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Goldberg CB, Adams L, Blumenthal D, Brennan PF, Brown N, Butte AJ, Cheatham M, deBronkart D, Dixon J, Drazen J, Evans BJ, Hoffman SM, Holmes C, Lee P, Manrai AK, Omenn GS, Perlin JB, Ramoni R, Sapiro G, Sarkar R, Sood H, Vayena E, Kohane IS. To do no harm - and the most good - with AI in health care. Nat Med 2024; 30:623-627. [PMID: 38388841 DOI: 10.1038/s41591-024-02853-7] [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] [Indexed: 02/24/2024]
Affiliation(s)
| | - Laura Adams
- National Academy of Medicine, Washington, DC, USA
| | - David Blumenthal
- Department of Health Policy and Management, Harvard University, T.H. Chan School of Public Health, Boston, MA, USA
| | - Patricia Flatley Brennan
- National Library of Medicine, Bethesda, MD, USA
- University of Wisconsin-Madison, Madison, WI, USA
| | - Noah Brown
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Morgan Cheatham
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Dave deBronkart
- e-Patient Dave, LLC, Nashua, NH, USA
- Society for Participatory Medicine, Pembroke, MA, USA
| | | | | | - Barbara J Evans
- Levin College of Law and Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Sara M Hoffman
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Chris Holmes
- Department of Statistics and Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Alan Turing Institute, London, UK
| | - Peter Lee
- Microsoft Corporation, Redmond, WA, USA
| | - Arjun Kumar Manrai
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- NEJM Group, Waltham, MA, USA
| | - Gilbert S Omenn
- University of Michigan Health System, University of Michigan, Ann Arbor, MI, USA
| | | | - Rachel Ramoni
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Rupa Sarkar
- The Lancet Ltd., Lancet Digital Health, London, UK
| | - Harpreet Sood
- National Health Service England, Hurley Group, Redditch, UK
- Huma, London, UK
| | | | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
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Perkins L, Adams L, Lerner D, Santorelli J, Smith AM, Kobayashi L. Predictors of direct oral anticoagulant concentrations in the trauma population. Trauma Surg Acute Care Open 2024; 9:e001208. [PMID: 38274020 PMCID: PMC10806470 DOI: 10.1136/tsaco-2023-001208] [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] [Indexed: 01/27/2024] Open
Abstract
Introduction Direct oral anticoagulant (DOAC) use is becoming more prevalent in patients presenting after trauma. We sought to identify the prevalence and predictors of subtherapeutic and therapeutic DOAC concentrations and hypothesized that increased anti-Xa levels would correlate with increased risk of bleeding and other poor outcomes. Methods A retrospective cohort study of all trauma patients on apixaban or rivaroxaban admitted to a level 1 trauma center between January 2015 and July 2021 was performed. Patients were excluded if they did not have a DOAC-specific anti-Xa level at presentation. Therapeutic levels were defined as an anti-Xa of 50 ng/mL to 250 ng/mL for rivaroxaban and 75 ng/mL to 250 ng/mL for apixaban. Linear regression was used to identify correlations between study variables and anti-Xa level, and binomial logistic regression was used to test the association of anti-Xa level with outcomes. Results There were 364 trauma patients admitted during the study period who were documented to be on apixaban or rivaroxaban. Of these, 245 patients had anti-Xa levels measured at admission. The population was 53% woman, with median age of 78 years, and median Injury Severity Score of 5. In total, 39% of patients had therapeutic and 20% had supratherapeutic anti-Xa levels. Female sex, increased age, decreased height and weight, and lower estimated creatinine clearance were associated with higher anti-Xa levels at admission. There was no correlation between anti-Xa level and the need for transfusion or reversal agent administration, admission diagnosis of intracranial hemorrhage (ICH), progression of ICH, hospital length of stay, or mortality. Conclusions Anti-Xa levels in trauma patients on DOACs vary widely; female patients who are older, smaller, and have decreased kidney function present with higher DOAC-specific anti-Xa levels after trauma. We were unable to detect an association between anti-Xa levels and clinical outcomes. Level of evidence III-Prognostic and Epidemiological.
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Affiliation(s)
- Louis Perkins
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Laura Adams
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Dmitri Lerner
- Department of Pharmacy, University of California San Diego, San Diego, California, USA
| | - Jarrett Santorelli
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Alan M Smith
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
| | - Leslie Kobayashi
- Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, California, USA
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Adams L, Amphlett A, Gardette E, Deroide F, Jones J. The modified HoVert (mHoVert) method improves diagnostic certainty compared to the St John's protocol for alopecia biopsy specimens: A retrospective single center study. J Cutan Pathol 2023; 50:1099-1103. [PMID: 37203369 DOI: 10.1111/cup.14447] [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: 06/23/2022] [Revised: 03/03/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Access to vertical and transverse sections of a punch biopsy specimen improves the diagnosis of alopecia. Both two biopsy specimen and single-punch biopsy specimen techniques to visualize both transverse and vertical sections have been described. Their comparative diagnostic certainty is not known. We aimed to assess the diagnostic certainty of a modified HoVert (mHoVert) method, without direct immunofluorescence (DIF), compared to the St John's protocol, a two-biopsy technique with DIF. METHODS Fifty-seven cases of alopecia processed using the St John's protocol and 60 cases of alopecia processed using mHoVert were reviewed. Diagnoses made were rated as certain/probable, possible, or uncertain, depending on the language in the histopathology report. Cases processed by the St John's protocol had final diagnosis and DIF result recorded. RESULTS In the mHoVert group, significantly more diagnoses were certain/probable (66%, 95% confidence interval [CI]: 57%-75%), compared to 46% (95% CI: 36%-56%) of diagnoses in the St John's protocol group (p = 0.005). DIF result did not affect the final diagnosis in any of the 57 cases reviewed. CONCLUSIONS DIF is not required in the diagnosis of most cases of alopecia. The mHoVert method provides more certain/probable diagnoses than the St John's protocol and can reduce cost and patient morbidity.
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Affiliation(s)
- Laura Adams
- Royal Free Hospital, London, UK
- Current institution: University Hospitals of Southampton, Southampton, UK
| | - Alexander Amphlett
- Royal Free Hospital, London, UK
- Current institution: St George's University Hospitals Foundation Trust, London, UK
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McIntosh SA, Alam F, Adams L, Boon IS, Callaghan J, Conti I, Copson E, Carson V, Davidson M, Fitzgerald H, Gautam A, Jones CM, Kargbo S, Lakshmipathy G, Maguire H, McFerran K, Mirandari A, Moore N, Moore R, Murray A, Newman L, Robinson SD, Segaran A, Soong CN, Walker A, Wijayaweera K, Atun R, Cutress RI, Head MG. Global funding for cancer research between 2016 and 2020: a content analysis of public and philanthropic investments. Lancet Oncol 2023; 24:636-645. [PMID: 37269844 DOI: 10.1016/s1470-2045(23)00182-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cancer is a leading cause of disease burden globally, with more than 19·3 million cases and 10 million deaths recorded in 2020. Research is crucial to understanding the determinants of cancer and the effects of interventions, and to improving outcomes. We aimed to analyse global patterns of public and philanthropic investment in cancer research. METHODS In this content analysis, we searched the UberResearch Dimensions database and Cancer Research UK data for human cancer research funding awards from public and philanthropic funders between Jan 1, 2016, and Dec 31, 2020. Included award types were project and programme grants, fellowships, pump priming, and pilot projects. Awards focused on operational delivery of cancer care were excluded. Awards were categorised by cancer type, cross-cutting research theme, and research phase. Funding amount was compared with global burden of specific cancers, measured by disability-adjusted life-years, years lived with disability, and mortality using data from the Global Burden of Disease study. FINDINGS We identified 66 388 awards with total investment of about US$24·5 billion in 2016-20. Investment decreased year-on-year, with the largest drop observed between 2019 and 2020. Pre-clinical research received 73·5% of the funding across the 5 years ($18 billion), phase 1-4 clinical trials received 7·4% ($1·8 billion), public health research received 9·4% ($2·3 billion), and cross-disciplinary research received 5·0% ($1·2 billion). General cancer research received the largest investment ($7·1 billion, 29·2% of the total funding). The most highly funded cancer types were breast cancer ($2·7 billion [11·2%]), haematological cancer ($2·3 billion [9·4%]), and brain cancer ($1·3 billion [5·5%]). Analysis by cross-cutting theme revealed that 41·2% of investment ($9·6 billion) went to cancer biology research, 19·6% ($4·6 billion) to drug treatment research, and 12·1% ($2·8 billion) to immuno-oncology. 1·4% of the total funding ($0·3 billion) was spent on surgery research, 2·8% ($0·7 billion) was spent on radiotherapy research, and 0·5% ($0·1 billion) was spent on global health studies. INTERPRETATION Cancer research funding must be aligned with the global burden of cancer with more equitable funding for cancer research in low-income and middle-income countries (which account for 80% of cancer burden), both to support research relevant to these settings, and build research capacity within these countries. There is an urgent need to prioritise investment in surgery and radiotherapy research given their primacy in the treatment of many solid tumours. FUNDING None.
