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Brown MC, Tickle K, Woods K, Sidonio RF. Adequate menstrual suppression in adolescents with inherited bleeding disorders often requires multiple treatment changes: Retrospective cohort study of a multidisciplinary clinic. Pediatr Blood Cancer 2024; 71:e30944. [PMID: 38462776 DOI: 10.1002/pbc.30944] [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: 12/08/2023] [Revised: 01/25/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
Heavy menstrual bleeding (HMB) is often the presenting symptom for females with inherited bleeding disorders (IBD). Multidisciplinary clinics leverage the expertise of hematologists and women's health specialists. This study characterizes the complexity of HMB management for adolescents with IBDs from a large multidisciplinary clinic. Adolescents often required multiple different menstrual suppression treatments, with only about 20% achieving acceptable suppression with their first treatment. Adolescents switched therapy most often for uncontrolled bleeding, followed by adverse effects, and patient preference. Given the difficulty in achieving adequate menstrual suppression, multidisciplinary clinics offer necessary expertise in accomplishing bleeding control with minimal adverse effects.
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Affiliation(s)
- Megan C Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kelly Tickle
- Aflac Cancer and Blood Disorders at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kalinda Woods
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert F Sidonio
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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2
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Hassanzadeh H, Ferro A, Woods K, Baring T. Review of the national usage of antibiotics in arthroplasty surgery: a need for evidence-based prescribing. Ann R Coll Surg Engl 2023. [PMID: 37381757 DOI: 10.1308/rcsann.2022.0145] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION Surgical site infections (SSI) remain one of the most serious complications of arthroplasty surgery. The role of antibiotic prophylaxis in preventing SSI post-arthroplasty is well established. However, there is considerable heterogeneity in prophylactic prescribing across the United Kingdom (UK), which is contradicted by the contemporaneous evidence. This descriptive study aimed to compare the current first-line antibiotic recommendations across hospitals in the UK and The Republic of Ireland for elective arthroplasty procedures. METHODS The MicroGuide mobile phone application was used to access hospital antibiotic guidelines. First-line antibiotic recommendation and dosing regimen for primary elective arthroplasties were recorded. FINDINGS A total of nine distinct antibiotic regimens were identified through our search. The most frequently used first-line antibiotic was cefuroxime. This was recommended by 30 of the 83 (36.1%) hospitals in the study. This was followed by a combination of flucloxacillin and gentamicin, which was used by 38 of 124 (31%) hospitals. There was also significant heterogeneity in dosing regimens. A single prophylactic dose was most commonly recommended (52%); 4% of hospitals recommended two prophylactic doses, 19% three doses and 23% four doses. CONCLUSIONS Single-dose prophylaxis is recognised as at least noninferior to multiple-dose prophylaxis in primary arthroplasty. There is considerable variation in the local antibiotic recommendations for surgical site prophylaxis post-primary arthroplasty surgery, with respect to both recommended first-line antibiotic and dosing regimens. With increasing emphasis on the importance of antibiotic stewardship and the emergence of antibiotic resistance, this study highlights the need for an evidence-based approach to prophylactic dosing across the UK.
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Affiliation(s)
- H Hassanzadeh
- Homerton University Hospital NHS Foundation Trust, UK
| | - A Ferro
- Homerton University Hospital NHS Foundation Trust, UK
| | - K Woods
- Homerton University Hospital NHS Foundation Trust, UK
| | - T Baring
- Homerton University Hospital NHS Foundation Trust, UK
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3
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Kaura A, Roddick AJ, Samuel NA, Mulla A, Glampson B, Davies J, Woods K, Kharbanda R, Patel RS, Shah AM, Perera D, Channon KM, Mayet J. The association between troponin level and mortality in patients admitted to hospital with acute stroke (NIHR Health Informatics Collaborative TROP-STROKE study). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1991] [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
Introduction
Acute stroke accounts for significant morbidity and mortality globally. The role of troponin for risk stratification in stroke is unclear.
Purpose
The aims of this study were to assess the relationship between peak troponin and mortality in patients with ischaemic stroke, haemorrhagic stroke, or subarachnoid haemorrhage and to compare this with the predictive value of first troponin or dynamic troponin change.
Methods
A retrospective cohort study was carried out using the National Institute for Health Research Health Informatics Collaborative Cardiovascular dataset of all consecutive patients who had a troponin measured at five hospitals between 2010 and 2017. Patients with at least one troponin measurement and a primary diagnosis of ischaemic stroke, haemorrhagic stroke or subarachnoid haemorrhage during a hospital admission were included. The main exposure variables were first and peak troponin, and dynamic troponin change, and the main outcome was all-cause mortality. Results were analysed using multivariable adjusted restricted cubic spline Cox regression. Survival analyses were adjusted for troponin assay, assay sensitivity (standard or highly sensitive), number of troponin measurements, age, sex, C-reactive protein level, white blood cell count, platelet count, haemoglobin, estimated glomerular filtration rate, angiography during admission, acute coronary syndrome during admission, and cardiovascular history (history of diabetes mellitus, myocardial infarction, heart failure, hypertension, stroke or atrial fibrillation). Receiver Operator Characteristic (ROC) curves were used to assess the predictive value of each exposure variable.
Results
4,712 patients were included in the analysis (ischaemic stroke: 3,346; haemorrhagic stroke: 718; subarachnoid haemorrhage: 648). Peak troponin was above the upper limit of normal in 47.4% of ischaemic stroke patients, 52.8% of haemorrhagic stroke patients, and 57.1% of subarachnoid haemorrhage patients. Patients with elevated peak troponin were older and had more cardiovascular risk factors.
A direct positive relationship was seen between peak troponin level and mortality hazard ratio in all three stroke subtypes (Figure 1). This relationship was consistent when considering dynamic troponin fold change for ischaemic or haemorrhagic stroke. For all three stroke subtypes, there was no added predictive value of peak troponin or dynamic troponin change over first troponin in predicting mortality (Figure 2).
Conclusions
A positive peak troponin was associated with increased mortality in patients presenting with ischaemic stroke, haemorrhagic stroke, or subarachnoid haemorrhage. Overall, serial troponin measurements may not improve mortality prediction beyond a single measurement. These findings may have implications for risk stratification of patients with acute stroke syndromes.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Imperial Biomedical Research Centre, as part of the NIHR Health Informatics Collaborative, and 2) British Heart Foundation
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Affiliation(s)
- A Kaura
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - A J Roddick
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - N A Samuel
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - A Mulla
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - B Glampson
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - J Davies
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - K Woods
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - R Kharbanda
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - R S Patel
- University College London Hospitals , London , United Kingdom
| | - A M Shah
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Perera
- Guy's & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - K M Channon
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - J Mayet
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
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Kaura A, Samuel NA, Roddick AJ, Glampson B, Mulla A, Davies J, Woods K, Patel RS, Shah AM, Perera D, Channon KM, Shah ASV, Mayet J. The prognostic significance of troponin level in patients with malignancy (NIHR Health Informatics Collaborative TROP-MALIGNANCY study). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2588] [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
Cardiac troponin is commonly raised in patients with malignancy and may aid clinicians in risk prediction. The prognostic significance of raised troponin in these patients with known malignancies remains unclear.
Purpose
We sought to investigate the relation between troponin and mortality in a large, well characterised cohort of patients undergoing cardiac troponin testing with a concomitant malignancy.
