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Phillips K, Sanders J, Warren LE. UK student midwives' theoretical knowledge, confidence, and experience of intermittent auscultation of the fetal heart rate during labour: An online cross-sectional survey. Midwifery 2024; 132:103952. [PMID: 38442530 DOI: 10.1016/j.midw.2024.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/21/2023] [Accepted: 02/10/2024] [Indexed: 03/07/2024]
Abstract
AIM This study aimed to explore student midwives' theoretical knowledge of intrapartum intermittent auscultation, their confidence in, and their experience of this mode of fetal monitoring. DESIGN AND SETTING An online cross-section survey with closed and open questions. Descriptive statistics were used to analyse participants' intermittent auscultation knowledge, confidence, and experience. Reflexive thematic analysis was used to identify patterns within the free text about participants' experiences. PARTICIPANTS Undergraduate midwifery students (n = 303) from Nursing and Midwifery Council-approved educational institutions within the United Kingdom. FINDINGS Most participants demonstrated good theoretical knowledge. They had witnessed the technique being used in clinical practice, and when performed, the practice was reported to be in line with national guidance. In closed questions, participants reported feeling confident in their intermittent auscultation skills; however, these data contrasted with free-text responses. CONCLUSION This cross-sectional survey found that student midwives possess adequate knowledge of intermittent auscultation. However, reflecting individual clinical experiences, their confidence in their ability to perform intermittent auscultation varied. A lack of opportunity to practice intermittent auscultation, organisational culture, and midwives' preferences have caused student midwives to question their capabilities with this essential clinical skill, leaving some with doubt about their competency close to registration.
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Affiliation(s)
- K Phillips
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom.
| | - J Sanders
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
| | - L E Warren
- School of Healthcare Sciences, Cardiff University, Room 0.43, Ground Floor, Ty'r Wyddfa, Heath Park West, St. Agnes Road, Cardiff CF14 4US, United Kingdom
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Phillips K, Nirantharakumar K, Wakerley BR, Crowe FL. Trends in the prevalence and pharmacological management of migraine during pregnancy in the UK, 2000-2018. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333530. [PMID: 38569874 DOI: 10.1136/jnnp-2024-333530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Migraine is common in women of reproductive age. This study aimed to (1) describe the prevalence of migraine in pregnant women in the UK, (2) identify drugs commonly prescribed for migraine during pregnancy and (3) identify characteristics associated with being prescribed medication for migraine during pregnancy. METHODS The Clinical Practice Research Datalink pregnancy register, a database of pregnancy episodes identified in anonymised primary care health records, was used.Crude and age-standardised prevalence of migraine during pregnancy and the proportion of women with migraine prescribed drugs used for migraine management were calculated for each year between 2000 and 2018.Logistic regression was used to describe the relationship between patient characteristics and being prescribed migraine medication during pregnancy. RESULTS 1 377 053 pregnancies were included, of which 187 328 were in women with a history of migraine. The age-adjusted prevalence increased from 11.4% in 2000 to 17.2% in 2018. There was an increase in the rates of prescription for numerous medications for the management of migraine.Older women (adjusted OR (aOR) 1.41 (1.20 to 1.66)), women of black (aOR 1.40 (1.32 to 1.48)) and South Asian ethnicity (aOR 1.48 (1.38 to 1.59)), those living in the most deprived areas (aOR 1.60 (1.54 to 1.66)), women who were obese (aOR 1.39 (1.35 to 1.43)), smokers (aOR 1.15 (1.12 to 1.18)) and those with comorbid conditions were more likely to receive a prescription during pregnancy. CONCLUSIONS Rates of recorded migraine have increased over the past two decades as well as rates of prescribing in women with migraine. Higher prescribing rates are seen in certain groups, which has the potential to exacerbate health inequalities.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Benjamin R Wakerley
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Haggerty K, Cantlay S, Young E, Cashbaugh MK, Delatore Iii EF, Schreiber R, Hess H, Komlosi DR, Butler S, Bolon D, Evangelista T, Hager T, Kelly C, Phillips K, Voellinger J, Shanks RMQ, Horzempa J. Identification of an N-terminal tag (580N) that improves the biosynthesis of fluorescent proteins in Francisella tularensis and other Gram-negative bacteria. Mol Cell Probes 2024; 74:101956. [PMID: 38492609 PMCID: PMC11000650 DOI: 10.1016/j.mcp.2024.101956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Utilization of fluorescent proteins is widespread for the study of microbial pathogenesis and host-pathogen interactions. Here, we discovered that linkage of the 36 N-terminal amino acids of FTL_0580 (a hypothetical protein of Francisella tularensis) to fluorescent proteins increases the fluorescence emission of bacteria that express these recombinant fusions. This N-terminal peptide will be referred to as 580N. Western blotting revealed that the linkage of 580N to Emerald Green Fluorescent Protein (EmGFP) in F. tularensis markedly improved detection of this protein. We therefore hypothesized that transcripts containing 580N may be translated more efficiently than those lacking the coding sequence for this leader peptide. In support, expression of emGFPFt that had been codon-optimized for F. tularensis, yielded significantly enhanced fluorescence than its non-optimized counterpart. Furthermore, fusing emGFP with coding sequence for a small N-terminal peptide (Serine-Lysine-Isoleucine-Lysine), which had previously been shown to inhibit ribosomal stalling, produced robust fluorescence when expressed in F. tularensis. These findings support the interpretation that 580N enhances the translation efficiency of fluorescent proteins in F. tularensis. Interestingly, expression of non-optimized 580N-emGFP produced greater fluorescence intensity than any other construct. Structural predictions suggested that RNA secondary structure also may be influencing translation efficiency. When expressed in Escherichia coli and Klebsiella pneumoniae bacteria, 580N-emGFP produced increased green fluorescence compared to untagged emGFP (neither allele was codon optimized for these bacteria). In conclusion, fusing the coding sequence for the 580N leader peptide to recombinant genes might serve as an economical alternative to codon optimization for enhancing protein expression in bacteria.
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Affiliation(s)
- Kristen Haggerty
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Stuart Cantlay
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Emily Young
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Mariah K Cashbaugh
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Elio F Delatore Iii
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Rori Schreiber
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Hayden Hess
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Daniel R Komlosi
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah Butler
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Dalton Bolon
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Theresa Evangelista
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Takoda Hager
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Claire Kelly
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Katherine Phillips
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Jada Voellinger
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA
| | - Robert M Q Shanks
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph Horzempa
- Department of Biomedical Sciences, West Liberty University, West Liberty, WV, USA.
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Phillips K, Clerkin-Oliver C, Nirantharakumar K, Crowe FL, Wakerley BR. How migraine and its associated treatment impact on pregnancy outcomes: Umbrella review with updated systematic review and meta-analysis. Cephalalgia 2024; 44:3331024241229410. [PMID: 38317644 DOI: 10.1177/03331024241229410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Migraine is common in reproductive aged women. Understanding the impact of migraine and associated treatments on pregnancy outcomes remains very important. An umbrella review of systematic reviews, with or without meta-analyses, examined the link between migraine and pregnancy outcomes. METHODS We systematically searched Medline, Embase and Cochrane to 27 October 2022. Quality appraisal was carried out using the AMSTAR2 tool. An established framework was used to determine whether included reviews were eligible for update. RESULTS Four studies met review criteria. Migraine was reported to be associated with increased odds ratio (OR) of pre-eclampsia, low birth weight and peripartum mental illness (pooled OR = 3.54 (2.24-5.59)). Triptan-exposed women had increased odds of miscarriage compared to women without migraine (pooled OR = 3.54 (2.24-5.59)). In updated meta-analyses, migraine was associated with an increased odds of pre-eclampsia and preterm birth (pooled OR = 2.05 (1.47-2.84) and 1.26 (1.21-1.32) respectively). CONCLUSIONS Migraine is associated with increased odds of pre-eclampsia, peripartum mental illness and preterm birth. Further investigation of the relationship between migraine and placental abruption, low birth weight and small for gestational age is warranted, as well as the relationship between migraine, triptans and miscarriage risk.Systematic Review Registration: Prospero CRD42022357630.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Benjamin R Wakerley
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- University Hospital Birmingham, Birmingham, UK
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Phillips K, Hazlehurst JM, Sheppard C, Bellary S, Hanif W, Karamat MA, Crowe FL, Stone A, Thomas GN, Peracha J, Fenton A, Sainsbury C, Nirantharakumar K, Dasgupta I. Inequalities in the management of diabetic kidney disease in UK primary care: A cross-sectional analysis of a large primary care database. Diabet Med 2024; 41:e15153. [PMID: 37223892 DOI: 10.1111/dme.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/25/2023]
Abstract
AIMS To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. METHODS A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation. RESULTS Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin-angiotensin-aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98-0.99), ACR: aRR 0.94 (0.92-0.96), BP: aRR 0.98 (0.97-0.99), HbA1c : aRR 0.99 (0.98-0.99) and serum cholesterol: aRR 0.97 (0.96-0.98) measured; achieve BP: aRR 0.95 (0.94-0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84-0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90-0.94) or statins: aRR 0.94 (0.92-0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96-0.99); achieve BP: aRR 0.91 (0.8-0.95) or HbA1c : aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87-0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97). CONCLUSIONS There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jonathan M Hazlehurst
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Srikanth Bellary
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Health and Life Sciences, Aston University, Birmingham, UK
| | - Wasim Hanif
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muhammad Ali Karamat
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Stone
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - G Neil Thomas
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Javeria Peracha
- Renal Unit, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Anthony Fenton
- Department of Renal Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Christopher Sainsbury
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Diabetes, Gartnavel General Hospital, Glasgow, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Vazquez MG, Joo JH, Grieb SMD, Maksym M, Phillips K, Platt R, Singh R, Suarez C, Torres V, Yeom S, Polk S. Community Health Workers Deliver Mental Health Intervention to Uninsured Latinx in Baltimore: Evaluation and Lessons Learned in a Pilot Program. Prog Community Health Partnersh 2024; 18:103-112. [PMID: 38661831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Implementation of evidence-based interventions to reduce depression among uninsured Latinx patients who are at high risk of depression are rare. OBJECTIVES Our goal was to evaluate Strong Minds, a language and culturally tailored, evidence-based intervention adapted from cognitive behavioral therapy (CBT) for mild-moderate depression and anxiety, delivered by community health workers (CHWs) in Spanish to uninsured Latinx immigrants. METHODS As part of the pilot, 35 participants, recruited from a free community primary care clinic, completed Strong Minds. Assessments and poststudy interviews were conducted. Paired t-tests were used to assess change of depressive symptoms at 3 and 6 months. LESSONS LEARNED CHW delivery of depression care to this population was feasible and among those who completed the program, preliminary evidence of depression outcomes suggests potential benefit. CHWs had specific training and support needs related to mental health care delivery. CONCLUSIONS Further implementation studies of depression care interventions using CHWs for underserved Latinx is needed.