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Affiliation(s)
- Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | | | - Laura Adams
- Department of Oncology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian S Boon
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jonathan Callaghan
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Isabella Conti
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ellen Copson
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Victoria Carson
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Mitchell Davidson
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Ashram Gautam
- Northern Centre for Cancer Care, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Saffron Kargbo
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Gokul Lakshmipathy
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Hannah Maguire
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kathryn McFerran
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Amatta Mirandari
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Natasha Moore
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ross Moore
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Aidan Murray
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Lydia Newman
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen D Robinson
- Sussex Cancer Centre, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Ashvina Segaran
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chin Nam Soong
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Andrew Walker
- Patrick G Johnston Centre for Cancer Research, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kusal Wijayaweera
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rifat Atun
- Department of Global Health & Population, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ramsey I Cutress
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Michael G Head
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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Perkins L, Horita H, Adams L, Marshall W, Lee J, Doucet J, Smith A, Santorelli JE. Inhalation Injury: Which Providers Can Assess the Need for Intubation? J Burn Care Res 2023:7142618. [PMID: 37208913 DOI: 10.1093/jbcr/irad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Previous studies have suggested that many burn patients undergo unnecessary intubation due to concern for inhalation injury. We hypothesized that burn surgeons would intubate burn patients at a lower rate than non-burn acute care surgeons (ACSs). We performed a retrospective cohort study of all patients admitted to an American Burn Association-verified burn center who presented emergently following burn injury from June 2015 to December 2021. Patients excluded include polytrauma patients, isolated friction burns, and patients intubated prior to hospital arrival. Our primary outcome was intubation rates between burn and non-burn ACSs. 388 patients met inclusion criteria. 240 (62%) patients were evaluated by a burn provider and 148 (38%) were evaluated by a non-burn provider; the groups were well-matched. In total, 73 (19%) of patients underwent intubation. There was no difference in the rate of emergent intubation, diagnosis of inhalation injury on bronchoscopy, time to extubation, or incidence of extubation within 48 hours between burn and non-burn ACSs. We found no difference between burn and non-burn ACSs in the airway evaluation and management of burn patients. Surgical providers with acute care surgery backgrounds and Advanced Trauma Life Support training are well-equipped for initial airway management in burn patients. Further studies should seek to compare other types of provider groups to identify opportunities for intervention and education in preventing unnecessary intubations.
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Affiliation(s)
- Louis Perkins
- University of California San Diego, San Diego, California, USA
| | - Henry Horita
- University of California San Diego, San Diego, California, USA
| | - Laura Adams
- University of California San Diego, San Diego, California, USA
| | | | - Jeanne Lee
- University of California San Diego, San Diego, California, USA
| | - Jay Doucet
- University of California San Diego, San Diego, California, USA
| | - Alan Smith
- University of California San Diego, San Diego, California, USA
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Abstract
This Viewpoint discusses the benefits and potential harms of using artificial intelligence (AI) algorithms in medicine and proposes the collaborative creation of a Code of Conduct for AI in Health Care.
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Affiliation(s)
- David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Laura Adams
- National Academy of Medicine, Washington, DC
| | - Peter Embí
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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Kretschmer M, Collins J, Dale AP, Garrett B, Koski L, Zabel K, Staab RN, Turnbow K, Nativio J, Andrews K, Smith WE, Townsend J, Busser N, Will J, Burr K, Jones FK, Santiago GA, Fitzpatrick KA, Ruberto I, Fitzpatrick K, White JR, Adams L, Sunenshine RH. Notes From the Field: First Evidence of Locally Acquired Dengue Virus Infection - Maricopa County, Arizona, November 2022. MMWR Morb Mortal Wkly Rep 2023; 72:290-291. [PMID: 36928186 PMCID: PMC10027408 DOI: 10.15585/mmwr.mm7211a5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Adams L, Nakafero G, Grainge MJ, Card T, Mallen CD, Van-Tam JSN, Williams HC, Abhishek A. Is vaccination against COVID-19 associated with psoriasis or eczema flare? Self-controlled case series analysis using data from the Clinical Practice Research Datalink (Aurum). Br J Dermatol 2023; 188:297-299. [PMID: 36763860 DOI: 10.1093/bjd/ljac061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Laura Adams
- University Hospitals of Derby and Burton, Derby, UK
| | | | | | - Tim Card
- Lifespan and Population Health and.,Nottingham Digestive Diseases Centre, Translational Medical Sciences; School of Medicine, University of Nottingham, Nottingham, UK
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
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Yang R, Adams L, Cooper K, Althaf R, Goei V. Prevalence of disaccharidase deficiencies in children with gastrointestinal symptoms undergoing esophagogastroduodenoscopy (EGD). Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Adams L, Lyons K, Monday J, Larkin E, Wyffels J. Costs of parthenogenesis on growth and longevity in ex situ zebra sharks Stegostoma tigrinum. ENDANGER SPECIES RES 2023. [DOI: 10.3354/esr01224] [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: 01/11/2023] Open
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Blocher R, Liu Y, Adams L, Polejaeva I. 219 Evaluation of mitochondrial quantity and distribution in bovine oocytes matured in cytokine-supplemented medium. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab219] [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: 12/07/2022] Open
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Adams L, Liu Y, Durrant B, Young C, Ruggeri E, Krisher R, Patrick T, Polejaeva I. 21 Quantification of mitochondrial DNA copy number in interspecies somatic cell nuclear transfer embryos. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab21] [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: 12/11/2022] Open
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Nguyen T, Zipparo M, Adams L, Glassey A, Madeen E, Santamaria U, Rehm C, Earhart J, Lau C, Maldarelli F. PP 3.17 – 00211 Genetic Diversity of HIV-1 Long Terminal Repeat in Proviral Populations During Long-Term Antiretroviral Therapy. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100197] [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: 12/24/2022] Open
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Maldarelli F, Nguyen T, Adams L, Zipparo M, Gorelick R, Hewitt S, Rajan S, Rubinstein P, Kanakry J. PP 3.16 – 00209 Prolonged persistence of HIV-infected cells in tissues after allogeneic hematopoietic transplant. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100196] [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: 12/24/2022] Open
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Adams L, Panthagani A, Hamaoui R. 34307 Paleo prurigo. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Adams L, Liu Y, Durrant B, Ruggeri E, Young C, Krisher R, Polejaeva I. Use of Bisection to Reduce Mitochondrial DNA in the Bovine Oocyte. J Vis Exp 2022. [PMID: 35876541 DOI: 10.3791/64060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Interspecies somatic cell nuclear transfer (iSCNT) may be used to rescue endangered species, but two distinct populations of mitochondrial DNA (mtDNA) exist within the reconstructed embryo: one within the recipient ooplasm and one within the donor somatic cell. This mitochondrial heteroplasmy can lead to developmental issues in the embryo and the fetus. Handmade cloning protocols include oocyte bisection, which can be used to decrease the mtDNA copy number, reducing the degree of mitochondrial heteroplasmy in a reconstructed embryo. Centrifugation of denuded, mature bovine oocytes produced a visible mitochondria-dense fraction at one pole of the oocyte. Oocytes' zonae pellucidae were removed by exposure to a pronase solution. Bisection was performed using a microblade to remove the visible mitochondria fraction. qPCR was used to quantify the mtDNA present in DNA samples extracted from whole oocytes and bisected ooplasts, providing a comparison of mtDNA copy numbers before and after bisection. Copy numbers were calculated using cycle threshold values, a standard curve's regression line formula, and a ratio that included the respective sizes of mtDNA PCR products and genomic PCR products. One bovine oocyte had an average mtDNA copy number (± standard deviation) of 137,904 ± 94,768 (n = 38). One mitochondria-depleted ooplast had an average mtDNA copy number of 8,442 ± 13,806 (n = 33). Average mtDNA copies present in a mitochondria-rich ooplast were 79,390 ± 58,526 mtDNA copies (n = 28). The differences between these calculated averages indicate that the centrifugation and subsequent bisection can significantly decrease the mtDNA copy numbers present in the mitochondria-depleted ooplast when compared to the original oocyte (P < 0.0001, determined by one-way ANOVA). The reduction in mtDNA should decrease the degree of mitochondrial heteroplasmy in a reconstructed embryo, possibly fostering standard embryonic and fetal development. Supplementation with mitochondrial extract from the somatic donor cell may also be essential to achieve successful embryonic development.