Methods
A retrospective cohort study was carried out using the National Institute for Health Research Health Informatics Collaborative Cardiovascular dataset of all consecutive patients who had a troponin measured at five hospitals between 2010 and 2017. Patients with a primary inpatient diagnosis of malignancy who had at least one cTn measurement during their hospital stay were identified. Patients were classified into solid tumour or haematological malignancy subgroups. Survival analyses were performed using multivariate Cox regression analyses and Kaplan-Meier plots. Cox regression analyses were adjusted for age, gender, C-reactive protein, haemoglobin, platelet count, white cell count, acute coronary syndrome, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, atrial fibrillation and angiography. The peak cTn level (highest level measured), standardised to the upper limit of normal (ULN), was used for all analyses.
Results
5571 patients undergoing troponin testing had a primary diagnosis of malignancy and comprised of twenty-one different cancer types. 4649 patients were diagnosed with solid tumours and 922 patients were diagnosed with haematological malignancies. Patients with raised troponin had a higher burden of cardiovascular comorbidities compared to patients with a troponin level below the ULN. The median follow-up in the cohort was 14 months (interquartile range 2–39 months). At 1-year follow-up, 2495 (42%) of patients died.
Figure 1 shows Kaplan-Meier plots for patients stratified by troponin level. Patients with a troponin level ≥1xULN had a higher risk of death compared to patients with a troponin level <1xULN (Figure 1A). A similar trend was shown in cancer subtypes (Figure 1B, C). Raised troponin was an independent predictor of mortality in all patients with malignancy (adjusted hazard ratio 1.66, 95% confidence interval [CI] 1.52–1.81), in solid tumours (adjusted hazard ratio 1.63, 95% CI 1.48–1.81) and in haematological malignancy (adjusted hazard ratio 1.75, 95% CI 1.44 to 2.13) when compared to patients with a troponin level <1xULN.
Conclusion
A raised troponin was associated with an increased mortality risk in patients with malignancy regardless of cancer subtype. Stratification of mortality risk using troponin may help guide clinicians in making management decisions for patients with malignancy.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIHR Imperial Biomedical Research Centre, as part of the NIHR Health Informatics Collaborative, and 2) British Heart Foundation
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Affiliation(s)
- A Kaura
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - N A Samuel
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - A J Roddick
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - B Glampson
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - A Mulla
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - J Davies
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - K Woods
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - R S Patel
- University College London Hospitals , London , United Kingdom
| | - A M Shah
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Perera
- Guy's & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - K M Channon
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - A S V Shah
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - J Mayet
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
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Kaura A, Sterne JAC, Trickey A, Mulla A, Glampson B, Davies J, Woods K, Panoulas V, Shah AD, Patel RS, Kharbanda R, Shah AM, Perera D, Channon KM, Mayet J. Developing informatics infrastructure to curate datasets using electronic health record data from five hospitals for translational cardiovascular research. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2794] [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
Introduction
It has been challenging for researchers to access granular electronic health record (EHR) data at scale. One emerging prospect is to use big data to traverse the translational spectrum from an early discovery phase to a later implementation phase.
Purpose
To create a research-ready dataset to support translational research in cardiovascular medicine, using routinely-collected EHR data from multiple hospitals. As an early discovery phase study, we estimated the effect of invasive versus non-invasive management on the survival of patients with non-ST elevation myocardial infarction (NSTEMI) aged 80 years or older (SENIOR-NSTEMI Study). As a later implementation phase study, we determined the relationship between the full spectrum of troponin level and mortality in patients in whom troponin testing was performed for clinical purposes (TROP-RISK Study).
Methods
Using Microsoft SQL we developed a dataset of 257948 consecutive patients who had a troponin measured between 2010 and 2017 at five hospitals. We extracted phenotypically detailed data, including demographics, blood tests, procedural data, and survival status.
For the SENIOR-NSTEMI Study, eligible patients were 80 years or older who were diagnosed with NSTEMI. We estimated mortality hazard ratios comparing invasive with non-invasive management. For the TROP-RISK Study, we modelled the relation between peak troponin level and all-cause mortality using multivariable adjusted restricted cubic spline Cox regression analyses.
Results
For the SENIOR-NSTEMI Study, 1500 patients with NSTEMI were included who had a median age of 86 (interquartile range (IQR) 82–89) years of whom (845 [56%]) received non-invasive management. During a median follow-up of 3 (IQR 1.2–4.8) years, the adjusted cumulative five-year mortality was 36% in the invasive and 55% in the non-invasive group (hazard ratio 0.68, 95% confidence interval 0.55–0.84).
For the TROP-RISK Study, during a median follow-up of 1198 days (IQR 514–1866 days), 55850 (21.7%) deaths occurred. There was an unexpected inverted U-shaped relation between troponin level and mortality in acute coronary syndrome (ACS) patients (n=120049) (Figure 1A). The paradoxical decline in mortality at very high troponin levels may be driven in part by the changing case mix as troponin levels increase; a higher proportion of patients with very high troponin levels received invasive management (Figure 1B).
Conclusion
Routine EHR data can be aggregated across multiple sites to create highly granular datasets for research. The SENIOR-NSTEMI Study showed a survival advantage of invasive compared with non-invasive management of elderly patients with NSTEMI, who were underrepresented in previous trials. The inverted U-shaped relationship between troponin and mortality in ACS patients in the TROP-RISK Study demonstrates that assembling sufficiently large datasets can cast light on patterns of disease that are impossible to adequately define in single centre studies.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1) NIHR Imperial Biomedical Research Centre, as part of the NIHR Health Informatics Collaborative, and 2) British Heart Foundation
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Affiliation(s)
- A Kaura
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - J A C Sterne
- University of Bristol , Bristol , United Kingdom
| | - A Trickey
- University of Bristol , Bristol , United Kingdom
| | - A Mulla
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - B Glampson
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - J Davies
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - K Woods
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - V Panoulas
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - A D Shah
- University College London Hospitals , London , United Kingdom
| | - R S Patel
- University College London Hospitals , London , United Kingdom
| | - R Kharbanda
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - A M Shah
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Perera
- Guy's & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - K M Channon
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - J Mayet
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
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Kaura A, Goswami S, Mulla A, Glampson B, Davies J, Woods K, Shah AM, Kharbanda R, Patel RS, Perera D, Channon KM, Quint J, Mayet J. The association between age, troponin level, and mortality in patients hospitalised with acute pulmonary embolism (NIHR Health Informatics Collaborative TROP-PE study). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1873] [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
A positive cardiac troponin (cTn) is an independent predictor of short-term mortality in individuals presenting with acute pulmonary embolism (PE). However, there is limited evidence regarding the impact age has on the association between cTn levels and mortality in patients with PE.
Purpose
The aim of our study was to investigate the relationship between cTn level, age, and all-cause mortality, in hospitalised patients diagnosed with an acute PE.
Methods
A retrospective cohort study using the National Institute for Health Research Health Informatics Collaborative Cardiovascular dataset of all consecutive patients who had a troponin measured at five hospitals between 2010 and 2017. Patients admitted to hospital with a primary diagnosis of PE with at least one cTn measurement were included. We modelled the relation between peak troponin level and all-cause mortality using multivariable adjusted restricted cubic spline Cox regression analyses. Effect estimates were adjusted for age, gender, high-sensitivity troponin assay, C-reactive protein, haemoglobin, platelet count, white cell count, creatinine, sodium, potassium, diabetes, hypertension, hypercholesterolaemia, acute coronary syndrome, atrial fibrillation, heart failure, acute kidney injury, chronic kidney disease, obstructive lung disease, inflammatory disorders, pneumonia and malignancy. The peak cTn level (highest level measured), standardised to the upper limit of normal (ULN), was used for all analyses.
