Aid (EMMA) digital application. Primary outcomes include global cognition (composite of memory, attention, and executive function tests) and everyday function (Everyday Cognition Questionnaire). Data will be collected at baseline and outcome visits, at approximately 6, 12, and 18 months. Qualitative interviews, self-report surveys (e.g., indicators of self-determination, health literacy) and EMMA data metrics will also be used to identify what components of the intervention are most effective and for whom they work. DISCUSSION Successful project completion will provide valuable information about how individuals with SCD respond to a compensation and preventative lifestyle intervention assisted by a digital application, including an understanding of factors that may impact outcomes, treatment uptake, and adherence. The work will also inform development, scaling, and personalization of future interventions that can delay disability in individuals at risk for ADRD. TRIAL REGISTRATION ClinicalTrials.gov. (NCT05027789, posted 8/30/2021).
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Affiliation(s)
| | - J Fox
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - H Dulaney
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - M Chan
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - S Namboodiri
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - D J Harvey
- Department of Biostatistics, University of California, Davis, Davis, USA
| | - A Weakley
- Department of Neurology, University of California, Davis, Sacramento, USA
| | - S Rahman
- Department of Psychology, Washington State University, Pullman, USA
| | - C Luna
- Department of Psychology, Washington State University, Pullman, USA
| | - B F Beech
- Department of Psychology, Washington State University, Pullman, USA
| | - L Campbell
- Department of Neurology, University of California, Davis, Sacramento, USA
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Thomas M, Baltatzis M, Price A, Fox J, Pearce L, Vilches-Moraga A. The influence of frailty on outcomes for older adults admitted to hospital with benign biliary disease: a single-centre, observational cohort study. Ann R Coll Surg Engl 2023; 105:231-240. [PMID: 35616268 PMCID: PMC9974336 DOI: 10.1308/rcsann.2021.0331] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The prevalence and complications of biliary disease increase with age. Frailty has been associated with adverse outcomes in the hospital setting. We describe the prevalence of frailty in older patients hospitalised with benign biliary disease and its association with duration of hospital stay, and 90-day and 1-year mortality. METHODS We performed a retrospective cohort study of patients aged 75 years and over admitted with acute biliary disease between 17 September 2014 and 20 March 2017. Clinical Frailty Scale (CFS) score was recorded on admission. RESULTS We included 200 patients with a median age of 82 (75-99) years, 60% were female; 154 (77%) were independent for personal activities of daily living (ADLs) and 99 (49.5%) for instrumental ADLs. Cholecystitis was the most common diagnosis (43%) followed by cholangitis (36%) and pancreatitis (21%). Ninety-nine patients were non frail (NF; CFS 1-4) and 101 were frail (F; CFS 5-9). Some 104 patients received medical treatment only. Surgery was more common in NF patients (11% vs F 2%), percutaneous drainage more frequently performed in F patients (15% vs NF 5%) and endoscopic cholangiopancreatography was similar in both groups (F 32% vs NF 31%). Frailty was associated with worse clinical outcomes in F vs NF: functional deconditioning (34% vs 11%), increased care level (19% vs 3%), length of stay (12 vs 7 days), 90-day mortality (8% vs 3%) and 1-year mortality (48% vs 24%). CONCLUSIONS Half of patients in our cohort were frail and spent longer in hospital, were less likely to undergo surgery and were less likely to remain alive at 1 year after discharge.
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Affiliation(s)
- M Thomas
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
| | - M Baltatzis
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
| | - A Price
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
| | - J Fox
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
| | - L Pearce
- Salford Royal NHS Foundation Trust, Northern Care Alliance, UK
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Lee M, Collins S, Kinloch S, Fox J, Seaton K, Tomaras G, Caskey M, Nussenzweig M, Frater J, Fidle S. OP 7.2 – 00035 Impact of 10-1074LS and 3BNC117-LS on viral rebound dynamics following treatment interruption six months after dosing: four cases from the open label arm of the RIO trial. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Aminzadeh A, Arhatari BD, Maksimenko A, Hall CJ, Hausermann D, Peele AG, Fox J, Kumar B, Prodanovic Z, Dimmock M, Lockie D, Pavlov KM, Nesterets YI, Thompson D, Mayo SC, Paganin DM, Taba ST, Lewis S, Brennan PC, Quiney HM, Gureyev TE. Imaging Breast Microcalcifications Using Dark-Field Signal in Propagation-Based Phase-Contrast Tomography. IEEE Trans Med Imaging 2022; 41:2980-2990. [PMID: 35584078 DOI: 10.1109/tmi.2022.3175924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Breast microcalcifications are an important primary radiological indicator of breast cancer. However, microcalcification classification and diagnosis may be still challenging for radiologists due to limitations of the standard 2D mammography technique, including spatial and contrast resolution. In this study, we propose an approach to improve the detection of microcalcifications in propagation-based phase-contrast X-ray computed tomography of breast tissues. Five fresh mastectomies containing microcalcifications were scanned at different X-ray energies and radiation doses using synchrotron radiation. Both bright-field (i.e. conventional phase-retrieved images) and dark-field images were extracted from the same data sets using different image processing methods. A quantitative analysis was performed in terms of visibility and contrast-to-noise ratio of microcalcifications. The results show that while the signal-to-noise and the contrast-to-noise ratios are lower, the visibility of the microcalcifications is more than two times higher in the dark-field images compared to the bright-field images. Dark-field images have also provided more accurate information about the size and shape of the microcalcifications.
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Praniewicz M, Ameta G, Fox J, Saldana C. Data registration for multi-method qualification of additive manufactured components. Addit Manuf 2022; 35:10.1016/j.addma.2020.101292. [PMID: 36936516 PMCID: PMC10020995 DOI: 10.1016/j.addma.2020.101292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This work refines surface registration methods for metrological datasets to improve the multi-method qualification accuracy of additively manufactured (AM) lattices. Datasets acquired from X-ray computed tomography and a coordinate measurement machine of an AM lattice were aligned using derived geometry datum features based on a theoretical supplemental surface definition, which has been established in recent draft standards, but has had limited examination using complex AM structures. A refined sampling registration approach for lattice geometry based on spatially-dependent subsampling is derived and shown to statistically decrease variation between measurement sources. This importance of well-defined sampling practice and definition is highlighted. The applicability of this approach for multi-method qualification of complex AM parts is discussed. This work lays the foundation of utilizing specifications under consideration in a new standard with possible verification techniques that can be employed.
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Affiliation(s)
- M. Praniewicz
- Georgia Institute of Technology, 801 Ferst Drive, Atlanta, GA 30318, United States
| | - G. Ameta
- Siemens Corporate Research, Princeton, NJ 08540, United States
| | - J. Fox
- National Institute of Standards and Technology, Gaithersburg, MD 20899, United States
| | - C. Saldana
- Georgia Institute of Technology, 801 Ferst Drive, Atlanta, GA 30318, United States
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Fenemore J, Boerckel W, Rigney M, McNamara A, Gaspar B, Mayans J, Hennink M, Fox J, Pretorius L, Daniels M, Winstone S, Thakrar R. P2.08-05 Lung Cancer Patients’ Willingness to Attend a Screening Appointment or Lung Health Check: Insights from a Global Patient Experience Survey. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Fenemore J, Boerckel W, Rigney M, McNamara A, Gaspar B, Mayans J, Hennink M, Fox J, Pretorius L, Daniels M, Winstone S, Thakrar R. P2.08-06 Patient Involvement in Decision-Making around Their Treatment and Care: Findings from a Global Patient Experience Survey. J Thorac Oncol 2022. [PMCID: PMC9452035 DOI: 10.1016/j.jtho.2022.07.234] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Patil YSS, Yu J, Frazier S, Wang Y, Johnson K, Fox J, Reichel J, Harris JGE. Measuring High-Order Phonon Correlations in an Optomechanical Resonator. Phys Rev Lett 2022; 128:183601. [PMID: 35594119 DOI: 10.1103/physrevlett.128.183601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/18/2022] [Indexed: 06/15/2023]
Abstract
We use single photon detectors to probe the motional state of a superfluid ^{4}He resonator of mass ∼1 ng. The arrival times of Stokes and anti-Stokes photons (scattered by the resonator's acoustic mode) are used to measure the resonator's phonon coherences up to the fourth order. By postselecting on photon detection events, we also measure coherences in the resonator when ≤3 phonons have been added or subtracted. These measurements are found to be consistent with predictions that assume the acoustic mode to be in thermal equilibrium with a bath through a Markovian coupling.
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Affiliation(s)
- Y S S Patil
- Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J Yu
- Department of Applied Physics, Yale University, New Haven, Connecticut 06520, USA
| | - S Frazier
- Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - Y Wang
- Department of Applied Physics, Yale University, New Haven, Connecticut 06520, USA
| | - K Johnson
- Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J Fox
- Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - J Reichel
- Laboratoire Kastler Brossel, ENS-Université PSL, CNRS, Sorbonne Université, Collège de France 24 rue Lhomond, 75005 Paris, France
| | - J G E Harris
- Department of Physics, Yale University, New Haven, Connecticut 06520, USA
- Department of Applied Physics, Yale University, New Haven, Connecticut 06520, USA
- Yale Quantum Institute, Yale University, New Haven, Connecticut 06520, USA
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Beck EJ, Loncar D, Mandalia S, Patel NH, Lwanga J, Sharp A, Fox J. Hospital and community care costs for people newly diagnosed of living with HIV in London, UK. AIDS Care 2022; 35:719-728. [PMID: 35277095 DOI: 10.1080/09540121.2022.2038362] [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: 10/18/2022]
Abstract
This study of people newly diagnosed of living with HIV (ND-PLHIV) calculated the use, cost and outcome of HIV services at a London HIV centre. ND-PLHIV were followed July 2017-October 2018. Hospital data included inpatient days (IP), outpatient (OP), dayward (DW) visits, tests and procedures, and anti-retroviral drugs (ARVs). Community services were recorded in daily diaries. Mean per patient-year (MPPY) use was multiplied by unit costs. 13.6 MPPY (95%CI 12.4-14.9) OP visits, 0.4 MPPY (95%CI 0.1-0.7) IP days, 0.09 MPPY (95%CI 0.01-0.2) DW visits and 4.6 MPPY community services (95%CI 3.4-5.8). Total annual costs per patient-year (CPPY) was £11,483 (95%CI £10,369-12,597): ARVs comprised 63% and community services 2%. White participants used fewer hospital and more community services compared with minority ethnic community (MEC) participants. Costs for White ND-PLHIV was £10,778 CPPY (95%CI £9629-11,928); £13,214 (95%CI £10,656-15,772) for MEC ND-PLHIV (p < 0.06). Annual costs were inversely related to CD4 count at entry (r = -5.58, p = 0.02); mean CD4 count was 476 cells/mm3 (95%CI 422-531) versus 373 cells/mm3 (95%CI 320-425) for White and MEC participants respectively (p = 0.03). Annual costs for ND-PLHIV with CD4 ≤ 350 cells/mm3 was £2478 PPY higher compared with CD4 count >350 cells/mm3 (p = 0.04).