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Affiliation(s)
- Laura Adams
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University
| | - Ying Liu
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University
| | - Barbara Durrant
- Reproductive Sciences, Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance
| | - Elena Ruggeri
- Reproductive Sciences, Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance
| | - Carly Young
- Reproductive Sciences, Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance
| | | | - Irina Polejaeva
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University;
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Abernethy A, Adams L, Barrett M, Bechtel C, Brennan P, Butte A, Faulkner J, Fontaine E, Friedhoff S, Halamka J, Howell M, Johnson K, Long P, McGraw D, Miller R, Lee P, Perlin J, Rucker D, Sandy L, Savage L, Stump L, Tang P, Topol E, Tuckson R, Valdes K. The Promise of Digital Health: Then, Now, and the Future. NAM Perspect 2022; 2022:10.31478/202206e. [PMID: 36177208 PMCID: PMC9499383 DOI: 10.31478/202206e 10.31478/202206e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lisa Stump
- Yale New Haven Health System and Yale School of Medicine
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Abernethy A, Adams L, Barrett M, Bechtel C, Brennan P, Butte A, Faulkner J, Fontaine E, Friedhoff S, Halamka J, Howell M, Johnson K, Long P, McGraw D, Miller R, Lee P, Perlin J, Rucker D, Sandy L, Savage L, Stump L, Tang P, Topol E, Tuckson R, Valdes K. The Promise of Digital Health: Then, Now, and the Future. NAM Perspect 2022; 2022:10.31478/202206e. [PMID: 36177208 PMCID: PMC9499383 DOI: 10.31478/202206e] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lisa Stump
- Yale New Haven Health System and Yale School of Medicine
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Bressem KK, Adams L, Proft F, Hermann KGA, Diekhoff T, Spiller L, Niehues S, Makowski M, Hamm B, Protopopov M, Rios Rodriguez V, Haibel H, Rademacher J, Torgutalp M, Lambert RG, Baraliakos X, Maksymowych WP, Vahldiek JL, Poddubnyy D. OP0152 A DEEP LEARNING FRAMEWORK FOR MRI DETECTION OF ACTIVE INFLAMMATORY AND STRUCTURAL CHANGES IN THE SACROILIAC JOINT CONSISTENT WITH AXIAL SPONDYLOARTHRITIS: AN INTERNATIONAL COLLABORATIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundMagnetic resonance tomography (MRI) plays a key role in the early diagnosis of axial spondyloarthritis (axSpA). However, the detection of changes indicative of axSpA requires specific expertise, which poses a challenge to non-specialized centers. Deep learning (an advanced machine learning method) based on training an artificial neural network may facilitate and support diagnostics in clinical practice.ObjectivesTo create a reliable deep learning tool for the detection of active inflammatory and structural changes indicative of axSpA on MRI of sacroiliac joints.MethodsIn this study, MRIs of sacroiliac joints from 477 patients from four cohorts (GESPIC-AS, GESPIC-Crohn, GESPIC-Uveitis and OptiRef comprising 266 patients with and 211 without axSpA) were used to develop a deep learning framework (randomly divided into training, n=404, and validation, n=73, datasets). MRIs from the ASAS cohort (n=116) were used for independent testing (test dataset). Each examination in the training/validation dataset was evaluated for the presence of active inflammatory and structural changes indicative of SpA by six experienced, trained and calibrated readers and by seven expert readers in the test dataset. The presence of the changes was defined as the majority vote amongst readers. Discordant cases in the training/validation dataset underwent consensus reading. In addition, the test dataset was evaluated by three radiologists not specifically trained in SpA. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity and specificity.ResultsThe prevalence of positive imaging findings for active inflammatory/structural changes indicative of axSpA was 41%/51% in the training/validation dataset and 22%/22% in the test dataset. The model for the detection of active inflammatory changes showed an AUC of 0.91 (0.83 – 0.97) – Figure 1 – and an accuracy of 84% on the validation dataset; the corresponding sensitivity and specificity were 96% and 76%, respectively. Despite a substantially lower prevalence of active inflammatory changes in the test dataset, the model showed good generalization with an AUC of 0.91 (0.84−0.97) and an accuracy of 75%; the sensitivity and specificity were 88% and 71%, respectively. The model demonstrated a similar performance on the validation and test datasets for the detection of active inflammatory changes fulfilling the ASAS definition. The model for the detection of structural changes indicative of axSpA showed good performance on the validation dataset with an AUC of 0.90 (0.82-0.96) for the detection of structural changes and an overall accuracy of 85%. The associated sensitivity and specificity were 95% and 75%, respectively. The model showed reasonable generalization to new data with an AUC of 0.89 (0.81−0.96) and an accuracy of 79%; the sensitivity and specificity were 85% and 78%, respectively. Overall, the model performed close to the individual human experts - Figure 1.ConclusionThe developed framework allowed the detection of active inflammatory and structural changes indicative of axSpA on MRI. This approach may be used as an assistant tool in the diagnostic workflow.AcknowledgementsGESPIC-AS has been financially supported by the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung - BMBF). GESPIC-Crohn has been supported by the Clinical Research Unit grant from the Berlin Institute of Health (BIH). GESPIC-Uveitis has been supported by a research grant from AbbVie. OptiRef has been supported by a research grant from Novartis. The Assessment of Spondyloarthritis International Society (ASAS) has supported the project with a research grant and provided access to the MRI images of the ASAS calssifiaction cohort.We want to thank colleagues who performed annotation of the images from the ASAS classification cohort: Pedro Machado, Mikkel Ostergaard, Suzanne Juhl Pedersen, Ulrich Weber. Further, we thank Torsten Karge for the development of the MRI reading interface for GESPIC and OptiRef images, Joel Paschke for development of the scoring interface for ASAS images.LCA is grateful for her participation in the BIH Charité–Junior Clinician and Clinician Scientist Program and KKB is grateful for his participation in the BIH Charité Digital Clinician Scientist Program all funded by the Charité–Universitätsmedizin Berlin and the Berlin Institute of Health. JR is grateful for her participation in the BIH Charité–Junior Clinician and Clinician Scientist Program.Disclosure of InterestsNone declared
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Munoz-Jordan J, Cardona J, Beltrán M, Colón C, Schiffer J, Stewart-Clark E, Zellner B, Semenova V, Li Y, Jia LT, Maniatis P, Pawloski L, Adams L, Paz-Bailey G, Rivera-Amill V, Medina F. Evaluation of Serologic Cross-Reactivity Between Dengue Virus and SARS-CoV-2 in Patients with Acute Febrile Illness — United States and Puerto Rico, April 2020–March 2021. MMWR Morb Mortal Wkly Rep 2022; 71:375-377. [PMID: 35271558 PMCID: PMC8912001 DOI: 10.15585/mmwr.mm7110a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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22
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Patella M, Brunelli A, Adams L, Cafarotti S, Costardi L, De Leyn P, Decaluwé H, Franks KN, Fuentes M, Jimenez MF, Karri S, Moons J, Novellis P, Ruffini E, Veronesi G, Voulaz E, Shargall Y. A risk model to predict the delivery of adjuvant chemotherapy following lung resection in patients with pathologically positive lymph nodes. Semin Thorac Cardiovasc Surg 2022; 35:387-398. [PMID: 35272025 DOI: 10.1053/j.semtcvs.2021.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 01/20/2023]
Abstract