Results
1,477 patients with at least one cTn measurement and a diagnosis of acute PE were included. During a median follow-up of 34.8 months, there were 290 (19.6%) deaths. Elevated cTn (>1xULN) was associated with a hazard ratio (HR) of 3.29 (95% confidence interval [CI] 1.95–5.53) for 30-day mortality and 2.12 (95% CI 1.63–2.75) for 3-year mortality. Higher cTn levels were progressively associated with a higher mortality risk, reaching a maximum HR of 2.59 (95% CI 1.64–4.09) at 141xULN (Figure 1). Younger patients (<55 years), compared with those aged over 55, had the highest 3-year HR associated with a positive cTn of 2.94 (95% CI 1.48–5.82) despite having the lowest troponin levels (mean 7.01xULN) on admission (Figure 2).
Conclusion
Elevated cTn, at all ages, is associated with an increased mortality risk in patients presenting with PE, with increasing cTn levels conferring a progressively worse long-term prognosis. Elevated cTn, no matter how small, needs to be taken seriously, particularly in young patients with an acute PE.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1) NIHR Imperial Biomedical Research Centre, as part of the NIHR Health Informatics Collaborative, and 2) British Heart Foundation
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Affiliation(s)
- A Kaura
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - S Goswami
- Barts and The London School of Medicine and Dentistry , London , United Kingdom
| | - A Mulla
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - B Glampson
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - J Davies
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - K Woods
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - A M Shah
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - R Kharbanda
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - R S Patel
- University College London Hospitals , London , United Kingdom
| | - D Perera
- Guy's & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - K M Channon
- Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| | - J Quint
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
| | - J Mayet
- Imperial College Hospital NHS Healthcare Trust , London , United Kingdom
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Kutsaev S, Agustsson R, Arodzero A, Berry R, Bezhanov A, Boucher S, Chimalpopoca O, Diego A, Faillace L, Gavryushkin D, Harrison M, Hartzell J, McNevin J, Ruelas M, Yu. Smirnov A, Verma A, Woods K. Compact X-Band Electron Linac for Radiotherapy and Security Applications. Radiat Phys Chem Oxf Engl 1993 2021; 185:109494. [PMID: 33935382 PMCID: PMC8081273 DOI: 10.1016/j.radphyschem.2021.109494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
RadiaBeam has developed a 6 MeV accelerator that is compact and light enough to be placed on a robotic arm or light truck. The main drivers of size and weight in conventional accelerators are the power source and the shielding. Small dimensions are enabled by operation at 9.3 GHz frequency (X-band), which allows reducing the size and weight of all accelerator components. Thanks to the robust design of the accelerating structure, the accelerator can be used as a source for novel cargo inspection and radiotherapy techniques. In this paper, we present the linac design and its components, as well the results of the experimental demonstration of beam acceleration.
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Affiliation(s)
- S.V. Kutsaev
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - R. Agustsson
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - A. Arodzero
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - R. Berry
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - A. Bezhanov
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - S. Boucher
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - O. Chimalpopoca
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - A. Diego
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - L. Faillace
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - D. Gavryushkin
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - M. Harrison
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - J.J. Hartzell
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - J. McNevin
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - M. Ruelas
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - A. Yu. Smirnov
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - A. Verma
- RadiaBeam Technologies LLC, 1717 Stewart St, Santa Monica, CA 90404, U.S.A
| | - K. Woods
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, U.S.A
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Brown MC, White MH, Friedberg R, Woods K, Childress K, Kulkarni M, Sidonio RF. Elevated von Willebrand factor levels during heavy menstrual bleeding episodes limit the diagnostic utility for von Willebrand disease. Res Pract Thromb Haemost 2021; 5:e12513. [PMID: 33977212 PMCID: PMC8105159 DOI: 10.1002/rth2.12513] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/11/2021] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heavy menstrual bleeding (HMB) is often the first bleeding symptom for female individuals with inherited bleeding disorders. Guidelines recommend performing the hemostatic evaluation at HMB presentation. Von Willebrand factor (VWF) levels increase with stress, making it unclear if VWF studies during acute bleeding are beneficial in diagnosing von Willebrand disease (VWD). OBJECTIVES To determine the utility of testing for VWD during acute HMB. PATIENTS/METHODS This retrospective cohort study evaluated VWF levels of individuals presenting to the emergency department (ED) with HMB from January 1, 2017, to December 31, 2018, after prospective implementation of a clinical practice guideline recommending hemostatic evaluation in the ED. We compared VWF and factor VIII (FVIII) levels between acute presentation and follow-up visit after bleeding resolution. We compared the diagnostic accuracy of initial and follow-up labs. RESULTS During the study period, 221 individuals were seen in the ED for acute HMB, and 39 had VWD testing at both time points. Median FVIII and VWF levels were higher during acute bleeding than at follow-up. The difference in VWF levels between visits was negligible when initial FVIII value was normal. Overall incidence of VWD was 7.5%; 69% of those with VWD had low VWF levels during acute HMB. CONCLUSION VWD testing during acute HMB detects the majority of individuals with VWD but also leads to elevated levels of VWF, potentially limiting at the accuracy of diagnostic labs during acute bleeding episodes. Delayed testing until resolution of anemia and active bleeding may provide more accurate diagnostic evaluation for VWD.
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Affiliation(s)
- Megan C. Brown
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaEmory UniversityAtlantaGAUSA
| | - Michael H. White
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaEmory UniversityAtlantaGAUSA
| | | | - Kalinda Woods
- Department of Gynecology and ObstetricsEmory UniversityAtlantaGAUSA
| | - Krista Childress
- Division of Pediatric SurgeryChildren's Healthcare of AtlantaAtlantaGAUSA
- Division of Gynecologic SpecialtiesDepartment of Gynecology and ObstetricsEmory UniversityAtlantaGAUSA
| | | | - Robert F. Sidonio
- Aflac Cancer and Blood Disorders CenterChildren's Healthcare of AtlantaEmory UniversityAtlantaGAUSA
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9
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Cetnar A, Ayan A, Graeper G, Weldon M, Woods K, Martin D, Pardo DAD, Gupta N. Can Periodic Imaging During Treatment Delivery be Used for Accurately Monitoring Intrafraction Prostate Motion? Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Woods K, Dettwiler M, Inglebert M, Maurizio M, Olias P, Doench J, Rottenberg S. Functional Genetic Screens to Dissect the Essentialome of Disease. J Comp Pathol 2020. [DOI: 10.1016/j.jcpa.2019.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Kaura A, Sterne J, Mulla A, Panoulas V, Glampson B, Davies J, Woods K, Omigie J, Melikian N, Francis DP, Kharbanda R, Shah AM, Perera D, Patel RS, Mayet J. 6029Invasive versus medical management for non-ST elevation myocardial infarction in the elderly (SENIOR-NSTEMI study). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0113] [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
Trials and registry studies suggest lower long-term mortality after invasive than medical management among patients with non-ST elevated myocardial infarction (NSTEMI), but elderly patients were underrepresented.
Purpose
To estimate the effect of invasive compared with medical management on survival in patients with NSTEMI aged ≥80 years, using routine clinical data.
Methods
We used National Institute for Health Research Health Informatics Collaborative data to identify eligible patients admitted during 2010–2017 at five tertiary centres. We compared patients who did and did not have invasive management within 3 days of their peak troponin level. To limit the effect of immortal time bias, follow-up started 3 days after peak troponin: deaths within three days were excluded. We conducted intention-to-treat analyses.
Propensity scores were derived from a logistic regression model based on pre-treatment variables: patient demographics, blood test results, cardiovascular risk factors, history of cardiovascular disease and other comorbidities. We modelled non-linear relationships using splines. Patients with high probability (based on propensity score) of medical or invasive intervention were excluded. We used Cox models to estimate hazard ratios (HR) comparing invasive with medical management. Three methods were used to control confounding; multivariable-adjusted, multivariable-adjusted additionally for continuous propensity score (primary analysis), and inverse-probability-of-treatment (IPT) weighting. Kaplan-Meier survival curves were plotted. The robustness of the results to unmeasured confounding was assessed in sensitivity analyses.