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Welti R, Chinotti M, Walsh O, Arcus M, Asgari J, Phillips K, Wallace J, Do L, Moynihan P, Silva M. Oral health messages for Australia: A national consensus statement. Aust Dent J 2023; 68:247-254. [PMID: 37665214 DOI: 10.1111/adj.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Oral health promotion initiatives must be evidence-based and consistent with broader health messaging. The Oral Health Messages for the Australian Public were first produced in 2009 and sought to enable a focused, and strategic approach to oral health promotion in Australia. As the evidence base and needs of the Australian population have since changed, this consensus statement was updated in 2022-2023. METHODS The process of updating the messages consisted of 3 phases (preparatory phase, the Delphi technique, final revision phase). The preparatory phase included public and expert consultation, an umbrella review of published scientific literature and review of available recommendations, policies and guidelines. The Delphi technique used in this study was guided by Guidance on Conducting and REporting DElphi Studies (CREDES) and included 2 voting rounds. There were 70 experts in round 1 and 60 experts in round 2. Delphi participants comprised of experts from a variety of fields to ensure diversity and inclusion, balance expertise and maximize stakeholder representation. Consensus was defined as 75% agreement. RESULTS A total of 11 messages were included in the 2022 update of Oral Health Messages for Australia. CONCLUSION The updated oral health messages will support oral health promotion policy and activity at both individual and population level to improve the oral health of Australians.
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Affiliation(s)
- R Welti
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - M Chinotti
- Australian Dental Association, St Leonards, New South Wales, Australia
| | - O Walsh
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - M Arcus
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - J Asgari
- Consumer Health Forum, Deakin, Australian Capital Territory, Australia
| | - K Phillips
- Queensland Health, Brisbane, Queensland, Australia
| | - J Wallace
- University of Newcastle, Newcastle, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - L Do
- University of Queensland, St Lucia, Queensland, Australia
| | - P Moynihan
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - M Silva
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Welti R, Chinotti M, Walsh O, Arcus M, Asgari J, Phillips K, Wallace J, Do L, Moynihan P, Silva M. Oral health messages for Australia: a national consensus statement. Aust Dent J 2023; 68:303-304. [PMID: 38009270 DOI: 10.1111/adj.13003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Affiliation(s)
- R Welti
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - M Chinotti
- Australian Dental Association, St Leonards, Sydney, Australia
| | - O Walsh
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - M Arcus
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - J Asgari
- Consumer Health Forum, Deakin, Australian Capital Territory, Australia
| | - K Phillips
- Queensland Health, Brisbane, Queensland, Australia
| | - J Wallace
- University of Newcastle, Callaghan, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - L Do
- University of Queensland, Saint Lucia, Queensland, Australia
| | - P Moynihan
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - M Silva
- Melbourne Dental School, The University of Melbourne, Melbourne, Victoria, Australia
- Inflammatory Origins, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Subramanian A, Lee SI, Hemali Sudasinghe SPB, Wambua S, Phillips K, Singh M, Azcoaga-Lorenzo A, Cockburn N, Wang J, Fagbamigbe A, Usman M, Damase-Michel C, Yau C, Kent L, McCowan C, OReilly D, Santorelli G, Hope H, Kennedy J, Mhereeg M, Abel KM, Eastwood KA, Black M, Loane M, Moss N, Brophy S, Brocklehurst P, Dolk H, Nelson-Piercy C, Nirantharakumar K. Detection and evaluation of signals associated with exposure to individual and combination of medications in pregnancy: a signal detection study protocol. BMJ Open 2023; 13:e073162. [PMID: 37813531 PMCID: PMC10565241 DOI: 10.1136/bmjopen-2023-073162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Considering the high prevalence of polypharmacy in pregnant women and the knowledge gap in the risk-benefit safety profile of their often-complex treatment plan, more research is needed to optimise prescribing. In this study, we aim to detect adverse and protective effect signals of exposure to individual and pairwise combinations of medications during pregnancy. METHODS AND ANALYSIS Using a range of real-world data sources from the UK, we aim to conduct a pharmacovigilance study to assess the safety of medications prescribed during the preconception period (3 months prior to conception) and first trimester of pregnancy. Women aged between 15 and 49 years with a record of pregnancy within the Clinical Practice Research Datalink (CPRD) Pregnancy Register, the Welsh Secure Anonymised Information Linkage (SAIL), the Scottish Morbidity Record (SMR) data sets and the Northern Ireland Maternity System (NIMATS) will be included. A series of case control studies will be conducted to estimate measures of disproportionality, detecting signals of association between a range of pregnancy outcomes and exposure to individual and combinations of medications. A multidisciplinary expert team will be invited to a signal detection workshop. By employing a structured framework, signals will be transparently assessed by each member of the team using a questionnaire appraising the signals on aspects of temporality, selection, time and measurement-related biases and confounding by underlying disease or comedications. Through group discussion, the expert team will reach consensus on each of the medication exposure-outcome signal, thereby excluding spurious signals, leaving signals suggestive of causal associations for further evaluation. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Independent Scientific Advisory Committee, SAIL Information Governance Review Panel, University of St. Andrews Teaching and Research Ethics Committee and Office for Research Ethics Committees Northern Ireland (ORECNI) for access and use of CPRD, SAIL, SMR and NIMATS data, respectively.
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Affiliation(s)
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, Fife, UK
- Hospital Rey Juan Carlos. Research Network on Chronicity, Primary Care and Health Promotion-RICAPPS (RICORS), Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adeniyi Fagbamigbe
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, Fife, UK
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Muhammad Usman
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, Fife, UK
| | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- Center for Epidemiology and Research in Population Health (CERPOP), INSERM, Toulouse, France
| | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Lisa Kent
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, Fife, UK
| | - Dermot OReilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
| | | | | | - Kathryn Mary Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, University of Manchester, Manchester, UK
- Manchester Mental Health & Social Care Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- The Institute of Nursing and Health Research, University of Ulster, Belfast, UK
| | | | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen Dolk
- The Institute of Nursing and Health Research, University of Ulster, Belfast, UK
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Lee SI, Hanley S, Vowles Z, Plachcinski R, Moss N, Singh M, Gale C, Fagbamigbe AF, Azcoaga-Lorenzo A, Subramanian A, Taylor B, Nelson-Piercy C, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Dolk H, Hope H, Phillips K, Abel KM, Eastwood KA, Kent L, Locock L, Loane M, Mhereeg M, Brocklehurst P, McCann S, Brophy S, Wambua S, Hemali Sudasinghe SPB, Thangaratinam S, Nirantharakumar K, Black M. The development of a core outcome set for studies of pregnant women with multimorbidity. BMC Med 2023; 21:314. [PMID: 37605204 PMCID: PMC10441728 DOI: 10.1186/s12916-023-03013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Heterogeneity in reported outcomes can limit the synthesis of research evidence. A core outcome set informs what outcomes are important and should be measured as a minimum in all future studies. We report the development of a core outcome set applicable to observational and interventional studies of pregnant women with multimorbidity. METHODS We developed the core outcome set in four stages: (i) a systematic literature search, (ii) three focus groups with UK stakeholders, (iii) two rounds of Delphi surveys with international stakeholders and (iv) two international virtual consensus meetings. Stakeholders included women with multimorbidity and experience of pregnancy in the last 5 years, or are planning a pregnancy, their partners, health or social care professionals and researchers. Study adverts were shared through stakeholder charities and organisations. RESULTS Twenty-six studies were included in the systematic literature search (2017 to 2021) reporting 185 outcomes. Thematic analysis of the focus groups added a further 28 outcomes. Two hundred and nine stakeholders completed the first Delphi survey. One hundred and sixteen stakeholders completed the second Delphi survey where 45 outcomes reached Consensus In (≥70% of all participants rating an outcome as Critically Important). Thirteen stakeholders reviewed 15 Borderline outcomes in the first consensus meeting and included seven additional outcomes. Seventeen stakeholders reviewed these 52 outcomes in a second consensus meeting, the threshold was ≥80% of all participants voting for inclusion. The final core outcome set included 11 outcomes. The five maternal outcomes were as follows: maternal death, severe maternal morbidity, change in existing long-term conditions (physical and mental), quality and experience of care and development of new mental health conditions. The six child outcomes were as follows: survival of baby, gestational age at birth, neurodevelopmental conditions/impairment, quality of life, birth weight and separation of baby from mother for health care needs. CONCLUSIONS Multimorbidity in pregnancy is a new and complex clinical research area. Following a rigorous process, this complexity was meaningfully reduced to a core outcome set that balances the views of a diverse stakeholder group.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Stephanie Hanley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Ngawai Moss
- Patient and public representative, London, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Hospital Rey Juan Carlos, Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain
| | | | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- Center for Epidemiology and Research in Population Health (CERPOP), INSERM, Toulouse, France
| | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Health Data Research UK, London, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Ulster University, Belfast, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lisa Kent
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Louise Locock
- Health Services Research Unit, Health Sciences Building, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- The Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Mohamed Mhereeg
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sharon McCann
- Health Services Research Unit, Health Sciences Building, Foresterhill, University of Aberdeen, Aberdeen, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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Deal B, Phillips K, Crelli C, Janjic JM, Pollock JA. RNA-Seq Reveals Sex Differences in Gene Expression during Peripheral Neuropathic Inflammation and in Pain Relief from a COX-2 Inhibiting Theranostic Nanoemulsion. Int J Mol Sci 2023; 24:ijms24119163. [PMID: 37298117 DOI: 10.3390/ijms24119163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/12/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Given decades of neuroinflammatory pain research focused only on males, there is an urgent need to better understand neuroinflammatory pain in females. This, paired with the fact that currently there is no long-term effective treatment for neuropathic pain furthers the need to evaluate how neuropathic pain develops in both sexes and how it can be relieved. Here we show that chronic constriction injury of the sciatic nerve caused comparable levels of mechanical allodynia in both sexes. Using a COX-2 inhibiting theranostic nanoemulsion with increased drug loading, both sexes achieved similar reduction in mechanical hypersensitivity. Given that both sexes have improved pain behavior, we specifically explored differential gene expression between sexes in the dorsal root ganglia (DRG) during pain and relief. Total RNA from the DRG revealed a sexually dimorphic expression for injury and relief caused by COX-2 inhibition. Of note, both males and females experience increased expression of activating transcription factor 3 (Atf3), however, only the female DRG shows decreased expression following drug treatment. Alternatively, S100A8 and S100A9 expression appear to play a sex specific role in relief in males. The sex differences in RNA expression reveal that comparable behavior does not necessitate the same gene expression.