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Affiliation(s)
- E J Beck
- NPMS-HHC CIC, London, UK.,London School of Hygiene & Tropical Medicine, London, UK
| | - D Loncar
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - N H Patel
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J Lwanga
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Sharp
- Kings College London, London, UK
| | - J Fox
- Harrison Wing, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Kings College London, London, UK
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Wymant C, Bezemer D, Blanquart F, Ferretti L, Gall A, Hall M, Golubchik T, Bakker M, Ong SH, Zhao L, Bonsall D, de Cesare M, MacIntyre-Cockett G, Abeler-Dörner L, Albert J, Bannert N, Fellay J, Grabowski MK, Gunsenheimer-Bartmeyer B, Günthard HF, Kivelä P, Kouyos RD, Laeyendecker O, Meyer L, Porter K, Ristola M, van Sighem A, Berkhout B, Kellam P, Cornelissen M, Reiss P, Fraser C, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S, van der Valk M, Geerlings SE, Goorhuis A, Hovius JW, Lempkes B, Nellen FJB, van der Poll T, Prins JM, Reiss P, van Vugt M, Wiersinga WJ, Wit FWMN, van Duinen M, van Eden J, Hazenberg A, van Hes AMH, Rajamanoharan S, Robinson T, Taylor B, Brewer C, Mayr C, Schmidt W, Speidel A, Strohbach F, Arastéh K, Cordes C, Pijnappel FJJ, Stündel M, Claus J, Baumgarten A, Carganico A, Ingiliz P, Dupke S, Freiwald M, Rausch M, Moll A, Schleehauf D, Smalhout SY, Hintsche B, Klausen G, Jessen H, Jessen A, Köppe S, Kreckel P, Schranz D, Fischer K, Schulbin H, Speer M, Weijsenfeld AM, Glaunsinger T, Wicke T, Bieniek B, Hillenbrand H, Schlote F, Lauenroth-Mai E, Schuler C, Schürmann D, Wesselmann H, Brockmeyer N, Jurriaans S, Gehring P, Schmalöer D, Hower M, Spornraft-Ragaller P, Häussinger D, Reuter S, Esser S, Markus R, Kreft B, Berzow D, Back NKT, Christl A, Meyer A, Plettenberg A, Stoehr A, Graefe K, Lorenzen T, Adam A, Schewe K, Weitner L, Fenske S, Zaaijer HL, Hansen S, Stellbrink HJ, Wiemer D, Hertling S, Schmidt R, Arbter P, Claus B, Galle P, Jäger H, Jä Gel-Guedes E, Berkhout B, Postel N, Fröschl M, Spinner C, Bogner J, Salzberger B, Schölmerich J, Audebert F, Marquardt T, Schaffert A, Schnaitmann E, Cornelissen MTE, Trein A, Frietsch B, Müller M, Ulmer A, Detering-Hübner B, Kern P, Schubert F, Dehn G, Schreiber M, Güler C, Schinkel CJ, Gunsenheimer-Bartmeyer B, Schmidt D, Meixenberger K, Bannert N, Wolthers KC, Peters EJG, van Agtmael MA, Autar RS, Bomers M, Sigaloff KCE, Heitmuller M, Laan LM, Ang CW, van Houdt R, Jonges M, Kuijpers TW, Pajkrt D, Scherpbier HJ, de Boer C, van der Plas A, van den Berge M, Stegeman A, Baas S, Hage de Looff L, Buiting A, Reuwer A, Veenemans J, Wintermans B, Pronk MJH, Ammerlaan HSM, van den Bersselaar DNJ, de Munnik ES, Deiman B, Jansz AR, Scharnhorst V, Tjhie J, Wegdam MCA, van Eeden A, Nellen J, Brokking W, Elsenburg LJM, Nobel H, van Kasteren MEE, Berrevoets MAH, Brouwer AE, Adams A, van Erve R, de Kruijf-van de Wiel BAFM, Keelan-Phaf S, van de Ven B, van der Ven B, Buiting AGM, Murck JL, de Vries-Sluijs TEMS, Bax HI, van Gorp ECM, de Jong-Peltenburg NC, de Mendonç A Melo M, van Nood E, Nouwen JL, Rijnders BJA, Rokx C, Schurink CAM, Slobbe L, Verbon A, Bassant N, van Beek JEA, Vriesde M, van Zonneveld LM, de Groot J, Boucher CAB, Koopmans MPG, van Kampen JJA, Fraaij PLA, van Rossum AMC, Vermont CL, van der Knaap LC, Visser E, Branger J, Douma RA, Cents-Bosma AS, Duijf-van de Ven CJHM, Schippers EF, van Nieuwkoop C, van Ijperen JM, Geilings J, van der Hut G, van Burgel ND, Leyten EMS, Gelinck LBS, Mollema F, Davids-Veldhuis S, Tearno C, Wildenbeest GS, Heikens E, Groeneveld PHP, Bouwhuis JW, Lammers AJJ, Kraan S, van Hulzen AGW, Kruiper MSM, van der Bliek GL, Bor PCJ, Debast SB, Wagenvoort GHJ, Kroon FP, de Boer MGJ, Jolink H, Lambregts MMC, Roukens AHE, Scheper H, Dorama W, van Holten N, Claas ECJ, Wessels E, den Hollander JG, El Moussaoui R, Pogany K, Brouwer CJ, Smit JV, Struik-Kalkman D, van Niekerk T, Pontesilli O, Lowe SH, Oude Lashof AML, Posthouwer D, van Wolfswinkel ME, Ackens RP, Burgers K, Schippers J, Weijenberg-Maes B, van Loo IHM, Havenith TRA, van Vonderen MGA, Kampschreur LM, Faber S, Steeman-Bouma R, Al Moujahid A, Kootstra GJ, Delsing CE, van der Burg-van de Plas M, Scheiberlich L, Kortmann W, van Twillert G, Renckens R, Ruiter-Pronk D, van Truijen-Oud FA, Cohen Stuart JWT, Jansen ER, Hoogewerf M, Rozemeijer W, van der Reijden WA, Sinnige JC, Brinkman K, van den Berk GEL, Blok WL, Lettinga KD, de Regt M, Schouten WEM, Stalenhoef JE, Veenstra J, Vrouenraets SME, Blaauw H, Geerders GF, Kleene MJ, Kok M, Knapen M, van der Meché IB, Mulder-Seeleman E, Toonen AJM, Wijnands S, Wttewaal E, Kwa D, van Crevel R, van Aerde K, Dofferhoff ASM, Henriet SSV, Ter Hofstede HJM, Hoogerwerf J, Keuter M, Richel O, Albers M, Grintjes-Huisman KJT, de Haan M, Marneef M, Strik-Albers R, Rahamat-Langendoen J, Stelma FF, Burger D, Gisolf EH, Hassing RJ, Claassen M, Ter Beest G, van Bentum PHM, Langebeek N, Tiemessen R, Swanink CMA, van Lelyveld SFL, Soetekouw R, van der Prijt LMM, van der Swaluw J, Bermon N, van der Reijden WA, Jansen R, Herpers BL, Veenendaal D, Verhagen DWM, Lauw FN, van Broekhuizen MC, van Wijk M, Bierman WFW, Bakker M, Kleinnijenhuis J, Kloeze E, Middel A, Postma DF, Schölvinck EH, Stienstra Y, Verhage AR, Wouthuyzen-Bakker M, Boonstra A, de Groot-de Jonge H, van der Meulen PA, de Weerd DA, Niesters HGM, van Leer-Buter CC, Knoester M, Hoepelman AIM, Arends JE, Barth RE, Bruns AHW, Ellerbroek PM, Mudrikova T, Oosterheert JJ, Schadd EM, van Welzen BJ, Aarsman K, Griffioen-van Santen BMG, de Kroon I, van Berkel M, van Rooijen CSAM, Schuurman R, Verduyn-Lunel F, Wensing AMJ, Bont LJ, Geelen SPM, Loeffen YGT, Wolfs TFW, Nauta N, Rooijakkers EOW, Holtsema H, Voigt R, van de Wetering D, Alberto A, van der Meer I, Rosingh A, Halaby T, Zaheri S, Boyd AC, Bezemer DO, van Sighem AI, Smit C, Hillebregt M, de Jong A, Woudstra T, Bergsma D, Meijering R, van de Sande L, Rutkens T, van der Vliet S, de Groot L, van den Akker M, Bakker Y, El Berkaoui A, Bezemer M, Brétin N, Djoechro E, Groters M, Kruijne E, Lelivelt KJ, Lodewijk C, Lucas E, Munjishvili L, Paling F, Peeck B, Ree C, Regtop R, Ruijs Y, Schoorl M, Schnörr P, Scheigrond A, Tuijn E, Veenenberg L, Visser KM, Witte EC, Ruijs Y, Van Frankenhuijsen M, Allegre T, Makhloufi D, Livrozet JM, Chiarello P, Godinot M, Brunel-Dalmas F, Gibert S, Trepo C, Peyramond D, Miailhes P, Koffi J, Thoirain V, Brochier C, Baudry T, Pailhes S, Lafeuillade A, Philip G, Hittinger G, Assi A, Lambry V, Rosenthal E, Naqvi A, Dunais B, Cua E, Pradier C, Durant J, Joulie A, Quinsat D, Tempesta S, Ravaux I, Martin IP, Faucher O, Cloarec N, Champagne H, Pichancourt G, Morlat P, Pistone T, Bonnet F, Mercie P, Faure I, Hessamfar M, Malvy D, Lacoste D, Pertusa MC, Vandenhende MA, Bernard N, Paccalin F, Martell C, Roger-Schmelz J, Receveur MC, Duffau P, Dondia D, Ribeiro E, Caltado S, Neau D, Dupont M, Dutronc H, Dauchy F, Cazanave C, Vareil MO, Wirth G, Le Puil S, Pellegrin JL, Raymond I, Viallard JF, Chaigne de Lalande S, Garipuy D, Delobel P, Obadia M, Cuzin L, Alvarez M, Biezunski N, Porte L, Massip P, Debard A, Balsarin F, Lagarrigue M, Prevoteau du Clary F, Aquilina C, Reynes J, Baillat V, Merle C, Lemoing V, Atoui N, Makinson A, Jacquet JM, Psomas C, Tramoni C, Aumaitre H, Saada M, Medus M, Malet M, Eden A, Neuville S, Ferreyra M, Sotto A, Barbuat C, Rouanet I, Leureillard D, Mauboussin JM, Lechiche C, Donsesco R, Cabie A, Abel S, Pierre-Francois S, Batala AS, Cerland C, Rangom C, Theresine N, Hoen B, Lamaury I, Fabre I, Schepers K, Curlier E, Ouissa R, Gaud C, Ricaud C, Rodet R, Wartel G, Sautron C, Beck-Wirth G, Michel C, Beck C, Halna JM, Kowalczyk J, Benomar M, Drobacheff-Thiebaut C, Chirouze C, Faucher JF, Parcelier F, Foltzer A, Haffner-Mauvais C, Hustache Mathieu M, Proust A, Piroth L, Chavanet P, Duong M, Buisson M, Waldner A, Mahy S, Gohier S, Croisier D, May T, Delestan M, Andre M, Zadeh MM, Martinot M, Rosolen B, Pachart A, Martha B, Jeunet N, Rey D, Cheneau C, Partisani M, Priester M, Bernard-Henry C, Batard ML, Fischer P, Berger JL, Kmiec I, Robineau O, Huleux T, Ajana F, Alcaraz I, Allienne C, Baclet V, Meybeck A, Valette M, Viget N, Aissi E, Biekre R, Cornavin P, Merrien