Results
The 2,239 patients (61.3% medical management) included in analyses had a median age of 85 (IQR 82–89) years. During a median follow-up of 32.1 (IQR 11.1–54.3) months, there were 1,015 (45.3%) deaths. At 3-years, cumulative survival was 78.9% and 50.3% in the invasive and medical management groups, respectively (Figure 1).
The crude HR comparing invasive with medical management was 0.34 (95% CI 0.29–0.40). The multivariable-adjusted HR was 0.44 (95% CI 0.36–0.53), was unchanged with additional adjustment for propensity score, and was 0.46 (95% CI 0.39–0.56) in the IPT-weighted model (all p<0.0001). The E-value for the point estimate was 2.91: this implies that residual confounding could explain the association if there is an unmeasured covariate with a relative risk of at least 2.91 for both mortality and undergoing invasive management. The highest mortality HR for comorbidities included in our model were aortic stenosis 1.66 (95% CI 1.28–2.14) and obstructive lung disease 1.50 (95% CI 1.16–1.94).
Figure 1. Kaplan-Meier survival curves
Conclusion
This study provides evidence that the survival advantage from invasive management may extend to elderly patients with NSTEMI. Future research should address the possibility of unmeasured confounding, including by post-admission prognostic factors that affect choice of invasive or medical management.
Acknowledgement/Funding
Funded by NIHR Imperial Biomedical Research Centre (BRC) using NIHR Health Informatics Collaborative data service, supported by OUH, GSTT & UCLH BRCs
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Affiliation(s)
- A Kaura
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - J Sterne
- Bristol Heart Institute, NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - A Mulla
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - V Panoulas
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - B Glampson
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - J Davies
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - K Woods
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - J Omigie
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - N Melikian
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - D P Francis
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - R Kharbanda
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - A M Shah
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - D Perera
- St Thomas' Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - R S Patel
- University College London Hospitals NHS Foundation Trust, NIHR University College London Biomedical Research Centre, University College London, London, United Kingdom
| | - J Mayet
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
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Kaura A, Davies J, Panoulas V, Glampson B, Mulla A, Woods K, Omigie J, Shah AD, Melikian N, Francis DP, Kharbanda R, Perera D, Shah AM, Patel RS, Mayet J. P4345Supporting big data research in cardiovascular medicine using routinely-collected data. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0753] [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
Many of the data points required to support translational research are collected as a matter of routine, and should be available within electronic patient records. Variations in clinical and data recording practice can mean that the extraction and standardisation of this data, with the aim of producing a large-scale, research-ready dataset, presents a number of challenges.
Purpose
We set out to create a large-scale, research-ready dataset to support translational research in cardiovascular medicine, using routinely-collected data from five large university-hospital partnerships. As an initial focus, we selected those data points that would support an investigation of the relationship between test results and outcomes in acute coronary syndrome (ACS).
Methods
The National Institute of Health Research (NIHR) Health Informatics Collaborative (HIC) is a programme of infrastructure development aimed at increasing the quality and availability of routinely-collected data for collaborative, translational research. Eighteen university-hospital partnerships signed the data sharing agreement, and are working to facilitate the sharing and re-use of data across centres, for approved research purposes.
With support from the Directors of the NIHR Biomedical Research Centres (BRCs) within five of the largest partnerships, we established a clinical data collaboration, specifying a dataset and selecting an initial research question (Figure 1). The NIHR HIC team worked to extract data against this specification. With approval from an ethics committee, and from the information governance teams at each contributing centre, data was processed by one of the centres for standardisation and analysis.
Results
The specified dataset represented a longitudinal record for patients presenting with a suspected ACS, characterised by a request for a troponin test (Figure 1). The dataset included 156 data points, grouped into demographics, cardiovascular risk factor profile, emergency department attendance and inpatient episodes, blood tests, echocardiography and mortality. Data was extracted from the records of patients for whom a troponin test was requested between 2010 and 2017. A total of 257,948 records were standardised and analysed.
The collaboration has been successful, and an initial version of the combined dataset has been created. The size of the dataset has yielded new insights into the relationship between test results and outcomes, and publications are in preparation. An expanded dataset of over 800 data points has been agreed for the next phase of the collaboration, and three other centres have joined.
Figure 1. NIHR HIC dataset generation
Conclusion
It is perfectly feasible – in terms of governance and technology – to re-use routinely-collected data for collaborative, translational research in cardiovascular medicine. The resulting dataset will be large and complex enough to require big data tools and techniques, and will yield the kind of insights afforded only by big data in medicine.
Acknowledgement/Funding
Funded by NIHR Imperial Biomedical Research Centre (BRC) using NIHR Health Informatics Collaborative data service, supported by OUH, GSTT & UCLH BRCs
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Affiliation(s)
- A Kaura
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - J Davies
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - V Panoulas
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - B Glampson
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - A Mulla
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - K Woods
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - J Omigie
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - A D Shah
- University College London Hospitals NHS Foundation Trust, NIHR University College London Biomedical Research Centre, University College London, London, United Kingdom
| | - N Melikian
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - D P Francis
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - R Kharbanda
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - D Perera
- St Thomas' Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - A M Shah
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - R S Patel
- University College London Hospitals NHS Foundation Trust, NIHR University College London Biomedical Research Centre, University College London, London, United Kingdom
| | - J Mayet
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
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13
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Kaura A, Hartley A, Panoulas V, Glampson B, Davies J, Mulla A, Woods K, Francis DP, Koenig W, Shah AM, Kharbanda R, Perera D, Patel RS, Mayet J, Khamis R. 2231HsCRP predicts mortality beyond troponin in 102,337 patients with suspected acute coronary syndrome (CRP-RISK study). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0127] [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
The incremental long-term prognostic value of high-sensitivity C-reactive protein (hsCRP) above troponin in a large real-world cohort of unselected patients presenting with suspected acute coronary syndromes (ACS) is unknown.
Purpose
We hypothesised that a mildly elevated hsCRP is associated with mortality risk in patients with suspected ACS, independent of troponin level.
Methods
We used the National Institute for Health Research Health Informatics Collaborative data of 257,948 patients who had a troponin measured at 5 cardiac centres. We excluded patients with clinically abnormal white cell counts and hsCRP >15 mg/L to try limiting the population to those without overt infections, malignancies or systemic inflammatory conditions that may confound our analyses. Patients were divided into four hsCRP groups (<2, 2–4.9, 5–9.9 and 10–15 mg/L) and the association between hsCRP levels and all-cause mortality assessed.
Results
There were 102,337 patients included in the analysis (hsCRP <2 mg/L (n=38,390), 2–4.9 mg/L (n=27,397), 5–9.9 mg/L (n=26,957) and 10–15 mg/L (n=9,593)). Figure 1A displays cumulative mortality per hsCRP group, revealing increasing mortality with each consecutive group. Figure 1B further stratifies the groups according to dichotomised peak troponin level as positive or negative. This shows the greatest mortality for patients in the highest hsCRP group who also had a positive troponin assay (36.0% at 3 years).
In Cox regression analysis with time-dependent covariates, even mildly raised hsCRP was an independent predictor of mortality over time, after adjusting for age, gender, haemoglobin, white cell count, platelet count, creatinine and troponin positivity. There was a positive and graded relationship between hsCRP level and mortality at baseline, which remained at 3-years (hazard ratio (95% CI) of 1.32 (1.18–1.48) for those with hsCRP 2.0–4.9mg/L, and 1.40 (1.26–1.57), and 2.00 (1.75–2.28) for those with hsCRP 5–9.9 mg/L and 10–15 mg/L, respectively.
