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McBride KA, O'Fee A, Hogan S, Stewart E, Madeley C, Wilkes J, Wylie E, White A, Hickey M, Stone J. Co-design of an intervention to optimize mammographic screening participation in women with obesity and/or physical disabilities. Radiography (Lond) 2024; 30:951-963. [PMID: 38657389 DOI: 10.1016/j.radi.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Mammographic breast screening/rescreening rates are suboptimal for women with obesity and/or physical disabilities. This study describes development of an intervention framework targeting obesity- and disability-related barriers to improve participation. METHODS Mixed methods combined a systematic review with first-person perspectives to optimise screening engagement among women with obesity and/or physical disabilities. Phase 1 (systematic review) was conducted following the PRISMA framework. Phase 2 involved in-depth interviews with n = 8 women with lived experience of obesity and/or physical disabilities. An inductive coding approach was applied to the data which was then combined with Phase 1 results to develop the intervention framework. RESULTS Six studies were included in the systematic review. Tailored education based on individual risk increased willingness to undergo mammographic screening. Recommendations to improve the screening experience included partnerships with consumers, targeted messaging, and enhanced professional development for breast screening staff. Participants also identified strategies to improve the uptake of screening and the experience itself. CONCLUSION Development and evaluation of interventions informed by frameworks like the one developed in this study are needed to improve engagement in screening to promote regular participation among women with physical disabilities and/or obesity. IMPLICATIONS FOR PRACTICE Successful implementation of practice interventions co-designed by women with obesity and/or physical disabilities are likely to improve their breast screening participation. Enhanced training of radiographers aimed at upskilling in empathetic communication around required manoeuvring and potentially longer screening times for clients with obesity and/or physical disabilities may encourage more positive client practitioner interactions. Client information aimed at women with obesity should include information on how to prepare for the appointment and explain there may be equipment limitations compromising imaging which may not be completed at an initial appointment.
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Affiliation(s)
- K A McBride
- School of Medicine, Western Sydney University, Penrith, NSW, Australia; Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.
| | - A O'Fee
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - S Hogan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - E Stewart
- BreastScreen Victoria, Melbourne, VIC, Australia
| | - C Madeley
- BreastScreen Western Australia, Perth, WA, Australia; Women and Newborn Health Service, King Edward Hospital, Perth, WA, Australia
| | - J Wilkes
- BreastScreen Western Australia, Perth, WA, Australia; Women and Newborn Health Service, King Edward Hospital, Perth, WA, Australia
| | - E Wylie
- BreastScreen Western Australia, Perth, WA, Australia; Women and Newborn Health Service, King Edward Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - A White
- Australian Breast Density Consumer Advisory Council, Australia
| | - M Hickey
- University of Melbourne Department of Obstetrics and Gynaecology and the Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - J Stone
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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Williams IA, Morris PG, Forristal K, Stone J, Gillespie DC. Illness representations of people with later-onset functional seizures. Epilepsy Behav 2024; 152:109666. [PMID: 38382188 DOI: 10.1016/j.yebeh.2024.109666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Although functional seizures can start at any age, little is known about the individuals for whom onset occurs after the age of 40. It has been proposed that health-related traumatic events are more relevant causal factors for people with 'later-onset functional seizures' than for those whose functional seizures begin earlier in life, however, the illness representations of people with later-onset functional seizures have not yet been investigated. This study aimed to understand the experiences and illness representations of people with later-onset functional seizures. METHODS This was a mixed-methods study. People with later-onset functional seizures were recruited via a neurologist's caseload and online membership-led organisations. Semi-structured interview transcripts were analysed using Template Analysis according to the Common-Sense Model (CSM). Self-report measures of demographic and clinical details were collected to characterise the sample and verify themes. RESULTS Eight people with later-onset functional seizures participated in the study. Illness representations relating to all domains of the CSM as well as an additional theme of 'Triggers' were identified. Functional seizures were characterised as a mysterious brain disorder analogous to a computer malfunction and involving involuntary movements associated with alterations in consciousness. Perceptions of duration were indefinite, and triggers were unknown or at the extremes of autonomic arousal. Half of the sample identified health-related events/trauma as causal. Opinions were divided on 'cumulative life stress' as a causal factor. Most perceived themselves to have limited or no control but having 'control' over seizures was conceptualised as different to reducing their likelihood, frequency, or impact. Later-onset functional seizures were viewed as being more detrimental for caring and financial responsibilities but to have advantages for acceptance. CONCLUSIONS This is the first study to assess the illness representations of people with later-onset functional seizures. Many themes were similar to those identified in samples including people with earlier-onset functional seizures. Health-related trauma or events were the most strongly endorsed perceived causal factor, but with the exception of 'consequences', all representations were characterised by uncertainty. Clinicians should hold in mind the interaction between life stage and the consequences of later-onset functional seizures.
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Affiliation(s)
- I A Williams
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; Department of Clinical and Health Psychology, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - P G Morris
- Department of Clinical and Health Psychology, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - K Forristal
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - D C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
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Gliddon HD, Ward Z, Heinsbroek E, Croxford S, Edmundson C, Hope VD, Simmons R, Mitchell H, Hickman M, Vickerman P, Stone J. Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals? Int J Drug Policy 2024:104324. [PMID: 38218700 DOI: 10.1016/j.drugpo.2024.104324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced. METHODS We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011-2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs' (2011-2014), 'Prioritised DAAs' (2015-2016) and 'Unrestricted DAAs' (2017-2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period. RESULTS The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95-2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45-0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12-0.60), never (vs current, aOR:0.31, 95 %CI:0.13-0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08-0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06-1.54). CONCLUSION COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.
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Affiliation(s)
- H D Gliddon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Public Health Specialty Training Programme, South West, United Kingdom
| | - Z Ward
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - E Heinsbroek
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - S Croxford
- National Public Health Speciality Training Programme, West Midlands, United Kingdom
| | - C Edmundson
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - V D Hope
- Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - R Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - H Mitchell
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Service, UK Health Security Agency, London, United Kingdom
| | - M Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - P Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom
| | - J Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, United Kingdom.
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Chalder T, Landau S, Stone J, Carson A, Reuber M, Medford N, Robinson EJ, Goldstein LH. How does cognitive behavior therapy for dissociative seizures work? A mediation analysis of the CODES trial. Psychol Med 2024:1-10. [PMID: 38197148 DOI: 10.1017/s0033291723003665] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms. METHODS We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression. RESULTS All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior. CONCLUSIONS Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes.
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Affiliation(s)
- T Chalder
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S Landau
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - J Stone
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - A Carson
- Department of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, London, UK
- Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | - L H Goldstein
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Wuu YR, Gui B, Kokabee M, Stone J, Karten JL, Harshan M, D'Amico R, Vojnic M, Wernicke G. Prioritizing Radiation and Targeted Systemic Therapy in Patients with Resected Brain Metastases from Lung Cancer Primaries with Targetable Mutations: A Report from a Multi-Site Single Institution. Int J Radiat Oncol Biol Phys 2023; 117:e157. [PMID: 37784747 DOI: 10.1016/j.ijrobp.2023.06.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Brain metastases (BrM) are a common complication of non-small cell lung cancer (NSCLC), present in up to 50% of patients. While treatment of BrM requires a multidisciplinary approach with surgery, radiotherapy (RT), and systemic therapy, advances in sequencing have improved outcomes with targetable alterations in PDL-1, EGFR, ALK, and KRAS mutations. With a push towards molecular characterization of cancers, we sought out to examine outcomes by treatment modalities at our institution with respect to prioritizing RT and targeted therapies. MATERIALS/METHODS After IRB approval, we identified patients treated with a surgical resection of BrM from NSCL primaries between 2011 to 2022 at 5 sites at our institution. Tumor molecular profiles were reviewed and patients with PDL-1, EGFR, ALK, and KRAS mutations were evaluated by a treatment modality: surgery alone or in combination with RT (SRS, WBRT) and/or systemic therapy (TKIs -1st-3rd generations, immunotherapy). The primary endpoints were in-brain freedom from progression (FFP) and overall survival (OS). SAS Studio version 4.4 was used to perform statistical analyses. RESULTS We identified 272 patients with 162/272 (60%) patients with adequate follow-up included in this analysis. The median follow-up was 27.8 months (range, 0.43 - 134.45 months). There were 59.2% females and 40.7% males, with median ages at diagnosis of 67 years for females and 66 for males, respectively. Of the entire cohort, 102/162 (63%) patients received adjuvant combination RT and systemic therapy, and 60/162 (37%) received adjuvant monotherapy (p <0.0001). The use of systemic therapy was associated with 9.89 months median time to progression vs 4.87 months without it (p = 0.077), respectively. Similarly, patients treated with a combination of RT and systemic therapy had a median FFP time of 9.77 months vs 5.28 months (p = 0.064). No significant difference in OS was found with or without systemic therapy. CONCLUSION After resection of BrM from NSCLC with PDL-1, EGFR, ALK, and KRAS mutations, we found that systemic therapy, including TKIs and immunotherapy, may have an increasing role in delaying time to progression. At our institution, as we continue to identify actionable mutations, a statistically significant number of patients continue to be treated with a combination of RT and systemic therapies with a trend toward superior FFP.