D, Seghezzi JC, Machado M, Diab G, Raffi F, Bonnet B, Allavena C, Grossi O, Reliquet V, Billaud E, Brunet C, Bouchez S, Morineau-Le Houssine P, Sauser F, Boutoille D, Besnier M, Hue H, Hall N, Brosseau D, Souala F, Michelet C, Tattevin P, Arvieux C, Revest M, Leroy H, Chapplain JM, Dupont M, Fily F, Patra-Delo S, Lefeuvre C, Bernard L, Bastides F, Nau P, Verdon R, de la Blanchardiere A, Martin A, Feret P, Geffray L, Daniel C, Rohan J, Fialaire P, Chennebault JM, Rabier V, Abgueguen P, Rehaiem S, Luycx O, Niault M, Moreau P, Poinsignon Y, Goussef M, Mouton-Rioux V, Houlbert D, Alvarez-Huve S, Barbe F, Haret S, Perre P, Leantez-Nainville S, Esnault JL, Guimard T, Suaud I, Girard JJ, Simonet V, Debab Y, Schmit JL, Jacomet C, Weinberck P, Genet C, Pinet P, Ducroix S, Durox H, Denes É, Abraham B, Gourdon F, Antoniotti O, Molina JM, Ferret S, Lascoux-Combe C, Lafaurie M, Colin de Verdiere N, Ponscarme D, De Castro N, Aslan A, Rozenbaum W, Pintado C, Clavel F, Taulera O, Gatey C, Munier AL, Gazaigne S, Penot P, Conort G, Lerolle N, Leplatois A, Balausine S, Delgado J, Timsit J, Tabet M, Gerard L, Girard PM, Picard O, Tredup J, Bollens D, Valin N, Campa P, Bottero J, Lefebvre B, Tourneur M, Fonquernie L, Wemmert C, Lagneau JL, Yazdanpanah Y, Phung B, Pinto A, Vallois D, Cabras O, Louni F, Pialoux G, Lyavanc T, Berrebi V, Chas J, Lenagat S, Rami A, Diemer M, Parrinello M, Depond A, Salmon D, Guillevin L, Tahi T, Belarbi L, Loulergue P, Zak Dit Zbar O, Launay O, Silbermann B, Leport C, Alagna L, Pietri MP, Simon A, Bonmarchand M, Amirat N, Pichon F, Kirstetter M, Katlama C, Valantin MA, Tubiana R, Caby F, Schneider L, Ktorza N, Calin R, Merlet A, Ben Abdallah S, Weiss L, Buisson M, Batisse D, Karmochine M, Pavie J, Minozzi C, Jayle D, Castel P, Derouineau J, Kousignan P, Eliazevitch M, Pierre I, Collias L, Viard JP, Gilquin J, Sobel A, Slama L, Ghosn J, Hadacek B, Thu-Huyn N, Nait-Ighil L, Cros A, Maignan A, Duvivier C, Consigny PH, Lanternier F, Shoai-Tehrani M, Touam F, Jerbi S, Bodard L, Jung C, Goujard C, Quertainmont Y, Duracinsky M, Segeral O, Blanc A, Peretti D, Cheret A, Chantalat C, Dulucq MJ, Levy Y, Lelievre JD, Lascaux AS, Dumont C, Boue F, Chambrin V, Abgrall S, Kansau I, Raho-Moussa M, De Truchis P, Dinh A, Davido B, Marigot D, Berthe H, Devidas A, Chevojon P, Chabrol A, Agher N, Lemercier Y, Chaix F, Turpault I, Bouchaud O, Honore P, Rouveix E, Reimann E, Belan AG, Godin Collet C, Souak S, Mortier E, Bloch M, Simonpoli AM, Manceron V, Cahitte I, Hiraux E, Lafon E, Cordonnier F, Zeng AF, Zucman D, Majerholc C, Bornarel D, Uludag A, Gellen-Dautremer J, Lefort A, Bazin C, Daneluzzi V, Gerbe J, Jeantils V, Coupard M, Patey O, Bantsimba J, Delllion S, Paz PC, Cazenave B, Richier L, Garrait V, Delacroix I, Elharrar B, Vittecoq D, Bolliot C, Lepretre A, Genet P, Masse V, Perrone V, Boussard JL, Chardon P, Froguel E, Simon P, Tassi S, Avettand Fenoel V, Barin F, Bourgeois C, Cardon F, Chaix ML, Delfraissy JF, Essat A, Fischer H, Lecuroux C, Meyer L, Petrov-Sanchez V, Rouzioux C, Saez-Cirion A, Seng R, Kuldanek K, Mullaney S, Young C, Zucchetti A, Bevan MA, McKernan S, Wandolo E, Richardson C, Youssef E, Green P, Faulkner S, Faville R, Herman S, Care C, Blackman H, Bellenger K, Fairbrother K, Phillips A, Babiker A, Delpech V, Fidler S, Clarke M, Fox J, Gilson R, Goldberg D, Hawkins D, Johnson A, Johnson M, McLean K, Nastouli E, Post F, Kennedy N, Pritchard J, Andrady U, Rajda N, Donnelly C, McKernan S, Drake S, Gilleran G, White D, Ross J, Harding J, Faville R, Sweeney J, Flegg P, Toomer S, Wilding H, Woodward R, Dean G, Richardson C, Perry N, Gompels M, Jennings L, Bansaal D, Browing M, Connolly L, Stanley B, Estreich S, Magdy A, O'Mahony C, Fraser P, Jebakumar SPR, David L, Mette R, Summerfield H, Evans M, White C, Robertson R, Lean C, Morris S, Winter A, Faulkner S, Goorney B, Howard L, Fairley I, Stemp C, Short L, Gomez M, Young F, Roberts M, Green S, Sivakumar K, Minton J, Siminoni A, Calderwood J, Greenhough D, DeSouza C, Muthern L, Orkin C, Murphy S, Truvedi M, McLean K, Hawkins D, Higgs C, Moyes A, Antonucci S, McCormack S, Lynn W, Bevan M, Fox J, Teague A, Anderson J, Mguni S, Post F, Campbell L, Mazhude C, Russell H, Gilson R, Carrick G, Ainsworth J, Waters A, Byrne P, Johnson M, Fidler S, Kuldanek K, Mullaney S, Lawlor V, Melville R, Sukthankar A, Thorpe S, Murphy C, Wilkins E, Ahmad S, Green P, Tayal S, Ong E, Meaden J, Riddell L, Loay D, Peacock K, Blackman H, Harindra V, Saeed AM, Allen S, Natarajan U, Williams O, Lacey H, Care C, Bowman C, Herman S, Devendra SV, Wither J, Bridgwood A, Singh G, Bushby S, Kellock D, Young S, Rooney G, Snart B, Currie J, Fitzgerald M, Arumainayyagam J, Chandramani S. A highly virulent variant of HIV-1 circulating in the Netherlands. Science 2022; 375:540-545. [PMID: 35113714 DOI: 10.1126/science.abk1688] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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Affiliation(s)
- Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France.,IAME, UMR 1137, INSERM, Université de Paris, Paris, France
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Astrid Gall
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Matthew Hall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Swee Hoe Ong
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Lele Zhao
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Norbert Bannert
- Division for HIV and Other Retroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Jacques Fellay
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Kate Grabowski
- Department of Pathology, John Hopkins University, Baltimore, MD, USA
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Laurence Meyer
- INSERM CESP U1018, Université Paris Saclay, APHP, Service de Santé Publique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
| | - Matti Ristola
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Kellam
- Kymab Ltd., Cambridge, UK.,Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marion Cornelissen
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Molecular Diagnostic Unit, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Fenemore J, Rigney M, Boerckel W, Mcnamara A, Hennink M, Mayans J, Gaspar B, Pretorius L, Daniels M, Fox J, Hall D, Winstone S. MA05.01 Patients’ Experiences During COVID-19: Insights from The Second Global Lung Cancer Coalition Patient Experience Survey. J Thorac Oncol 2021. [PMCID: PMC8523142 DOI: 10.1016/j.jtho.2021.08.129] [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: 11/17/2022]
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Fox K, Fox J, Bexfield N, Freeman P. Computerised decision support in veterinary medicine, exemplified in a canine idiopathic epilepsy care pathway. J Small Anim Pract 2021; 62:911-917. [PMID: 34155645 DOI: 10.1111/jsap.13345] [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] [Received: 11/11/2020] [Revised: 02/23/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022]
Abstract
Computerised decision support is of emerging and increasing importance in human medicine, but as yet has not been thoroughly applied or evaluated in veterinary medicine. In this essay, the authors report on the first example of a veterinary care pathway, a specific form of computerised decision support, which guides clinicians through a clinical workflow and incorporates individual patient data to inform patient-specific decision recommendations. The veterinary care pathway was designed using consensus statements and specialist neurologist opinion to create a decision support tool concerning canine idiopathic epilepsy. The authors evaluated the care pathway by comparing 35 clinical decisions made by referral clinicians in historical cases of idiopathic epilepsy to decisions recommended by the care pathway when presented with the same clinical case. Their results show that in 77.1% (95% confidence interval [59.9, 89.6]) of cases the care pathway recommended a decision that was the same or similar to a specialist neurologist's decision. Whilst further studies are needed to explore the potential use of such technology in clinical practice, the authors believe this first application provides great promise of a new and alternative method of clinical decision support.