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Affiliation(s)
- Brooke Deal
- Department of Biological Sciences, School of Science & Engineering, Duquesne University, Pittsburgh, PA 15282, USA
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, PA 15282, USA
| | - Katherine Phillips
- Department of Biological Sciences, School of Science & Engineering, Duquesne University, Pittsburgh, PA 15282, USA
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, PA 15282, USA
| | - Caitlin Crelli
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, PA 15282, USA
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA 15282, USA
| | - Jelena M Janjic
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, PA 15282, USA
- Graduate School of Pharmaceutical Sciences, Duquesne University, Pittsburgh, PA 15282, USA
| | - John A Pollock
- Department of Biological Sciences, School of Science & Engineering, Duquesne University, Pittsburgh, PA 15282, USA
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, PA 15282, USA
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12
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Anand A, Phillips K, Subramanian A, Lee SI, Wang Z, McCowan R, Agrawal U, Fagbamigbe AF, Nelson-Piercy C, Brocklehurst P, Damase-Michel C, Loane M, Nirantharakumar K, Azcoaga-Lorenzo A. Prevalence of polypharmacy in pregnancy: a systematic review. BMJ Open 2023; 13:e067585. [PMID: 36878655 PMCID: PMC9990613 DOI: 10.1136/bmjopen-2022-067585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/22/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVES The use of medications among pregnant women has been rising over the past few decades but the reporting of polypharmacy has been sporadic. The objective of this review is to identify literature reporting the prevalence of polypharmacy among pregnant women, the prevalence of multimorbidity in women taking multiple medications in pregnancy and associated effects on maternal and offspring outcomes. DESIGN MEDLINE and Embase were searched from their inception to 14 September 2021 for interventional trials, observational studies and systematic reviews reporting on the prevalence of polypharmacy or the use of multiple medications in pregnancy were included.Data on prevalence of polypharmacy, prevalence of multimorbidity, combinations of medications and pregnancy and offspring outcomes were extracted. A descriptive analysis was performed. RESULTS Fourteen studies met the review criteria. The prevalence of women being prescribed two or more medications during pregnancy ranged from 4.9% (4.3%-5.5%) to 62.4% (61.3%-63.5%), with a median of 22.5%. For the first trimester, prevalence ranged from 4.9% (4.7%-5.14%) to 33.7% (32.2%-35.1%). No study reported on the prevalence of multimorbidity, or associated pregnancy outcomes in women exposed to polypharmacy. CONCLUSION There is a significant burden of polypharmacy among pregnant women. There is a need for evidence on the combinations of medications prescribed in pregnancy, how this specifically affects women with multiple long-term conditions and the associated benefits and harms. TWEETABLE ABSTRACT Our systematic review shows significant burden of polypharmacy in pregnancy but outcomes for women and offspring are unknown. PROSPERO REGISTRATION NUMBER CRD42021223966.
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Affiliation(s)
- Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zhaonan Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, UK
| | - Adeniyi Frances Fagbamigbe
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, UK
- Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Maria Loane
- Institute of Nursing and Health Research, University of Ulster, Belfast, UK
| | | | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, University of Saint Andrews School of Medicine, St. Andrews, UK
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13
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Lee SI, Hope H, O'Reilly D, Kent L, Santorelli G, Subramanian A, Moss N, Azcoaga-Lorenzo A, Fagbamigbe AF, Nelson-Piercy C, Yau C, McCowan C, Kennedy JI, Phillips K, Singh M, Mhereeg M, Cockburn N, Brocklehurst P, Plachcinski R, Riley RD, Thangaratinam S, Brophy S, Hemali Sudasinghe SPB, Agrawal U, Vowles Z, Abel KM, Nirantharakumar K, Black M, Eastwood KA. Maternal and child outcomes for pregnant women with pre-existing multiple long-term conditions: protocol for an observational study in the UK. BMJ Open 2023; 13:e068718. [PMID: 36828655 PMCID: PMC9972454 DOI: 10.1136/bmjopen-2022-068718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION One in five pregnant women has multiple pre-existing long-term conditions in the UK. Studies have shown that maternal multiple long-term conditions are associated with adverse outcomes. This observational study aims to compare maternal and child outcomes for pregnant women with multiple long-term conditions to those without multiple long-term conditions (0 or 1 long-term conditions). METHODS AND ANALYSIS Pregnant women aged 15-49 years old with a conception date between 2000 and 2019 in the UK will be included with follow-up till 2019. The data source will be routine health records from all four UK nations (Clinical Practice Research Datalink (England), Secure Anonymised Information Linkage (Wales), Scotland routine health records and Northern Ireland Maternity System) and the Born in Bradford birth cohort. The exposure of two or more pre-existing, long-term physical or mental health conditions will be defined from a list of health conditions predetermined by women and clinicians. The association of maternal multiple long-term conditions with (a) antenatal, (b) peripartum, (c) postnatal and long-term and (d) mental health outcomes, for both women and their children will be examined. Outcomes of interest will be guided by a core outcome set. Comparisons will be made between pregnant women with and without multiple long-term conditions using modified Poisson and Cox regression. Generalised estimating equation will account for the clustering effect of women who had more than one pregnancy episode. Where appropriate, multiple imputation with chained equation will be used for missing data. Federated analysis will be conducted for each dataset and results will be pooled using random-effects meta-analyses. ETHICS AND DISSEMINATION Approval has been obtained from the respective data sources in each UK nation. Study findings will be submitted for publications in peer-reviewed journals and presented at key conferences.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Lisa Kent
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | | | - Ngawai Moss
- Patient and Public Representative, London, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, University of St Andrews School of Medicine, St Andrews, UK
- Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Hospital Rey Juan Carlos, Mostoles, Spain
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, University of St Andrews School of Medicine, St Andrews, UK
- Department of Epidemiology and Medical Statistics, University of Ibadan College of Medicine, Ibadan, Nigeria
| | | | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Health Data Research UK, London, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, University of St Andrews School of Medicine, St Andrews, UK
| | | | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mohamed Mhereeg
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Richard D Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | | | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, University of St Andrews School of Medicine, St Andrews, UK
| | - Zoe Vowles
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kathryn Mary Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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14
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Subramanian A, Azcoaga-Lorenzo A, Anand A, Phillips K, Lee SI, Cockburn N, Fagbamigbe AF, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Hope H, Kennedy JI, Abel KM, Eastwood KA, Locock L, Black M, Loane M, Moss N, Plachcinski R, Thangaratinam S, Brophy S, Agrawal U, Vowles Z, Brocklehurst P, Dolk H, Nelson-Piercy C, Nirantharakumar K. Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019. BMC Med 2023; 21:21. [PMID: 36647047 PMCID: PMC9843951 DOI: 10.1186/s12916-022-02722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The number of medications prescribed during pregnancy has increased over the past few decades. Few studies have described the prevalence of multiple medication use among pregnant women. This study aims to describe the overall prevalence over the last two decades among all pregnant women and those with multimorbidity and to identify risk factors for polypharmacy in pregnancy. METHODS A retrospective cohort study was conducted between 2000 and 2019 using the Clinical Practice Research Datalink (CPRD) pregnancy register. Prescription records for 577 medication categories were obtained. Prevalence estimates for polypharmacy (ranging from 2+ to 11+ medications) were presented along with the medications commonly prescribed individually and in pairs during the first trimester and the entire pregnancy period. Logistic regression models were performed to identify risk factors for polypharmacy. RESULTS During the first trimester (812,354 pregnancies), the prevalence of polypharmacy ranged from 24.6% (2+ medications) to 0.1% (11+ medications). During the entire pregnancy period (774,247 pregnancies), the prevalence ranged from 58.7 to 1.4%. Broad-spectrum penicillin (6.6%), compound analgesics (4.5%) and treatment of candidiasis (4.3%) were commonly prescribed. Pairs of medication prescribed to manage different long-term conditions commonly included selective beta 2 agonists or selective serotonin re-uptake inhibitors (SSRIs). Risk factors for being prescribed 2+ medications during the first trimester of pregnancy include being overweight or obese [aOR: 1.16 (1.14-1.18) and 1.55 (1.53-1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33-2.47), 1.71 (1.65-1.76), 1.41 (1.35-1.47) and 1.39 (1.30-1.49) among women from South Asian, Black, other and mixed ethnicities compared to white women] and smoking or previously smoking [aOR: 1.19 (1.18-1.20) and 1.05 (1.03-1.06)]. Higher and lower age, higher gravidity, increasing number of comorbidities and increasing level of deprivation were also associated with increased odds of polypharmacy. CONCLUSIONS The prevalence of polypharmacy during pregnancy has increased over the past two decades and is particularly high in younger and older women; women with high BMI, smokers and ex-smokers; and women with multimorbidity, higher gravidity and higher levels of deprivation. Well-conducted pharmaco-epidemiological research is needed to understand the effects of multiple medication use on the developing foetus.
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Affiliation(s)
- Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- INSERM, Center for Epidemiology and Research in Population Health (CERPOP), Toulouse, CIC 1436, France
| | - Christopher Yau
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Health Data Research UK, Oxford, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | | | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Louise Locock
- Health Services Research Unit, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Ngawai Moss
- Patient and Public Representative, London, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
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15
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Singh M, Crowe F, Thangaratinam S, Abel KM, Black M, Okoth K, Riley R, Eastwood KA, Hope H, Wambua S, Healey J, Lee SI, Phillips K, Vowles Z, Cockburn N, Moss N, Nirantharakumar K. Association of pregnancy complications/risk factors with the development of future long-term health conditions in women: overarching protocol for umbrella reviews. BMJ Open 2022; 12:e066476. [PMID: 36581409 PMCID: PMC9806074 DOI: 10.1136/bmjopen-2022-066476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION With good medical care, most pregnancy complications like pre-eclampsia, gestational diabetes, etc resolve after childbirth. However, pregnancy complications are known to be associated with an increased risk of new long-term health conditions for women later in life, such as cardiovascular disease. These umbrella reviews aim to summarise systematic reviews evaluating the association between pregnancy complications and five groups of long-term health conditions: autoimmune conditions, cancers, functional disorders, mental health conditions and metabolic health conditions (diabetes and hypertension). METHODS AND ANALYSIS We will conduct searches in Medline, Embase and the Cochrane database of systematic reviews without any language restrictions. We will include systematic reviews with or without meta-analyses that studied the association between pregnancy complications and the future risk of the five groups of long-term health conditions in women. Pregnancy complications were identified from existing core outcome sets for pregnancy and after consultation with experts. Two reviewers will independently screen the articles. Data will be synthesised with both narrative and quantitative methods. Where a meta-analysis has been carried out, we will report the combined effect size from individual studies. For binary data, pooled ORs with 95% CIs will be presented. For continuous data, we will use the mean difference with 95% CIs. The findings will be presented in forest plots to assess heterogeneity. The methodological quality of the studies will be evaluated with the AMSTAR 2 tool or the Cochrane risk of bias tool. The corrected covered area method will be used to assess the impact of overlap in reviews. The findings will be used to inform the design of prediction models, which will predict the risk of women developing these five group of health conditions following a pregnancy complication. ETHICS AND DISSEMINATION No ethical approvals required. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.