To investigate factors associated with the ability to receive adjuvant chemotherapy in patients with pathological N1 and N2 stage after anatomic lung resections for non-small cell lung cancer (NSCLC). Multicenter retrospective analysis on 707 consecutive patients found pathologic N1 (pN1) or N2 (pN2) disease following anatomic lung resections for NSCLC (2014-2019). Multiple imputation logistic regression was used to identify factors associated with adjuvant chemotherapy and to develop a model to predict the probability of starting this treatment. The model was externally validated in a population of 253 patients. In the derivation set, 442 patients were pN1 and 265 pN2. 58% received at least one cycle of adjuvant chemotherapy. The variables significantly associated with the probability of starting chemotherapy after multivariable regression analysis were: younger age (p<0.0001), Body Mass Index (BMI) (p=0.031), Forced Expiratory Volume in 1 second (FEV1) (p=0.037), better performance status (PS) (p<0.0001), absence of chronic kidney disease (CKD) (p=0.016), resection lesser than pneumonectomy (p=0.010). The logit of the prediction model was: 6.58 -0.112 x age +0.039 x BMI +0.009 x FEV1 -0.650 x PS -1.388 x CKD -0.550 x pneumonectomy. The predicted rate of adjuvant chemotherapy in the validation set was 59.2 and similar to the observed one (59%, p=0.87) confirming the model performance in external setting. This study identified several factors associated with the probability of initiating adjuvant chemotherapy after lung resection in node-positive patients. This information can be used during preoperative multidisciplinary meetings and patients counseling to support decision-making process regarding the timing of systemic treatment.
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Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Beckett St, Harehills, Leeds LS9 7TF, Leeds, United Kingdom
| | - Laura Adams
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett St, Harehills, Leeds LS9 7TF, Leeds, UK
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Via Ospedale, 6500, Bellinzona, Switzerland
| | - Lorena Costardi
- Department of Thoracic Surgery, University Hospital of Torino, Città della Salute e della Scienza, Corso Bramante, 88, 10126, Torino, Italy
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Kevin N Franks
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett St, Harehills, Leeds LS9 7TF, Leeds, UK
| | - Marta Fuentes
- Service of Thoracic Surgery, Salamanca University Hospital, IBSAL, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - Marcelo F Jimenez
- Service of Thoracic Surgery, Salamanca University Hospital, IBSAL, Paseo de San Vicente, 58-182, 37007, Salamanca, Spain
| | - Sunanda Karri
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E., Hamilton, ON L8N 4A6, Canada
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Pierluigi Novellis
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano (MI), Italy; Present address: Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy Via Olgettina 58, 20132 Milano
| | - Enrico Ruffini
- Department of Thoracic Surgery, University Hospital of Torino, Città della Salute e della Scienza, Corso Bramante, 88, 10126, Torino, Italy
| | - Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano (MI), Italy; Present address: Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy Via Olgettina 58, 20132 Milano
| | - Emanuele Voulaz
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089, Rozzano (MI), Italy
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E., Hamilton, ON L8N 4A6, Canada
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Paz-Bailey G, Adams L, Wong JM, Poehling KA, Chen WH, McNally V, Atmar RL, Waterman SH. Dengue Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep 2021; 70:1-16. [PMID: 34978547 PMCID: PMC8694708 DOI: 10.15585/mmwr.rr7006a1] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Dengue is a vectorborne infectious disease caused by dengue viruses (DENVs), which are predominantly transmitted by Aedes aegypti and Aedes albopictus mosquitos. Dengue is caused by four closely related viruses (DENV-1–4), and a person can be infected with each serotype for a total of four infections during their lifetime. Areas where dengue is endemic in the United States and its territories and freely associated states include Puerto Rico, American Samoa, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. This report summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of the Dengvaxia vaccine in the United States. The vaccine is a live-attenuated, chimeric tetravalent dengue vaccine built on a yellow fever 17D backbone. Dengvaxia is safe and effective in reducing dengue-related hospitalizations and severe dengue among persons who have had dengue infection in the past. Previous natural infection is important because Dengvaxia is associated with an increased risk for severe dengue in those who experience their first natural infection (i.e., primary infection) after vaccination. Dengvaxia was licensed by the Food and Drug Administration for use among children and adolescents aged 9–16 years (referred to in this report as children). ACIP recommends vaccination with Dengvaxia for children aged 9–16 having evidence of a previous dengue infection and living in areas where dengue is endemic. Evidence of previous dengue infection, such as detection of anti-DENV immunoglobulin G with a highly specific serodiagnostic test, will be required for eligible children before vaccination.
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Adams L, Liu Y, Durrant B, Ruggeri E, Young C, Polejaeva I. 16 Use of a hand-made cloning protocol to reduce oocyte mitochondria. Reprod Fertil Dev 2021; 34:242. [PMID: 35231368 DOI: 10.1071/rdv34n2ab16] [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: 11/23/2022] Open
Affiliation(s)
- L Adams
- Utah State University, Logan, UT, USA
| | - Y Liu
- Utah State University, Logan, UT, USA
| | - B Durrant
- Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance, Escondido, CA, USA
| | - E Ruggeri
- Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance, Escondido, CA, USA
| | - C Young
- Beckman Center for Conservation Research, San Diego Zoo Wildlife Alliance, Escondido, CA, USA
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25
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O'Donnell R, Amos A, Turner SW, Adams L, Henderson T, Lyttle S, Mitchell S, Semple S. 'They only smoke in the house when I'm not in': understanding the limited effectiveness of a smoke-free homes intervention. J Public Health (Oxf) 2021; 43:647-654. [PMID: 32323719 PMCID: PMC8458016 DOI: 10.1093/pubmed/fdaa042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/21/2020] [Revised: 11/14/2019] [Accepted: 01/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Children’s second-hand smoke (SHS) exposure in the home is highest in socio-economically disadvantaged areas. Personalized household air-quality measurements can promote changes in smoking that reduce SHS exposure. The ‘First Steps 2 Smoke-free’ (FS2SF) intervention is the first to trial this approach delivered as part of health professionals’ routine work. This paper reports the findings of qualitative interviews with participants that explored their experiences of the intervention and why outcomes varied. Methods 120 women were recruited from the NHS First Steps Programme, which supports disadvantaged mothers. They received either personalized feedback on their home air quality and advice on reducing SHS or standard SHS advice. Qualitative interviews with 15 mothers were analyzed thematically using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Results The intervention increased women’s capability to change home-smoking behaviour, through increasing awareness and salience of SHS risks to their children, and motivation to act. However, taking effective action was constrained by their limited social and environmental opportunities, including others’ smoking in the home. Conclusions The FS2SF intervention was ineffective as it was unable to fully address the precarious, complex life circumstances that make creating a smoke-free home particularly difficult for women experiencing intersecting dimensions of disadvantage.