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Affiliation(s)
- K Fox
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
| | - J Fox
- Department of Engineering, University of Oxford, Oxford, Oxfordshire, OX1 3PJ, UK
| | - N Bexfield
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
| | - P Freeman
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, UK
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14
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Thomas M, Baltatzis M, Price A, Pearce L, Fox J, Vilches-Moraga A. 513 THE INFLUENCE OF FRAILTY ON OUTCOMES FOR OLDER ADULTS ADMITTED TO HOSPITAL WITH BENIGN BILIARY AND PANCREATIC DISEASE. Age Ageing 2021. [DOI: 10.1093/ageing/afab119.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The prevalence and complications of biliary disease increase with age. We describe the prevalence of frailty in older patients hospitalised with benign biliary and pancreatic disease and establish its association with mortality and duration of hospital stay.
Methods
Prospective observational cohort study of patients aged 75 years and over admitted with a diagnosis of acute biliary disease to a surgical hospital unit between 17/09/2014 and 20/03/2017. Clinical Frailty Scale (CFS) score was recorded on admission.
Results
We included 200 patients with a median age of 82 (75–99), 60% females, 89% lived in their homes, 154 (77%) were independent for personal and 99 (49.5%) for instrumental ADLs, 95% mobilised independently, 17.5% had memory impairment and 8% low mood. Acute cholecystitis was the most common diagnosis (43%) followed by acute cholangitis (36%) and acute pancreatitis (21%). 99 patients were non-frail (NF = CFS 1–4) and 101 were frail (F = CFS ≥5). 104 patients received medical treatment only. Surgery was more common in non-frail (F 2% vs. NF 11%), percutaneous drainage more frequently carried out in frail patients (15% vs. NF 5%) and endoscopic cholangiopancreatography (ERCP) was similar in both groups (F 32%vs. NF 31%). Frailty was associated with worse clinical outcomes in F vs. NF: functional deconditioning (34% vs. 11%), increased care level (19% vs 3%), length of stay (12 vs. 7 days), 90-day (8% vs. 3%) and 1 year-mortality (48% vs. 24%).
Conclusion
Half of patients in our cohort of older adults hospitalised with acute biliary disease were frail. Higher scores of frailty are associated with increased mortality. Compared with non-frail patients, individuals living with frailty were less likely to undergo surgical treatment, spent longer in hospital and were less likely to remain alive at 12 months after hospital discharge.
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Affiliation(s)
- M Thomas
- Department of General Surgery, Salford Royal Foundation Trust, Salford, United Kingdom
| | - M Baltatzis
- Department of General Surgery, Salford Royal Foundation Trust, Salford, United Kingdom
| | - A Price
- Geriatric Medicine Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | - L Pearce
- Department of General Surgery, Salford Royal Foundation Trust, Salford, United Kingdom
| | - J Fox
- Geriatric Medicine Unit, Salford Royal Foundation Trust, Salford, United Kingdom
| | - A Vilches-Moraga
- Geriatric Medicine Unit, Salford Royal Foundation Trust, Salford, United Kingdom
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15
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Thomas M, Cookson K, Clark R, Pearce L, Fox J, Price A. 472 A PILOT COLORECTAL AND GERIATRIC MEDICINE (CGM) CLINIC FOR OLDER, FRAIL PATIENTS REFERRED VIA A 2 WEEK WAIT PATHWAY. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The two week wait (2ww) colorectal referral pathway was introduced to expedite referrals where cancer is suspected, facilitating prompt diagnosis +/− intervention. Older frail patients are referred via this 2ww pathway even when invasive testing and intervention may not be appropriate. These patients may benefit more from holistic assessment than a universally surgical approach. A Colorectal and Geriatric Medicine (CGM) 2ww referral clinic was piloted, delivered by an urgent referral colorectal specialist nurse and an advanced clinical practitioner in geriatric medicine.
Method
Patients >65 years with a Clinical Frailty Scale (CFS) score of 5 or more at referral were directed to the CGM clinic. A telephone consultation was undertaken, incorporating both 2ww assessment and aspects of comprehensive geriatric assessment.
Results
42-patients were reviewed in the clinic. Mean age was 86.1 years and mean CFS 6. 12-patients underwent CT, and 2 CT virtual colonoscopy. No patients underwent endoscopic investigation and 28-patients declined any investigation. Of those who underwent investigation, no cancers were identified. 1 patient was referred on for endosocpic mucosal resection of polyps. 5-patients had severe diverticular disease, which accounted for their symptoms. Medication recommendations were made for 30-patients, some of which led to symptom cessation. Onward referrals were made to a community geriatrician, diabetes and continence teams, and palliative care specialists. 9-patients were identified as meeting criteria for advance care planning. This was commenced during the consultation and communicated back to the referring clinician for further action.
Conclusion
Older, frail patients are often not able, nor wish to undergo, invasive investigations but should not be disadvantaged or delayed in their pathway. Further work is needed to determine the most appropriate referral pathway for this group of patients. Holistic assessment that leads to improvement in symptoms and future planning may not be achievable through a solely surgical assessment.
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Affiliation(s)
- M Thomas
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - K Cookson
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - R Clark
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - L Pearce
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - J Fox
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
| | - A Price
- Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Colorectal Surgery; Department of Colorectal Surgery, Department of Colorectal Surgery; Department of Ageing and Complex Medicine; Department of Ageing and Complex Medicine; Salford Royal Foundation NHS Trust
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16
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Appavu B, Foldes S, Fox J, Shetty S, Oh A, Bassal F, Marku I, Mangum T, Boerwinkle V, Neilson D, Kruer M. Treatment Timing, EEG, Neuroimaging, and Outcomes After Acute Necrotizing Encephalopathy in Children. J Child Neurol 2021; 36:517-524. [PMID: 33393838 DOI: 10.1177/0883073820984063] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute necrotizing encephalopathy (ANE) is a rare condition associated with rapid progression to coma and high incidence of morbidity and mortality. METHODS Clinical, electroencephalographic (EEG), and brain magnetic resonance imaging (MRI) characteristics and immunomodulatory therapy timing were retrospectively analyzed in children with ANE. ANE severity scores (ANE-SS) and MRI scores were also assessed. The associations of patient characteristics with 6-month modified Rankin scale (mRS) and length of hospitalization were determined using either univariate linear regression or one-way analysis of variance. RESULTS 7 children were retrospectively evaluated. Normal EEG sleep spindles (P = .024) and early treatment (R2 = .57, P = .030) were associated with improved outcomes (ie, decreased mRS). Higher ANE-SS (R2 = .79, P = .011), higher age (R2 = .62, P = .038), and presence of brainstem lesions (P = .015) were associated with longer length of hospitalization. Other patient characteristics were not significantly associated with mRS or length of hospitalization. CONCLUSION Early immunomodulatory therapy and normal sleep spindles are associated with better functional outcome in children with ANE.
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Affiliation(s)
- Brian Appavu
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Stephen Foldes
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Jordana Fox
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Sheetal Shetty
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Ann Oh
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Freddy Bassal
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Iris Marku
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Tara Mangum
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Varina Boerwinkle
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Derek Neilson
- Department of Genetics, Phoenix Children's Hospital, 42283University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Michael Kruer
- Department of Neurosciences, Barrow Neurological Institute at 14524Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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17
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Morgan SO, Fox J, Lowe C, Adawi AM, Bouillard JSG, Stasiuk GJ, Horozov TS, Buzza DMA. Adsorption trajectories of nonspherical particles at liquid interfaces. Phys Rev E 2021; 103:042604. [PMID: 34005913 DOI: 10.1103/physreve.103.042604] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/22/2021] [Indexed: 11/07/2022]
Abstract
The adsorption of colloidal particles at liquid interfaces is of great importance scientifically and industrially, but the dynamics of the adsorption process is still poorly understood. In this paper we use a Langevin model to study the adsorption dynamics of ellipsoidal colloids at a liquid interface. Interfacial deformations are included by coupling our Langevin dynamics to a finite element model while transient contact line pinning due to nanoscale defects on the particle surface is encoded into our model by renormalizing particle friction coefficients and using dynamic contact angles relevant to the adsorption timescale. Our simple model reproduces the monotonic variation of particle orientation with time that is observed experimentally and is also able to quantitatively model the adsorption dynamics for some experimental ellipsoidal systems but not others. However, even for the latter case, our model accurately captures the adsorption trajectory (i.e., particle orientation versus height) of the particles. Our study clarifies the subtle interplay between capillary, viscous, and contact line forces in determining the wetting dynamics of micron-scale objects, allowing us to design more efficient assembly processes for complex particles at liquid interfaces.