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Affiliation(s)
- Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Francesca Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kathryn Mary Abel
- Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, Manchester, UK
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Richard Riley
- Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Kelly-Ann Eastwood
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Steven Wambua
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jemma Healey
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ngawai Moss
- Patient and public representative, London, UK
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Phillips K, Davison J, Wakerley B. Headache in pregnancy: a brief practical guide. Br J Gen Pract 2022; 72:593-594. [PMID: 36424161 PMCID: PMC9710804 DOI: 10.3399/bjgp22x721457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | | | - Benjamin Wakerley
- Department of Neurology, University Hospital Birmingham, Birmingham; senior clinical lecturer, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham
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Bigelow BF, Martínez DA, Phillips K, Parent C, Saxton RE, Yang C, Page KR. Coalition of Faith Leaders, Community Organizations, and Governmental Organizations to Implement a COVID-19 Campaign in a Latino Neighborhood, Baltimore, Maryland, 2020-2021. Am J Public Health 2022; 112:S913-S917. [PMID: 36446060 PMCID: PMC9707716 DOI: 10.2105/ajph.2022.307074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2022] [Indexed: 11/30/2022]
Abstract
The disproportionate impact of COVID-19 on low-income Latinos with limited access to health care services prompted the expansion of community-based COVID-19 services. From June 25, 2020, to May 20, 2021, we established a coalition of faith leaders, community organizations, and governmental organizations to implement a Spanish-language hotline and social media campaign that linked people to a COVID-19 testing site at a local church in a high-density Latino neighborhood in Baltimore, Maryland. This retrospective analysis compared the characteristics of Latinos accessing testing in community versus health care facility-based settings. (Am J Public Health. 2022;112(S9):S913-S917. https://doi.org/10.2105/AJPH.2022.307074).
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Affiliation(s)
- Benjamin F Bigelow
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Diego A Martínez
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Katherine Phillips
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Cassandra Parent
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Ronald E Saxton
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Cui Yang
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
| | - Kathleen R Page
- Benjamin F. Bigelow, Cassandra Parent, Ronald E. Saxton, and Kathleen R. Page are with the Johns Hopkins School of Medicine, Baltimore, MD. Diego A. Martínez is with the School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile. Katherine Phillips is with the Esperanza Center, Baltimore. Cui Yang is with the Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers University, New Brunswick, NJ
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Lee SI, Cooper J, Fenton A, Subramanian A, Taverner T, Gokhale KM, Phillips K, Patel M, Harper L, Thomas GN, Nirantharakumar K. Decreased renal function is associated with incident dementia: An IMRD-THIN retrospective cohort study in the UK. Alzheimers Dement 2022; 18:1943-1956. [PMID: 34978143 DOI: 10.1002/alz.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Decreased renal function is a potential risk factor for dementia. METHODS This retrospective cohort study of 2.8 million adults aged ≥50 years used the IMRD-THIN database, representative of UK primary care, from January 1, 1995 to February 24, 2020. The associations between estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) with incident all-cause dementia were analyzed using Cox regression. RESULTS In the eGFR cohort (n = 2,797,384), worsening renal dysfunction was associated with increased hazard of all-cause dementia, with greatest hazard at eGFR 15-30 ml/min/1.73min2 (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.19-1.33). In the ACR cohort (n = 641,912), the hazard of dementia increased from ACR 3-30 mg/mmol (HR 1.13, 95% CI 1.10-1.15) to ACR > 30 mg/mmol (HR 1.25, 95% CI 1.18-1.33). DISCUSSION Worsening eGFR and albuminuria have graded associations with the risk of dementia, which may have significant implications for the care of patients with kidney disease.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Jennifer Cooper
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Anthony Fenton
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | | | - Tom Taverner
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Krishna M Gokhale
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Mitesh Patel
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
| | - Lorraine Harper
- Institute of Clinical Sciences, Centre for Translational Inflammation Research, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Sciences, University of Birmingham, Birmingham, UK
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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20
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Subramanian A, Lee SI, Phillips K, Toulis KA, Kempegowda P, O'Reilly MW, Adderley NJ, Thangaratinam S, Arlt W, Nirantharakumar K. Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England. BMC Med 2022; 20:298. [PMID: 36038914 PMCID: PMC9425992 DOI: 10.1186/s12916-022-02473-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) affects up to one in five women of childbearing age. Observational studies assessing the association between maternal PCOS and adverse obstetric outcomes have reported varying results, depending on patient population, diagnostic criteria for PCOS and covariates accounted for in their analyses. We aimed to assess the risk of obstetric outcomes among a population-based representative cohort of women with PCOS compared to an age-matched cohort of women without PCOS. METHODS A retrospective cohort study was conducted of pregnancies of women in England aged 15-49 years identified from the Clinical Practice Research Datalink (CPRD) GOLD pregnancy register and linked Hospital Episodes Statistic (HES) data between March 1997 and March 2020. Pregnancies from the register that had a linked HES delivery record were included. Linked CPRD primary care data was used to ascertain maternal PCOS exposure prior to pregnancy. To improve detection of PCOS, in addition to PCOS diagnostic codes, codes for (1) polycystic ovaries or (2) hyperandrogenism and anovulation together were also considered. Sensitivity analysis was limited to only pregnant women with a diagnostic code for PCOS. Primary outcomes ascertained from linked HES data were (1) preterm delivery (gestation < 37 weeks), (2) mode of delivery, (3) high (> 4000 g) or low birthweight (< 2500 g) and (4) stillbirth. Secondary outcomes were (1) very preterm delivery (< 32 weeks), (2) extremely preterm delivery (< 28 weeks), (3) small and (4) large for gestational age. Conditional logistic regression models were performed adjusting for age, ethnicity, deprivation, dysglycaemia, hypertension, thyroid disorders, number of babies born at index pregnancy, and pre-gravid BMI. Multiple imputation was performed for missing outcome data. RESULTS 27,586 deliveries with maternal PCOS were matched for age (± 1 year) to 110,344 deliveries without PCOS. In the fully adjusted models, maternal PCOS was associated with an increased risk of (1) preterm birth [aOR: 1.11 (95% CI 1.06-1.17)], and (2) emergency caesarean, elective caesarean and instrumental vaginal compared to spontaneous delivery [aOR: 1.10 (1.05-1.15), 1.07 (1.03-1.12) and 1.04 (1.00-1.09), respectively]. There was absence of association with low birthweight, high birthweight and stillbirth. In the sensitivity analysis, the association with preterm birth [aOR: 1.31 (95% CI 1.13-1.52)], emergency caesarean [aOR: 1.15 (95% CI 1.02-1.30)], and elective caesarean [aOR: 1.03 (95% CI 1.02-1.03)] remained. While there was no significant association with any of the secondary outcomes in the primary analysis, in the sensitivity analysis maternal PCOS was associated with increased risk of extremely preterm delivery [aOR: 1.86 (95% CI 1.31-2.65)], and lower risk of small for gestational age babies [aOR: 0.74 (95% CI 0.59-0.94)]. CONCLUSIONS Maternal PCOS was associated with increased risk of preterm and caesarean delivery. Association with low birthweight may be largely mediated by lower gestational age at birth.
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Affiliation(s)
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Punith Kempegowda
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Global Women's Health, University of Birmingham, Birmingham, UK
| | - Michael W O'Reilly
- Endocrinology and Metabolism Unit, Department of Medicine, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Global Women's Health, University of Birmingham, Birmingham, UK.,Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Global Women's Health, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Midlands Health Data Research UK, Birmingham, UK
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21
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Favaro RR, Phillips K, Delaunay-Danguy R, Ujčič K, Markert UR. Emerging Concepts in Innate Lymphoid Cells, Memory, and Reproduction. Front Immunol 2022; 13:824263. [PMID: 35774779 PMCID: PMC9237338 DOI: 10.3389/fimmu.2022.824263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/15/2022] [Indexed: 12/28/2022] Open
Abstract
Members of the innate immune system, innate lymphoid cells (ILCs), encompass five major populations (Natural Killer (NK) cells, ILC1s, ILC2s, ILC3s, and lymphoid tissue inducer cells) whose functions include defense against pathogens, surveillance of tumorigenesis, and regulation of tissue homeostasis and remodeling. ILCs are present in the uterine environment of humans and mice and are dynamically regulated during the reproductive cycle and pregnancy. These cells have been repurposed to support pregnancy promoting maternal immune tolerance and placental development. To accomplish their tasks, immune cells employ several cellular and molecular mechanisms. They have the capacity to remember a previously encountered antigen and mount a more effective response to succeeding events. Memory responses are not an exclusive feature of the adaptive immune system, but also occur in innate immune cells. Innate immune memory has already been demonstrated in monocytes/macrophages, neutrophils, dendritic cells, and ILCs. A population of decidual NK cells characterized by elevated expression of NKG2C and LILRB1 as well as a distinctive transcriptional and epigenetic profile was found to expand during subsequent pregnancies in humans. These cells secrete high amounts of interferon-γ and vascular endothelial growth factor likely favoring placentation. Similarly, uterine ILC1s in mice upregulate CXCR6 and expand in second pregnancies. These data provide evidence on the development of immunological memory of pregnancy. In this article, the characteristics, functions, and localization of ILCs are reviewed, emphasizing available data on the uterine environment. Following, the concept of innate immune memory and its mechanisms, which include epigenetic changes and metabolic rewiring, are presented. Finally, the emerging role of innate immune memory on reproduction is discussed. Advances in the comprehension of ILC functions and innate immune memory may contribute to uncovering the immunological mechanisms underlying female fertility/infertility, placental development, and distinct outcomes in second pregnancies related to higher birth weight and lower incidence of complications.
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22
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Jones JE, Damery SL, Phillips K, Retzer A, Nayyar P, Jolly K. Real-time remote outpatient consultations in secondary and tertiary care: A systematic review of inequalities in invitation and uptake. PLoS One 2022; 17:e0269435. [PMID: 35657995 PMCID: PMC9165897 DOI: 10.1371/journal.pone.0269435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/23/2022] [Indexed: 01/07/2023] Open
Abstract
Background
Health policies in most high income countries increasingly recommend provision of routine outpatient care via remote (video and/or telephone) appointments, especially due to the pandemic. This is thought to improve access to care and promote efficiency within resource-constrained health services. There is limited evidence about the impact on existing inequalities in the invitation and uptake of health services when remote outpatient care is offered.
Aim
To systematically review the evidence on the offer and/or uptake of real-time remote outpatient consultations in secondary and tertiary care, assessed according to key sociodemographic characteristics.
Methods
Seven electronic bibliographic databases were searched for studies reporting the proportion of patients with key characteristics (following PROGRESS Plus criteria) who were offered and/or accepted real-time remote outpatient consultation for any chronic condition. Comparison groups included usual care (face-to-face), another intervention, or offer/uptake within a comparable time period. Study processes were undertaken in duplicate. Data are reported narratively.
Results
Twenty-nine studies were included. Uptake of video consultations ranged from 5% to 78% and telephone consultations from 12% to 78%. Patients aged over 65, with lower educational attainment, on lower household incomes and without English as a first language were least likely to have a remote consultation. Females were generally more likely to have remote consultations than males. Non-white ethnicities were less likely to use remote consultations but where they did, were significantly more likely to choose telephone over video appointments (p<0.001).
Conclusions
Offering remote consultations may perpetuate or exacerbate existing health inequalities in access to healthcare. More research is needed on current health disparities by sociodemographic characteristics and to explore what works well for different patient groups and why so that processes can be designed to ameliorate these health disparities.