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Affiliation(s)
- Y R Wuu
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - B Gui
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - M Kokabee
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Pathology and Laboratory Medicine at Lenox Hill Hospital, New York, NY
| | - J Stone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - J L Karten
- NYIT College Of Osteopathic Medicine, Old Westbury, NY
| | - M Harshan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Pathology and Laboratory Medicine at Lenox Hill Hospital, New York, NY
| | - R D'Amico
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Neurosurgery at Lenox Hill Hospital, New York, NY
| | - M Vojnic
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Medical Oncology, Northwell Health Cancer Institute at MEETH, New York, NY
| | - G Wernicke
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Radiation Medicine at Lenox Hill Hospital, New York, NY
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Kulyk A, Shafer LA, Graff LA, Stone J, Witges K, Targownik LE, Bernstein C. A74 URGENCY FOR BOWEL MOVEMENTS IS A HIGHLY DISCRIMINATORY SYMPTOM FOR ACTIVE DISEASE IN PERSONS WITH IBD (THE MANITOBA LIVING WITH IBD STUDY). J Can Assoc Gastroenterol 2023. [PMCID: PMC9991290 DOI: 10.1093/jcag/gwac036.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background The Inflammatory Bowel Disease Symptom Inventory (IBDSI) is a validated patient self-reported measure used to assess IBD disease activity. Purpose We aimed to assess the prevalence of symptoms, and examine which symptoms are most associated with disease activity as measured by a symptom index and objective measure of inflammation. Method The Manitoba Living with IBD Study is a prospective study of 156 participants with confirmed IBD who completed bi-weekly Inflammatory Bowel Disease Symptom Inventory (IBDSI) surveys. Relative risks (RR) (with 95% confidence interval (CI)), positive and negative predictive values (PPV, NPV), and area under receiver operator curve (AUC) were reported for each symptom to predict active disease defined as: (1) active IBDSI, (2) self-reported flare, and (3) elevated fecal calprotectin (FCAL) (>250µg/g). Analyses were undertaken following stratification based on sex, and disease type (Crohn’s disease (CD) and ulcerative colitis (UC)). Result(s) In total, 69.2% of participants were female; 64.7% had CD. Fatigue was the most prevalent symptom in both inactive and active disease, across all 3 disease measures (IBDSI: 24.5% and 75.1%, self-reported flare: 42.2% and 72.2%, FCAL: 46.0% and 60.6%). Absence of fatigue had a high NPV for active IBDSI and self-reporting a flare in both CD and UC. Urgency had a consistently strong NPV, RR and AUC across all three disease measures in both IBD subtypes and sexes. The number of loose/liquid bowel movements predicted elevated FCAL in UC (RR in men = 3.5, 95% CI 1.2-9.9, RR in women = 1.8, 95% CI 1.2-2.7, AUC in men = 0.73, 95% CI 0.59-0.84, AUC in women = 0.65, 95% CI 0.56-0.72), as did blood in stool in females with UC (RR = 1.8, 95% CI 1.2-2.7). In men with CD, excessive bowel gas (RR = 2.0, 95% CI 1.2-3.4) and urgency (RR = 3.9, 95% CI 1.6-9.3) best predicted an elevated FCAL. No symptom was strongly predictive of elevated FCAL in females with CD. Conclusion(s) Fatigue was the most prevalent symptom irrespective of disease activity. Urgency stood out as being consistently associated with disease activity, irrespective of the disease measure. Individual symptoms have different impacts on subjective (IBDSI) and objective (FCAL) measures in IBD. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- A Kulyk
- Internal Medicine, University of Manitoba,University of Manitoba IBD Clinical and Research Centre
| | - L A Shafer
- Internal Medicine, University of Manitoba,University of Manitoba IBD Clinical and Research Centre
| | - L A Graff
- Internal Medicine, University of Manitoba,Department of Clinical Health Psychology, University of Manitoba
| | - J Stone
- Internal Medicine, University of Manitoba,University of Manitoba IBD Clinical and Research Centre
| | - K Witges
- University of Manitoba IBD Clinical and Research Centre
| | - L E Targownik
- University of Manitoba IBD Clinical and Research Centre,Internal Medicine, University of Toronto, Winnipeg, Canada
| | - C Bernstein
- Internal Medicine, University of Manitoba,University of Manitoba IBD Clinical and Research Centre
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Kandala B, Plock N, Chawla A, Largajolli A, Robey S, Watson K, Thatavarti R, Dubey SA, Cheung SA, de Greef R, Stone J, Sachs JR. Accelerating model-informed decisions for COVID-19 vaccine candidates using a model-based meta-analysis approach. EBioMedicine 2022; 84:104264. [PMID: 36182824 PMCID: PMC9514977 DOI: 10.1016/j.ebiom.2022.104264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID-19 pandemic has increased the need for innovative quantitative decision tools to support rapid development of safe and efficacious vaccines against SARS-CoV-2. To meet that need, we developed and applied a model-based meta-analysis (MBMA) approach integrating non-clinical and clinical immunogenicity and protection data. Methods A systematic literature review identified studies of vaccines against SARS-CoV-2 in rhesus macaques (RM) and humans. Summary-level data of 13 RM and 8 clinical trials were used in the analysis. A RM MBMA model was developed to quantify the relationship between serum neutralizing (SN) titres after vaccination and peak viral load (VL) post-challenge in RM. The translation of the RM MBMA model to a clinical protection model was then carried out to predict clinical efficacies based on RM data alone. Subsequently, clinical SN and efficacy data were integrated to develop three predictive models of efficacy – a calibrated RM MBMA, a joint (RM-Clinical) MBMA, and the clinical MBMA model. The three models were leveraged to predict efficacies of vaccine candidates not included in the model and efficacies against newer strains of SARS-CoV-2. Findings Clinical efficacies predicted based on RM data alone were in reasonable agreement with the reported data. The SN titre predicted to provide 50% efficacy was estimated to be about 21% of the mean human convalescent titre level, and that value was consistent across the three models. Clinical efficacies predicted from the MBMA models agreed with reported efficacies for two vaccine candidates (BBV152 and CoronaVac) not included in the modelling and for efficacies against delta variant. Interpretation The three MBMA models are predictive of protection against SARS-CoV-2 and provide a translational framework to enable early Go/No-Go and study design decisions using non-clinical and/or limited clinical immunogenicity data in the development of novel SARS-CoV-2 vaccines. Funding This study was funded by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.
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DeBolt CA, Rosenberg HM, Pruzan A, Goldberger C, Kaplowitz E, Buckley A, Vieira L, Stone J, Bianco A. Patients with resolution of low-lying placenta and placenta previa remain at increased risk of postpartum hemorrhage. Ultrasound Obstet Gynecol 2022; 60:103-108. [PMID: 34826174 DOI: 10.1002/uog.24825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine whether women who experience resolution of low placentation (low-lying placenta or placenta previa) are at increased risk of postpartum hemorrhage compared to those with normal placentation throughout pregnancy. METHODS This was a retrospective cohort study of women who delivered at Mount Sinai Hospital between 2015 and 2019, and who were diagnosed with low-lying placenta or placenta previa on transvaginal ultrasound at the time of the second-trimester anatomical survey, with resolution of low placentation on subsequent ultrasound examination. Women undergoing second-trimester anatomical survey who had normal placentation on transvaginal ultrasound 3 days before or after the cases were randomly identified for comparison. The primary outcome was the rate of postpartum hemorrhage. Secondary outcomes included the need for a blood transfusion, use of additional uterotonic medication, the need for additional procedures to control bleeding, and maternal admission to the intensive care unit. Outcomes were assessed using a multivariable logistic regression model. RESULTS A total of 1256 women were identified for analysis, of whom 628 had resolved low placentation and 628 had normal placentation. Women with resolved low placentation, compared to those with normal placentation throughout pregnancy, had significantly higher mean age (33.0 ± 5.4 years vs 31.9 ± 5.5 years; P < 0.01) and lower mean body mass index at delivery (27.9 ± 5.5 kg/m2 vs 30.2 ± 5.7 kg/m2 ; P < 0.01), and were more likely to have undergone in-vitro fertilization, be of non-Hispanic white race, have posterior placental location (all P < 0.01) and have private/commercial health insurance (P = 0.04). Patients with resolved low placentation vs normal placentation had greater odds of postpartum hemorrhage (adjusted odds ratio (aOR), 3.5 (95% CI, 2.0-6.0); P < 0.01), use of additional uterotonic medication (aOR, 2.2 (95% CI, 1.5-3.1); P < 0.01) and increased rates of additional procedures to control bleeding (aOR, 4.0 (95% CI, 1.3-11.9); P = 0.01). CONCLUSION Despite high rates of resolution of low-lying placenta and placenta previa by term, women with resolved low placentation remain at increased risk of postpartum hemorrhage compared to those with normal placentation throughout pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C A DeBolt
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - H M Rosenberg
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Pruzan
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Goldberger
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E Kaplowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Buckley
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - L Vieira
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Stone
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Bianco
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Goldstein LH, Robinson EJ, Chalder T, Stone J, Reuber M, Medford N, Carson A, Moore M, Landau S. Moderators of cognitive behavioural therapy treatment effects and predictors of outcome in the CODES randomised controlled trial for adults with dissociative seizures. J Psychosom Res 2022; 158:110921. [PMID: 35617911 DOI: 10.1016/j.jpsychores.2022.110921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 11/14/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We explored moderators of cognitive behavioural therapy (CBT) treatment effects and predictors of outcome at 12-month follow-up in the CODES Trial (N = 368) comparing CBT plus standardised medical care (SMC) vs SMC-alone for dissociative seizures (DS). METHODS We undertook moderator analyses of baseline characteristics to determine who had benefited from being offered CBT 12 months post-randomisation. Outcomes included: monthly DS frequency, psychosocial functioning (Work and Social Adjustment Scale - WSAS), and health-related quality of life (Mental Component Summary (MCS) and Physical Component Summary (PCS) SF-12v2 scores). When moderating effects were absent, we tested whether baseline variables predicted change irrespective of treatment allocation. RESULTS Moderator analyses revealed greater benefits (p < 0.05) of CBT on DS frequency for participants with more (≥22) symptoms (Modified PHQ-15) or ≥ 1 current (M.I.N.I.-confirmed) comorbid psychiatric diagnosis at baseline. The effect of CBT on PCS scores was moderated by gender; women did better than men in the CBT + SMC group. Predictors of improved outcome included: not receiving disability benefits, lower anxiety and/or depression scores (PCS, MCS, WSAS); shorter duration, younger age at DS onset, employment, fewer symptoms and higher educational qualification (PCS, WSAS); stronger belief in the diagnosis and in CBT as a "logical" treatment (MCS). Some variables that clinically might be expected to moderate/predict outcome (e.g., maladaptive personality traits, confidence in treatment) were not shown to be relevant. CONCLUSION Patient complexity interacted with treatment. CBT was more likely to reduce DS frequency in those with greater comorbidity. Other patient characteristics predicted outcome regardless of the received intervention.
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Affiliation(s)
- L H Goldstein
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - E J Robinson
- King's College London, School of Population Health and Environmental Sciences, UK; Research Data and Statistics Unit, Royal Marsden Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK.
| | - T Chalder
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK.
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK.
| | - N Medford
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - A Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - M Moore
- Centre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK.
| | - S Landau
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, UK.
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10
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Beck K, Arumuham A, Brugger S, Mccutcheon R, Veronese M, Kaar S, Pillinger T, Stone J, Howes O. N-Methyl-D-Aspartate Receptor availability in First-Episode Psychosis: a multi-modal PET-MR brain imaging study. Eur Psychiatry 2022. [PMCID: PMC9565749 DOI: 10.1192/j.eurpsy.2022.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction N-Methyl-D-Aspartate Receptor (NMDAR) hypofunction is hypothesised to underlie psychosis but this has not been tested early in illness. Objectives
Our aim was to determine if NMDAR availability was lower in patients with first episode psychosis compared to healthy controls. Methods To address this, we studied 40 volunteers (21 patients with first episode psychosis and 19 matched healthy controls) using PET imaging with an NMDAR selective ligand, [18F]GE179, that binds to the ketamine binding site to index its distribution volume ratio (DVR) and volume of distribution (VT). Striatal glutamatergic indices (glutamate and Glx) were measured simultaneously using magnetic resonance spectroscopy imaging (1H-MRS). Results
Hippocampal DVR, but not VT, was significantly lower in patients relative to controls (p=0.02, Cohen’s d=0.81; p=0.15, Cohen’s d=0.49), and negatively associated with total (rho=-0.47, p= 0.04), depressive (rho=-0.67, p=0.002), and general symptom severity (rho=-0.74, p<0.001). Exploratory analyses found no significant differences in other brain regions (anterior cingulate cortex, thalamus, striatum and temporal cortex). We found an inverse relationship between hippocampal NMDAR availability and striatal glutamate levels in people with first-episode psychosis (rho = -0.74, p <0.001) but not in healthy controls (rho = -0.22, p = 0.44). Conclusions These findings are consistent with the NMDAR hypofunction hypothesis and identify the hippocampus as a key locus for relative NMDAR hypofunction, although further studies should test specificity and causality. Disclosure No significant relationships.