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Affiliation(s)
- S O Morgan
- Department of Physics & Mathematics, University of Hull, Hull HU6 7RX, United Kingdom
| | - J Fox
- Department of Physics & Mathematics, University of Hull, Hull HU6 7RX, United Kingdom.,School of Physics & Astronomy, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - C Lowe
- Department of Physics & Mathematics, University of Hull, Hull HU6 7RX, United Kingdom
| | - A M Adawi
- Department of Physics & Mathematics, University of Hull, Hull HU6 7RX, United Kingdom
| | - J-S G Bouillard
- Department of Physics & Mathematics, University of Hull, Hull HU6 7RX, United Kingdom
| | - G J Stasiuk
- Imaging Chemistry & Biology, King's College London, Strand, London WC2R 2LS, United Kingdom
| | - T S Horozov
- Department of Chemistry & Biochemistry, University of Hull, Hull HU6 7RX, United Kingdom
| | - D M A Buzza
- Department of Physics & Mathematics, University of Hull, Hull HU6 7RX, United Kingdom
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18
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Burns JE, Stöhr W, Kinloch-De Loes S, Fox J, Clarke A, Nelson M, Thornhill J, Babiker A, Frater J, Pett SL, Fidler S. Tolerability of four-drug antiretroviral combination therapy in primary HIV-1 infection. HIV Med 2021; 22:770-774. [PMID: 33964099 PMCID: PMC8612356 DOI: 10.1111/hiv.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Objectives Rapid initiation of antiretroviral therapy (ART) is important for individuals with high baseline viral loads, such as in primary HIV‐1 infection (PHI). Four‐drug regimens are sometimes considered; however, data are lacking on tolerability. We aimed to evaluate the tolerability of four‐drug regimens used in the Research in Viral Eradication of HIV‐1 Reservoirs (RIVER) study. Methods At enrolment, ART‐naïve adult participants or those newly commenced on ART were initiated or intensified to four‐drug regimens within 4 weeks of PHI. Rapid start was defined as pre‐confirmation or ≤ 7 days of confirmed diagnosis. Primary and secondary outcomes were patient‐reported adherence measured by 7‐day recall and regimen switches between enrolment and randomization, respectively. Results Overall, 54 men were included: 72.2% were of white ethnicity, with a median age of 32 years old, 42.6% had a viral load of ≥ 100 000 HIV‐1 RNA copies/mL, and in 92.6% sex with men was the mode of acquisition of HIV‐1. Twenty (37%) started a four‐drug regimen and 34 (63%) were intensified. Rapid ART initiation occurred in 28%, 100% started in ≤ 4 weeks. By weeks 4, 12, and 24, 37.0%, 69.0%, and 94.0% were undetectable (viral load < 50 copies/mL), respectively. Adherence rates of 100% at weeks 4, 12, 22 and 24 were reported in 88.9%, 87.0%, 82.4% and 94.1% of participants, respectively. Five individuals switched to three drugs, four changed their regimen constituents, and two switched post‐randomization. Conclusions Overall, four‐drug regimens were well tolerated and had high levels of adherence. Whilst their benefit over three‐drug regimens is lacking, our findings should provide reassurance if a temporarily intensified regimen is clinically indicated to help facilitate treatment.
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Affiliation(s)
- J E Burns
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - W Stöhr
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Kinloch-De Loes
- Department of Infection and Immunity, Royal Free Hospital, London, UK.,Institute of Immunity & Transplantation, University College London, London, UK
| | - J Fox
- Department of Genitourinary Medicine and Infectious Diseases, Guys and St, Thomas' NHS Trust, London, UK.,Department of Genitourinary Medicine and Infectious Diseases, NIHR Biomedical Research Centre, King's College London, London, UK
| | - A Clarke
- Elton John Centre, Brighton, UK.,Department of HIV and Sexual Health, Sussex University Hospital, Brighton, UK.,Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - M Nelson
- Department of HIV Medicine, Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - J Thornhill
- Department of Infectious Disease, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - A Babiker
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - J Frater
- Nuffield Department of Medicine, Oxford University, Oxford, UK.,Nuffield Department of Medicine, Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - S L Pett
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Fidler
- Department of Infectious Disease, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
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19
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Abstract
OBJECTIVE Genetic variants of the neuronal nicotinic acetylcholine receptor (nAChR) cause autosomal dominant sleep-related hypermotor epilepsy. Approximately 30% of autosomal dominant sleep-related hypermotor epilepsy patients are medically intractable. In preclinical models, pathogenic nAChR variants cause a gain of function mutation with sensitivity to acetylcholine antagonists and agonists. Nicotine modifies the activity of nAChRs and can be used as targeted therapy. METHODS We reviewed next-generation sequencing epilepsy panels from a single laboratory (GeneDx) from patients at Children's Medical Center Dallas between 2011 and 2015 and identified patients with nAChR variants. Retrospective review of records included variant details, medical history, neuroimaging findings, and treatment history. RESULTS Twenty-one patients were identified. Four patients were prescribed nicotine patches for intractable seizures. Three of 4 patients had a clinical response, with >50% seizure reduction. CONCLUSIONS Treatment with a nicotine patch can be an effective therapy in epilepsy patients with nAChR gene variants. We propose consideration of transdermal nicotine treatment in intractable epilepsy with known nAChR variants as an experimental therapy. Further clinical trials are needed to fully define therapeutic effects.
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Affiliation(s)
- Jordana Fox
- Barrow Neurological Institute at 14524Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | - Alison M Dolce
- 196285University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.,Children's Medical Center of Dallas, Dallas, TX, USA
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20
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Beattie V, Boerckel W, Rigney M, O'Hagan K, Hennink M, Fox J. 209P_PR Understanding patient experience in Europe: The first global lung cancer coalition patient experience survey. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)02051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Nash S, Dietrich J, Ssemata AS, Herrera C, O'Hagan K, Else L, Chiodi F, Kelly C, Shattock R, Chirenje M, Lebina L, Khoo S, Bekker LG, Weiss HA, Gray C, Stranix-Chibanda L, Kaleebu P, Seeley J, Martinson N, Fox J. Combined HIV Adolescent Prevention Study (CHAPS): comparison of HIV pre-exposure prophylaxis regimens for adolescents in sub-Saharan Africa-study protocol for a mixed-methods study including a randomised controlled trial. Trials 2020; 21:900. [PMID: 33121503 PMCID: PMC7596950 DOI: 10.1186/s13063-020-04760-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV remains a major public health issue, especially in Eastern and Southern Africa. Pre-exposure prophylaxis is highly effective when adhered to, but its effectiveness is limited by cost, user acceptability and uptake. The cost of a non-inferiority phase III trial is likely to be prohibitive, and thus, it is essential to select the best possible drug, dose and schedule in advance. The aim of this study, the Combined HIV Adolescent PrEP and Prevention Study (CHAPS), is to investigate the drug, dose and schedule of pre-exposure prophylaxis (PrEP) required for the protection against HIV and the acceptability of PrEP amongst young people in sub-Saharan Africa, and hence to inform the choice of intervention for future phase III PrEP studies and to improve strategies for PrEP implementation. METHODS We propose a mixed-methods study amongst young people aged 13-24 years. The first component consists of qualitative research to identify the barriers and motivators towards the uptake of PrEP amongst young people in South Africa, Uganda and Zimbabwe. The second component is a randomised clinical trial (ClinicalTrials.gov NCT03986970, June 2019) using a novel ex vivo HIV challenge method to investigate the optimal PrEP treatment (FTC-TDF vs FTC-TAF), dose and schedule. We will recruit 144 amongst HIV-negative uncircumcised men aged 13-24 years from voluntary male medical circumcision clinics in two sites (South Africa and Uganda) and randomise them into one of nine arms. One group will receive no PrEP prior to surgery; the other arms will receive either FTC-TDF or FTC-TAF, over 1 or 2 days, and with the final dose given either 6 or 20 h prior to surgery. We will conduct an ex vivo HIV challenge on their resected foreskin tissue. DISCUSSION This study will provide both qualitative and quantitative results to help decide the optimum drug, dose and schedule for a future phase III trial of PrEP. The study will also provide crucial information on successful strategies for providing PrEP to young people in sub-Saharan Africa. TRIAL REGISTRATION ClinicalTrials.gov NCT03986970 . Registered on 14 June 2019.
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Affiliation(s)
- S Nash
- London School of Hygiene and Tropical Medicine, London, UK
| | - J Dietrich
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - A S Ssemata
- MRC/UVRI Uganda Research Unit On Aids, Entebbe, Uganda
| | | | - K O'Hagan
- University of Cape Town, Cape Town, South Africa
| | - L Else
- University of Liverpool, Liverpool, UK
| | - F Chiodi
- Karolinska Institutet, Solna, Sweden
| | - C Kelly
- King's College London, London, UK
| | | | - M Chirenje
- University of Zimbabwe, Harare, Zimbabwe
| | - L Lebina
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - S Khoo
- University of Liverpool, Liverpool, UK
| | - L-G Bekker
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | - H A Weiss
- London School of Hygiene and Tropical Medicine, London, UK
| | - C Gray
- University of Cape Town, Cape Town, South Africa
| | | | - P Kaleebu
- MRC/UVRI Uganda Research Unit On Aids, Entebbe, Uganda
| | - J Seeley
- London School of Hygiene, London, UK
| | - N Martinson
- University of the Witwatersrand Perinatal HIV Research Unit, Johannesburg, South Africa
| | - J Fox
- King's College London, London, UK.