Trial registration
PROSPERO registration no: CRD42021241791.
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Affiliation(s)
- Janet E. Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Sarah L. Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ameeta Retzer
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Pamela Nayyar
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Kottmaier M, Inaba O, Phillips K, Adsett M, Hayes J, Gkalapis C, Lengauer S, Clementy N, Bailey C, Kaneko S. Initial experience using a novel algorithm to calculate omnipolar electrograms using a high-density grid-style catheter. Europace 2022. [DOI: 10.1093/europace/euac053.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
A novel mapping algorithm recently became available in Europe and select countries in the Asia Pacific region. EnSite Omnipolar Technology (OT) utilizes the Advisor HD Grid Mapping Catheter, Sensor Enabled (HD Grid) to calculate electrograms in 360 degrees from two bipolar and three unipolar electrograms acquired from a triangular set of three electrodes. This software also enables calculation of wavefront characteristics including maximum voltage, activation direction and wave speed. Procedural characteristics and clinical utilization of this novel software have not yet been reported.
Purpose
To examine the clinical utility and procedural characteristics associated with the use of this novel mapping algorithm among participating centers.
Methods
Acute procedural data were prospectively collected in 386 cases at 52 centers utilizing the newly approved mapping software in the initial phases of commercialization in Europe and the Asia Pacific region. Procedural characteristics recorded included indication for mapping/ablation, navigation mode, mapping reference, and maps and tools used to diagnose/locate ablation targets.
Results
A total of 14 indications for mapping and ablation were represented including AF, atypical flutter, and VT (Table 1). VoXel (magnetic primary) navigation mode was used in most cases (n=325, 84%). The CS catheter was used as the map reference in 280 cases (73%). A variety of workflows were used with OT to diagnose and locate ablation targets including voltage maps (n=275, 71%), LAT maps (n=226, 59%), OT activation vectors (n=124, 32%), propagation maps (n=94, 24%), and sparkle maps (n=69, 18%); note: total exceeds 100%, multiple workflows per case observed. EnSite LiveView Dynamic Display (LiveView) was used in 129 cases (33%) to diagnose and locate ablation targets, including 28 (22%) where OT activation vectors were used with LiveView. Several benefits of OT were reported including rapid identification of ablation target(s) (n=133, 35%), higher point density (n=82, 21%), better signals (n=69, 18%), and improved procedure efficiency (n=48, 12%).
Conclusion(s)
Initial experience with this novel mapping software in Europe and the Asia-Pacific region illustrated utility in a variety of arrhythmias to diagnose and locate ablation targets. The use of OT provided several benefits including rapid identification of ablation targets and higher point density, however further examination of its impact on procedural efficiencies and acute outcomes is likely warranted.
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Affiliation(s)
- M Kottmaier
- German Heart Center of Munich, Munich, Germany
| | - O Inaba
- Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - K Phillips
- Greenslopes Private Hospital, Brisbane, Australia
| | - M Adsett
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - J Hayes
- St Andrews War Memorial Hospital, Brisbane, Australia
| | | | - S Lengauer
- German Heart Center of Munich, Munich, Germany
| | - N Clementy
- University Hospital of Tours, Tours, France
| | - C Bailey
- Abbott, St. Paul, United States of America
| | - S Kaneko
- Toyota Kosei Hospital, Toyota, Japan
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Collins E, Martin C, Blomquist T, Phillips K, Cantlay S, Fisher N, Horzempa J. The utilization of Blaptica dubia cockroaches as an in vivo model to test antibiotic efficacy. Sci Rep 2021; 11:24004. [PMID: 34907348 PMCID: PMC8671488 DOI: 10.1038/s41598-021-03486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/03/2021] [Indexed: 12/03/2022] Open
Abstract
Insects are now well recognized as biologically relevant alternative hosts for dozens of mammalian pathogens and they are routinely used in microbial pathogenesis studies. Unfortunately, these models have yet to be incorporated into the drug development pipeline. The purpose of this work was to begin to evaluate the utility of orange spotted (Blaptica dubia) cockroaches in early antibiotic characterization. To determine whether these model hosts could exhibit mortality when infected with bacteria that are pathogenic to humans, we subjected B. dubia roaches to a range of infectious doses of Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Acinetobacter baumannii to identify the medial lethal dose. These results showed that lethal disease did not develop following infection of high doses of S. aureus, and A. baumannii. However, cockroaches infected with E. coli and K. pneumoniae succumbed to infection (LD50s of 5.82 × 106 and 2.58 × 106 respectively) suggesting that this model may have limitations based on pathogen specificity. However, because these cockroaches were susceptible to infection from E. coli and K. pneumoniae, we used these bacterial strains for subsequent antibiotic characterization studies. These studies suggested that β-lactam antibiotic persistence and dose was associated with reduction of hemolymph bacterial burden. Moreover, our data indicated that the reduction of bacterial CFU was directly due to the drug activity. Altogether, this work suggests that the orange-spotted cockroach infection model provides an alternative in vivo setting from which antibiotic efficacy can be evaluated.
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Affiliation(s)
- Elliot Collins
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
| | - Caleb Martin
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
| | - Tyler Blomquist
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
| | - Katherine Phillips
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
| | - Stuart Cantlay
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA
| | | | - Joseph Horzempa
- Department of Biological Sciences, West Liberty University, West Liberty, WV, USA.
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Lowe K, Dawson J, Phillips K, Minucci J, Wambaugh JF, Qian H, Ramanarayanan T, Egeghy P, Ingle B, Brunner R, Mendez E, Embry M, Tan YM. Incorporating human exposure information in a weight of evidence approach to inform design of repeated dose animal studies. Regul Toxicol Pharmacol 2021; 127:105073. [PMID: 34743952 DOI: 10.1016/j.yrtph.2021.105073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 10/20/2022]
Abstract
Human health risks from chronic exposures to environmental chemicals are typically estimated from potential human exposure estimates and dose-response data obtained from repeated-dose animal toxicity studies. Various criteria are available for selecting the top (highest) dose used in these animal studies. For example, toxicokinetic (TK) and toxicological data provided by shorter-term or dose range finding studies can be evaluated in a weight of evidence approach to provide insight into the dose range that would provide dose-response data that are relevant to human exposures. However, there are concerns that a top dose resulting from the consideration of TK data may be too low compared to other criteria, such as the limit dose or the maximum tolerated dose. In this paper, we address several concerns related to human exposures by discussing 1) the resources and methods available to predict human exposure levels and the associated uncertainty and variability, and 2) the margin between predicted human exposure levels and the dose levels used in repeated-dose animal studies. A series of case studies, ranging from data-rich to data-poor chemicals, are presented to demonstrate that expected human exposures to environmental chemicals are typically orders of magnitude lower than no-observed-adverse-effect levels/lowest-observed-adverse-effect levels (NOAELs/LOAELs) when available (used as conservative surrogates for top doses). The results of these case studies support that a top dose based, in part, on TK data is typically orders of magnitude higher than expected human exposure levels.
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Affiliation(s)
- Kelly Lowe
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - Jeffrey Dawson
- U.S. Environmental Protection Agency, Office of Chemical Safety and Pollution Prevention, Washington, DC, USA
| | - Katherine Phillips
- U.S. Environmental Protection Agency, Office of Research & Development, Durham, NC, USA
| | - Jeffrey Minucci
- U.S. Environmental Protection Agency, Office of Research & Development, Durham, NC, USA
| | - John F Wambaugh
- U.S. Environmental Protection Agency, Office of Research & Development, Durham, NC, USA
| | - Hua Qian
- ExxonMobil Biomedical Sciences, Inc., Annandale, NJ, USA
| | | | - Peter Egeghy
- U.S. Environmental Protection Agency, Office of Research & Development, Durham, NC, USA
| | - Brandall Ingle
- U.S. Environmental Protection Agency, Office of Pesticide Program, Durham, NC, USA
| | - Rachel Brunner
- U.S. Environmental Protection Agency, Office of Pesticide Program, Durham, NC, USA
| | - Elizabeth Mendez
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - Michelle Embry
- Health and Environmental Sciences Institute, Washington, DC, USA.
| | - Yu-Mei Tan
- U.S. Environmental Protection Agency, Office of Pesticide Program, Durham, NC, USA
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Tan YM, Barton HA, Boobis A, Brunner R, Clewell H, Cope R, Dawson J, Domoradzki J, Egeghy P, Gulati P, Ingle B, Kleinstreuer N, Lowe K, Lowit A, Mendez E, Miller D, Minucci J, Nguyen J, Paini A, Perron M, Phillips K, Qian H, Ramanarayanan T, Sewell F, Villanueva P, Wambaugh J, Embry M. Opportunities and challenges related to saturation of toxicokinetic processes: Implications for risk assessment. Regul Toxicol Pharmacol 2021; 127:105070. [PMID: 34718074 DOI: 10.1016/j.yrtph.2021.105070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 02/08/2023]
Abstract
Top dose selection for repeated dose animal studies has generally focused on identification of apical endpoints, use of the limit dose, or determination of a maximum tolerated dose (MTD). The intent is to optimize the ability of toxicity tests performed in a small number of animals to detect effects for hazard identification. An alternative approach, the kinetically derived maximum dose (KMD), has been proposed as a mechanism to integrate toxicokinetic (TK) data into the dose selection process. The approach refers to the dose above which the systemic exposures depart from being proportional to external doses. This non-linear external-internal dose relationship arises from saturation or limitation of TK process(es), such as absorption or metabolism. The importance of TK information is widely acknowledged when assessing human health risks arising from exposures to environmental chemicals, as TK determines the amount of chemical at potential sites of toxicological responses. However, there have been differing opinions and interpretations within the scientific and regulatory communities related to the validity and application of the KMD concept. A multi-stakeholder working group, led by the Health and Environmental Sciences Institute (HESI), was formed to provide an opportunity for impacted stakeholders to address commonly raised scientific and technical issues related to this topic and, more specifically, a weight of evidence approach is recommended to inform design and dose selection for repeated dose animal studies. Commonly raised challenges related to the use of TK data for dose selection are discussed, recommendations are provided, and illustrative case examples are provided to address these challenges or refute misconceptions.