We explored whether inclusion of hsCRP could better reclassify the population into at-risk mortality groups. The association with 30-day, 1-year and 3-year mortality was assessed using three different risk models (model 1: age, gender, haemoglobin, creatinine; model 2: model 1 plus troponin (positivity versus negativity); model 3: model 2 plus hsCRP groups. For cumulative mortality at each time point, each successive model was better able to discriminate risk than its precursor (p<0.0001); such that inclusion of troponin and hsCRP gave the most robust risk discrimination. Model 3 achieved an AUROC >0.8 at 30 days, 1-year and 3-year mortality, surpassing the use of troponin on its own.
Figure 1. Kaplan-Meier mortality curves
Conclusions
These multi-centre, real-world data from a large cohort of patients with suspected ACS identify hsCRP as a clinically meaningful prognostic marker in addition to troponin levels and point to its potential utility in selecting patients for novel treatments targeting inflammation.
Acknowledgement/Funding
Funded by NIHR Imperial Biomedical Research Centre (BRC) using NIHR Health Informatics Collaborative data service, supported by OUH, GSTT & UCLH BRCs
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Affiliation(s)
- A Kaura
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - A Hartley
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - V Panoulas
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - B Glampson
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - J Davies
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - A Mulla
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - K Woods
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - D P Francis
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - W Koenig
- Deutsches Herzzentrum Technische Universitat, German Centre for Cardiovascular Research, Munich, Germany
| | - A M Shah
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - R Kharbanda
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - D Perera
- St Thomas' Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - R S Patel
- University College London Hospitals NHS Foundation Trust, NIHR University College London Biomedical Research Centre, University College London, London, United Kingdom
| | - J Mayet
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - R Khamis
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
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Kaura A, Panoulas V, Glampson B, Davies J, Mulla A, Woods K, Omigie J, Shah AD, Melikian N, Kharbanda R, Perera D, Shah AM, Patel RS, Francis DP, Mayet J. P3592Troponin level and mortality risk in an unselected population of over 250,000 patients (TROP-RISK study). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0452] [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
Current evidence suggests a direct relationship between the magnitude of troponin elevation and mortality, albeit over a limited range of troponin levels, and clinicians generally work under the impression that higher troponins signify higher mortality in all age groups.
Purpose
The objective was to use big data to determine the relationship between the full spectrum of troponin level and mortality in patients in whom troponin testing has been performed for clinical purposes.
Methods
As part of the National Institute for Health Research Health Informatics Collaborative project, all troponin values measured during the study period (2010 to 2017) were assembled from five cardiovascular centres. Troponin concentrations were standardised as a multiple of each laboratory's 99th-percentile of the upper limit of normal (ULN). All patients were followed up until death or censoring on 1st April 2017. To model the relation between peak troponin level and all-cause mortality we used restricted cubic spline Cox regression analysis. Splines were adjusted for patient age, gender, haemoglobin, creatinine, white cell count and C-reactive protein.
Results
257,948 patients underwent troponin assessment. During a median follow-up of 1,198 (IQR, 514–1,866) days, there were 55,850 (21.7%) deaths. Using multivariable-adjusted restricted cubic spline Cox regression analysis, an inverted-U shaped relationship was observed between peak troponin level and mortality in all patients (Figure 1A). Among patients who were admitted to hospital, the recorded diagnostic code was acute coronary syndrome (ACS) in 14,468 patients and non-ACS in 120,049 patients.
The revascularisation rate within 3 months was 61.0% (n=8,820) in ACS versus 4.0% (n=4,793) in non-ACS patients. There was a very different rate of revascularisation across the spectrum of troponin. The rate was only 1.4% for troponins below 1 xULN, and 6.1% between 1 and 10 xULN. Beyond 10 xULN, rate of revascularisation rose rapidly to over 85% for greater than 10,000 xULN (Figure 1B). Stratifying patients by revascularisation, the restricted cubic spline Cox regression curve showed a progressive increase in mortality within both the revascularised and non-revascularised strata, even to very high peak troponin levels (Figure 1C). Overall, revascularisation was associated with lower hazard ratios across all troponin levels. A similar pattern was seen when patients were stratified by the presence or absence of ACS diagnosis.
Figure 1. Troponin level and mortality
Conclusions
An elevated troponin, even slightly above the ULN should be taken seriously. The inverted-U shaped mortality relationship with troponin occurred because patients with the highest troponin formed a different clinical subgroup who underwent different clinical management with a high revascularisation rate. These data on troponin level and mortality may help to inform clinical practice decisions and guide future risk stratification algorithms for patients with elevated troponin.
Acknowledgement/Funding
Funded by NIHR Imperial Biomedical Research Centre (BRC) using NIHR Health Informatics Collaborative data service, supported by OUH, GSTT & UCLH BRCs
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Affiliation(s)
- A Kaura
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - V Panoulas
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - B Glampson
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - J Davies
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - A Mulla
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - K Woods
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - J Omigie
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - A D Shah
- University College London Hospitals NHS Foundation Trust, NIHR University College London Biomedical Research Centre, University College London, London, United Kingdom
| | - N Melikian
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - R Kharbanda
- Oxford University Hospitals NHS Trust, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - D Perera
- St Thomas' Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - A M Shah
- Kings College Hospital, NIHR King's Biomedical Research Centre, King's College London, London, United Kingdom
| | - R S Patel
- University College London Hospitals NHS Foundation Trust, NIHR University College London Biomedical Research Centre, University College London, London, United Kingdom
| | - D P Francis
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
| | - J Mayet
- Imperial College Healthcare NHS Trust, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
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Huddleston C, Martin L, Woods K, Dindo L. One-Day Behavioral Intervention for Distressed Veterans with Migraine: Results of a Multimethod Pilot Study. Mil Med 2019; 183:e184-e192. [PMID: 29420786 DOI: 10.1093/milmed/usx090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/08/2017] [Indexed: 01/09/2023] Open
Abstract
Introduction Migraine, a chronic neurological disorder characterized by episodic severe headache pain and functional impairment, affects approximately 12% of the general US population. Veterans returning from Iraq or Afghanistan have two to four times the incidence of migraine of the general population. Veterans with migraines are more than twice as likely to have comorbid psychiatric conditions as veterans without migraines, with depression and post-traumatic stress disorder being most prevalent. This psychiatric-migraine comorbidity is of major public health significance, as it leads to decreased quality of life, poorer response to migraine and mental health treatment, and overall worse prognosis. Unfortunately, acceptable and effective treatments for these comorbid problems have rarely been investigated. The aims of this study are to examine the acceptability, feasibility, and preliminary efficacy of a 1-d acceptance and commitment therapy (ACT) plus Migraine Education workshop. Method Twenty-five veterans with migraines and co-occurring depression and/or anxiety completed the 1-d ACT plus Migraine Education workshop. Veterans completed assessments of depressive and anxiety symptoms, general functioning, headache-related disability, and ACT-specific skills at baseline and 3 mo after the workshop. Changes from baseline to 3-mo follow-up on the self-report and clinician-rated measures were assessed using the paired t-test and Wilcoxon signed-rank test. Veterans also completed semistructured qualitative interviews documenting their experiences with the workshop 2 wk and 3 mo following the intervention. Qualitative data were analyzed via directed content analysis. Individual codes were aggregated into larger themes agreed upon by consensus. Results At 3-mo follow-up, veterans significantly improved in depressive and anxiety symptoms, general functioning, and headache-related disability compared with baseline. Additionally, veterans significantly improved in pain acceptance and engagement in valued life areas. In interviews, veterans indicated that the migraine education helped them feel more knowledgeable about their condition, and this empowered them to better manage their headaches, including talking to their physician about medication adjustments. The ACT component led to greater awareness of the role stress plays in exacerbating pain and ways to manage this stress, including greater acceptance and greater engagement in valued life activities. For some, however, the role of stress in exacerbating migraines needed to be highlighted more. Veterans appreciated being in a group with other veterans with similar health difficulties and wanted this to be incorporated into ongoing care at the Veterans Affairs medical center. The patient education manuals were useful to the veterans, with some referring to them during the months following the workshop. Conclusion Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. A 1-d ACT plus Migraine Education workshop is an acceptable and feasible treatment approach for veterans with migraines and significant distress. Significantly reduced distress and disability, as well as improved coping skills, suggest that veterans were activated to engage more fully in their lives and clinical care. The availability of an effective transdiagnostic intervention that can be completed in 1 d is particularly valuable for veterans who have multiple comorbid conditions and who encounter practical barriers to engaging in the usual prescribed weekly therapy treatments.