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22
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Mahoney DT, Fox J, Al-Aamery N, Clare E. Integrating connectivity theory within watershed modelling part II: Application and evaluating structural and functional connectivity. Sci Total Environ 2020; 740:140386. [PMID: 32624176 DOI: 10.1016/j.scitotenv.2020.140386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
Integrating connectivity theory within watershed modelling is one solution to overcome spatial and temporal shortcomings of sediment transport prediction, and Part I and II of these companion papers advance this overall goal. In Part II of these companion papers, we investigate sediment flux via connectivity formula discretized over many catchments and then integrated via sediment routing; and we advance model evaluation technology by using hysteresis of sensor data. Model evaluation with hysteresis indices provides nearly a 100% increase in model statistics. Hysteresis loop evaluation shows a shift from near linear behavior at low to moderate events and then clock-wise loops for larger events indicating the importance of proximal sediment sources. Catchment-scale sediment flux varies as function of the probability of timing and extent of connectivity of an individual catchment. Watershed-scale sediment flux shows self-similarity for the main stem of the river channel as the 181 catchments are integrated moving down gradient. Sediment flux varies from event-to-event as a function of the most sensitive connected pathways, including ephemeral gullies and roadside ditches in this basin. These sensitive pathways contribute disproportionately large amounts to overall sediment yield regardless of the total rainfall depth. Prediction requires the connectivity formula, erosion formula and sediment routing formula; and the probability of connectivity alone was a poor predictor for sediment transport. The result highlights the importance of coupling connectivity simulations with sediment transport formula, and our method provides one such approach.
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Affiliation(s)
- D T Mahoney
- Dept. of Civil Engineering, University of Kentucky, United States of America
| | - J Fox
- Dept. of Civil Engineering, University of Kentucky, United States of America.
| | - N Al-Aamery
- Dept. of Civil Engineering, University of Kentucky, United States of America
| | - E Clare
- Dept. of Civil Engineering, University of Kentucky, United States of America
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23
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Mahoney DT, Fox J, Al-Aamery N, Clare E. Integrating connectivity theory within watershed modelling part I: Model formulation and investigating the timing of sediment connectivity. Sci Total Environ 2020; 740:140385. [PMID: 32624177 DOI: 10.1016/j.scitotenv.2020.140385] [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] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
Integrating connectivity theory within watershed modelling is one solution to overcome spatial and temporal shortcomings of sediment transport prediction, and Part I and II of these companion papers advance this overall goal. In Part I of these companion papers, we present the theoretical development of probability of connectivity formula considering connectivity's magnitude, extent, timing and continuity that can be applied to watershed modelling. Model inputs include a high resolution digital elevation model, hydrologic watershed variability, and field connectivity assessments. We use the model to investigate the dependence of the probability of connected timing and spatial connectivity on sediment transport predictors. Results show the spatial patterns of connectivity depend on both structural and functional characteristics of the catchment, such as hillslope gradient, upstream contributing area, soil texture, and stream network configuration (structural) and soil moisture content and runoff generation (functional). Spatial connectivity changes from catchment-to-catchment as a function of soil type and drainage area; and it varies from event-to-event as a function of runoff depth and soil moisture conditions. The most sensitive connected pathways provide the stencil for the probability of connectivity, and pathways connected from smaller hydrologic events are consistently reconnected and built upon during larger hydrologic events. Surprisingly, we find the probability of connected timing only depends on structural characteristics of catchments, which are considered static over the timescales analyzed herein. The timing of connectivity does not statistically depend on functional characteristics, which relaxes the parameterization across events of different magnitudes. This result occurs because the pathway stencil accumulates sediment from adjacent soils as flow intensity increases, but this does not statistically shift the frequency distribution.
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Affiliation(s)
- D T Mahoney
- Dept. of Civil Engineering, University of Kentucky, United States of America
| | - J Fox
- Dept. of Civil Engineering, University of Kentucky, United States of America.
| | - N Al-Aamery
- Dept. of Civil Engineering, University of Kentucky, United States of America
| | - E Clare
- Dept. of Civil Engineering, University of Kentucky, United States of America
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24
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Fox J, Jenks CL, Farhat A, Li X, Liu Y, James E, Karasick S, Morriss MC, Sirsi D, Raman L. EEG is A Predictor of Neuroimaging Abnormalities in Pediatric Extracorporeal Membrane Oxygenation. J Clin Med 2020; 9:jcm9082512. [PMID: 32759731 PMCID: PMC7463499 DOI: 10.3390/jcm9082512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/31/2022] Open
Abstract
The goal of this project was to evaluate if severity of electroencephalogram (EEG) during or shortly after being placed on extracorporeal membrane oxygenation (ECMO) would correlate with neuroimaging abnormalities, and if that could be used as an early indicator of neurologic injury. This was a retrospective chart review spanning November 2009 to May 2018. Patients who had an EEG recording during ECMO or within 48 hours after being decannulated (early group) or within 3 months of being on ECMO (late group) were included if they also had ECMO-related neuroimaging. In the early EEG group, severity of the EEG findings of mild, moderate, and severe EEG correlated to mild, moderate, and severe neuroimaging scores. Patients on venoarterial (VA) ECMO were noted to have higher EEG and neuroimaging severity; this was statistically significant. There was no association in the late EEG group to neuroimaging abnormalities. Our study highlights that EEG severity can be an early predictor for neuroimaging abnormalities that can be identified by computed tomography (CT) and or magnetic resonance imaging (MRI). This can provide guidance for both the medical team and families, allowing for a better understanding of overall prognosis.
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Affiliation(s)
- Jordana Fox
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA;
| | | | - Abdelaziz Farhat
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA; (A.F.); (D.S.)
- Children’s Medical Center of Dallas, Dallas, TX 75235, USA; (E.J.); (S.K.); (M.C.M.)
| | - Xilong Li
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (X.L.); (Y.L.)
| | - Yulun Liu
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (X.L.); (Y.L.)
| | - Ellen James
- Children’s Medical Center of Dallas, Dallas, TX 75235, USA; (E.J.); (S.K.); (M.C.M.)
| | - Stephanie Karasick
- Children’s Medical Center of Dallas, Dallas, TX 75235, USA; (E.J.); (S.K.); (M.C.M.)
| | - Michael C. Morriss
- Children’s Medical Center of Dallas, Dallas, TX 75235, USA; (E.J.); (S.K.); (M.C.M.)
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Deepa Sirsi
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA; (A.F.); (D.S.)
- Children’s Medical Center of Dallas, Dallas, TX 75235, USA; (E.J.); (S.K.); (M.C.M.)
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lakshmi Raman
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA; (A.F.); (D.S.)
- Children’s Medical Center of Dallas, Dallas, TX 75235, USA; (E.J.); (S.K.); (M.C.M.)
- Correspondence:
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Abstract
The purpose of the study reported here was to teach a preschool child with a visual impairment and significant developmental delay to reach out and locate objects systematically and accurately from a sitting position and to locate and move toward given objects in the environment using the Infant Sonicguide. Although the child achieved the first goal, time constraints prevented him from reaching the second goal.
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Affiliation(s)
- M.-M. Hill
- Department of Special Education, Box 328, Peabody College, Vanderbilt University, Nashville, TN 37013
| | - B. Dodson-Burk
- Tennessee School for the Blind, 1005 Milton Avenue, Pittsburgh, PA 15218
| | - E.W. Hill
- Department of Special Education, Peabody College, Vanderbilt University
| | - J. Fox
- Center for Early Childhood Learning and Development, East Tennessee State University, P.O. Box 70434, Johnson City, TN 37614
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Biltcliffe DO, Kleyn DH, Trout JR, Azzara D, Bissonette J, Bradley R, Brown R, Chamberlin W, Cheryan M, Dimick R, Duthie A, Fox J, Sherbon J, Somkuti G, Zimmerman A. Enzymatic-Ultraviolet Method for Measuring Lactose in Milk: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/67.3.637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Collaborators in 8 dairy and food industry laboratories performed one lactose determination on each of 8 unknown samples of milk, lowfat milk, or skim milk, as 3 pairs of blind duplicates. Two known samples were provided to gain experience prior to analysis of the unknown samples. All of the above samples were also analyzed for lactose content by the official AOAC gravimetric method (16.507) by a commercial laboratory. From the overall mean of results on all samples, determinations by the enzymatic method averaged 0.49% lower than by the AOAC method. This difference was significant by the t-test (P = 0.05), which indicated a lack of agreement between the compared methods in determining lactose content. Standard deviations were similar for the 3 sets of blind duplicates which ranged between 3.67 and 4.55% lactose content. F-values revealed that variations between means obtained by laboratories differed significantly as compared with variations within laboratory means. The method has been adopted official first action.
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Affiliation(s)
- David O Biltcliffe
- New Jersey Agricultural Experiment Station, Rutgers University, Department of Food Science and Department of Statistics, New Brunswick, NJ 08903
| | - Dick H Kleyn
- New Jersey Agricultural Experiment Station, Rutgers University, Department of Food Science and Department of Statistics, New Brunswick, NJ 08903
| | - J Richard Trout
- New Jersey Agricultural Experiment Station, Rutgers University, Department of Food Science and Department of Statistics, New Brunswick, NJ 08903
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Gureyev TE, Nesterets YI, Baran PM, Taba ST, Mayo SC, Thompson D, Arhatari B, Mihocic A, Abbey B, Lockie D, Fox J, Kumar B, Prodanovic Z, Hausermann D, Maksimenko A, Hall C, Peele AG, Dimmock M, Pavlov KM, Cholewa M, Lewis S, Tromba G, Quiney HM, Brennan PC. Propagation-based x-ray phase-contrast tomography of mastectomy samples using synchrotron radiation. Med Phys 2019; 46:5478-5487. [PMID: 31574166 DOI: 10.1002/mp.13842] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/02/2019] [Accepted: 09/18/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Propagation-based phase-contrast computed tomography (PB-CT) is a method for three-dimensional x-ray imaging that utilizes refraction, as well as absorption, of x rays in the tissues to increase the signal-to-noise ratio (SNR) in the resultant images, in comparison with equivalent conventional absorption-only x-ray tomography (CT). Importantly, the higher SNR is achieved without sacrificing spatial resolution or increasing the radiation dose delivered to the imaged tissues. The present work has been carried out in the context of the current development of a breast CT imaging facility at the Australian Synchrotron. METHODS Seven unfixed complete mastectomy samples with and without breast cancer lesions have been imaged using absorption-only CT and PB-CT techniques under controlled experimental conditions. The radiation doses delivered to the mastectomy samples during the scans were comparable to those approved for mammographic screening. Physical characteristics of the reconstructed images, such as spatial resolution and SNR, have been measured and compared with the results of the radiological quality assessment of the complete absorption CT and PB-CT image stacks. RESULTS Despite the presence of some image artefacts, the PB-CT images have outperformed comparable absorption CT images collected at the same radiation dose, in terms of both the measured objective image characteristics and the radiological image scores. The outcomes of these experiments are shown to be consistent with predictions of the theory of PB-CT imaging and previous reported experimental studies of this imaging modality. CONCLUSIONS The results presented in this paper demonstrate that PB-CT holds a high potential for improving on the quality and diagnostic value of images obtained using existing medical x-ray technologies, such as mammography and digital breast tomosynthesis (DBT). If implemented at suitable synchrotron imaging facilities, PB-CT can be used to complement existing imaging modalities, leading to more accurate breast cancer diagnosis.