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11
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Shaw RJ, Boazak M, Tiase V, Porter G, Wosik J, Bumatay S, Michaels L, Stone J, Cohen D, Dolor R. Integrating Patient-generated Digital Health Data into Electronic Health Records (EHRs) in Ambulatory Care Settings: EHR Vendor Survey and Interviews. AMIA Jt Summits Transl Sci Proc 2022; 2022:439-445. [PMID: 35854713 PMCID: PMC9285170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Data traditionally collected in a clinic or hospital setting is now collected electronically in everyday environments from patients, known as patient-generated health data (PGHD). We conducted informal interviews and collected survey data from major ambulatory care EHR vendors that serve the majority of the U.S. market to collect information on how their clients are integrating PGHD into EHRs. Of the 9 EHR vendors contacted, 6 completed the survey and 5 participated in a 45-minute interview. Feedback from the vendors included how PGHD use has steadily risen over the past decade and how the COVID-19 pandemic accelerated PGHD use. Pathways for data from devices or surveys to be brought securely into the EHR are increasing. While promising, adoption of health IT systems has its challenges. There are disparities in EHRs, devices, and applications. We concluded that more supportive policies are needed to advance PGHD integration.
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Affiliation(s)
- Ryan J Shaw
- Duke Mobile App Gateway, Clinical & Translational Science Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Mina Boazak
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Victoria Tiase
- The Value Institute, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Jedrek Wosik
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sarah Bumatay
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - LeAnn Michaels
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | | | - Deborah Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Rowena Dolor
- Duke Primary Care Research Consortium, Duke Clinical & Translational Science Institute, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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12
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Anderson M, Dockendorf MF, McIntosh I, Xie I, Breidinger S, Meng D, Ren S, Zhong W, Zhang L, Roadcap B, Bateman KP, Stone J, Woolf E. An Investigation of Instability in Dried Blood Spot Samples for Pharmacokinetic Sampling in Phase 3 Trials of Verubecestat. AAPS J 2022; 24:52. [PMID: 35384529 DOI: 10.1208/s12248-022-00683-4] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
In-clinic dried blood spot (DBS) pharmacokinetic (PK) sampling was incorporated into two phase 3 studies of verubecestat for Alzheimer's disease (EPOCH [NCT01739348] and APECS [NCT01953601]), as a potential alternative to plasma PK sampling for improved logistical feasibility and decreased blood volume burden. However, an interim PK analysis revealed verubecestat concentrations in DBS samples declined with time to assay in both trials. An investigation revealed wide variation in implementation practices for DBS sample handling procedures resulting in insufficient desiccation which caused verubecestat instability. High-resolution mass spectrometry evaluations of stressed and aged verubecestat DBS samples revealed the presence of two hydrolysis degradants. To minimize instability, new DBS handling procedures were implemented that provided additional desiccant and minimized the time to analysis. Both verubecestat hydrolysis products were previously discovered and synthesized during active pharmaceutical ingredient stability characterization. A liquid chromatography-mass spectrometry assay to quantitate the dominant verubecestat degradant in DBS samples was developed and validated. The application of this method to stressed and aged verubecestat DBS samples confirmed that degradant concentrations accounted for the observed decreases in the verubecestat concentration. Furthermore, after increasing desiccant amounts, degradant concentrations accounted for approximately 7% of the verubecestat concentration in DBS clinical samples, indicating that issues with sample handling were minimized with new storage and shipping conditions. This case study illustrates the challenges with employing new sampling techniques in large, global trials, and the importance of anticipating and mitigating implementation risks.
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Affiliation(s)
- Melanie Anderson
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA.
| | - Marissa F Dockendorf
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Ian McIntosh
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Iris Xie
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Sheila Breidinger
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Dongfang Meng
- Process Chemistry, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Sumei Ren
- SM PR&D, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Wendy Zhong
- Analytical Research & Development, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Li Zhang
- Analytical Research & Development, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Brad Roadcap
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Kevin P Bateman
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Julie Stone
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA
| | - Eric Woolf
- Pharmacokinetics, Pharmacodynamics and Drug Metabolism, Merck & Co., Inc., Kenilworth, New Jersey, USA
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13
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Su S, Stone J, Bernstein CN. A154 COMPARING RESPONSE TO INTRAVENOUS IRON INFUSION IN CROHN’S DISEASE AND ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859146 DOI: 10.1093/jcag/gwab049.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Iron deficiency anemia (IDA) is common in persons with inflammatory bowel disease (IBD). Current evidence-based guidelines suggest iron replacement therapy in IBD patients with IDA. Intravenous (IV) iron has been demonstrated to be more effective than oral iron replacement in the IBD population, and this is thought to be related to oral iron being poorly tolerated, absorbed, and possibly having an adverse impact on the gut microbiome. Studies have not directly compared the response of IV iron between persons with ulcerative colitis (UC) and Crohn’s disease (CD).
Aims
(1) To compare the increase in serum hemoglobin and ferritin following IV iron therapy between persons with UC and CD. (2) To determine factors associated with response to IV iron (other than disease type), including age, sex, IBD therapies, abdominal surgeries, and IBD phenotype.
Methods
In a retrospective chart review, we evaluated 536 IV iron infusions (iron sucrose) prescribed to 117 IBD patients by a single gastroenterologist between 2012–2020, and collected data on IBD type, age, sex, medications (IBD therapies, NSAIDs, ASA, oral iron), abdominal surgeries, and IBD phenotype. Statistical analysis was performed using SPSS version 26.
Results
Most IV iron infusions were given to patients with CD (77% of infusions, 68% of persons). The majority of infusions were given as a series of multiple iron infusions (84%) over a mean of 27 weeks, rather than a single infusion. Persons with UC had a greater increase in serum ferritin than those with CD (mean difference ± SE of 13.2 ± 5.6 µg/L, p = 0.02). There was no significant difference in the increase in serum hemoglobin between UC and CD (UC= 6.5 ± 1.0 g/L; CD 4.9 ± 2.1 g/L; p = 0.62).
Conclusions
Persons with UC had a better ferritin response to IV iron therapy than persons with CD. Patients with UC were prescribed less IV iron than those with CD. In summary, persons with CD may require greater dosing of IV iron therapy than patients with UC. Further studies are needed to discern if this difference is secondary to CD being associated with a greater extent of mucosal disease burden, impaired iron absorption, or a greater intolerance to oral iron.
Funding Agencies
Fellowship Funding from Pfizer Canada
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Affiliation(s)
- S Su
- Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
| | - J Stone
- Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
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14
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Immerzeel J, Debruyne F, Schatteman P, De Naeyer G, Beerlage H, Stone J, Stone N. Remote training using augmented reality on surgical phantoms. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Prohn M, Cho CR, Viberg A, Dykstra K, Davis C, Sabato P, Stone J, Badshah C, Murata Y, Leavitt R, Fancourt C, Macha S. Exposure-Response Analyses of Letermovir Following Oral and Intravenous Administration in Allogeneic Hematopoietic Cell Transplantation Recipients. Clin Pharmacol Ther 2021; 111:485-495. [PMID: 34674258 DOI: 10.1002/cpt.2456] [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] [Received: 03/21/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
The cytomegalovirus (CMV) viral terminase inhibitor letermovir is approved for prophylaxis of CMV infection and disease in adult CMV-seropositive allogeneic hematopoietic stem cell transplantation recipients. In a phase III trial (NCT02137772), letermovir significantly reduced clinically significant CMV infection (CS-CMVi) rate vs. placebo through Week 24 (primary end point) and Week 14 (secondary end point) post transplantation. Here, exposure-response relationships were investigated using efficacy and selected safety end points from the phase III trial to inform the proposed clinical dose. Post hoc exposure estimates were derived from a population pharmacokinetic model. No significant exposure dependencies were found for CS-CMVi through Week 24 or Week 14 among letermovir-treated participants. Evaluated covariates had no impact on exposure-efficacy relationships and letermovir plasma exposure did not affect time of CS-CMVi onset. There was no dependence between adverse event incidence and letermovir exposure. These results support current dosing recommendations in several countries and regions, including the United States and European Union.
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Affiliation(s)
| | | | | | | | - Casey Davis
- Merck & Co., Inc., Kenilworth, New Jersey, USA
| | | | - Julie Stone
- Merck & Co., Inc., Kenilworth, New Jersey, USA
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16
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Lee SC, Pirikahu S, Phillips M, Bellinge J, Stone J, Wylie E, Stuckey BGA, Schultz C. Reproductive factors and breast arterial calcification: a systematic review and meta-analysis. Climacteric 2021; 25:147-154. [PMID: 34668812 DOI: 10.1080/13697137.2021.1985991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Breast arterial calcification (BAC) is a common incidental finding on screening mammography. Recent evidence suggests that BAC is associated with cardiovascular disease (CVD). We systematically reviewed the associations between BAC and reproductive factors (menopausal status, hormone replacement therapy [HRT] use, oral contraceptive [OC] use and parity). METHODS MEDLINE and EMBASE databases, references of relevant papers and Web of Science were searched up to February 2020 for English-language studies that evaluated these associations. Study quality were determined and a random effects model was used to assess these associations. RESULTS Nineteen observational studies (n = 47,249; three cohort studies, seven case-control studies, nine cross-sectional studies) were included. BAC was associated with menopause (nine studies; n = 15,870; odds ratio [OR] 2.67; 95% confidence interval [CI] 1.50-4.77) and parity (seven studies; n = 27,728; OR 2.50; 95% CI 1.68-3.71) and inversely with HRT use (10 studies; n = 33,156; OR 0.57; 95% CI 0.40-0.80). No association was found with OC use. Eleven studies were considered good in quality. Marked heterogeneity existed across all analyses. CONCLUSIONS BAC is associated with HRT use, menopause and parity. However, careful interpretation is required as marked heterogeneity existed across all analyses. Traditional cardiovascular risk factors may need to be taken into account in future investigations of associations between BAC and reproductive factors. PROSPERO CRD42020141644.