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Affiliation(s)
- C Huddleston
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX
| | - L Martin
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, One Baylor Plaza, Suite 011D, Houston, TX.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Blvd, Houston, TX
| | - K Woods
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Blvd, Houston, TX
| | - L Dindo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Blvd, Houston, TX
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Woodley-Hume TA, Woods K. Exploring the role of assistant educational psychologists within local authority educational psychology services in England. Educational Psychology in Practice 2019. [DOI: 10.1080/02667363.2018.1548345] [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. A. Woodley-Hume
- School of Environment, Education and development, University of Manchester, Manchester, UK
| | - K. Woods
- School of Environment, Education and development, University of Manchester, Manchester, UK
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Woods K, Nguyen D, Neph R, O'Connor D, Sheng K. A Sparse Orthogonal Collimator for Small Animal IMRT Using Rectangular Aperture Optimization. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Puryer J, Woods K, Terry J, Sandy J, Ireland AJ. The confidence of undergraduate dental students when carrying out prosthodontic treatment and their perception of the quality of prosthodontic education. Eur J Dent Educ 2018; 22:e142-e148. [PMID: 28493628 DOI: 10.1111/eje.12271] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Despite the falling number of edentulous patients within the UK, there is still a large demand for the provision of removable prostheses. On qualification, dentists should have the knowledge and skills to provide these prostheses, but previous studies have shown that final-year dental undergraduate confidence in treating denture patients is lacking. AIM To explore undergraduate dental student confidence whilst carrying out prosthodontic treatment, and to explore their perceptions of the quality of their prosthodontic education. METHOD An anonymous questionnaire was distributed to all (n=203) dental undergraduates in Years 3 to 5 at the University of Bristol. The questionnaire utilised a range of data collection methods including confidence interval ranked responses and qualitative measures. The data were analysed using SPSS. RESULTS The response rate was 51%. Undergraduate perception of confidence increased throughout the years of study (P<.001). There was also an increase in the number of partial and complete denture cases treated as students progressed through the course (P<.001). Overall, students were satisfied with their prosthodontic teaching, although students thought that too much time was allocated to laboratory teaching, and that increasing their clinical experience would be most beneficial in increasing their confidence levels. CONCLUSION Student confidence in carrying out prosthetic treatment increased as students progressed through the course, and confidence levels would be increased further with increased clinical experience.
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Affiliation(s)
- J Puryer
- School of Oral and Dental Sciences, Bristol Dental Hospital, Bristol, UK
| | - K Woods
- School of Oral and Dental Sciences, Bristol Dental Hospital, Bristol, UK
| | - J Terry
- School of Oral and Dental Sciences, Bristol Dental Hospital, Bristol, UK
| | - J Sandy
- School of Oral and Dental Sciences, Bristol Dental Hospital, Bristol, UK
| | - A J Ireland
- School of Oral and Dental Sciences, Bristol Dental Hospital, Bristol, UK
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Woods K, Nic-Fhogartaigh C, Arnold C, Boutthasavong L, Phuklia W, Lim C, Chanthongthip A, Tulsiani SM, Craig SB, Burns MA, Weier SL, Davong V, Sihalath S, Limmathurotsakul D, Dance DAB, Shetty N, Zambon M, Newton PN, Dittrich S. A comparison of two molecular methods for diagnosing leptospirosis from three different sample types in patients presenting with fever in Laos. Clin Microbiol Infect 2017; 24:1017.e1-1017.e7. [PMID: 29092789 PMCID: PMC6125144 DOI: 10.1016/j.cmi.2017.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To compare two molecular assays (rrs quantitative PCR (qPCR) versus a combined 16SrRNA and LipL32 qPCR) on different sample types for diagnosing leptospirosis in febrile patients presenting to Mahosot Hospital, Vientiane, Laos. METHODS Serum, buffy coat and urine samples were collected on admission, and follow-up serum ∼10 days later. Leptospira spp. culture and microscopic agglutination tests (MAT) were performed as reference standards. Bayesian latent class modelling was performed to estimate sensitivity and specificity of each diagnostic test. RESULTS In all, 787 patients were included in the analysis: 4/787 (0.5%) were Leptospira culture positive, 30/787 (3.8%) were MAT positive, 76/787 (9.7%) were rrs qPCR positive and 20/787 (2.5%) were 16SrRNA/LipL32 qPCR positive for pathogenic Leptospira spp. in at least one sample. Estimated sensitivity and specificity (with 95% CI) of 16SrRNA/LipL32 qPCR on serum (53.9% (33.3%-81.8%); 99.6% (99.2%-100%)), buffy coat (58.8% (34.4%-90.9%); 99.9% (99.6%-100%)) and urine samples (45.0% (27.0%-66.7%); 99.6% (99.3%-100%)) were comparable with those of rrs qPCR, except specificity of 16SrRNA/LipL32 qPCR on urine samples was significantly higher (99.6% (99.3%-100%) vs. 92.5% (92.3%-92.8%), p <0.001). Sensitivities of MAT (16% (95% CI 6.3%-29.4%)) and culture (25% (95% CI 13.3%-44.4%)) were low. Mean positive Cq values showed that buffy coat samples were more frequently inhibitory to qPCR than either serum or urine (p <0.001). CONCLUSIONS Serum and urine are better samples for qPCR than buffy coat, and 16SrRNA/LipL32 qPCR performs better than rrs qPCR on urine. Quantitative PCR on admission is a reliable rapid diagnostic tool, performing better than MAT or culture, with significant implications for clinical and epidemiological investigations of this global neglected disease.
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Affiliation(s)
- K Woods
- National Infection Service, Public Health England, London, UK; Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos.