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Affiliation(s)
- T E Gureyev
- The University of Melbourne, Parkville, 3010, Australia.,The University of Sydney, Lidcombe, 2141, Australia.,Monash University, Clayton, 3800, Australia.,University of New England, Armidale, 2351, Australia
| | - Ya I Nesterets
- University of New England, Armidale, 2351, Australia.,Commonwealth Scientific and Industrial Research Organisation, Clayton, 3168, Australia
| | - P M Baran
- The University of Melbourne, Parkville, 3010, Australia
| | - S T Taba
- The University of Sydney, Lidcombe, 2141, Australia
| | - S C Mayo
- Commonwealth Scientific and Industrial Research Organisation, Clayton, 3168, Australia
| | - D Thompson
- University of New England, Armidale, 2351, Australia.,Commonwealth Scientific and Industrial Research Organisation, Clayton, 3168, Australia
| | - B Arhatari
- The University of Melbourne, Parkville, 3010, Australia.,La Trobe University, Bundoora, 3086, Australia
| | - A Mihocic
- La Trobe University, Bundoora, 3086, Australia
| | - B Abbey
- La Trobe University, Bundoora, 3086, Australia
| | - D Lockie
- Maroondah BreastScreen, Ringwood East, 3135, Australia
| | - J Fox
- Monash University, Clayton, 3800, Australia
| | - B Kumar
- Monash University, Clayton, 3800, Australia
| | | | - D Hausermann
- Australian Synchrotron, ANSTO, Clayton, 3168, Australia
| | - A Maksimenko
- Australian Synchrotron, ANSTO, Clayton, 3168, Australia
| | - C Hall
- Australian Synchrotron, ANSTO, Clayton, 3168, Australia
| | - A G Peele
- Australian Synchrotron, ANSTO, Clayton, 3168, Australia
| | - M Dimmock
- Monash University, Clayton, 3800, Australia
| | - K M Pavlov
- Monash University, Clayton, 3800, Australia.,University of New England, Armidale, 2351, Australia.,University of Canterbury, Christchurch, 8041, New Zealand
| | - M Cholewa
- University of Rzeszow, 35-310, Rzeszow, Poland
| | - S Lewis
- The University of Sydney, Lidcombe, 2141, Australia
| | - G Tromba
- Elettra Sincrotrone, 34149, Basovizza, Trieste, Italy
| | - H M Quiney
- The University of Melbourne, Parkville, 3010, Australia
| | - P C Brennan
- The University of Sydney, Lidcombe, 2141, Australia
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Fox J, Scanlan A, Stanton R, O’Grady C, Sargent C. In-game but not training workloads impact sleep in basketball players. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O’Grady C, Sargent C, Scanlan A, Stanton R, Fox J. The effects of game-related situational variables on sleep in basketball players. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pach E, Brinckmann J, Fox J, Mauch C, Zigrino P. 449 Deletion of fibroblast MMP-14 in the skin leads to reduced melanoma growth. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.499] [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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Martin G, Pace M, Meyerowitz J, Thornhill J, Lwanga J, Lewis H, Solano T, Bull R, Fox J, Nwokolo N, Fidler S, Willberg C, Frater J. Persistent elevation of Tim-3 and PD-1 on memory T cells despite early ART initiation during primary HIV infection. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)31031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Rheinheimer G, Bethoney C, Boone J, Fox J, Stradinger J. Analytical sensitivity of urine dipstick leukocyte esterase tests. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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Andraos T, Orisamolu A, Fox J. EP-1332 An Urban Institution's Experience with the Oncotype DCIS Score: Predictors and Outcomes. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31752-9] [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: 10/26/2022]
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35
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Helbig KL, Lauerer RJ, Bahr JC, Souza IA, Myers CT, Uysal B, Schwarz N, Gandini MA, Huang S, Keren B, Mignot C, Afenjar A, Billette de Villemeur T, Héron D, Nava C, Valence S, Buratti J, Fagerberg CR, Soerensen KP, Kibaek M, Kamsteeg EJ, Koolen DA, Gunning B, Schelhaas HJ, Kruer MC, Fox J, Bakhtiari S, Jarrar R, Padilla-Lopez S, Lindstrom K, Jin SC, Zeng X, Bilguvar K, Papavasileiou A, Xing Q, Zhu C, Boysen K, Vairo F, Lanpher BC, Klee EW, Tillema JM, Payne ET, Cousin MA, Kruisselbrink TM, Wick MJ, Baker J, Haan E, Smith N, Sadeghpour A, Davis EE, Katsanis N, Corbett MA, MacLennan AH, Gecz J, Biskup S, Goldmann E, Rodan LH, Kichula E, Segal E, Jackson KE, Asamoah A, Dimmock D, McCarrier J, Botto LD, Filloux F, Tvrdik T, Cascino GD, Klingerman S, Neumann C, Wang R, Jacobsen JC, Nolan MA, Snell RG, Lehnert K, Sadleir LG, Anderlid BM, Kvarnung M, Guerrini R, Friez MJ, Lyons MJ, Leonhard J, Kringlen G, Casas K, El Achkar CM, Smith LA, Rotenberg A, Poduri A, Sanchis-Juan A, Carss KJ, Rankin J, Zeman A, Raymond FL, Blyth M, Kerr B, Ruiz K, Urquhart J, Hughes I, Banka S, Hedrich UB, Scheffer IE, Helbig I, Zamponi GW, Lerche H, Mefford HC, Allori A, Angrist M, Ashley P, Bidegain M, Boyd B, Chambers E, Cope H, Cotten CM, Curington T, Davis EE, Ellestad S, Fisher K, French A, Gallentine W, Goldberg R, Hill K, Kansagra S, Katsanis N, Katsanis S, Kurtzberg J, Marcus J, McDonald M, Mikati M, Miller S, Murtha A, Perilla Y, Pizoli C, Purves T, Ross S, Sadeghpour A, Smith E, Wiener J. De Novo Pathogenic Variants in CACNA1E Cause Developmental and Epileptic Encephalopathy with Contractures, Macrocephaly, and Dyskinesias. Am J Hum Genet 2019; 104:562. [PMID: 30849329 DOI: 10.1016/j.ajhg.2019.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sahlem G, Short E, McCall W, Rosenquist P, Fox J, Manett A, Nahas Z, Mazingue C, George M, Sackeim H. A two-site, open-label, non-randomized update, suggests focal electrically administered seizure therapy (FEAST) may have a reduced time to re-orientation compared to right unilateral ultra-brief pulse electroconvulsive therapy (UBP-RUL ECT). Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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37
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Rowley M, Paracha A, Khan H, Springall N, Fox J, Vilches-Moraga A. 114FRAILTY AS A PREDICTOR OF 12-MONTH MORTALITY IN OLDER PATIENTS UNDERGOING EMERGENCY LAPAROTOMY: A PROSPECTIVE STUDY. Age Ageing 2019. [DOI: 10.1093/ageing/afy204.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Rowley
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - A Paracha
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - H Khan
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - N Springall
- School of Medicine, University of Manchester
| | - J Fox
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - A Vilches-Moraga
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
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Vilches-Moraga A, Springall N, Rowley M, Khan H, Paracha A, Price A, Pedersen A, Miguel-Alhambra L, Fox J. 67THE OLDER EMERGENCY GENERAL SURGERY PATIENT. FACTORS PRESENT AT THE TIME OF HOSPITAL ADMISSION THAT ARE PREDICTIVE OF DEATH AT 12-MONTHS: SALFORD POPS-GS. Age Ageing 2019. [DOI: 10.1093/ageing/afy214.04] [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: 11/12/2022] Open
Affiliation(s)
- A Vilches-Moraga
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
- School of Medicine, University of Manchester
| | - N Springall
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - M Rowley
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - H Khan
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - A Paracha
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - A Price
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - A Pedersen
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - L Miguel-Alhambra
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
| | - J Fox
- Department of Ageing and Complex Medicine, Salford Royal NHS Foundation Trust
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Helbig KL, Lauerer RJ, Bahr JC, Souza IA, Myers CT, Uysal B, Schwarz N, Gandini MA, Huang S, Keren B, Mignot C, Afenjar A, Billette de Villemeur T, Héron D, Nava C, Valence S, Buratti J, Fagerberg CR, Soerensen KP, Kibaek M, Kamsteeg EJ, Koolen DA, Gunning B, Schelhaas HJ, Kruer MC, Fox J, Bakhtiari S, Jarrar R, Padilla-Lopez S, Lindstrom K, Jin SC, Zeng X, Bilguvar K, Papavasileiou A, Xing Q, Zhu C, Boysen K, Vairo F, Lanpher BC, Klee EW, Tillema JM, Payne ET, Cousin MA, Kruisselbrink TM, Wick MJ, Baker J, Haan E, Smith N, Sadeghpour A, Davis EE, Katsanis N, Corbett MA, MacLennan AH, Gecz J, Biskup S, Goldmann E, Rodan LH, Kichula E, Segal E, Jackson KE, Asamoah A, Dimmock D, McCarrier J, Botto LD, Filloux F, Tvrdik T, Cascino GD, Klingerman S, Neumann C, Wang R, Jacobsen JC, Nolan MA, Snell RG, Lehnert K, Sadleir LG, Anderlid BM, Kvarnung M, Guerrini R, Friez MJ, Lyons MJ, Leonhard J, Kringlen G, Casas K, El Achkar CM, Smith LA, Rotenberg A, Poduri A, Sanchis-Juan A, Carss KJ, Rankin J, Zeman A, Raymond FL, Blyth M, Kerr B, Ruiz K, Urquhart J, Hughes I, Banka S, Hedrich UB, Scheffer IE, Helbig I, Zamponi GW, Lerche H, Mefford HC, Allori A, Angrist M, Ashley P, Bidegain M, Boyd B, Chambers E, Cope H, Cotten CM, Curington T, Davis EE, Ellestad S, Fisher K, French A, Gallentine W, Goldberg R, Hill K, Kansagra S, Katsanis N, Katsanis S, Kurtzberg J, Marcus J, McDonald M, Mikati M, Miller S, Murtha A, Perilla Y, Pizoli C, Purves T, Ross S, Sadeghpour A, Smith E, Wiener J. De Novo Pathogenic Variants in CACNA1E Cause Developmental and Epileptic Encephalopathy with Contractures, Macrocephaly, and Dyskinesias. Am J Hum Genet 2018; 103:666-678. [PMID: 30343943 DOI: 10.1016/j.ajhg.2018.09.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/17/2018] [Indexed: 12/27/2022] Open
Abstract
Developmental and epileptic encephalopathies (DEEs) are severe neurodevelopmental disorders often beginning in infancy or early childhood that are characterized by intractable seizures, abundant epileptiform activity on EEG, and developmental impairment or regression. CACNA1E is highly expressed in the central nervous system and encodes the α1-subunit of the voltage-gated CaV2.3 channel, which conducts high voltage-activated R-type calcium currents that initiate synaptic transmission. Using next-generation sequencing techniques, we identified de novo CACNA1E variants in 30 individuals with DEE, characterized by refractory infantile-onset seizures, severe hypotonia, and profound developmental impairment, often with congenital contractures, macrocephaly, hyperkinetic movement disorders, and early death. Most of the 14, partially recurring, variants cluster within the cytoplasmic ends of all four S6 segments, which form the presumed CaV2.3 channel activation gate. Functional analysis of several S6 variants revealed consistent gain-of-function effects comprising facilitated voltage-dependent activation and slowed inactivation. Another variant located in the domain II S4-S5 linker results in facilitated activation and increased current density. Five participants achieved seizure freedom on the anti-epileptic drug topiramate, which blocks R-type calcium channels. We establish pathogenic variants in CACNA1E as a cause of DEEs and suggest facilitated R-type calcium currents as a disease mechanism for human epilepsy and developmental disorders.