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Affiliation(s)
- Yu-Mei Tan
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Durham, NC, USA
| | | | | | - Rachel Brunner
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Durham, NC, USA
| | | | - Rhian Cope
- Australian Pesticides and Veterinary Medicines Authority, Sydney, NSW, Australia
| | - Jeffrey Dawson
- U.S. Environmental Protection Agency, Office of Chemical Safety and Pollution Prevention, Washington, DC, USA
| | | | - Peter Egeghy
- U.S. Environmental Protection Agency, Office of Research & Development, Durham, NC, USA
| | - Pankaj Gulati
- Australian Pesticides and Veterinary Medicines Authority, Sydney, NSW, Australia
| | - Brandall Ingle
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Durham, NC, USA
| | - Nicole Kleinstreuer
- National Toxicology Program, Interagency Center for the Evaluation of Alternative Toxicological Methods, Research Triangle Park, NC, USA
| | - Kelly Lowe
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - Anna Lowit
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - Elizabeth Mendez
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - David Miller
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - Jeffrey Minucci
- U.S. Environmental Protection Agency, Office of Research & Development, Durham, NC, USA
| | - James Nguyen
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - Alicia Paini
- European Commission, Joint Research Centre, Ispra, Italy
| | - Monique Perron
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - Katherine Phillips
- U.S. Environmental Protection Agency, Office of Research & Development, Durham, NC, USA
| | - Hua Qian
- ExxonMobil Biomedical Sciences, Inc., Annandale, NJ, USA
| | | | - Fiona Sewell
- National Centre for the Replacement, Refinement, and Reduction of Animals in Research, London, UK
| | - Philip Villanueva
- U.S. Environmental Protection Agency, Office of Pesticide Programs, Washington, DC, USA
| | - John Wambaugh
- U.S. Environmental Protection Agency, Office of Research & Development, Durham, NC, USA
| | - Michelle Embry
- Health and Environmental Sciences Institute, Washington DC, USA.
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Abe M, Tsunawaki S, Dejonckheere M, Cigolle CT, Phillips K, Rubinstein EB, Matsuda M, Fetters MD, Inoue M. Practices and perspectives of primary care physicians in Japan and the United States about diagnosing dementia: a qualitative study. BMC Geriatr 2021; 21:540. [PMID: 34635089 PMCID: PMC8503990 DOI: 10.1186/s12877-021-02457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. Methods Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. Results Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. Conclusions Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02457-7.
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Affiliation(s)
- M Abe
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Hamamatsu, Japan
| | - S Tsunawaki
- Omaezaki Family Medicine Center, Shizuoka, Omaezaki, Japan.,Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan
| | - M Dejonckheere
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA
| | - C T Cigolle
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System (VAAHS) Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
| | - K Phillips
- VA Ann Arbor Healthcare System (VAAHS) Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA
| | - E B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, North Dakota, USA
| | - M Matsuda
- Shizuoka Family Medicine Program, Shizuoka, Hamamatsu, Japan.,Kikugawa Family Medicine Center, Shizuoka, Kikugawa, Japan
| | - M D Fetters
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA. .,The School of Health Humanities, Peking University Health Science Center, Beijing, China.
| | - M Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka, Hamamatsu, Japan
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Phillips K, Subramanian A, Thomas GN, Khan N, Chandan JS, Brady P, Marshall T, Nirantharakumar K, Fabritz L, Adderley NJ. Trends in the pharmacological management of atrial fibrillation in UK general practice 2008-2018. Heart 2021; 108:517-522. [PMID: 34226195 DOI: 10.1136/heartjnl-2021-319338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/15/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The pharmacological management of atrial fibrillation (AF) comprises anticoagulation, for stroke prophylaxis, and rate or rhythm control drugs to alleviate symptoms and prevent heart failure. The aim of this study was to investigate trends in the proportion of patients with AF prescribed pharmacological therapies in the UK between 2008 and 2018. METHODS Eleven sequential cross-sectional analyses were performed yearly from 2008 to 2018. Data were derived from an anonymised UK primary care database. Outcomes were the proportion of patients with AF prescribed anticoagulants, rhythm and rate control drugs in the whole cohort, those at high risk of stroke and those with coexisting heart failure. RESULTS Between 2008 and 2018, the proportion of patients prescribed anticoagulants increased from 45.3% (95% CI 45.0% to 45.7%) to 71.1% (95% CI 70.7% to 71.5%) driven by increased prescription of non-vitamin K antagonist anticoagulants. The proportion of patients prescribed rate control drugs remained constant between 2008 and 2018 (69.3% (95% CI 68.9% to 69.6%) to 71.6% (95% CI 71.2% to 71.9%)). The proportion of patients prescribed rhythm control therapy by general practitioners (GPs) decreased from 9.5% (95% CI 9.3% to 9.7%) to 5.4% (95% CI 5.2% to 5.6%). CONCLUSIONS There has been an increase in the proportion of patients with AF appropriately prescribed anticoagulants following National Institute for Health and Care Excellence and European Society of Cardiology guidelines, which correlates with improvements in mortality and stroke outcomes. Beta-blockers appear increasingly favoured over digoxin for rate control. There has been a steady decline in GP prescribing rates for rhythm control drugs, possibly related to concerns over efficacy and safety and increased availability of AF ablation.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nazish Khan
- Department of Cardiology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Brady
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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James S, Tyrrell-Price J, Atkinson C, Hunt L, Searle A, Phillips K, Penfold C, Carter J, Ness A. Evaluation of urinary chloride dipsticks for the rapid estimation of hydration status in patients receiving artificial nutrition: Feasibility study. Clin Nutr ESPEN 2021; 42:339-347. [PMID: 33745603 DOI: 10.1016/j.clnesp.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS The home parenteral nutrition (HPN) population face many challenges, especially with respect to fluid balance management. A low urinary sodium concentration of <20 mmol/L is commonly used as an indicator of dehydration that requires clinical assessment in these patients. The Quantab titrator dipstick measures chloride concentration of a solution and correlates with sodium concentration. We assessed whether it would be feasible to use the Quantab dipstick in the HPN population and explored relationships between Quantab dipstick estimated chloride concentration and quality of life (QOL). METHODS Patients on HPN were asked to collect urine samples at 5 specific times points (day 0,7,14, 21 and 28) to send to the laboratory for formal electrolyte analysis. The participant and a member of laboratory staff tested these samples with the Quantab dipstick to estimate urinary chloride concentration. Participants were instructed to complete a QOL questionnaire at each of the 5 time-points in addition to a baseline demographic questionnaire and an end-of-study questionnaire. Six participants completed an interview at the end of the study period. The relationship between participant-derived and laboratory-derived data was assessed using rank correlation coefficients. QOL assessment was correlated with urine dipstick measurements. RESULTS 10 patients on HPN completed the study. Data on chloride concentration as estimated by the dipstick (assessed by participants and by the laboratory) and sodium concentration from the laboratory were available for 47 urine samples. There was a positive relationship between participant dipstick estimated chloride concentration and laboratory sodium (Kendall's τ = 0.45; P < 0.001; Spearman's rs = 0.58 P < 0.001; 47 pairs). There was a strong correlation between chloride concentrations estimated by dipstick in the laboratory and by participants (Kendall 0.58 p < 0.001, Spearman's 0.69 p < 0.001; 47 pairs). In exploratory analyses, there was no relationship between QOL and dipstick estimated chloride concentration. Participants had no issues collecting urine samples but some difficulties were reported with determining the dipstick reading. CONCLUSIONS Patients on HPN are able to collect urine specimens, complete QOL questionnaires, and are capable of using the Quantab dipstick to estimate urinary chloride concentration. The Quantab dipstick correlates with laboratory measured sodium and chloride concentrations. Further work is required to fully establish whether this point-of-care test could be used to guide fluid balance management in the HPN population.
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Affiliation(s)
- S James
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - J Tyrrell-Price
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - L Hunt
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - A Searle
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - K Phillips
- Department of Biochemistry, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Penfold
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - J Carter
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - A Ness
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
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Cunningham TK, Draper H, Bexhell H, Allgar V, Allen J, Mikl D, Phillips K. A double-blinded randomised controlled study to investigate the effect of intraperitoneal levobupivacaine on post laparoscopic pain. Facts Views Vis Obgyn 2020; 12:155-161. [PMID: 33123690 PMCID: PMC7580260] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Laparoscopic surgery is the cornerstone of modern gynaecological surgery, with shorter hospital stays and a quicker return to normal activities. However postoperative pain remains problematic. No strategy to reduce phrenic nerve irritation, including heating or humidifying the insufflating gas, alternatives to CO2, and intraperitoneal analgesics, has shown superiority. METHODS 100 women undergoing laparoscopic surgery were randomly allocated, having either 40ml of 0.25% levobupivacaine or 40ml 0.9% sodium chloride solution administered into the peritoneal cavity following surgery. The patients and the main researcher were blinded. All women received standardised anaesthetic and laparoscopic technique, and postoperative pain control including nursing position and nature of analgesia. Postoperative pain was assessed 3 hours, 8 hours, day 1 and day 4/5 postoperatively. RESULTS 100 patients were recruited undergoing surgery for benign causes aged 19-73(mean 40.3±13). There was no difference between the groups for age(p=0.64) or length of operation(p=0.56). There were no adverse events related to use of intraperitoneal instillation. There was a significant reduction in shoulder-tip pain scores in the levobupivacaine group at 3 hours(p=0.04). Furthermore, there was a significant reduction in wound-pain scores in the levobupivacaine group at 8hrs(p=0.04) and at day 4(p=0.04). No difference was found in pelvic pain between the two groups. No significant difference was found in the use of post-operative analgesia. CONCLUSIONS Intraperitoneal instillation of 40ml of levobupivacaine has some benefit in reducing postoperative pain and need for analgesia in the initial hours following gynaecological surgery. However, further well-designed randomised control trials are required to decide the optimum route and concentration of administering local anaesthetic.
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Affiliation(s)
- TK Cunningham
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - H Draper
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - H Bexhell
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - V Allgar
- Centre for Health and Population Sciences, Hull York Medical School, Hull, United Kingdom, HU6 7RX
| | - J Allen
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - D Mikl
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
| | - K Phillips
- Department of Obstetrics & Gynaecology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom, HU32JZ
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Bhambra R, Pascoe M, Kominsky A, Mehra R, Aylor J, Wang L, Phillips K, Waters T, Walia HK. 0687 Comparative Changes Of Patient Reported Outcomes In Positive Airway Pressure And Upper Airway Stimulation For Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Upper Airway Stimulation (UAS) is increasingly being used for obstructive sleep apnea (OSA) treatment, however, data comparing changes in patient reported outcomes (PROs) in response to positive airway pressure (PAP) versus UAS are limited. We hypothesize that there will be no difference in PROs between the two groups after treatment.
Methods
UAS and PAP groups were 1:3 matched on age, sex, Body Mass Index (BMI) and Apnea Hypopnea Index (AHI, category 15-30, >30). Linear mixed models assessed the difference of change in Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Patient Health Questionnaire (PHQ9) and Insomnia Severity Index (ISI) measures on matched strata of UAS versus PAP groups with adjustment of baseline and matching factors. All analysis was performed in SAS software (version 9.4, Cary, NC).
Results
The analytic sample comprised 193 PAP patients and 69 UAS patients, with mean age=62.9+/-9.4 years, 27.5% female, mean BMI=29.1+/-3.2kg/m2, and median AHI 42.7, IQR: 31.5, 57.2. ESS in PAP (n=190) reduced by -2.63 (-3.38,-1.88) and in UAS (n=56) reduced by -2.22 (-3.34, -1.10), with a mean difference of 0.41 (-0.70, 1.52, p=.46). FOSQ in PAP (n=188) showed a change of 1.38 (0.99, 1.78) and in UAS (n=49) a change of 1.82 (1.17, 2.46), with a mean difference of 0.43 (-0.23, 1.09, p=.19). PHQ9 in PAP (n=185) showed a significant change of -2.24(-3.00, 1.47) and in UAS (n=45) a change of -3.75(-5.07,-2.42), with a mean difference of -1.51(-2.93,-0.088, p=.038). ISI in PAP (n=193) showed a significant change of -3.20(-4.39,-2.02) and in UAS (n=47) a change of -4.83(-6.77,-2.90), with a mean difference of -1.63(-3.62, 0.37, p=.11).