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Affiliation(s)
- R O'Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - A Amos
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - S W Turner
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - L Adams
- NHS Lanarkshire, Airdrie ML6 6DB, UK
| | | | - S Lyttle
- NHS Lanarkshire, Hamilton ML3 0TA, UK
| | | | - S Semple
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
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Kadiwar S, Griffiths J, Ailoaei S, Barton B, Samchkuashvili N, Adams L, Browne S, Paynter A, Kempny A, Ernst S. Peripheral vascular access from the arms for invasive cardiac investigation using ultrasound guidance. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Vascular access for invasive cardiac investigations has traditionally been gained from the femoral vessels, however, a “radial-first” approach has become increasingly popular for coronary interventions [1]. Transradial access has shown lower complication rates, shorter admission times, and reduced healthcare costs for coronary interventions [4]. A “superior” approach via the jugular and subclavian veins have been reported for electrophysiology (EP) studies and radiofrequency catheter ablation (RFCA) but is associated with an increased risk of complications such as pneumo- and haemothorax [9].
Purpose
EP procedures often require the use of both venous and arterial catheters, and the potential advantage of non-femoral peripheral access is yet to be investigated. This study was performed to provide comprehensive anatomical evidence that the vessels of the arms are suitable for use during EP procedures, as assessed by vascular ultrasound.
Methods
A portable ultrasound device was used to measure the diameter of the brachial artery, brachial vein, basilic vein & cephalic vein on the left and right upper limbs of 63 healthy adult volunteers. Measurements were also taken of the circumference at the elbow and at the mid-bicep level on both arms. A subgroup of 15 volunteers had additional measurements taken of the same veins and artery on both arms with a tourniquet at the upper bicep level.
Results
The basilic vein was found to have the largest diameter with a median of 4.6 mm and 4.5 mm (right and left diameter, respectively), followed by the cephalic (median of 3.1 and 3.0 mm) and the brachial vein (median of 2.8 mm for both arms). 100% of volunteers had at least one vein that was equal to a 3 mm diameter (which would allow for a 8F sheath insertion), with 98% having 2 suitable veins and >80% having 3 suitable venous vessels. More than 90% had a suitable diameter of more than 3 mm for both the right and left brachial artery. There was significant correlation between gender, and basilic vein and brachial artery diameters. There was no correlation between BMI, height, weight and elbow or bicep circumference.
Conclusion
To our knowledge, this is the first study to investigate the feasibility of adopting peripheral access in the electrophysiology lab. 100% of volunteers examined had one vein which was at least 3mm in size and would be suitable for 8F sheath insertion. We demonstrate the anatomic evidence that the vessels in the arm are capable of housing the size of sheath and catheters commonly used in the EP lab.
Funding Acknowledgement
Type of funding sources: None. Figure 2. measurementsFigure 3. Vessel diameters
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Affiliation(s)
- S Kadiwar
- Royal Brompton Hospital, London, United Kingdom
| | - J Griffiths
- Royal Brompton Hospital, London, United Kingdom
| | - S Ailoaei
- Royal Brompton Hospital, London, United Kingdom
| | - B Barton
- Royal Brompton Hospital, London, United Kingdom
| | | | - L Adams
- Royal Brompton Hospital, London, United Kingdom
| | - S Browne
- Royal Brompton Hospital, London, United Kingdom
| | - A Paynter
- Royal Brompton Hospital, London, United Kingdom
| | - A Kempny
- Royal Brompton Hospital, London, United Kingdom
| | - S Ernst
- Royal Brompton Hospital, London, United Kingdom
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Davis H, Mishra S, Adams L, Culmer C, Shrestha A. 1487 The Pied-Piper, How Gastroenteritis Led Us Astray. Fibromuscular Dysplasia: A Surgical Perspective of a Rare Vascular Disorder. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A 73-year-old female was admitted for abdominal pain after eating an out-of-date pie. She was treated for gastroenteritis for 48hours, after which she became unexpectedly haemodynamically unstable. Computerised Tomography (CT) suggested mesocolic arterial bleed with a large mesenteric haematoma. CT angiography confirmed false aneurysms of the middle colic artery and multiple beading of coeliac branches, small mesenteric vessels and the inferior mesenteric artery. Opinion was sought from multiple specialties, pseudoaneurysm embolisation was undertaken and steroids commenced for presumed vasculitis. Vasculitis screen was negative, and PET CT scan showed no metabolically active vasculitis. It was felt a diagnosis of fibromuscular dysplasia (FMD) was likely. Steroids have been weaned and the patient is under active observation.
Background
FMD is a rare idiopathic condition of abnormal cellular growth in medium/large arterial vessel walls. It has a frequency of approximately 0.02%, predominantly affecting middle-aged Caucasian women. It manifests mostly in renal and cerebrovascular arteries and can present as hypertension or stroke. Complications include aneurysms, stenosis and dissections. Characteristic angiographical finding is a “beads on a string” appearance. There is no current cure, but surgical or interventional involvement by angioplasty and stenting may play a role treatment.
Conclusions
This case elegantly highlights the ambiguity in diagnosis of abdominal pain in a general surgical setting; with a wide variety of differentials spanning multiple specialties, it emphasises the importance to consider rare presentations of equally rare pathologies. It is a celebration of the merits of a multi-disciplinary approach to solve complex clinical questions.
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Affiliation(s)
- H Davis
- William Harvey Hospital, Kent, United Kingdom
| | - S Mishra
- William Harvey Hospital, Kent, United Kingdom
| | - L Adams
- Lewisham University Hospital, London, United Kingdom
| | - C Culmer
- Queen Elizabeth Hospital Woolwich, London, United Kingdom
| | - A Shrestha
- William Harvey Hospital, Kent, United Kingdom
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Lopez-Soto C, Bates E, Anderson C, Saha S, Adams L, Aulakh A, Bowtell F, Buckel M, Emms T, Shebl M, Metaxa V. The Role of a Liaison Team in ICU Family Communication During the COVID 19 Pandemic. J Pain Symptom Manage 2021; 62:e112-e119. [PMID: 33892123 PMCID: PMC8057931 DOI: 10.1016/j.jpainsymman.2021.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT In the name of public safety, a general suspension on hospital visiting was imposed in the U.K., prohibiting family and friends to visit hospitalized patients, even if they were critically ill. OBJECTIVES we aimed to assess the impact of the FLT on the communication with patients' family and friends (PFF), especailly around end-of-life care, and their interaction with CC clinicians. METHODS A retrospective, mixed-methods analysis of a family liaison team (FLT) formed by redeployed clinicians in critical care (CC) during the first surge of the 2020 COVID 19 pandemic. RESULTS The FLT was constituted predominantly of non-ICU consultants (30/39, 77%). Following two one-hourly webinars around basic communication skills, the FLT facilitated over 12,000 video and telephone calls with 172 patients' family and friends (PFF). The majority of the PFF interviewed were mostly, very or extremely satisfied with the frequency, ease, understanding, honesty, completeness, and consistency of the information provided. Approximately 5% of the interviewees reported to be slightly or very dissatisfied in one or more of the following 3 categories: frequency, consistency, and ease of getting the information. The thematic analysis identified 3 themes: 1) being there with/ for the patient; 2) breakdown in communication; 3) disbelief at the speed of deterioration. In 14.9% of cases there was documented discrepancy between the information transmitted by the CC team and that by the FLT, particularly around the severity of the patient's illness and their imminent death. CONCLUSION The formation of a dedicated FLT was feasible and associated with high levels of satisfaction by the PFF. Friction was created when communication was not consistent and did not convey the severity of the patient's condition, to prepare the PFF for a bad outcome.