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Fox J. ES05.03 Discrepancies and Sustainable Access to Innovative Therapies: Transforming Patient Experience in to Patient Voice. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.034] [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: 10/28/2022]
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Rigney M, McNamara A, Fox J, Manuel G, Winstone S. P1.02-11 Lung Cancer Symptom Awareness: Findings from a Global Consumer Survey. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.681] [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: 11/30/2022]
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Staley C, Holzmann T, Fox J, Hudson H. 61OUTCOMES IN OLDER PEOPLE ADMITTED TO CRITICAL CARE IN SALFORD ROYAL NHS FOUNDATION TRUST. Age Ageing 2018. [DOI: 10.1093/ageing/afy127.10] [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: 11/15/2022] Open
Affiliation(s)
- C Staley
- Salford Royal NHS Foundation Trust
| | | | - J Fox
- Salford Royal NHS Foundation Trust
| | - H Hudson
- Salford Royal NHS Foundation Trust
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Abstract
We report a 10-month-old boy with treatment-resistant infantile spasms associated with hypothalamic hamartoma (HH). Electroencephalography before surgical treatment showed modified hypsarrhythmia. Transventricular endoscopic resection and disconnection resulted in immediate and enduring disappearance of the epileptic spasms and improvement in the postoperative electroencephalography. After 8 years of treatment, the patient has nondisabling gelastic seizures associated with a small amount of residual HH but no other seizure types. He is not taking any antiepilepsy drugs. He is academically and socially successful. We are not aware of any prior reports of surgical treatment of HH with concurrent infantile spasms as an uncontrolled seizure type. The immediate disappearance of infantile spasms demonstrates that the HH lesion itself is an active and necessary component within the epileptic network responsible for spasms in this particular condition. This case contributes to the recognition that focal pathologies can be responsible for infantile spasms with hypsarrhythmia and respond successfully to surgical intervention.
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Affiliation(s)
- Jordana Fox
- Division of Pediatric Neurology, Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ
| | - Shaun Hussain
- Division of Pediatric Neurology, Pediatric Epilepsy Program, Department of Pediatrics, UCLA School of Medicine, Mattel Children's Hospital, Los Angeles, CA
| | - Raman Sankar
- Division of Pediatric Neurology, Pediatric Epilepsy Program, Department of Pediatrics, UCLA School of Medicine, Mattel Children's Hospital, Los Angeles, CA
| | - John F Kerrigan
- Division of Pediatric Neurology, Hypothalamic Hamartoma Program, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ.
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Vilches-Moraga A, Fox J, Paracha A, Gomez-Quintanilla A, Epstein J, Pearce L. Predicting in-hospital mortality in older general surgical patients. Ann R Coll Surg Engl 2018; 100:529-533. [PMID: 29909664 DOI: 10.1308/rcsann.2018.0086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction A significant number of emergency general surgical admissions occur in older patients. Clinical decision making in this group is challenging and current risk prediction tools extrapolate data from cohorts of younger patients. This is the first UK study to examine risk factors predicting in-hospital mortality in older acute surgical patients undergoing comprehensive geriatric assessment. Methods This was a prospective study of consecutive patients aged ≥75 years admitted non-electively to general surgery wards between September 2014 and February 2017 who were reviewed by an elderly medicine in-reach service. Results A total of 577 patients were included with a mean age of 82.9 years. There was a female predominance (56%). The majority were living at home alone or with carers (93%) and most were independent in basic activities of daily living (79%). Over two-thirds (69%) were mobile with no walking aids or use of a walking stick and overt here-quarters (79%) had no cognitive impairment. Seventy-seven per cent of patients were managed non-operatively. The in-hospital mortality rate was 6.9%. Female sex (p=0.031), dependence in activities of daily living (p<0.001), cognitive impairment (p<0.001) and incontinence (p<0.001) were predictors of in-hospital mortality. ASA (American Society of Anesthesiologists) grade ≥3 was also associated with increased in-hospital mortality (odds ratio: 5.3, 95% confidence interval: 2.6-10.7). Conclusions Older general surgical patients present a high level of complexity. This study highlights the predictive role of mobility, functional and cognitive impairment when assessing this population. Accurate risk stratification requires global assessment by teams experienced in care of the older patient rather than the traditional focus on co-morbidities.
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Affiliation(s)
| | - J Fox
- Salford Royal NHS Foundation Trust , UK
| | - A Paracha
- Salford Royal NHS Foundation Trust , UK
| | | | - J Epstein
- Salford Royal NHS Foundation Trust , UK
| | - L Pearce
- Salford Royal NHS Foundation Trust , UK
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Abstract
SummaryEMYCIN was used to develop an expert system for the interpretation of immunological data obtained in the cell surface phenotyping of leukaemia. Access to a recognised expert, and a large quantity of data on the leukaemias, has facilitated a systematic study of knowledge acquisition and knowledge base refinement based on tape recorded commentaries made by the expert. System performance was analysed at six stages in its development, and ways in which it differed from that of the human diagnostician were identified. Among the most suggestive observations were differences in the way that “undiagnosable” patients were treated and a failure of the elicitation technique to reveal structural aspects of the task. The tools and techniques of knowledge engineering are a significant advance, but a better methodology for developing high quality knowledge bases is needed.
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Howell A, Harkness E, Fox J, Astley S, Wiseman J, Eriksson M, Wilson M, Warren R, Hall P, Cuzick J, Evans G. Abstract P4-08-01: Not presented. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-08-01] [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
This abstract was not presented at the symposium.
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Affiliation(s)
- A Howell
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - E Harkness
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Fox
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - S Astley
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Wiseman
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - M Eriksson
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - M Wilson
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - R Warren
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - P Hall
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Cuzick
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - G Evans
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
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Abstract
Recent proposals have suggested that rule-based systems of diagnostic inference are an attractive medium for computer-aided diagnosis, in part because clinicians find their behaviour easy to understand. Bayesian systems have been more prominent in this field to date, but no direct comparison of their clinical abilities has been reported. A rule-based system that was closely modelled on clinical thinking is described and a quantitative comparison with a successful Bayesian system for the diagnosis of »dyspepsia« is presented. The results suggest that the rule-based approach may have considerable potential as an efficient alternative to Bayesian inference.
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Coulson AS, Glasspool DW, Emery J, Fox J. RAGs: A Novel Approach to Computerized Genetic Risk Assessment and Decision Support from Pedigrees. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary
Objectives:
To assist general practitioners in evaluating patients’ genetic risk of cancer on the basis of family history data.
Methods:
A new computer application, RAGs (Risk Assessment in Genetics), has been developed to help doctors create graphical family trees and assess the genetic risk of breast and colorectal cancer. RAGs possesses two features that distinguish it from similar software: (i) a user-centred design, which takes into account the requirements of the doctor-patient encounter; (ii) effective and accessible risk reporting by employing qualitative evidence for or against increased risk, which is more easily understood than numerical probabilities. The system allows any rule-based genetic risk guideline to be implemented, and may be readily modified to cater for the varying degrees of information required by different specialists.
Results:
RAGs permits fast, accurate data entry, and results in more appropriate management decisions than those made via other techniques. In addition, RAGs enables both the clinician and the patient to understand how it arrives at its conclusions, since the use of qualitative evidence allows the program to provide explanations for its reasoning.
Conclusions:
The RAGs system promises to help practitioners be more effective gatekeepers to genetic services. It may empower doctors both to make an informed choice when deciding to refer patients who are at increased genetic risk of breast or colorectal cancer, and to reassure those who are at low risk.
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