Conclusion
Similar improvements in PROs were observed in both UAS and PAP patient groups, however UAS appeared to confer greater benefit in depressive symptoms relative to PAP. Randomized clinical trials should be designed to confirm these findings.
Support
N/A
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Affiliation(s)
- R Bhambra
- Sleep Disorders Center, Cleveland, OH
| | - M Pascoe
- Sleep Disorders Center, Cleveland, OH
| | - A Kominsky
- Department of Otolaryngology, Cleveland, OH
| | - R Mehra
- Sleep Disorders Center, Cleveland, OH
| | - J Aylor
- Sleep Disorders Center, Cleveland, OH
| | - L Wang
- Department of Quantitative Health Sciences, Cleveland, OH
| | | | - T Waters
- Sleep Disorders Center, Cleveland, OH
| | - H K Walia
- Sleep Disorders Center, Cleveland, OH
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32
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Harland BF, Oberleas D, Ellis R, Gelroth J, Gordon D, Phillips K, Ranhotra G, Shah BG, Stoecker B, Trick KD, Zymonas J. Anion-Exchange Method for Determination of Phytate in Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/69.4.667] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Phytate, a naturally occurring organic compound found in plant seeds, roots, and tubers, was determined in a collaborative study using a modified anion-exchange method. Seven samples (peanut flour, oats, rice, isolated soybean protein, a vegetarian diet composite, wheat bran, and whole wheat bread), supplied as blind duplicate samples, were analyzed in triplicate by 7 collaborators. Phytate concentrations in the samples ranged from 2.38 to 46.70 mg/g. Relative standard deviations (RSD = CV) for repeatability ranged from 2.5 to 10.1%, and for reproducibility, from 4.5 to 11.0%. The method has been adopted official first action.
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Affiliation(s)
| | - Donald Oberleas
- Howard University, School of Human Ecology, Washington, DC 20059
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He W, Ali F, O'Shea K, Phillips K, Thomas S, Priestley M, Singleton A, McIntyre D, Chow C, Thiagalingam A. 752 Text Messages Targeting Smoking Cessation in Surgical Patients: Comparing Clinician and Consumer Review. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Isaacs KK, Dionisio K, Phillips K, Bevington C, Egeghy P, Price PS. Establishing a system of consumer product use categories to support rapid modeling of human exposure. J Expo Sci Environ Epidemiol 2020; 30:171-183. [PMID: 31712628 PMCID: PMC7745729 DOI: 10.1038/s41370-019-0187-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/23/2019] [Accepted: 09/17/2019] [Indexed: 05/22/2023]
Abstract
Consumer product categorizations for use in predicting human chemical exposure provide a bridge between product composition data and consumer product use pattern information. Furthermore, the categories reflect other factors relevant to developing consumer product exposure scenarios, such as microenvironment of use (e.g., indoors or outdoors), method of application/form of release (e.g., spray versus liquid), release to various media, removal processes (e.g., rinse-off or wipe-off), and route-specific exposure factors (dermal surface areas of application, fraction of release in respirable form). While challenging, developing harmonized product categories can generalize the factors described above allowing for rapid parameterization of route-specific exposure scenario algorithms for new chemical/product applications and efficient utilization of new data on product use or composition. This can be accomplished via mapping product categories to likewise categorized release and use patterns or exposure factors. Here, hierarchical product use categories (PUCs) for consumer products that provide such mappings are presented and crosswalked with other internationally harmonized product categories for consumer exposure assessment. The PUCs were defined by applying use and exposure scenario information to the products in EPA's Chemical and Products Database (CPDat). This paper demonstrates how these PUCs are being used to rapidly parameterize algorithms for scenario-specific use, fate, and exposure in a probabilistic aggregate model of human exposure to chemicals used in consumer products. The PUCs provide a generic representation of consumer products for use in exposure assessment and provide an efficient framework for flexible and rapid data reporting and consumer exposure model parameterization.
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Affiliation(s)
- Kristin K Isaacs
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA.
| | - Kathie Dionisio
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Katherine Phillips
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Charles Bevington
- Office of Pollution Prevention and Toxics, 1200 Pennsylvania Avenue, North West Washington, DC, 20460, USA
| | - Peter Egeghy
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA
| | - Paul S Price
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC, 27709, USA
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Nomidis SK, Caraglio M, Laleman M, Phillips K, Skoruppa E, Carlon E. Twist-bend coupling, twist waves, and the shape of DNA loops. Phys Rev E 2019; 100:022402. [PMID: 31574750 DOI: 10.1103/physreve.100.022402] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Indexed: 06/10/2023]
Abstract
By combining analytical and numerical calculations, we investigate the minimal-energy shape of short DNA loops of approximately 100 base pairs (bp). We show that in these loops the excess twist density oscillates as a response to an imposed bending stress, as recently found in DNA minicircles and observed in nucleosomal DNA. These twist oscillations, here referred to as twist waves, are due to the coupling between twist and bending deformations, which in turn originates from the asymmetry between DNA major and minor grooves. We introduce a simple analytical variational shape that reproduces the exact loop energy up to the fourth significant digit and is in very good agreement with shapes obtained from coarse-grained simulations. We, finally, analyze the loop dynamics at room temperature, and show that the twist waves are robust against thermal fluctuations. They perform a normal diffusive motion, whose origin is briefly discussed.
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Affiliation(s)
- S K Nomidis
- Laboratory for Soft Matter and Biophysics, KU Leuven, Celestijnenlaan 200D, 3001 Leuven, Belgium
- Flemish Institute for Technological Research (VITO), Boeretang 200, B-2400 Mol, Belgium
| | - M Caraglio
- Laboratory for Soft Matter and Biophysics, KU Leuven, Celestijnenlaan 200D, 3001 Leuven, Belgium
- Institut für Theoretische Physik, Universität Innsbruck, Technikerstraße 21A, A-6020 Innsbruck, Austria
| | - M Laleman
- Laboratory for Soft Matter and Biophysics, KU Leuven, Celestijnenlaan 200D, 3001 Leuven, Belgium
| | - K Phillips
- Laboratory for Soft Matter and Biophysics, KU Leuven, Celestijnenlaan 200D, 3001 Leuven, Belgium
| | - E Skoruppa
- Laboratory for Soft Matter and Biophysics, KU Leuven, Celestijnenlaan 200D, 3001 Leuven, Belgium
| | - E Carlon
- Laboratory for Soft Matter and Biophysics, KU Leuven, Celestijnenlaan 200D, 3001 Leuven, Belgium
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Paterson J, Keys C, Phillips K, Yntema M, MacKay JRD. Peer-Led Academic Support for Pre-Arrival Students of the BVM&S Degree Program. J Vet Med Educ 2019; 46:481-488. [PMID: 30806564 DOI: 10.3138/jvme.1017-149r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mental health challenges are of growing concern to the veterinary community. Within veterinary education, there has been increasing focus on building resilience in students and identifying likely stressors, such as the transition into the veterinary curriculum for first-year students. In this study, we evaluated a peer-led project to provide pre-arrival materials to incoming students. Through a combination of learner analytics and post-course surveys, we investigated usage of resources and the effects on student's attitudes toward the veterinary curriculum. Over the 2 years the course has been running, 159 students (64% of total) have visited the course, but only 39% (n = 98) have actively engaged with the materials. The course was most frequently accessed from Friday to Sunday (53% of visits), and over 50% of the visits occurred 1 week before arrival. The post-course questionnaire in the first year of the course's delivery had a 17% response rate (n = 24) and most students (71%) reflected on feeling anxious about beginning their studies. 88% said they felt they had benefited from the material's availability. While not all students used the resources, providing peer-led teaching opportunities at high-stress points is an effective method of easing transitions.
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Affiliation(s)
| | | | | | | | - Jill R D MacKay
- School of Veterinary Studies, University of Edinburgh, Easter Bush Campus
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He W, Thiagalingam A, Ali F, O'Shea K, Phillips K, McIntyre D, Singleton A, Priestley M, Thomas S, Chow C. Development of Mobile Phone Text Messages Targeting Smoking Cessation in Surgical Patients. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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38
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Phillips K. COMMUNITY CONNECTIONS: LINKING AFFORDABLE HOUSING AND ACADEMIA. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Phillips
- Community Impact Strategies, Washington DC, Washington, United States
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39
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Dionisio KL, Phillips K, Price PS, Grulke CM, Williams A, Biryol D, Hong T, Isaacs KK. The Chemical and Products Database, a resource for exposure-relevant data on chemicals in consumer products. Sci Data 2018; 5:180125. [PMID: 29989593 PMCID: PMC6038847 DOI: 10.1038/sdata.2018.125] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/30/2018] [Indexed: 01/29/2023] Open
Abstract
Quantitative data on product chemical composition is a necessary parameter for characterizing near-field exposure. This data set comprises reported and predicted information on more than 75,000 chemicals and more than 15,000 consumer products. The data's primary intended use is for exposure, risk, and safety assessments. The data set includes specific products with quantitative or qualitative ingredient information, which has been publicly disclosed through material safety data sheets (MSDS) and ingredient lists. A single product category from a refined and harmonized set of categories has been assigned to each product. The data set also contains information on the functional role of chemicals in products, which can inform predictions of the concentrations in which they occur. These data will be useful to exposure and risk assessors evaluating chemical and product safety.