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Affiliation(s)
- S C Lee
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - S Pirikahu
- Genetic Epidemiology Group, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - M Phillips
- Centre for Medical Research (affiliated with the Harry Perkins Institute of Medical Research), University of Western Australia, Perth, WA, Australia
| | - J Bellinge
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - J Stone
- Genetic Epidemiology Group, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - E Wylie
- School of Medicine, University of Western Australia, Perth, WA, Australia.,Department of Radiology, Royal Perth Hospital, Perth, WA, Australia
| | - B G A Stuckey
- School of Medicine, University of Western Australia, Perth, WA, Australia.,Keogh Institute for Medical Research, Perth, WA, Australia.,Department of Endocrinology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - C Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.,School of Medicine, University of Western Australia, Perth, WA, Australia
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17
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Doelman DS, Snik F, Por EH, Bos SP, Otten GPPL, Kenworthy M, Haffert SY, Wilby M, Bohn AJ, Sutlieff BJ, Miller K, Ouellet M, de Boer J, Keller CU, Escuti MJ, Shi S, Warriner NZ, Hornburg K, Birkby JL, Males J, Morzinski KM, Close LM, Codona J, Long J, Schatz L, Lumbres J, Rodack A, Van Gorkom K, Hedglen A, Guyon O, Lozi J, Groff T, Chilcote J, Jovanovic N, Thibault S, de Jonge C, Allain G, Vallée C, Patel D, Côté O, Marois C, Hinz P, Stone J, Skemer A, Briesemeister Z, Boehle A, Glauser AM, Taylor W, Baudoz P, Huby E, Absil O, Carlomagno B, Delacroix C. Vector-apodizing phase plate coronagraph: design, current performance, and future development [Invited]. Appl Opt 2021; 60:D52-D72. [PMID: 34263828 DOI: 10.1364/ao.422155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/19/2021] [Indexed: 06/13/2023]
Abstract
Over the last decade, the vector-apodizing phase plate (vAPP) coronagraph has been developed from concept to on-sky application in many high-contrast imaging systems on 8 m class telescopes. The vAPP is a geometric-phase patterned coronagraph that is inherently broadband, and its manufacturing is enabled only by direct-write technology for liquid-crystal patterns. The vAPP generates two coronagraphic point spread functions (PSFs) that cancel starlight on opposite sides of the PSF and have opposite circular polarization states. The efficiency, that is, the amount of light in these PSFs, depends on the retardance offset from a half-wave of the liquid-crystal retarder. Using different liquid-crystal recipes to tune the retardance, different vAPPs operate with high efficiencies (${\gt}96\%$) in the visible and thermal infrared (0.55 µm to 5 µm). Since 2015, seven vAPPs have been installed in a total of six different instruments, including Magellan/MagAO, Magellan/MagAO-X, Subaru/SCExAO, and LBT/LMIRcam. Using two integral field spectrographs installed on the latter two instruments, these vAPPs can provide low-resolution spectra (${\rm{R}} \sim 30$) between 1 µm and 5 µm. We review the design process, development, commissioning, on-sky performance, and first scientific results of all commissioned vAPPs. We report on the lessons learned and conclude with perspectives for future developments and applications.
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18
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Townsel C, Stone J, Debolt C, Hussain N, Campbell WA. Fetal gastric area ratio to predict severe neonatal opioid withdrawal syndrome. J Matern Fetal Neonatal Med 2021; 35:7957-7961. [PMID: 34151686 DOI: 10.1080/14767058.2021.1939302] [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: 10/21/2022]
Abstract
OBJECTIVE Neonatal opioid withdrawal syndrome (NOWS) can occur in newborns exposed to opioids in pregnancy. Opioids delay gastric emptying and inhibit gastric motility in adults, but little is known about their effect in the fetus. We sought to assess gastric area ratio (GAR) in opioid-exposed fetuses. STUDY DESIGN Retrospective cohort study including opioid-exposed maternal-neonatal dyads between 2007-2017. Primary outcome: severe NOWS (three consecutive Finnegan scores ≥8 or three scores totaling ≥24 within 96 h of life). GAR: (gastric area)/(transverse abdominal area) × 100. Data analysis was by descriptive, parametric, and non-parametric tests. RESULTS Forty-nine maternal-neonatal dyads were included, 67% (n = 33) with severe NOWS. GAR <95th percentile for gestational age was seen in 80% of neonates (n = 39). However, GAR was not different between groups (p = .90) and did not predict severe NOWS. CONCLUSION Fetal GAR was <95th percentile in 80% of opioid-exposed neonates. However, fetal GAR may not predict NOWS treatment.
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Affiliation(s)
- Courtney Townsel
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Julie Stone
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA, USA
| | - Chelsea Debolt
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
| | - Naveed Hussain
- Department of Pediatrics, Division of Neonatology, Connecticut Children's Hospital, Farmington, CT, USA
| | - Winston A Campbell
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Connecticut, Farmington, CT, USA
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19
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Woodfield J, Brennan PM, Statham P, Stone J, Hoeritzauer I. Suspected cauda equina syndrome: no reduction in investigation, referral and treatment during the COVID-19 pandemic. Ann R Coll Surg Engl 2021; 103:432-437. [PMID: 33682481 DOI: 10.1308/rcsann.2021.0011] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Compression of the cauda equina can lead to bladder, bowel and sexual dysfunction with lower limb pain, numbness and weakness. Urgent surgical decompression aims to prevent progressive neurological deficit. Symptoms of cauda equina syndrome (CES), such as back pain, sciatica and bladder dysfunction are common in the population, but the majority of those investigated do not have radiological cauda equina compression. However, a missed diagnosis can have significant medical, social and legal consequences. We investigated the effect of the COVID-19 pandemic on presentation and management of suspected CES. METHODS This retrospective cohort study analysed referral, investigation and treatment of CES in a regional neurosurgical centre during the initial COVID-19 surge between March and May 2020 compared with March to May 2019. RESULTS Referrals for suspected CES were similar during the COVID-19 pandemic (n = 275) compared with 2019 (n = 261, p = 0.596) despite a significant (19%) decrease in total emergency neurosurgical referrals (1248 in 2020 vs 1544 in 2019, p < 0.001). Nineteen (7%) of the suspected CES referrals underwent decompression in 2020, similar to 16 (6%) in 2019 (p = 0.867). There were no differences in outcomes or complications and no evidence of delays in presentation or treatment. CONCLUSIONS Unlike other emergency neurosurgical conditions, the number of referrals for suspected CES and the percentage of referrals with radiological cauda equina compression were unchanged during the COVID-19 pandemic. The persistence of CES referrals when many people stayed away from hospital highlights the distress and worry caused by suspected CES and its symptoms to both patients and healthcare providers.
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Affiliation(s)
- J Woodfield
- University of Edinburgh, UK.,NHS Lothian, UK
| | - P M Brennan
- University of Edinburgh, UK.,NHS Lothian, UK
| | | | - J Stone
- University of Edinburgh, UK.,NHS Lothian, UK
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20
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Stone J, Shafer L, Graff LA, Witges K, Lix L, Haviva C, Targownik LE, Bernstein CN. A172 THE ASSOCIATION OF EFFICACY, OPTIMISM, UNCERTAINTY AND HEALTH ANXIETY IN INFLAMMATORY BOWEL DISEASE ACTIVITY OVER TIME. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
We aimed to assess if the presence of positive or negative psychological attributes are associated with disease activity in a prospective inflammatory bowel disease (IBD) cohort using validated psychological assessment tools and various measures of disease activity.
Methods
The study included 146 adults with confirmed and recently active IBD enrolled in a prospective longitudinal cohort study. Demographics, disease information, validated measures of psychological functioning related to self-efficacy, optimism, health anxiety and intolerance of uncertainty were collected at baseline, week 26 and week 52. Disease activity indicators included fecal calprotection (FCAL), the Inflammatory Bowel Disease Symptom Inventory (IBDSI), and self-reported flares and were collected at study baseline, week 26 and week 52. Logistic regression was used to identify the relationship between psychological functioning and disease activity.
Results
Participants’ mean age was 42.9 years (SD 12.6; range 18–70), with 70.5% women. Almost two thirds (65.1%) had a diagnosis of Crohn’s disease (CD), 34.2% had ulcerative colitis (UC), and 0.7% (n=1) was IBD unclassified. 22% had income <$50,000 and 63% were in a current relationship. Patient-reported active disease (i.e., IBDSI; flare self-report) was significantly less likely with higher self-efficacy [OR= 0.87, 95% CI 0.82–0.93 (IBDSI); OR= 0.86, 95% CI 0.81–0.91 (self-report)] and significantly more likely with higher health anxiety (OR=1.09, 95% CI 1.04–1.15) with the association remaining for self-reported flares after adjusting for demographic variables. The psychological attributes were not associated with active disease based on FCAL levels.
Conclusions
Higher health anxiety increases the likelihood of experiencing an IBD flare, while higher general self-efficacy may be protective of a disease flare.
Funding Agencies
None
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Affiliation(s)
- J Stone
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - L Shafer
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - L A Graff
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - K Witges
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - L Lix
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - C Haviva
- Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - L E Targownik
- Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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21
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Rosmalen JGM, Burton C, Carson A, Cosci F, Frostholm L, Lehnen N, Olde Hartman TC, Rask CU, Rymaszewska J, Stone J, Tak LM, Witthöft M, Löwe B. The European Training Network ETUDE (Encompassing Training in fUnctional Disorders across Europe): a new research and training program of the EURONET-SOMA network recruiting 15 early stage researchers. J Psychosom Res 2021; 141:110345. [PMID: 33385705 DOI: 10.1016/j.jpsychores.2020.110345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- J G M Rosmalen
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Dimence Group, Deventer, the Netherlands.
| | - C Burton
- University of Sheffield, Sheffield, UK
| | - A Carson
- University of Edinburgh, Edinburgh, UK
| | - F Cosci
- University of Florence, Florence, Italy
| | | | - N Lehnen
- Technical University Munich, Munich, Germany
| | | | - C U Rask
- Aarhus University Hospital, Aarhus, Denmark
| | | | - J Stone
- University of Edinburgh, Edinburgh, UK
| | - L M Tak
- Dimence Group, Deventer, the Netherlands
| | - M Witthöft
- Johannes Gutenberg-University, Mainz, Germany
| | - B Löwe
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Ricker J, Douglass KO, Syssoev S, Stone J, Avdiaj S, Hendricks JH. Transient heating in fixed length optical cavities for use as temperature and pressure standards. Metrologia 2021; 58:10.1088/1681-7575/abe8e0. [PMID: 34446973 PMCID: PMC8384112 DOI: 10.1088/1681-7575/abe8e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Optical refractometry techniques enable realization of both pressure and temperature directly from properties of the gas. The NIST refractometer, a fixed length optical cavity (FLOC) has previously been evaluated for operation as pressure standard, and now in this paper, is evaluated for the feasibility of operation as a primary temperature standard as well. The challenge is that during operation, one cavity is filled with gas. Gas dynamics predicts that this will result in heating which in turn will affect the cavity temperature uniformity, impeding the ability to measure the gas temperature with sufficient accuracy to make the standard useful as a primary standard for temperature or pressure. Temperature uniformity across the refractometer must be less than 0.5 mK for measurements of the refractivity to be sufficiently accurate for the FLOC. This paper compares computer modeling to laboratory measurements, enabling us to validate the model to predict thermal behavior and to accurately determine the measurement uncertainty of the technique. The results presented in this paper show that temperature of the glass elements of the refractometer and 'thermal-shell' copper chamber are equivalent to within 0.5 mK after an equilibration time of 3000 s (when going from 1 kPa to 100 kPa). This finding enables measurements of the copper chamber to determine the gas temperature to within an uncertainty (k = 1) of 0.5 mK. Additionally, the NIST refractometer is evaluated for feasibility of operation as temperature standard.