| | - C Nic-Fhogartaigh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Bart's Health Division of Infection, Pathology and Pharmacy Department, Royal London Hospital, London, UK
| | - C Arnold
- National Infection Service, Public Health England, London, UK
| | - L Boutthasavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - W Phuklia
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - C Lim
- Mahidol-Oxford-Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - A Chanthongthip
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - S M Tulsiani
- Queensland Health Forensic and Scientific Service, WHO Collaborating Centre for Reference and Research on Leptospirosis, Brisbane, Qld, Australia
| | - S B Craig
- Queensland Health Forensic and Scientific Service, WHO Collaborating Centre for Reference and Research on Leptospirosis, Brisbane, Qld, Australia; University of the Sunshine Coast, Faculty of Science Health, Education and Engineering, Sippy Downs, Qld, Australia; Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
| | - M-A Burns
- Queensland Health Forensic and Scientific Service, WHO Collaborating Centre for Reference and Research on Leptospirosis, Brisbane, Qld, Australia
| | - S L Weier
- Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
| | - V Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - S Sihalath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - D Limmathurotsakul
- Mahidol-Oxford-Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
| | - D A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - N Shetty
- National Infection Service, Public Health England, London, UK
| | - M Zambon
- National Infection Service, Public Health England, London, UK
| | - P N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
| | - S Dittrich
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK; Foundation for Innovative New Diagnostics, Geneva, Switzerland
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Lickliter J, Gan H, Gao B, Grimison P, Zou J, Kallender H, Sun K, Chen X, Behren A, Fernandez-Penas P, Nagrial A, Voskoboynik M, Woods K, Millward M, Meniawy T. A first-in-human study of a novel monoclonal antibody INCSHR01210 directed against programmed cell death protein 1 (PD-1) in patients with advanced or metastatic cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yu V, Tran A, Nguyen D, Woods K, Kaprealian T, Chin R, Low D, Sheng K. Significant Cord and Esophagus Dose Reduction by 4π Non-Coplanar Spine Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hitchcock MJM, Woods K, De Boeck H, Ho HT. Biochemical Pharmacology of 2′-Fluoro-2′,3′-Dideoxyarabinosyladenine, an Inhibitor of HIV with Improved Metabolic and Chemical Stability over 2′,3′-Dideoxyadenosine. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/095632029000100507] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We have investigated some properties of the acid stable, 2′-arafluoro-substituted congeners of dideoxyadenosine (ddA) and dideoxyinosine (ddl) in order to understand their potential for in vivo utility as anti-HIV agents. Activities of 2′-fluoro-2′,3′-dideoxyarabinosyl-adenine (FddA) and hypoxanthine (Fddl) against human immunodeficiency virus (HIV) in cells are similar and are about an order of magnitude lower than those of ddA and ddl. FddA is a much poorer substrate than ddA for adenosine deaminase, and is deaminated about 50-fold slower at pharmacological concentrations. The product Fddl is (in contrast to ddl) resistant to cleavage by purine nucleoside phosphorylase. As for ddl, Fddl is phosphorylated by a 5′-nucleotidase, using inosine monophosphate (IMP) as the phosphate donor. In cells, both FddA and Fddl are phosphorylated to the triphosphate of FddA (FddATP). However, the concentration of FddATP produced from FddA is about two-to five-fold higher than from Fddl. FddATP is extremely stable in cells and persists with a half-life of 20 h after removal of FddA from the medium. Using HIV reverse transcriptase, FddATP is a less efficient inhibitor than ddATP by about 20-fold. Thus the activity of these compounds against HIV in cells correlates well with the intracellular concentration and potency of their triphosphates. If the efficacy of ddl in clinical trials is the result of its activity in certain cell types, the fluoro congeners could be active in similar cells since they use the same enzymes for activation to the active triphosphorylated forms. The reduction in potency may, to some extent, be offset by the greater stability to acid and enzyme degradation. Thus further evaluation of FddA and Fddl as anti-HIV agents is warranted.
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Affiliation(s)
- M. J. M. Hitchcock
- Pharmaceutical Research Institute, Bristol-Myers Squibb Company PO Box 5100, 5 Research Parkway, Wallingford, CT 06492-7660, USA
| | - K. Woods
- Pharmaceutical Research Institute, Bristol-Myers Squibb Company PO Box 5100, 5 Research Parkway, Wallingford, CT 06492-7660, USA
| | - H. De Boeck
- Pharmaceutical Research Institute, Bristol-Myers Squibb Company PO Box 5100, 5 Research Parkway, Wallingford, CT 06492-7660, USA
| | - H.-T. Ho
- Pharmaceutical Research Institute, Bristol-Myers Squibb Company PO Box 5100, 5 Research Parkway, Wallingford, CT 06492-7660, USA
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Zhang J, Nguyen D, Woods K, Tran A, Li X, Ding X, Kabolizadeh P, Guerrero T, Sheng K. SU-F-T-186: A Treatment Planning Study of Normal Tissue Sparing with Robustness Optimized IMPT, 4Pi IMRT, and VMAT for Head and Neck Cases. Med Phys 2016. [DOI: 10.1118/1.4956323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Woods K, Karunamuni R, Tran A, Yu V, Nguyen D, Hattangadi-Gluth J, Sheng K. TH-EF-BRB-01: BEST IN PHYSICS (THERAPY): Dosimetric Comparison of 4π and Clinical IMRT for Cortex-Sparing High-Grade Glioma Treatment. Med Phys 2016. [DOI: 10.1118/1.4958247] [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: 11/07/2022] Open
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Woods K, Ayan A, Woollard J, Gardner N, Gupta N. SU-F-J-53: A 3D Printed Phantom for the Use of Daily Quality Assurance Alignment Tests. Med Phys 2016. [DOI: 10.1118/1.4955961] [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: 11/07/2022] Open
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Woods K, Harrison M, Boucher S, McNevin J, Kutsaev S, Faillace L, Sheng K. TH-EF-BRB-07: Novel Hardware and Software Platform for Intermediate Energy 4π Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4958253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tran A, Ruan D, Woods K, Yu V, Nguyen D, Sheng K. SU-D-BRB-01: A Comparison of Learning Methods for Knowledge Based Dose Prediction for Coplanar and Non-Coplanar Liver Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4955627] [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: 11/07/2022] Open
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Woods K, DiCostanzo D, Gupta N. SU-F-J-74: High Z Geometric Integrity and Beam Hardening Artifact Assessment Using a Retrospective Metal Artifact Reduction (MAR) Reconstruction Algorithm. Med Phys 2016. [DOI: 10.1118/1.4955982] [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: 11/07/2022] Open
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Yu V, Tran A, Nguyen D, Woods K, Cao M, Kaprealian T, Chin R, Low D, Sheng K. TH-EF-BRB-03: Significant Cord and Esophagus Dose Reduction by 4π Non-Coplanar Spine Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery. Med Phys 2016. [DOI: 10.1118/1.4958249] [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: 11/07/2022] Open
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Tran A, Woods K, Nguyen D, Yu V, Cao M, Lee P, Kupelian P, Low D, Sheng K. Practical 4π Liver SBRT Using Eclipse Planning. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tran A, Woods K, Nguyen D, Yu V, Cao M, Lee P, Low D, Sheng K. Predicting Liver SBRT Eligibility and Plan Quality Using Geometrical Parameters. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.2053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tran A, Yu V, Nguyen D, Woods K, Low D, Sheng K. SU-F-BRB-10: A Statistical Voxel Based Normal Organ Dose Prediction Model for Coplanar and Non-Coplanar Prostate Radiotherapy. Med Phys 2015. [DOI: 10.1118/1.4925205] [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: 11/07/2022] Open
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Woods K, Woollard J, Ayan A, Sandu A, Sommerfeld J, Laurel A, Gupta N. SU-E-T-234: Daily Quality Assurance for a Six Degrees of Freedom Couch Using a Novel Phantom. Med Phys 2015. [DOI: 10.1118/1.4924595] [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: 11/07/2022] Open
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Tran A, Zhang J, Woods K, Yu V, Nguyen D, Sheng K. SU-E-T-765: Treatment Planning Comparison of SFUD Proton and 4Ï€ Radiotherapy for Prostate Cases. Med Phys 2015. [DOI: 10.1118/1.4925129] [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: 11/07/2022] Open
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Woods K, Nguyen D, Tran A, Yu V, Cao M, Sheng K. SU-F-BRB-04: Comparison of Coplanar VMAT, Non-Coplanar VMAT, and 4π Treatment Plans. Med Phys 2015. [DOI: 10.1118/1.4925199] [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: 11/07/2022] Open