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Affiliation(s)
- Carmen Lopez-Soto
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Eleanor Bates
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Charlotte Anderson
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Sian Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Laura Adams
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Alex Aulakh
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Francesca Bowtell
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Marie Buckel
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Emms
- Ashford & St Peter's Hospital NHS Trust, Ashford, UK
| | - Moustafa Shebl
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
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Wijs L, Doherty D, Keelan J, Burton P, Yovich J, Beilin L, Mori T, Huang RC, Adams L, Olynyk J, Ayonrinde O, Hart R. O-072 Markers of cardiometabolic health of adolescents conceived through assisted reproductive technologies (ART) appear reassuring. Hum Reprod 2021. [DOI: 10.1093/humrep/deab125.002] [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
Study question
Is the cardiometabolic health of adolescents conceived through ART worse than that of their spontaneously-conceived counterparts?
Summary answer
The majority of cardiometabolic and vascular health parameters of ART-conceived adolescents are more favourable than those of their spontaneously-conceived counterparts of similar age.
What is known already
It has been proposed that ART induces epigenetic alterations during embryonic development which could lead to cardiometabolic disease later in life. However, individuals requiring ART may themselves be metabolically less healthy than the general population, which could lead to a genetically increased risk of cardiometabolic disorders in the offspring, rather than the ART procedure. The literature pertaining to cardiometabolic health of ART-conceived offspring is contradictory, but generally suggests unfavourable cardiometabolic health parameters. With over 8 million children and adults born through ART worldwide, it is imperative to investigate whether early signs of adverse cardiometabolic differences persist into adolescence and beyond.
Study design, size, duration
The Growing Up Healthy Study (GUHS) is a prospective study that recruited 303 ART-conceived adolescents, born 1991-2001 in Western Australia. Their health parameters, including cardiometabolic factors, were assessed and compared with spontaneously conceived counterparts of similar socioeconomic background and age from the Raine Study Generation 2 (Gen2). The 2868 Gen2 participants were born 1989-1992 and are representative of the Western Australian adolescent population. At age 16-17 (2013-2017), GUHS participants replicated assessments previously completed by Gen2.
Participants/materials, setting, methods
Cardiometabolic parameters were compared between 165 GUHS (male = 50.9%) and 1690 Gen2 (male = 49.8%) adolescents. Assessments consisted of a detailed questionnaire; health and demographic parameters, anthropometric assessments; height, weight, body-mass index (BMI), waist circumference and skinfold thickness, fasting serum biochemistry, arterial stiffness and blood pressure assessment using applanation tonometry, assessment of non-alcoholic fatty liver (NAFLD) and thickness of abdominal fat compartments using ultrasonography. Chi2, Fisher’s Exact and Mann-Whitney U tests, performed in SPSS V25, examined cohort differences.
Main results and the role of chance
GUHS adolescents appeared to be healthier from a cardiometabolic perspective than their Gen2 counterparts. They were leaner, with lower BMI (median: 21.23 vs. 22.06, P = 0.004), lower waist circumference (median: 74.10 vs. 76.75 cm, P = 0.031), and thinner skinfolds (triceps median: 12.1 vs. 14.0 mm, P = 0.019, subscapular median: 10.6 vs. 11.9 mm, P < .001, mid-abdominal median: 16.0 vs. 19.9 mm, P < 0.001, supraspinal median: 10.7 vs. 13.5 mm, P < 0.001). No significant differences were detected in the following serum fasting parameters: glucose, insulin, HOMA-IR, LDL cholesterol, total cholesterol, cholesterol/HDL-ratio, triglycerides, CRP and ALT. HDL cholesterol levels were more favourable in GUHS (P < 0.001). NAFLD was present in 10.9% of GUHS vs. 15.2% of Gen2 adolescents (P = 0.174), with no difference in steatosis severity score (P = 0.309). ART offspring had less subcutaneous adipose tissue (median: 8.0 vs. 14.0 mm, P < .001), more visceral adipose tissue (median: 40.0 vs. 32.0 mm, P < 0.001), with no difference in pre-peritoneal adipose tissue (P = 0.087). Measures of arterial stiffness were lower in GUHS. Pulse wave velocity: median 6.1 vs. 6.4 m/s, P < 0.001 and heart rate corrected augmentation index: median -10.25 vs. -8.00, P = 0.006. No significant differences in blood pressure or heart rate were detected. Stratification by sex did not greatly alter the results.
Limitations, reasons for caution
Despite the substantial study size and the unique study design, we were unable to differentiate between different types of ART (e.g. IVF vs. ICSI), draw definite conclusions or relate outcomes to cause of infertility. Given the observational character of this study, causation cannot be proven.
Wider implications of the findings
In this study we did not detect any adverse effect of ART on cardiometabolic health at adolescence, in contrast to some studies. Given the lack of consensus, future well-designed and appropriately-powered studies are necessary to investigate cardiometabolic health in ART adults.
Trial registration number
not applicable
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Affiliation(s)
- L Wijs
- University of Western Australia, Medical School- Division of Obstetrics and Gynaecology, Perth, Australia
| | - D Doherty
- University of Western Australia, Medical School- Division of Obstetrics and Gynaecology and Women and Infants Research Foundation, Perth, Australia
| | - J Keelan
- University of Western Australia, Medical School- Division of Obstetrics and Gynaecology, Perth, Australia
| | - P Burton
- Edith Cowan University, School of Medical and Health Sciences and Concept Fertility Centre, Perth, Australia
| | - J Yovich
- Curtin University, School of Pharmacy and Biomedical Sciences and PIVET Medical Centre, Perth, Australia
| | - L Beilin
- University of Western Australia, Medical School- Division of Internal Medicine, Perth, Australia
| | - T Mori
- University of Western Australia, Medical School- Division of Internal Medicine, Perth, Australia
| | - R C Huang
- University of Western Australia, Centre for Child Health Research and Telethon Kids Institute, Perth, Australia
| | - L Adams
- University of Western Australia, Medical School- Division of Internal Medicine, Perth, Australia
| | - J Olynyk
- Edith Cowan University, School of Medical and Health Sciences and Department of Gastroenterology & Hepatology, Perth, Australia
| | - O Ayonrinde
- University of Western Australia, Medical School- Division of Internal Medicine and Curtin University Faculty of Health Sciences, Perth, Australia
| | - R Hart
- University of Western Australia, Medical School- Division of Obstetrics and Gynaecology and Fertility Specialists of Western Australia, Perth, Australia
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Godfred-Cato S, Newton S, Adams L, Valencia-Prado M, Lake-Burger H, Morrison A, Jones AM, Olson SM, Roth NM, Tong VT, Gilboa SM, Meaney Delman D, Honein MA, Staples JE, Moore CA. Clinical phenotype in infants with negative Zika virus immunoglobulin M testing born to mothers with confirmed Zika virus infection during pregnancy. Birth Defects Res 2021; 113:1267-1274. [PMID: 34327866 DOI: 10.1002/bdr2.1945] [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: 05/17/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recommended testing for both infants with Zika-associated birth defects (i.e., microcephaly and selected brain or eye anomalies) and infants without birth defects whose mothers had laboratory evidence of possible Zika virus (ZIKV) infection during pregnancy includes nucleic acid amplification testing (NAAT) and immunoglobulin M (IgM) testing within days after birth. Brain and eye defects highly specific for congenital ZIKV infection have been described; sporadic reports have documented negative ZIKV testing in such infants. METHODS Infants from the U.S. Zika Pregnancy and Infant Registry and Zika Birth Defects Surveillance with Zika-associated birth defects and maternal and infant laboratory testing for ZIKV and two congenital infections (i.e., cytomegalovirus [CMV] and toxoplasmosis) were reviewed for phenotype and laboratory results. Infants with at least one defect considered highly specific for congenital ZIKV infection were designated as having congenital Zika syndrome (CZS) clinical phenotype for this study. RESULTS Of 325 liveborn infants with Zika-associated birth defects and laboratory evidence of maternal ZIKV infection, 33 (10%) had CZS clinical phenotype; 172 (53%) had ZIKV IgM testing with negative or no ZIKV NAAT. ZIKV IgM was negative in the remaining 121 infants, and for 90%, testing for CMV and toxoplasmosis was missing/incomplete. Among 11 infants testing negative for ZIKV IgM, CMV, and toxoplasmosis, 2 infants had CZS clinical phenotype. CONCLUSIONS These data add support to previous reports of negative ZIKV IgM testing in infants with clear maternal and phenotypic evidence of congenital ZIKV infection. Follow-up care consistent with the diagnosis is recommended regardless of infant ZIKV test results.