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Affiliation(s)
- J Ricker
- Thermodynamic Metrology Group, National Institute of Standards and Technology (NIST), Gaithersburg, MD, United States of America
| | - K O Douglass
- Thermodynamic Metrology Group, National Institute of Standards and Technology (NIST), Gaithersburg, MD, United States of America
| | - S Syssoev
- MKS Instruments, Inc, Andover, MA, United States of America
| | - J Stone
- Dimensional Metrology Group, NIST, Gaithersburg, MD, United States of America
- Retired
| | - S Avdiaj
- Department of Physics, University of Prishtina, Prishtina, Kosovo
- Guest researcher (Fulbright Scholar) at Thermodynamic Metrology Group, NIST, Gaithersburg, MD, USA
| | - J H Hendricks
- Thermodynamic Metrology Group, National Institute of Standards and Technology (NIST), Gaithersburg, MD, United States of America
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23
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Trickey A, Stone J, Semchuk N, Saliuk T, Sazonova Y, Varetska O, Lim AG, Walker JG, Vickerman P. Is contact between men who have sex with men and non-governmental organizations providing harm reduction associated with improved HIV outcomes? HIV Med 2020; 22:262-272. [PMID: 33179855 PMCID: PMC7984049 DOI: 10.1111/hiv.13010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 11/27/2022]
Abstract
Objectives There is a high prevalence of HIV (5.2% in 2018) among men who have sex with men (MSM) in Ukraine. HIV testing, condom provision and facilitated linkage to HIV treatment have been funded by various bodies through non‐governmental organizations (NGOs). We investigated whether contact with these NGOs was associated with improved prevention and treatment outcomes among MSM in Ukraine. Methods Data were taken from four rounds of integrated bio‐behavioural surveys among MSM in Ukraine (2011, N = 5950; 2013, N = 8101; 2015, N = 4550; 2018, N = 5971) including HIV testing combined with questionnaire responses. Data were analysed using mixed‐effect regression models, which estimated associations between being an NGO client and behavioural, HIV testing and HIV treatment outcomes, adjusted for demographic factors. Results Those MSM who were NGO clients were more likely than non‐clients to have been HIV tested in the last year [adjusted odds ratio (aOR) = 7.01, 95% confidence interval (CI): 6.45–7.62] or ever (aOR = 11.00, 95% CI: 9.77–12.38), to have used a condom for the last anal sex act (aOR = 1.32, 95% CI: 1.21–1.43), and to have recently either bought or received condoms (aOR = 21.27, 95% CI: 18.01–25.12). HIV‐positive MSM were more likely to have contact with NGOs (aOR = 1.61, 95% CI: 1.39–1.86). Among the HIV‐positive MSM, those who were NGO clients were more likely to be registered at an AIDS centre (aOR = 2.24, 95% CI: 1.61–3.11) and to be on antiretroviral treatment (aOR = 2.20, 95% CI: 1.51–3.20). Conclusions In Ukraine, being in contact with MSM‐targeted NGOs is associated with better outcomes for HIV prevention, testing and treatment, suggesting that NGO harm reduction projects for MSM have had a beneficial impact on reducing HIV transmission and morbidity.
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Affiliation(s)
- A Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - J Stone
- Population Health Sciences, University of Bristol, Bristol, UK
| | - N Semchuk
- Alliance for Public Health, Kiev, Ukraine
| | - T Saliuk
- Alliance for Public Health, Kiev, Ukraine
| | - Y Sazonova
- Alliance for Public Health, Kiev, Ukraine
| | - O Varetska
- Alliance for Public Health, Kiev, Ukraine
| | - A G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | - J G Walker
- Population Health Sciences, University of Bristol, Bristol, UK
| | - P Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
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24
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Breathett K, Yee E, Pool N, Hebdon M, Crist J, Yee R, Knapp S, Solola S, Luy L, Herrera‐Theut K, Zabala L, Stone J, McEwen M, Calhoun E, Sweitzer N. Sex and Race Biases in Allocation of Advanced Heart Failure Therapies. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13397] [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: 12/01/2022] Open
Affiliation(s)
| | - E. Yee
- University of Arizona Tucson AZ United States
| | - N. Pool
- University of Arizona Tucson AZ United States
| | - M. Hebdon
- University of Arizona Tucson AZ United States
| | - J. Crist
- University of Arizona Tucson AZ United States
| | - R. Yee
- University of Arizona Tucson AZ United States
| | - S. Knapp
- University of Arizona Tucson AZ United States
| | - S. Solola
- University of Arizona Tucson AZ United States
| | - L. Luy
- University of Rochester Rochester NY United States
| | | | - L. Zabala
- University of Arizona Tucson AZ United States
| | - J. Stone
- University of Arizona Tucson AZ United States
| | - M. McEwen
- University of Arizona Tucson AZ United States
| | - E. Calhoun
- University of Arizona Tucson AZ United States
| | - N. Sweitzer
- University of Arizona Tucson AZ United States
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25
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Lidstone SC, Araújo R, Stone J, Bloem BR. Ten myths about functional neurological disorder. Eur J Neurol 2020; 27:e62-e64. [DOI: 10.1111/ene.14310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023]
Affiliation(s)
- S. C. Lidstone
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease Faculty of Medicine Toronto Western Hospital University of Toronto Toronto ON Canada
| | - R. Araújo
- Department of Neurology Centro Hospitalar Universitário de São João Porto Portugal
- Department of Clinical Neurosciences and Mental Health Faculty of Medicine of University of Porto Porto Portugal
| | - J. Stone
- Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK
| | - B. R. Bloem
- Donders Institute for Brain Cognition and Behaviour Department of Neurology Centre of Expertise for Parkinson & Movement Disorders Radboud University Medical Centre Nijmegen The Netherlands
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26
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Chandy E, Taylor H, Gaito S, Wells E, Jones C, Meehan C, Burland H, Stone J, Snowball C, Mashru J, Riddell C, Hon Y, Welsh L, Saran F, Mandeville H. Hypofractionated Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Tumours in Children and Young Adults. Clin Oncol (R Coll Radiol) 2020; 32:316-326. [DOI: 10.1016/j.clon.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/09/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022]
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27
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LaFaver K, Lang AE, Stone J, Morgante F, Edwards M, Lidstone S, Maurer CW, Hallett M, Dwivedi AK, Espay AJ. Opinions and clinical practices related to diagnosing and managing functional (psychogenic) movement disorders: changes in the last decade. Eur J Neurol 2020; 27:975-984. [DOI: 10.1111/ene.14200] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- K. LaFaver
- Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - A. E. Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital University of Toronto Toronto CN Canada
| | - J. Stone
- Centre for Clinical Brain Sciences University of Edinburgh EdinburghUK
| | - F. Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute St George's University of London London UK
- Department of Clinical and Experimental Medicine University of Messina Messina Italy
| | - M. Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute St George's University of London London UK
| | - S. Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic Toronto Western Hospital University of Toronto Toronto CN Canada
| | - C. W. Maurer
- Department of Neurology Stony Brook University School of Medicine Stony Brook NYUSA
| | - M. Hallett
- Human Motor Control Section Medical Neurology Branch National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda MDUSA
| | - A. K. Dwivedi
- Division of Biostatistics and Epidemiology Department of Molecular and Translational Medicine Texas Tech University Health Sciences Center El Paso El Paso TXUSA
| | - A. J. Espay
- Department of Neurology UC Gardner Neuroscience Institute James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders University of Cincinnati Cincinnati OH USA
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28
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Kinariwala D, Khaja M, McCann S, Sheeran D, Park A, Stone J, Wilkins L, Matsumoto A, Redick D. 3:36 PM Abstract No. 169 Preoperative uterine artery embolization before hysterectomy or myomectomy: a case series. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.205] [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: 11/17/2022] Open
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29
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Ahamadi M, Conrado DJ, Macha S, Sinha V, Stone J, Burton J, Nicholas T, Gallagher J, Dexter D, Bani M, Boroojerdi B, Smit H, Weidemann J, Chen C, Yang M, Maciuca R, Lawson R, Burn D, Marek K, Venuto C, Stafford B, Akalu M, Stephenson D, Romero K. Development of a Disease Progression Model for Leucine-Rich Repeat Kinase 2 in Parkinson's Disease to Inform Clinical Trial Designs. Clin Pharmacol Ther 2020; 107:553-562. [PMID: 31544231 PMCID: PMC7939141 DOI: 10.1002/cpt.1634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/05/2019] [Indexed: 11/06/2022]
Abstract
A quantitative assessment of Parkinson's disease (PD) progression is critical for optimizing clinical trials design. Disease progression model was developed using pooled data from the Progression Marker Initiative study and the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson's Disease study. Age, gender, concomitant medication, and study arms were predictors of baseline. A mutation in the leucine-rich repeat kinase 2 (LRRK2) encoding gene was associated with the disease progression rate. The progression rate in subjects with PD who carried LRRK2 mutation was slightly slower (~0.170 points/month) than that in PD subjects without the mutation (~0.222 points/month). For a nonenriched placebo-controlled clinical trial, approximately 70 subjects/arm would be required to detect a drug effect of 50% reduction in the progression rate with 80% probability, whereas 85, 93, and 100 subjects/arm would be required for an enriched clinical trial with 30%, 50%, and 70% subjects with LRRK2 mutations, respectively.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rachael Lawson
- Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson’s Disease
| | - David Burn
- Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in Parkinson’s Disease
| | - Kenneth Marek
- Institute of Neurodegenerative Diseases, New Haven, CT, USA
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30
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Stone J, El-Matary W. A88 EARLY-ONSET GASTRIC POLYPS IN CHILDREN WITH FAMILIAL ADENOMATOUS POLYPOSIS: A CASE SERIES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Familial adenomatous polyposis (FAP) syndrome is a familial inherited autosomal dominant polyposis syndrome which predisposes affected individuals to a significantly increasing risk of colorectal cancer before the age of 30 years. Studies examining the rates of duodenal and gastric neoplasia in patients with FAP are scarce. Recent reports have shown a concerning rise in gastric cancer in Western FAP patients with certain endoscopic features. Current guidelines suggest screening with gastroscopy beginning at the age of 20 to 25 years.
Aims
We report a case series of seven pediatric patients with evidence of early-onset upper gastrointestinal adenomatous polyps.
Methods
A retrospective chart review was performed for all patients diagnosed with FAP between January 2012 and December 2016 in Winnipeg Children’s Hospital which is the only pediatric tertiary-care hospital in Manitoba. A total of seven pediatric patients from 3 different families were enrolled in our case series. The following data were collected: age of diagnosis, gene mutation, time of first screening endoscopy and total number of endoscopies, number of gastric and colonic polyps, pathology results, surgeries and further routine investigations. Descriptive data were then reported on each patient.