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Woods K, Probst Y, McMahon A, Clancy A. Tools used to assess flavonoid intake of adults in food-based studies: A systematic literature review. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Clancy A, Probst Y, McMahon A, Woods K. Requirements of phytochemical food composition databases: Comparing current use in food industry and biomedical research. Journal of Nutrition & Intermediary Metabolism 2014. [DOI: 10.1016/j.jnim.2014.10.161] [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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Woods K, Rong Y, Weldon M, Gupta N. SU-E-CAMPUS-J-01: TG142 Complied Comprehensive Commissioning and Quality Assurance Procedure for Respiratory Gating. Med Phys 2014. [DOI: 10.1118/1.4889021] [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: 11/07/2022] Open
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Lu L, Noa K, Woods K, Weldon M, Gupta N. SU-E-J-274: Image Distortion Quantification and Image Registration QA in GammaKnife Radiosurgery Using A Modus GRID3D Phantom. Med Phys 2014. [DOI: 10.1118/1.4888328] [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: 11/07/2022] Open
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Sauk J, Coron E, Kava L, Suter M, Gora M, Gallagher K, Rosenberg M, Ananthakrishnan A, Nishioka N, Lauwers G, Woods K, Brugge W, Forcione D, Bouma BE, Tearney G. Interobserver agreement for the detection of Barrett's esophagus with optical frequency domain imaging. Dig Dis Sci 2013; 58:2261-5. [PMID: 23508980 PMCID: PMC3732518 DOI: 10.1007/s10620-013-2625-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/26/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Optical frequency domain imaging (OFDI) is a second-generation form of optical coherence tomography (OCT) providing comprehensive cross-sectional views of the distal esophagus at a resolution of ~7 μm. AIM Using validated OCT criteria for squamous mucosa, gastric cardia mucosa, and Barrett's esophagus (BE), the objective of this study was to determine the inter- and intra-observer agreements by a large number of OFDI readers for differentiating these tissues. METHODS OFDI images were obtained from nine subjects undergoing screening and surveillance for BE. Sixty-four OFDI image regions of interest were randomly selected for review. A training set of 19 images was compiled distinguishing squamous mucosa from gastric cardia and BE using previously validated OCT criteria. The ten readers then interpreted images in a test set of 45 different images of squamous mucosa (n = 15), gastric cardia (n = 15), or BE (n = 15). Interobserver agreement differentiating the three tissue types and BE versus non-BE mucosa was determined using multi-rater Fleiss's κ value. The images were later randomized again and four readers repeated the test 3 weeks later to assess intraobserver reliability. RESULTS All ten readers showed excellent agreement for the differentiation of BE versus non-BE mucosa (κ = 0.811 p < 0.0001) and for differentiating BE versus gastric cardia versus squamous mucosa (κ = 0.866, p < 0.0001). For the four readers who repeated the test, the median intraobserver agreement (BE vs. non-BE) was high (κ = 0.975, IQR: 0.94, 1.0). CONCLUSIONS Trained readers have a high interobserver agreement for differentiating BE, squamous, and gastric cardia mucosa using OFDI.
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Affiliation(s)
- J Sauk
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - E Coron
- Department of Gastroenterology and Hepatology; University Hospital; Nantes, France
| | - L Kava
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Suter
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Gora
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - K Gallagher
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - M Rosenberg
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - A Ananthakrishnan
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - N Nishioka
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - G Lauwers
- Department of Pathology, Massachusetts General Hospital; Boston, Massachusetts
| | - K Woods
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts,Digestive Diseases, Interventional Endoscopy, Emory University School of Medicine; Atlanta, Georgia
| | - W Brugge
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - D Forcione
- Gastroenterology Division, Massachusetts General Hospital; Boston, Massachusetts
| | - BE Bouma
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts
| | - G Tearney
- Wellman Center for Photomedicine; Harvard Medical School; Massachusetts General Hospital; Boston, Massachusetts,Department of Pathology, Massachusetts General Hospital; Boston, Massachusetts
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Issa N, Salud L, Woods K, Pugh C. Validity and Reliability of a Sensor Enabled Intubation Trainer. J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
There remains a significant paediatric workload through the military hospital in Camp Bastion. In this paper the authors review and discuss particular problems with resuscitation, investigation, anaesthetic and surgical issues in dealing with children suffering from ballistic injuries. Personal experience and recent papers are used for a qualitative analysis of difficult decisions in the management of paediatric ballistic trauma. Key questions are answered in separate paragraphs for each specialty. The information described in this paper should assist any deployed physician deal with paediatric casualties particularly if they are unaccustomed to paediatric patients in their normal practice.
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Woods K. 813 poster A RANDOMISED STUDY COMPARING TWO IMMOBILISATION DEVICES FOR PATIENTS RECEIVING RADIOTHERAPY FOR HEAD AND NECK CANCER (H & N) VIA CONE-BEAM CT. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70935-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Woods K, Apsley A, Semple S, Turner SW. P77 Children's exposure to airborne fine particulate matter at home and asthma outcomes. Thorax 2010. [DOI: 10.1136/thx.2010.150979.28] [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: 11/03/2022]
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Williams L, Tarling C, Woods K, Brastianos H, Li C, Zhang R, Andersen R, Withers S, Brayer G. Inhibition of human pancreatic alpha-amylase by montbretin A: a new drug for diabetes and obesity? Acta Crystallogr A 2008. [DOI: 10.1107/s0108767308088934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
The Pacific coastline of North America extends from Alaska in the north to Panama in the south. Chemical studies of skin extracts from nudibranchs collected along this coast have resulted in the isolation of over 100 chemically diverse secondary metabolites. The majority of the compounds are terpenoids, but polyketides, steroids, and alkaloids have also been found. Observations of geographic variation in metabolite content and stable isotope-feeding experiments have provided information about the de novo biosynthetic or dietary sequestration origins of the skin extract metabolites.
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Affiliation(s)
- R J Andersen
- Departments of Chemistry and Earth & Ocean Sciences, University of British Columbia V6T 1Z1 Vancouver, BC., Canada
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Liu L, Ergun G, Ertan A, Woods K, Sachs I, Younes M. Detection of oxidative DNA damage in oesophageal biopsies of patients with reflux symptoms and normal pH monitoring. Aliment Pharmacol Ther 2003; 18:693-8. [PMID: 14510742 DOI: 10.1046/j.1365-2036.2003.01734.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux has been shown to induce oxidative DNA damage. AIM To determine whether oxidative DNA damage, detected in oesophageal biopsies by simple immunohistochemical staining, correlates with gastro-oesophageal reflux disease as determined by pH monitoring. METHODS The study included 47 patients with reflux symptoms who had oesophageal biopsy and 24-h pH monitoring studies performed within 3 months of each other with no variation in treatment in the time between the two procedures. Sections of formalin-fixed and paraffin-embedded oesophageal biopsies were stained for 8-hydroxy-2'-deoxyguanosine using the standard immunoperoxidase method. Positive nuclear immunoreactivity was considered to indicate oxidative DNA damage. RESULTS Seven (33%) of the 21 cases with normal 24-h pH monitoring results were negative for oxidative DNA damage, compared with only two (8%) of the 26 cases with abnormal 24-h pH results (P=0.058, two-sided Fisher's exact test). Five of the patients with normal 24-h pH results had oesophageal biopsies performed within 24 h of the monitoring procedure and, of these, four (80%) were positive for oxidative DNA damage, including a case in which both biopsy and 24-h pH monitoring were performed on the same day whilst the patient was on proton pump inhibitor therapy. All cases with normal 24-h pH results and positive oxidative DNA damage showed features of reflux on routine morphological evaluation. CONCLUSIONS Oxidative DNA damage can occur in the absence of acid reflux and despite adequate antisecretory therapy. This may indicate that other agents, such as bile, can induce oxidative DNA damage in an acid-suppressed environment. The significant discordance between oxidative DNA damage and 24-h pH results makes the determination of oxidative DNA damage a poor surrogate marker for 24-h pH monitoring.
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Affiliation(s)
- L Liu
- Baylor College of Medicine and The Methodist Hospital, Houston, TX 77030, USA
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