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Affiliation(s)
- Shana Godfred-Cato
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | | | - Laura Adams
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia, USA
| | - Miguel Valencia-Prado
- Children with Special Medical Needs Division, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Heather Lake-Burger
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Andrea Morrison
- Division of Disease Control and Health Protection, Florida Department of Health, Tallahassee, Florida, USA
| | - Abbey M Jones
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Samantha M Olson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Nicole M Roth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Dana Meaney Delman
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Margaret A Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Jennifer Erin Staples
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia, USA
| | - Cynthia A Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
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Bonaparte SC, Adams L, Bakamutumaho B, Barbosa Costa G, Cleaton JM, Gilbert AT, Osinubi M, Pieracci EG, Recuenco S, Tugumizemu V, Wamala J, Wallace RM. Rabies post-exposure healthcare-seeking behaviors and perceptions: Results from a knowledge, attitudes, and practices survey, Uganda, 2013. PLoS One 2021; 16:e0251702. [PMID: 34077427 PMCID: PMC8171952 DOI: 10.1371/journal.pone.0251702] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/02/2021] [Indexed: 12/11/2022] Open
Abstract
Background Rabies is a viral disease of animals and people causing fatal encephalomyelitis if left untreated. Although effective pre- and post-exposure vaccines exist, they are not widely available in many endemic countries within Africa. Since many individuals in these countries remain at risk of infection, post-exposure healthcare-seeking behaviors are crucial in preventing infection and warrant examination. Methodology A rabies knowledge, attitudes, and practices survey was conducted at 24 geographically diverse sites in Uganda during 2013 to capture information on knowledge concerning the disease, response to potential exposure events, and vaccination practices. Characteristics of the surveyed population and of the canine-bite victim sub-population were described. Post-exposure healthcare-seeking behaviors of canine-bite victims were examined and compared to the related healthcare-seeking attitudes of non-bite victim respondents. Wealth scores were calculated for each household, rabies knowledge was scored for each non-bitten survey respondent, and rabies exposure risk was scored for each bite victim. Logistic regression was used to determine the independent associations between different variables and healthcare-seeking behaviors among canine-bite victims as well as attitudes of non-bitten study respondents. Results A total of 798 households were interviewed, capturing 100 canine-bite victims and a bite incidence of 2.3 per 100 person-years. Over half of bite victims actively sought medical treatment (56%), though very few received rabies post-exposure prophylaxis (3%). Bite victims who did not know or report the closest location where PEP could be received were less likely to seek medical care (p = 0.05). Respondents who did not report having been bitten by a dog with higher knowledge scores were more likely to respond that they would both seek medical care (p = 0.00) and receive PEP (p = 0.06) after a potential rabies exposure event. Conclusions There was varying discordance between what respondents who did not report having been bitten by a dog said they would do if bitten by a dog when compared to the behaviors exhibited by canine-bite victims captured in the KAP survey. Bite victims seldom elected to wash their wound or receive PEP. Having lower rabies knowledge was a barrier to theoretically seeking care and receiving PEP among not bitten respondents, indicating a need for effective and robust educational programs in the country.
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Affiliation(s)
- Sarah C. Bonaparte
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- ORISE Fellow, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Laura Adams
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Galileu Barbosa Costa
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- ORISE Fellow, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Julie M. Cleaton
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- ORISE Fellow, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy T. Gilbert
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Modupe Osinubi
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Emily G. Pieracci
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sergio Recuenco
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Tugumizemu
- Veterinary Public Health Division, Ministry of Health, Kampala, Uganda
| | | | - Ryan M. Wallace
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, National Center of Emerging and Zoonotic Infectious Diseases, United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Murthy BP, Sterrett N, Weller D, Zell E, Reynolds L, Toblin RL, Murthy N, Kriss J, Rose C, Cadwell B, Wang A, Ritchey MD, Gibbs-Scharf L, Qualters JR, Shaw L, Brookmeyer KA, Clayton H, Eke P, Adams L, Zajac J, Patel A, Fox K, Williams C, Stokley S, Flores S, Barbour KE, Harris LQ. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-April 10, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:759-764. [PMID: 34014911 PMCID: PMC8136424 DOI: 10.15585/mmwr.mm7020e3] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lee FC, Adams L, Graves SJ, Massetti GM, Calanan RM, Penman-Aguilar A, Henley SJ, Annor FB, Van Handel M, Aleshire N, Durant T, Fuld J, Griffing S, Mattocks L, Liburd L. Counties with High COVID-19 Incidence and Relatively Large Racial and Ethnic Minority Populations - United States, April 1-December 22, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:483-489. [PMID: 33793463 PMCID: PMC8022874 DOI: 10.15585/mmwr.mm7013e1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Rodríguez DM, Ryff K, Sánchez-Gonzalez L, Rivera-Amill V, Paz-Bailey G, Adams L. HTrack: A new tool to facilitate public health field visits and electronic data capture. PLoS One 2020; 15:e0244028. [PMID: 33320896 PMCID: PMC7737954 DOI: 10.1371/journal.pone.0244028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Many applications have been developed for electronic data collection. However, offline field navigation tools incorporating secure electronic data capture and field visit tracking are currently scarce. We created an R-Shiny application, HTrack (Household Tracking), for use on encrypted Android devices in the field. The application was implemented in the Communities Organized to Prevent Arboviruses (COPA) project, a study beginning in 2018 to better understand arboviral disease incidence in 38 communities in Puerto Rico. The application was used to navigate to randomly selected structures and capture visit outcomes after conducting multiple visits for participant recruitment. It also served as a bridge to an alternate software, Epi Info, to collect participant-level questionnaire data. This application successfully captured each visit outcome and improved the logistics of field level activities for the COPA project, eliminating the use of paper maps for navigation. We show the development of HTrack and comment on the limitations and strengths of this application and further improvements.
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Affiliation(s)
- Dania M. Rodríguez
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
- * E-mail:
| | - Kyle Ryff
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Liliana Sánchez-Gonzalez
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Gabriela Paz-Bailey
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Laura Adams
- Division of Vector Borne Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Abstract
Extracranial internal carotid artery (ICA) aneurysms account for <1.0% all aneurysms and a rare indication for carotid intervention. Causes include atherosclerotic degeneration, trauma, dissection, previous carotid surgery, connective tissue disorders, and infection. Authors report a case of a middle-aged male found to have a large aneurysm of the left ICA who underwent repair by resection and reconstruction with end-to-end anastomosis under neuroprotection with flow reversal. Our discussion includes a recommendation for this particular surgical repair. The patient in this case report has granted the authors consent for review of records and subsequent publication submission.