Results
Five of seven patients (71.4%) exhibited maternal inheritance of the APC gene mutation. The mean age of diagnosis was 5.3 years (SE 2.4, range 2–9 years) with male predominance (n=5, 71.4%). Mean age at first colonoscopy was 9.8 years (SE 2.05; range 6.6–11.9) and 9.9 years (SE 1.88; range 6.6–11.9 years) at first gastroscopy. Five (71.4%) patients had evidence of gastric polyps and three (43%) had evidence of duodenal polyps before the age of 14 years. All patients showed an increasing burden of gastric polyposis with age. Tubular adenomas were seen in all patients who developed >50 gastric polyps (n=5), two with low-grade dysplasia diagnosed at the ages of 11 and 15 year. One patient with duodenal polyps showed tubular adenomatous changes at the age of 13.6 years. Capsule endoscopy was performed in all patients and none showed any small bowel polyposis beyond the duodenum. All seven patients had colonic tubular adenomas, two with low-grade dysplasia (at ages of 14 and 15 years) and only one without polyps at the initiation of endoscopic screening. No patients underwent surgery prior to age 15 years.
Conclusions
The presence of gastric and duodenal polyps in pediatric patients with FAP is not uncommon and may be underestimated. Early screening gastroscopy with gastric and duodenal biopsies should be considered at a younger age than what has currently been recommended.
Funding Agencies
None
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Affiliation(s)
- J Stone
- Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
| | - W El-Matary
- Pediatric Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
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31
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Stone J, Witges K, Shafer L, Targownik LE, Lix LM, Haviva C, Walker J, Graff LA, Vagianos K, Sargent M, Bernstein CN. A224 THE MANITOBA LIVING WITH IBD STUDY: MEDICATION ADHERENCE AND MARS-5 VALIDATION. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Medication non-adherence in IBD has previously been reported to be quite variable, ranging from 7 to 73%, and is considered to be an important contributor to disease flares. While there is currently no gold standard for medication adherence reporting in IBD, the Medication Adherence Reporting Scale 5 (MARS-5) has frequently been used in this population, but never validated.
Aims
This study aimed to analyze medication adherence rates in a cohort of persons with IBD in Manitoba, report predictors of medication non-adherence on self-reported symptoms, and validate the MARS-5 as a medication adherence tool.
Methods
55 subjects were prospectively followed with biweekly online surveys in the Manitoba Living with IBD Study. Subjects not taking any medications for IBD or only taking as needed, missing adherence data and those lost to follow-up were excluded, leaving 112 subjects. Descriptive data on demographics, surgeries, IBD medications, medication adherence, and measures of disease activity utilizing IBDSI-SF scores were collected. Mean annual medication adherence percentage, IBDSI-SF(>14=active for Crohn’s,>13=active for UC) and MARS-5 scores were calculated. Logistic regression analysis was performed to determine variables associated with medication adherence and to validate the MARS-5.
Results
Mean age was 42.9 years (SD 12.8), with 71.4% being female. Crohn’s disease (CD) was diagnosed in 67.9%, with 37.5% having undergone at least one abdominal surgery. 70.5% of patients were on 2 or more IBD medications. Mean IBDSI score was 15.5 and mean MARS-5 score was 22.5. 20 (17.9%) patients reported a mean adherence of <90% across all medications- 18 were oral medication users, 1 was on an infusion biologic and 1 on subcutaneous adalimumab. 10 (9.8%) had adherence <80%, all of which were to oral medications. Multivariate regression analysis revealed only a diagnosis of Crohn’s disease (OR 4.62; 95% CI 1.37–15.7; p=0.014) to be a predictor of adherence. Disease activity as defined by IBDSI (OR 0.43, 95% CI 0.13–1.45; p=0.139) and fecal calprotectin >250ug/L (OR 1.04, 95% CI 0.35–3.11; p=0.724), age >55 (OR 2.37, 95% CI 0.65–8.65; p=0.476), female sex (OR 0.38, 95% CI 0.097–1.52; p=0.150) and stress (OR 0.67, 95% CI 0.19–2.32; p=0.498) were not shown to be predictors. MARS-5 was compared to percentage adherence, showing moderate correlation (Pearson r=0.46). Logistic regression analysis showed each additional MARS-5 point was associated with a 1.7 times greater odds of >90% adherence.
Conclusions
We report a highly adherent Manitoba IBD cohort. A diagnosis of CD was the only predicitor of adherence. MARS-5 showed moderate correlation with mean percentage adherence values, suggesting it is a valid assessment tool for determining medication adherence in an IBD population.
Funding Agencies
None
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Affiliation(s)
- J Stone
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - K Witges
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - L Shafer
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - L E Targownik
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - L M Lix
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - C Haviva
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - J Walker
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - L A Graff
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - K Vagianos
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - M Sargent
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
| | - C N Bernstein
- University of Manitoba IBD Clinical and Research Center, Winnipeg, MB, Canada
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32
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Kulyk A, Stone J, Bernstein CN. A258 ASSOCIATION BETWEEN SYMPTOMS AND INFLAMMATORY BOWEL DISEASE ACTIVITY USING INFLAMMATORY BOWEL DISEASE SYMPTOM INVENTORY – A RETROSPECTIVE ANALYSIS FROM THE MANITOBA LIVING WITH IBD STUDY. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gut and includes predominantly Crohn’s disease (CD) and ulcerative colitis (UC). The Inflammatory Bowel Disease Symptom Inventory (IBDSI), developed at the University of Manitoba is a validated patient self-report symptom inventory which has shown to demonstrate good validity to accepted clinician-based assessments of disease activity. The IBDSI focuses of 5 main symptom clusters: bowel symptoms, abdominal discomfort, fatigue, bowel complications, and systemic complications. While there is good evidence for the presence of these symptoms in IBD, there has yet to be an analysis of the correlation between specific symptom clusters and active IBD.
Aims
Our aim is to identify symptoms experienced by patients with IBD being followed prospectively over one year and further analyze which of these symptoms are correlated with disease activity.
Methods
155 patients enrolled in the Manitoba Living with IBD Study were eligible for the current study. Bi-weekly IBDSI short-form survey results were analyzed to determine which IBD-related symptoms were experienced by each patient over the study period (1 year). Descriptive data for symptoms will be reported, and will then be compared to disease activity (defined in Crohn’s disease as an IBDSI score >14 and in UC>13 and fecal calprotectin level (FCAL) >250 ug/g) to determine which symptoms most correlate with active IBD.
Results
The study population ranged from ages 18–70, with a mean age of 43 years. 30.3% (47) of the population were male. 65.8% (102) of the population consisted of CD, 31.0% (48) had UC, the remaining 3.2% (5) had IBD-type unclassified. Some of the symptoms for analysis will include abdominal pain, frequency and consistency of bowel movements, blood within the stool, and other associated symptoms such as nausea and loss of appetite. The results for the frequency of symptoms reported and which are most correlated with disease activity is still under analysis.
Conclusions
This will be the first study assessing the association between symptoms experienced by subjects contrasted to disease activity using the self-reported measurement IBDSI and FCAL.
Funding Agencies
None
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Affiliation(s)
- A Kulyk
- Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J Stone
- Gastroenterology, University of Manitoba, Winnipeg, MB, Canada
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33
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Higgins DL, Robison BJ, Bailey S, Hagen C, Higgins D, Jankow D, Jost K, Kallay K, Kulhanek C, Madden J, Matushek M, Okolo C, Pratt M, Sloan E, Stone J, Tuncan E, Weagent S, Weatherington J. Comparison of MICRO-ID Listeria Method with Conventional Biochemical Methods for Identification of Listeria Isolated From Food and Environmental Samples: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/76.4.831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Fourteen laboratories participated in a collaborative study to evaluate the ability of the MICRO-ID Listeria identification method to correctly identify Listeria isolated from food and environmental sources. Each collaborator received 60 isolates consisting of 51 Listeria and 9 non-Listeria cultures. All isolates were identified by conventional biochemical analyses in the principal laboratory. Cultures were checked for purity by Gram staining and examined for oxidase and catalase activities. Only Gram positive, oxidase negative, catalase positive cultures were tested with the method. Colonies from trypticase soy agar with 0.6% yeast extract were suspended in 4.6 ml_ physiological saline to a MacFarland No. 1 turbidity standard and used to inoculate the test strip. In addition, the hemolytic reaction of each isolate was determined by using the Christie-Atkins-Munch-Peterson (CAMP) test and by stabbing sheep blood agar. Identification of Listeria is based on the octal code obtained from the strip and the hemolytic reaction of the isolate. The MICRO-ID Listeria method agreed with conventional biochemical identification for 98.0% of L. monocytogenes, 77.1% of L. seeligeri, 98.0% of L ivanovii, 96.4% of L. grayi/L. murrayi, 73.9% of L. welshimeri, and 100% of L innocua isolates. A large percentage of errors in identification of the L. seeligeri and L ivanovii cultures was caused by inaccurate reading of the CAMP and hemolysis tests rather than errors in the test strip. The method was adopted first action by AOAC International.
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Affiliation(s)
- Don L Higgins
- Organon Teknika Corp., 100 Akzo Ave, Durham, NC 27704
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Feldsine PT, Falbo-Nelson MT, Hustead DL, Aaronson J, Arling V, Baker M, Bozzuffi J, Bremer N, Chlebowski E, Clarke J, Crane A, Daniell E, Daugherty N, David J, Davis T, Diaz R, Donnelly S, Elwood M, Forgey R, Freshley J, Glowka L, Gottshall R, Graham R, Gray M, Griffith M, Hansen M, Harmon T, Herman R, Hofstrand P, Huether K, Irbys S, Jackey B, Jackson J, Jones T, Khasmakhi A, Lifur L, Linger T, MaCeda J, Mackin M, Marone C, McClure A, McDonagh S, Milligan L, Nelson J, Pandit K, Poole S, Rizzo M, Robinson J, Sparano R, Schriver J, Seibert M, Stone J, Summers D, Sweger L, Tebay D, Vera G, Weaver A, Wempe J, Wilkinson C, Willett J, Willoughby S, Zook T. Substrate Supporting Disc Method for Confirmed Detection of Total Coliforms and E. coli in all Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/76.5.988] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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]
Abstract
Abstract
The Coli Complete® substrate supporting disc (SSD) method for simultaneous confirmed total coliform count and Escherichia coli determination in all foods was compared with AOAC most probable number (MPN) methods, 966.23 and 966.24. Twenty-nine laboratories participated in this collaborative study in which 6 food types were analyzed. Four food types, raw ground beef, pork sausage, raw liquid milk, and nut meats, were naturally contaminated with coliform bacteria. Two foods, dry egg and fresh frozen vegetables, were seeded with coliforms. Three food types, ground beef, raw liquid milk, and pork sausage, were naturally contaminated with E. coli. Although pork sausage was naturally contaminated, the level was very low (<10/50 g); therefore, additional E. coli were inoculated into 1 lot of this food type. Three food types, nut meats, dry egg, and fresh frozen vegetables, were inoculated with E. coli. For naturally contaminated samples, duplicate determinations were made on 3 separate lots for each food type. For inoculated samples, low, medium, and high contamination levels plus uninoculated control samples were examined in duplicate. Data were analyzed separately for total coliform bacteria and for E. coli. Mean log MPN counts were determined by the SSD method and the appropriate AOAC MPN method. Results were then analyzed for repeatability, reproducibility, and mean log MPN statistical equivalence. Results were statistically equivalent for all total coliform levels in all food types except frozen vegetable and raw nut meat uninoculated control samples and 1 lot of pork sausage where the SSD method produced statistically significant greater numbers. For the E. coli determinations, results were statistically equivalent across all samples and all levels for each food type. The SSD method has been adopted first action by AOAC International for confirmed detection of total coliforms and E. coli in all foods.