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Affiliation(s)
- Kathie L. Dionisio
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Katherine Phillips
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Paul S. Price
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Christopher M. Grulke
- U.S. Environmental Protection Agency, National Center for Computational Toxicology, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Antony Williams
- U.S. Environmental Protection Agency, National Center for Computational Toxicology, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Derya Biryol
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Tao Hong
- ICF International, 2635 Meridian Pkwy #200, Durham, NC 27713, USA
| | - Kristin K. Isaacs
- U.S. Environmental Protection Agency, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, USA
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Barger J, Siow M, Kader M, Phillips K, Fatterpekar G, Kleinberg D, Zagzag D, Sen C, Golfinos JG, Lebowitz R, Placantonakis DG. The posterior nasoseptal flap: A novel technique for closure after endoscopic transsphenoidal resection of pituitary adenomas. Surg Neurol Int 2018. [PMID: 29527390 PMCID: PMC5838838 DOI: 10.4103/sni.sni_192_17] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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] [Indexed: 12/15/2022] Open
Abstract
Background: While effective for the repair of large skull base defects, the Hadad-Bassagasteguy nasoseptal flap increases operative time and can result in a several-week period of postoperative crusting during re-mucosalization of the denuded nasal septum. Endoscopic transsphenoidal surgery for pituitary adenoma resection is generally not associated with large dural defects and high-flow cerebrospinal fluid (CSF) leaks requiring extensive reconstruction. Here, we present the posterior nasoseptal flap as a novel technique for closure of skull defects following endoscopic resection of pituitary adenomas. This flap is raised in all surgeries during the transnasal exposure using septal mucoperiosteum that would otherwise be discarded during the posterior septectomy performed in binostril approaches. Methods: We present a retrospective, consecutive case series of 43 patients undergoing endoscopic transsphenoidal resection of a pituitary adenoma followed by posterior nasoseptal flap placement and closure. Main outcome measures were extent of resection and postoperative CSF leak. Results: The mean extent of resection was 97.16 ± 1.03%. Radiographic measurement showed flap length to be adequate. While a defect in the diaphragma sellae and CSF leak were identified in 21 patients during surgery, postoperative CSF leak occurred in only one patient. Conclusions: The posterior nasoseptal flap provides adequate coverage of the surgical defect and is nearly always successful in preventing postoperative CSF leak following endoscopic transsphenoidal resection of pituitary adenomas. The flap is raised from mucoperiosteum lining the posterior nasal septum, which is otherwise resected during posterior septectomy. Because the anterior septal cartilage is not denuded, raising such flaps avoids the postoperative morbidity associated with the larger Hadad-Bassagasteguy nasoseptal flap.
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Affiliation(s)
- James Barger
- Department of Neurosurgery, New York University School of Medicine, New York, USA
| | - Matthew Siow
- Department of Neurosurgery, New York University School of Medicine, New York, USA
| | - Michael Kader
- Department of Neurosurgery, New York University School of Medicine, New York, USA
| | - Katherine Phillips
- Department of Neurosurgery, New York University School of Medicine, New York, USA
| | - Girish Fatterpekar
- Department of Radiology, New York University School of Medicine, New York, USA.,Department of Perlmutter Cancer Center, New York University School of Medicine, New York, USA.,Department of Brain Tumor Center, New York University School of Medicine, New York, USA
| | - David Kleinberg
- Department of Medicine, New York University School of Medicine, New York, USA
| | - David Zagzag
- Department of Neurosurgery, New York University School of Medicine, New York, USA.,Department of Pathology, New York University School of Medicine, New York, USA.,Department of Perlmutter Cancer Center, New York University School of Medicine, New York, USA.,Department of Brain Tumor Center, New York University School of Medicine, New York, USA
| | - Chandranath Sen
- Department of Neurosurgery, New York University School of Medicine, New York, USA.,Department of Perlmutter Cancer Center, New York University School of Medicine, New York, USA.,Department of Brain Tumor Center, New York University School of Medicine, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, New York University School of Medicine, New York, USA.,Department of Perlmutter Cancer Center, New York University School of Medicine, New York, USA.,Department of Brain Tumor Center, New York University School of Medicine, New York, USA
| | - Richard Lebowitz
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, USA
| | - Dimitris G Placantonakis
- Department of Neurosurgery, New York University School of Medicine, New York, USA.,Department of Perlmutter Cancer Center, New York University School of Medicine, New York, USA.,Department of Brain Tumor Center, New York University School of Medicine, New York, USA
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Eccleston D, Swale M, Phillips K, Tan I, Young G. Is there an Outcome Hazard for Elderly Australians After Device Implantation: Observations from the GenesisCare Cardiovascular Outcomes Registry (GCOR). Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.291] [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: 11/24/2022]
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Phillips K, Ansell J. The clinical implications of new oral anticoagulants: Will the potential advantages be achieved? Thromb Haemost 2017; 103:34-9. [DOI: 10.1160/th09-06-0361] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 10/15/2009] [Indexed: 11/05/2022]
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43
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Biryol D, Nicolas CI, Wambaugh J, Phillips K, Isaacs K. High-throughput dietary exposure predictions for chemical migrants from food contact substances for use in chemical prioritization. Environ Int 2017; 108:185-194. [PMID: 28865378 PMCID: PMC5894819 DOI: 10.1016/j.envint.2017.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 05/21/2023]
Abstract
Under the ExpoCast program, United States Environmental Protection Agency (EPA) researchers have developed a high-throughput (HT) framework for estimating aggregate exposures to chemicals from multiple pathways to support rapid prioritization of chemicals. Here, we present methods to estimate HT exposures to chemicals migrating into food from food contact substances (FCS). These methods consisted of combining an empirical model of chemical migration with estimates of daily population food intakes derived from food diaries from the National Health and Nutrition Examination Survey (NHANES). A linear regression model for migration at equilibrium was developed by fitting available migration measurements as a function of temperature, food type (i.e., fatty, aqueous, acidic, alcoholic), initial chemical concentration in the FCS (C0) and chemical properties. The most predictive variables in the resulting model were C0, molecular weight, log Kow, and food type (R2=0.71, p<0.0001). Migration-based concentrations for 1009 chemicals identified via publicly-available data sources as being present in polymer FCSs were predicted for 12 food groups (combinations of 3 storage temperatures and food type). The model was parameterized with screening-level estimates of C0 based on the functional role of chemicals in FCS. By combining these concentrations with daily intakes for food groups derived from NHANES, population ingestion exposures of chemical in mg/kg-bodyweight/day (mg/kg-BW/day) were estimated. Calibrated aggregate exposures were estimated for 1931 chemicals by fitting HT FCS and consumer product exposures to exposures inferred from NHANES biomonitoring (R2=0.61, p<0.001); both FCS and consumer product pathway exposures were significantly predictive of inferred exposures. Including the FCS pathway significantly impacted the ratio of predicted exposures to those estimated to produce steady-state blood concentrations equal to in-vitro bioactive concentrations. While these HT methods have large uncertainties (and thus may not be appropriate for assessments of single chemicals), they can provide critical refinement to aggregate exposure predictions used in risk-based chemical priority-setting.
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Affiliation(s)
- Derya Biryol
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, United States; U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
| | - Chantel I Nicolas
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, United States; U.S. Environmental Protection Agency, Office of Research and Development, National Center for Computational Toxicology, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
| | - John Wambaugh
- U.S. Environmental Protection Agency, Office of Research and Development, National Center for Computational Toxicology, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
| | - Katherine Phillips
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
| | - Kristin Isaacs
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States.
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Boyle RJ, Umasunthar T, Smith JG, Hanna H, Procktor A, Phillips K, Pinto C, Gore C, Cox HE, Warner JO, Vickers B, Hodes M. A brief psychological intervention for mothers of children with food allergy can change risk perception and reduce anxiety: Outcomes of a randomized controlled trial. Clin Exp Allergy 2017; 47:1309-1317. [DOI: 10.1111/cea.12981] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 05/12/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- R. J. Boyle
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - T. Umasunthar
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - J. G. Smith
- Population Health Research Institute; St. George's, University of London; London UK
| | - H. Hanna
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - A. Procktor
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - K. Phillips
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - C. Pinto
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - C. Gore
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - H. E. Cox
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - J. O. Warner
- Section of Paediatrics; Imperial College London; London UK
- Imperial College Healthcare NHS Trust; London UK
| | - B. Vickers
- Adolescent Assertive Outreach Team; South West London and St Georges’ Mental Health NHS Trust; London UK
| | - M. Hodes
- Imperial College Healthcare NHS Trust; London UK
- Centre for Mental Health; Imperial College London; London UK
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45
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Phillips K, Priest V, McBride P, Simmonds M, Mudge M. Indirect Comparison of Left Atrial Appendage Closure (LAAC) Versus Aspirin and Best Supportive Care (BSC) in Patients with Non-Valvular Atrial Fibrillation (NVAF). Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Phillips K, Santoso T, Sanders P, Alison J, Chan JLK, Pak H, Chandavimol M, Ghamdi MAL, Stein K, Shanker A, Omar R. Percutaneous Left Atrial Appendage Closure with the WATCHMAN Device: 12 Month Outcomes from the WASP Asia-Pacific Registry. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.330] [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: 11/15/2022]
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47
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Madsen MD, Hulet A, Phillips K, Staley JL, Davies KW, Svejcar TJ. Extruded seed pellets: a novel approach for enhancing sagebrush seedling emergence. ACTA ACUST UNITED AC 2016. [DOI: 10.3368/npj.17.3.230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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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Isaacs KK, Goldsmith MR, Egeghy P, Phillips K, Brooks R, Hong T, Wambaugh JF. Characterization and prediction of chemical functions and weight fractions in consumer products. Toxicol Rep 2016; 3:723-732. [PMID: 28959598 PMCID: PMC5616074 DOI: 10.1016/j.toxrep.2016.08.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/05/2016] [Accepted: 08/31/2016] [Indexed: 10/25/2022] Open
Abstract
Assessing exposures from the thousands of chemicals in commerce requires quantitative information on the chemical constituents of consumer products. Unfortunately, gaps in available composition data prevent assessment of exposure to chemicals in many products. Here we propose filling these gaps via consideration of chemical functional role. We obtained function information for thousands of chemicals from public sources and used a clustering algorithm to assign chemicals into 35 harmonized function categories (e.g., plasticizers, antimicrobials, solvents). We combined these functions with weight fraction data for 4115 personal care products (PCPs) to characterize the composition of 66 different product categories (e.g., shampoos). We analyzed the combined weight fraction/function dataset using machine learning techniques to develop quantitative structure property relationship (QSPR) classifier models for 22 functions and for weight fraction, based on chemical-specific descriptors (including chemical properties). We applied these classifier models to a library of 10196 data-poor chemicals. Our predictions of chemical function and composition will inform exposure-based screening of chemicals in PCPs for combination with hazard data in risk-based evaluation frameworks. As new information becomes available, this approach can be applied to other classes of products and the chemicals they contain in order to provide essential consumer product data for use in exposure-based chemical prioritization.
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Affiliation(s)
- Kristin K. Isaacs
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
| | - Michael-Rock Goldsmith
- Chemical Computing Group, Suite 910, 1010 Sherbrooke Street West, Montreal, QC H3A 2R7, Canada
| | - Peter Egeghy
- U.S. Environmental Protection Agency, Office of Research and Development, National Exposure Research Laboratory, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
| | - Katherine Phillips
- Oak Ridge Institute for Science and Education, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
| | - Raina Brooks
- Student Services Contractor, U.S. Environmental Protection Agency, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
| | - Tao Hong
- ICF International, 2635 Meridian Pkwy #200, Durham, NC 27713, United States
| | - John F. Wambaugh
- U.S. Environmental Protection Agency, Office of Research and Development, National Center for Computational Toxicology, 109 T.W. Alexander Drive, Research Triangle Park, NC 27709, United States
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Phillips K, Carter E. Assessment of Chronic Watchman Left Atrial Appendage Occlusion by Cardiac Computed Tomography Angiography. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Dedini K, Phillips K, Arumugam D, Rehmani A, Pavia S, Scalia G. Bi-Ventricular Pacing Upgrade Dramatically Increases Ejection Fraction and Functional Status Despite no Significant Decrease in Qrs Duration. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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