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Affiliation(s)
- Philip T Feldsine
- BioControl Systems, Inc., 19805 North Creek Parkway, Bothell, WA 98011
| | | | - David L Hustead
- BioControl Systems, Inc., 19805 North Creek Parkway, Bothell, WA 98011
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Conrado DJ, Burton J, Hill D, Willis B, Sinha V, Stone J, Coello N, Wang W, Chen D, Nicholas T, Gold M, Hartley E, Kern VD, Romero K. Hippocampal Neuroimaging-Informed Clinical Trial Enrichment Tool for Amnestic Mild Cognitive Impairment Using Open Data. Clin Pharmacol Ther 2020; 107:903-914. [PMID: 31899810 DOI: 10.1002/cpt.1766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/08/2019] [Indexed: 11/05/2022]
Abstract
Our goal was to assess the enrichment utility of hippocampal volume (HV) as an enrichment biomarker in amnestic mild cognitive impairment (aMCI) clinical trials, and, hence, develop an HV neuroimaging-informed clinical trial enrichment tool. Modeling of integrated longitudinal patient-level data came from open-access natural history studies in patients diagnosed with aMCI-the Alzheimer's Disease Neuroimaging Initiative (ADNI)-1 and ADNI-2-and indicated that a decrease of 1 cm3 with respect to the analysis dataset median baseline intracranial volume-adjusted HV (ICV-HV; ~ 5 cm3 ) is associated with > 50% increase in disease progression rate as measured by the Clinical Dementia Rating Scale-Sum of Boxes. Clinical trial simulations showed that the inclusion of aMCI subjects with baseline ICV-HV below the 84th or 50th percentile allowed an approximate reduction in trial size of at least 26% and 55%, respectively. This clinical trial enrichment tool can help design more efficient and informative clinical trials.
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Affiliation(s)
| | | | - Derek Hill
- Panoramic Digital Health, Grenoble, France.,Critical Path Institute, Tucson, Arizona, USA
| | - Brian Willis
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Vikram Sinha
- Merck & Co. Inc., Philadelphia, Pennsylvania, USA
| | - Julie Stone
- Merck & Co. Inc., Philadelphia, Pennsylvania, USA
| | - Neva Coello
- Novartis Pharmaceuticals, Basel, Switzerland
| | - Wenping Wang
- Novartis Pharmaceuticals, Philadelphia, Pennsylvania, USA
| | - Danny Chen
- Pfizer Inc, Cambridge, Massachusetts, USA
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Lee S, Phillips M, Bellinge J, Stone J, Wylie E, Stuckey B, Schultz C. 744 Oestrogen as a Potential Shared Mechanism Between Medial Calcification and Intimal Atherosclerosis. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.751] [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: 11/29/2022]
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Gelauff JM, Rosmalen JGM, Gardien J, Stone J, Tijssen MAJ. Shared demographics and comorbidities in different functional motor disorders. Parkinsonism Relat Disord 2019; 70:1-6. [PMID: 31785442 DOI: 10.1016/j.parkreldis.2019.11.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Received: 04/29/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Functional motor disorders are often delineated according to the dominant motor symptom. In a large cohort, we aimed to find if there were differences in demographics, mode of onset, pain, fatigue, depression and anxiety and levels of physical functioning, quality of life and social adjustment between patients with different dominant motor symptoms. METHODS Baseline data from the Self-Help and Education on the Internet for Functional Motor Disorders Trial was used. Patients were divided into dominant motor symptom groups based on the diagnosis of the referring neurologist. Data on the above topics were collected by means of an online questionnaire and compared between groups using parametric and nonparametric statistics. RESULTS In 160 patients a dominant motor symptom could be determined, 31 had tremor, 45 myoclonus, 23 dystonia, 30 paresis, 31 gait disorder. No statistical differences between groups were detected for demographics, mode of onset and severity of pain, fatigue, depression and anxiety. Physical functioning was worse in the gait disorder group (median 20, IQR 25) compared to tremor (50 (55), p = 0.002) and myoclonus (50 (52), p = 0.001). Work and social adjustment was less impaired in the myoclonus group (median 20, IQR 18) compared to gait disorder (median 30, IQR18, p < 0.001) and paresis (28, IQR 10, p = 0.001). Self-report showed large overlap in motor symptoms. CONCLUSION No differences were detected between groups of functional motor symptoms, regarding demographics, mode of onset, depression, anxiety, pain and fatigue. The large overlap in symptoms contributes to the hypothesis of shared underlying mechanisms of functional motor disorders.
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Affiliation(s)
- J M Gelauff
- University of Groningen, University Medical Center Groningen, Department of Neurology, the Netherlands
| | - J G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, the Netherlands
| | - J Gardien
- University of Groningen, University Medical Center Groningen, Department of Neurology, the Netherlands
| | - J Stone
- University of Edinburgh, Centre for Clinical Brain Sciences, Edinburgh, United Kingdom
| | - M A J Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, the Netherlands.
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Abstract
With advances in medical care, many women with genetic conditions previously known to decrease life expectancy are reaching childbearing age. Thus, it is important to understand the management of patients in the preconception, antepartum, and postpartum periods as they pose a unique challenge to the obstetrician. Most rare disorders lack well-established clinical guidelines for management in pregnancy. Existing data stem from case reports, case series, and expert opinion. We aim to summarize these recommendations and develop a clinical reference for managing reproductive age women with these conditions. We review recommendations for women with inborn errors in metabolism, connective tissue disorders, skeletal dysplasia, and selected single gene disorders. In all cases, it is crucial to employ a multidisciplinary team to optimize care for patients with rare disease before, during, and immediately after their pregnancies. The emphasis on expert consensus recommendations in the guidance of obstetric care is a signal that more studies are needed to determine best practices.
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Affiliation(s)
- Julie Stone
- Tufts Medical Center, 800 Washington Center, Boston, MA, 02111, USA
| | - Dallas Reed
- Tufts Medical Center, 800 Washington Center, Boston, MA, 02111, USA.
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Nold C, Jensen T, O'Hara K, Stone J, Yellon SM, Vella AT. Replens prevents preterm birth by decreasing type I interferon strengthening the cervical epithelial barrier. Am J Reprod Immunol 2019; 83:e13192. [DOI: 10.1111/aji.13192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Christopher Nold
- Department of Women's Health Hartford Hospital Hartford CT USA
- Department of Pediatrics University of Connecticut School of Medicine Farmington CT USA
| | - Todd Jensen
- Department of Pediatrics University of Connecticut School of Medicine Farmington CT USA
| | - Kathleen O'Hara
- Department of Pediatrics University of Connecticut School of Medicine Farmington CT USA
| | - Julie Stone
- Department of Obstetrics and Gynecology Tufts Medical Center Boston MA USA
| | - Steven M. Yellon
- Longo Center for Perinatal Biology Loma Linda University School of Medicine Loma Linda CA USA
| | - Anthony T. Vella
- Department of Immunology University of Connecticut School of Medicine Farmington CT USA
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Lee M, Gill C, Serauto Canache A, Donisan T, Balanescu D, Marah N, Stone D, Stone J, Boone D, Cervoni Curet F, Agha A, Iliescu C, Palaskas N. P678Pericardiocentesis in thrombocytopenic cancer patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pericardial effusion is a known complication in cancer patients, resulting in chest pain, cardiac tamponade, and cardiogenic shock. Although technological advances allow for early detection, treatment options are limited for those also suffering from thrombocytopenia.
Purpose
Our study aims to evaluate survivorship of thrombocytopenic cancer patients who underwent pericardiocentesis.
Methods
From 2008 to 2019, we assessed overall mortality and follow-up post-pericardiocentesis in cancer patients with concurrent thrombocytopenia (<150,000 cells/microliter) at our cancer center. Thrombocytopenia grading was determined on the procedure day via serology platelet cell count with the following thresholds: Grade 1 (<50x103 cells/mL), Grade 2 (51–100x103 cells/mL), and Grade 3 (101–149x103 cells/mL).
Results
In 137 patients, we identified 65 (47%) patients with Grade 1, 30 (22%) with Grade 2, and 42 (31%) with Grade 3 thrombocytopenia. The calculated platelet count average was 66x103 cells/mL, median was 59x103 cells/mL, and range was 6 to 147x103 cells/mL. Of note, 7 (5%) patients had platelets <10x103 cells/mL. One patient developed a hematoma at the percutaneous site of pericardial drain, no other complications were noted. Kaplan Meier survival analysis by log-rank (mantel-cox) showed statistical significance (p=0.025). Comparatively, the cumulative survival of patients at 30 days was 63% in Grade 1, 67% in Grade 2, and 83% in Grade 3 patients. At one year, it was 26% in Grade 1, 37% in Grade 2, and 48% in Grade 3 patients.
Conclusion
Pericardiocentesis offers rapid symptomatic relief and can be life-saving in cardiac tamponade. In cancer patients, the development of pericardial effusions and thrombocytopenia increases due to the underlying malignancy and cancer therapeutics. Although thrombocytopenia is thought to increase peri-procedural risks, in this cohort there was only one minor complication and this occurred in Grade 2 thrombocytopenia. For thrombocytopenic cancer patients suffering from large pericardial effusions, high pre-operative risk scores often exclude them from receiving surgical pericardial windows. Although mortality was higher in severe thrombocytopenia, this is likely due to the competing risk of more severe cancer; there were no complications with Grade 1 thrombocytopenia. Especially noteworthy, no complications in those with platelets <10,000 cells/uL. Our study shows that in this population of patients, pericardiocentesis is a feasible intervention with low complication rate to help improve quality of life and potentially life-saving treatment.
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Affiliation(s)
- M Lee
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - C Gill
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - A Serauto Canache
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - T Donisan
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Balanescu
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - N Marah
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Stone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - J Stone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Boone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - F Cervoni Curet
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - A Agha
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - C Iliescu
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - N Palaskas
- University of Texas MD Anderson Cancer Center, Houston, United States of America
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Powles T, Balar A, Gravis G, Jones R, Ravaud A, Florence J, Grivas P, Petrylak D, Galsky M, Carles J, Sridhar S, Arkenau HT, Carroll D, DeCesare J, Mercier F, Hodgson D, Stone J, Cosaert J, Landers D. An adaptive, biomarker directed platform study in metastatic urothelial cancer (BISCAY) with durvalumab in combination with targeted therapies. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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42
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Jackson K, Stone J. 361 Emergency Physician Workflow Disruptions Due to Ultrasound-Guided IV Placement. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.322] [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: 11/29/2022]
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Egan MF, Mukai Y, Voss T, Kost J, Stone J, Furtek C, Mahoney E, Cummings JL, Tariot PN, Aisen PS, Vellas B, Lines C, Michelson D. Further analyses of the safety of verubecestat in the phase 3 EPOCH trial of mild-to-moderate Alzheimer's disease. Alzheimers Res Ther 2019; 11:68. [PMID: 31387606 PMCID: PMC6685277 DOI: 10.1186/s13195-019-0520-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Verubecestat, a BACE1 inhibitor that reduces Aβ levels in the cerebrospinal fluid of humans, was not effective in a phase 3 trial (EPOCH) of mild-to-moderate AD and was associated with adverse events. To assist in the development of BACE1 inhibitors, we report detailed safety findings from EPOCH. METHODS EPOCH was a randomized, double-blind, placebo-controlled 78-week trial evaluating verubecestat 12 mg and 40 mg in participants with mild-to-moderate AD diagnosed clinically. The trial was terminated due to futility close to its scheduled completion. Of 1957 participants who were randomized and took treatment, 652 were assigned to verubecestat 12 mg, 652 to verubecestat 40 mg, and 653 to placebo. Adverse events and relevant laboratory, vital sign, and ECG findings were assessed. RESULTS Verubecestat 12 mg and 40 mg were associated with an increase in the percentage of participants reporting adverse events versus placebo (89 and 92% vs. 82%), although relatively few participants discontinued treatment due to adverse events (8 and 9% vs. 6%). Adverse events that were increased versus placebo included falls and injuries, suicidal ideation, weight loss, sleep disturbance, rash, and hair color change. Most were mild to moderate in severity. Treatment differences in suicidal ideation emerged within the first 3 months but did not appear to increase after 6 months. In contrast, treatment differences in falls and injuries continued to increase over time. CONCLUSIONS Verubecestat was associated with increased risk for several types of adverse events. Falls and injuries were notable for progressive increases over time. While the mechanisms underlying the increased adverse events are unclear, they may be due to BACE inhibition and should be considered in future clinical development programs of BACE1 inhibitors. TRIAL REGISTRATION ClinicalTrials.gov NCT01739348 , registered on 29 November 2012.
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Affiliation(s)
- Michael F Egan
- Merck & Co., Inc., Kenilworth, NJ, USA. .,Merck & Co., Inc., UG 4C-06, P.O. Box 1000, North Wales, PA, 19454-1099, USA.
| | | | | | | | | | | | | | - Jeffrey L Cummings
- University of Nevada Las Vegas Department of Brain Health, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | | | - Paul S Aisen
- University of Southern California, San Diego, CA, USA
| | - Bruno Vellas
- Gerontopole, INSERM U 1027, Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France
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Toole K, Bull T, Keegan E, Loi E, Goralewski J, Lee S, Van De Voorde R, Young E, Ristevska S, Roffey P, Burger F, Cho K, Davies B, Fraser M, Goodman-Jones A, Nelson K, Robertson G, Shaw T, Stone J, Reinhard M. Nuclear forensic science in Australia: current status and future plans. AUST J FORENSIC SCI 2019. [DOI: 10.1080/00450618.2019.1568564] [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: 10/27/2022]
Affiliation(s)
| | - T. Bull
- ANSTO, Sydney, NSW, Australia
| | | | - E. Loi
- ANSTO, Sydney, NSW, Australia
| | | | - S. Lee
- ANSTO, Sydney, NSW, Australia
| | | | | | - S. Ristevska
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - P. Roffey
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - F. Burger
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - K. Cho
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - B. Davies
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - M. Fraser
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - A. Goodman-Jones
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - K. Nelson
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - G. Robertson
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - T. Shaw
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
| | - J. Stone
- Specialist Operations (Forensics), Australian Federal Police, Canberra, Australia
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Jin H, Mitchum M, Panstruga R, Stone J. Focus Issue Editorial: Biotic Stress. Plant Physiol 2019; 179:1193-1195. [PMID: 30940733 PMCID: PMC6446788 DOI: 10.1104/pp.19.00330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Hailing Jin
- Department of Microbiology and Plant Pathology, Center for Plant Cell Biology, Institute for Integrative Genome Biology, University of California, Riverside, California 92521
| | - Melissa Mitchum
- Division of Plant Sciences, Life Sciences Center, University of Missouri, Columbia, Missouri 65211-7310
| | - Ralph Panstruga
- Institute for Biology I, Unit of Plant Molecular Cell Biology, Worringerweg 1, 52056 Aachen, Germany
| | - Julie Stone
- Department of Biochemistry, University of Nebraska-Lincoln, N146 Beadle Center, Lincoln, Nebraska 68588-0662
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Uflacker A, Keefe N, Salzar R, Henderson K, Spratley E, Nacey N, David B, Whitehair R, Chahin J, Safavian D, Neiderer J, Stone J, Wick M, Cui Q, Haskal Z. Abstract No. 613 Intraarticular sodium monoiodoacetate injection induced osteoarthritis in sheep: a non-surgical large animal model for geniculate artery embolization. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.718] [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] Open
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Abstract
OBJECTIVES: This article draws attention to an initiative aimed at benefiting colleagues in developing countries, through financial and/or moral support. It describes an attempt to engage The Royal College of Australian and New Zealand Psychiatrists ('the College') in supporting this philanthropic activity. It further aims to attract interest from the College and fellows in contributing to international philanthropy. CONCLUSIONS: Doubling provides a credible model for facilitating better mental health care in situations where there are trained staff but inadequate resources. The College's resistance to engagement with this project may represent a missed opportunity for philanthropic support.
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Affiliation(s)
- Jon Jureidini
- Research Leader, Critical and Ethical Mental Health Research Group, Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Julie Stone
- Infant, Child and Family Psychiatrist, Melbourne, VIC Australia
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Stone J, Hoeritzauer I, Tesolin L, Carson A. Functional movement disorders of the face: A historical review and case series. J Neurol Sci 2018; 395:35-40. [DOI: 10.1016/j.jns.2018.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
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Nold C, Stone J, O'Hara K, Davis P, Kiveliyk V, Blanchard V, Yellon SM, Vella AT. Block of Granulocyte-Macrophage Colony-Stimulating Factor Prevents Inflammation-Induced Preterm Birth in a Mouse Model for Parturition. Reprod Sci 2018; 26:551-559. [PMID: 30296925 DOI: 10.1177/1933719118804420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A multitude of factors promotes inflammation in the reproductive tract leading to preterm birth. Macrophages peak in the cervix prior to birth and their numbers are increased by the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF). We hypothesize GM-CSF is produced from multiple sites in the genital tract and is a key mediator in preterm birth. STUDY DESIGN Ectocervical, endocervical, and amniotic fluid mesenchymal stem cells were treated with lipopolysaccharide (LPS), and the concentration and expression of GM-CSF was measured. Pregnant CD-1 mice on gestational day 17 received LPS and an intravenous injection of either anti-mouse GM-CSF or control antibody. After 6 hours, the preterm birth rate was recorded. RESULTS Treatment with LPS increased the GM-CSF concentration and messenger RNA expression after 24 hours in all 3 cell lines ( P < .01). Mice treated with LPS and the GM-CSF antibody had a preterm birth rate of 25%, compared to a 66.7% preterm birth rate in controls, within 6 hours ( P < .05, χ2). Treatment with the anti-mouse GM-CSF antibody decreased the concentration of GM-CSF in the mouse serum ( P < .01) but did not alter the number of macrophages or collagen content in the cervix. CONCLUSION These studies demonstrate that GM-CSF is produced from multiple sites in the genital tract and that treatment with an antibody to GM-CSF prevents preterm birth. Curiously, the anti-mouse GM-CSF antibody did not decrease the number of macrophages in the cervix. Further research is needed to determine whether antibodies to GM-CSF can be utilized as a therapeutic agent to prevent preterm birth.
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Affiliation(s)
- Christopher Nold
- 1 Department of Women's Health, Hartford Hospital, Hartford, CT, USA.,2 Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Julie Stone
- 2 Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Kathleen O'Hara
- 2 Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Patricia Davis
- 2 Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Vladislav Kiveliyk
- 2 Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Vanessa Blanchard
- 3 Longo Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Steven M Yellon
- 3 Longo Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Anthony T Vella
- 2 Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
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Kozioziemski BJ, Ayers J, Bell P, Bradley DK, Descalle MA, Hau-Riege S, McCarville TJ, Pardini T, Pickworth LA, Vogel JK, Stone J, Robinson J, Ampleford DJ, Ball CR, Bourdon CJ, Fein JR, Wu M, Ames A, Bruni R, Romaine S. An x-ray optic calibration facility for high energy density diagnostics. Rev Sci Instrum 2018; 89:10G112. [PMID: 30399878 DOI: 10.1063/1.5038742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
A facility to calibrate x-ray imaging optics was built at Lawrence Livermore National Laboratory to support high energy density (HED) and inertial confinement fusion (ICF) diagnostics such as those at the National Ignition Facility and the Sandia Z-Machine. Calibration of the spectral reflectivity and resolution of these x-ray diagnostics enable absolute determination of the x-ray flux and wavelengths generated in the HED and ICF experiments. Measurement of the optic point spread function is used to determine spatial resolution of the optic. This facility was constructed to measure (1) the x-ray reflectivity to ±5% over a spectral range from 5 to 60 keV; (2) point spread functions with a resolution of 50 μm (currently) and 13 μm (future) in the image plane; and (3) optic distance relative to the x-ray source and detector to within ±100 μm in each dimension. This article describes the capabilities of the calibration facility, concept of operations, and initial data from selected x-ray optics.
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Affiliation(s)
- B J Kozioziemski
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - J Ayers
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - P Bell
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - D K Bradley
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - M-A Descalle
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - S Hau-Riege
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - T J McCarville
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - T Pardini
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - L A Pickworth
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - J K Vogel
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - J Stone
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - J Robinson
- Lawrence Livermore National Laboratory, P.O. Box 808, Livermore, California 94551, USA
| | - D J Ampleford
- Sandia National Laboratories, 1515 Eubank Blvd. SE, Albuquerque, New Mexico 87123, USA
| | - C R Ball
- Sandia National Laboratories, 1515 Eubank Blvd. SE, Albuquerque, New Mexico 87123, USA
| | - C J Bourdon
- Sandia National Laboratories, 1515 Eubank Blvd. SE, Albuquerque, New Mexico 87123, USA
| | - J R Fein
- Sandia National Laboratories, 1515 Eubank Blvd. SE, Albuquerque, New Mexico 87123, USA
| | - M Wu
- Sandia National Laboratories, 1515 Eubank Blvd. SE, Albuquerque, New Mexico 87123, USA
| | - A Ames
- Smithsonian Astrophysical Observatory, 60 Garden Street, Cambridge, Massachusetts 02138, USA
| | - R Bruni
- Smithsonian Astrophysical Observatory, 60 Garden Street, Cambridge, Massachusetts 02138, USA
| | - S Romaine
- Smithsonian Astrophysical Observatory, 60 Garden Street, Cambridge, Massachusetts 02138, USA
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