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Affiliation(s)
- Dipankar Mukherjee
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Devon T Collins
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Laura Adams
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
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Santosh P, Singh J, Adams L, Mastroianni M, Heaney N, Lievesley K, Sagar-Ouriaghli I, Allibrio G, Appleton R, Davidović N, de Girolamo G, Dieleman G, Dodig-Ćurković K, Franić T, Gatherer C, Gerritsen S, Gheza E, Madan J, Manenti L, Maras A, Margari F, McNicholas F, Pastore A, Paul M, Purper-Ouakil D, Rinaldi F, Sakar V, Schulze U, Signorini G, Street C, Tah P, Tremmery S, Tuffrey A, Tuomainen H, Verhulst F, Warwick J, Wilson A, Wolke D, Fiori F, Singh S. Validation of the Transition Readiness and Appropriateness Measure (TRAM) for the Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare in Europe (MILESTONE) study. BMJ Open 2020; 10:e033324. [PMID: 32580979 PMCID: PMC7312331 DOI: 10.1136/bmjopen-2019-033324] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Young people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16-18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person's readiness for transition, and their outcomes at the transfer boundary. DESIGN MILESTONE prospective study. SETTING Eight European Union (EU) countries participating in the EU-funded MILESTONE study. PARTICIPANTS The first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised trial) involved over 1000 young people. RESULTS The development of the TRAM began with a literature review on transitioning and a review of important items regarding transition by a panel of 34 mental health experts. A list of 64 items of potential importance were identified, which together comprised the TRAM. The psychometric properties of the different versions of the TRAM were evaluated and showed that the TRAM had good reliability for all versions and low-to-moderate correlations when compared with other established instruments and a well-defined factor structure. The main results of the cohort study with the nested cluster randomised trial are not reported. CONCLUSION The TRAM is a reliable instrument for assessing transition readiness and appropriateness. It highlighted the barriers to a successful transition and informed clinicians, identifying areas which clinicians on both sides of the transfer boundary can work on to ease the transition for the young person. TRIAL REGISTRATION NUMBER ISRCTN83240263 (Registered 23 July 2015), NCT03013595 (Registered 6 January 2017); Pre-results.
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Affiliation(s)
- Paramala Santosh
- Child and Adolescent Psychiatry, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker, Gillingham, UK
| | - Jatinder Singh
- Child and Adolescent Psychiatry, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK
| | - Laura Adams
- School of Psychology, University of Plymouth, Plymouth, Devon, UK
| | - Mathilde Mastroianni
- Child and Adolescent Psychiatry, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK
| | - Natalie Heaney
- Child and Adolescent Psychiatry, King's College London, London, UK
| | | | | | - Giovanni Allibrio
- Unit of Neuropsychiatry, ASST Spedali Civili di Brescia Dipartimento di Salute Mentale, Brescia, Lombardia, Italy
| | - Rebecca Appleton
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Nikolina Davidović
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | | | - Tomislav Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Charlotte Gatherer
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Elisa Gheza
- Neuropsychiatry Service of Childhood and Adolescence, Mental Health Department, ASST della Valcamonica, Breno, Lombardia, Italy
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Coventry, UK
| | - Lidia Manenti
- Unit of Neuropsychiatry, ASST Spedali Civili di Brescia Dipartimento di Salute Mentale, Brescia, Lombardia, Italy
| | - Athanasios Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
- Yulius Academy, Rotterdam, The Netherlands
| | - Francesco Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Puglia, Italy
| | - Fiona McNicholas
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
- Geary Institute, University College Dublin, Dublin, Ireland
- Department of Child Psychiatry, Our Lady's Hospital For Sick Children, Crumlin, Ireland
- Lucena Clinic, Saint John of God Hospitaller Services, Dublin, Ireland
| | - Adriana Pastore
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Puglia, Italy
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, Coventry, UK
| | - Diane Purper-Ouakil
- Psychological Medicine for Children and Adolescents, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Francesco Rinaldi
- Neuropsychiatry Service of Childhood and Adolescence, Mental Health Department, ASST della Valcamonica, Breno, Lombardia, Italy
| | - Vehbi Sakar
- Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, Universitatsklinikum Ulm, Ulm, Baden-Württemberg, Germany
| | - Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Priya Tah
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Amanda Tuffrey
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frank Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Coventry, UK
| | - Anna Wilson
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Dieter Wolke
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, University of Warwick, Warwick, UK
| | - Federico Fiori
- Child and Adolescent Psychiatry, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker, Gillingham, UK
| | - Swaran Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, Coventry, UK
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Rosenberg ES, Doyle K, Munoz-Jordan JL, Klein L, Adams L, Lozier M, Weiss K, Sharp TM, Paz-Bailey G. Prevalence and Incidence of Zika Virus Infection Among Household Contacts of Patients With Zika Virus Disease, Puerto Rico, 2016-2017. J Infect Dis 2020; 220:932-939. [PMID: 30544195 DOI: 10.1093/infdis/jiy689] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/12/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Little is known about the prevalence or incidence of Zika virus (ZIKV) infection in settings affected by the 2015-2016 Zika pandemic and associated risk factors. We assessed these factors among household contacts of patients with ZIKV disease enrolled in a cohort study in Puerto Rico during 2016-2017. METHODS Household contacts of index case patients completed a questionnaire and gave specimens for real-time polymerase chain reaction (RT-PCR) and immunoglobulin M enzyme-linked immunosorbent assay testing to detect ZIKV infection. We measured the prevalence of ZIKV infection among contacts and associated individual and household factors, examined sexual transmission using a sexual-networks approach, and assessed incident infection among initially uninfected household contacts 2-4 months later. RESULTS Of 366 contacts, 34.4% had evidence of ZIKV infection at enrollment, including 11.2% by RT-PCR. Having open doors and windows that were either screened (prevalence ratio [PR], 2.1 [95% confidence interval {CI}, 1.2-3.6]) or unscreened (PR, 2.5 [95% CI, 1.5-4.1]) was associated with increased prevalence. Sexual partners were more likely to both be RT-PCR positive relative to other relationships (odds ratio, 2.2 [95% CI, 1.1-4.5]). At follow-up, 6.1% of contacts had evidence of incident infection. CONCLUSIONS This study identified sexual contact as a risk factor for ZIKV infection. Persons living with ZIKV-infected individuals should be a focus of public health efforts.
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Affiliation(s)
- Eli S Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer
| | - Kate Doyle
- National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jorge L Munoz-Jordan
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Liore Klein
- Oak Ridge Institute for Science and Education, Tennessee
| | - Laura Adams
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Matthew Lozier
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Kevin Weiss
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Tyler M Sharp
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Gabriela Paz-Bailey
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Curren EJ, Venkat H, Sunenshine R, Fitzpatrick K, Kosoy O, Krow-Lucal E, Zabel K, Adams L, Kretschmer M, Fischer M, Hills SL. Assessment of Immunoglobulin M Enzyme-Linked Immunosorbent Assay Ratios to Identify West Nile Virus and St. Louis Encephalitis Virus Infections During Concurrent Outbreaks of West Nile Virus and St. Louis Encephalitis Virus Diseases, Arizona 2015. Vector Borne Zoonotic Dis 2020; 20:619-623. [PMID: 32315576 DOI: 10.1089/vbz.2019.2571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are closely related mosquito-borne flaviviruses that cause clinical disease ranging from febrile illness to encephalitis. The standard for serological diagnosis is immunoglobulin M (IgM) testing followed by confirmatory plaque reduction neutralization test (PRNT) to differentiate the infecting virus. However, the PRNT is time-consuming and requires manipulation of live virus. During concurrent WNV and SLEV outbreaks in Arizona in 2015, we assessed use of a diagnostic algorithm to simplify testing. It incorporated WNV and SLEV ratios based on positive-to-negative (P/N) values derived from the IgM antibody-capture enzyme-linked immunosorbent assay. We compared each sample's ratio-based result with the confirmed WNV or SLEV sample result indicated by PRNT or PCR testing. We analyzed data from 70 patients with 77 serum and cerebrospinal fluid samples, including 53 patients with confirmed WNV infection and 17 patients with confirmed SLEV infection. Both WNV and SLEV ratios had specificity ≥95%, indicating a high likelihood that each ratio was correctly identifying the infecting virus. The SLEV ratio sensitivity of 30% was much lower than the WNV ratio sensitivity of 91%, likely because of higher cross-reactivity of SLEV antibodies and generation of lower P/N values. The standard for serological diagnosis of WNV and SLEV infections remains IgM testing followed by PRNT. However, these results suggest the ratios could potentially be used as part of a diagnostic algorithm in outbreaks to substantially reduce the need for PRNTs.
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Affiliation(s)
- Emily J Curren
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Heather Venkat
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Maricopa County Department of Public Health, Phoenix, Arizona, USA.,Arizona Department of Health Services, Phoenix, Arizona, USA
| | | | | | - Olga Kosoy
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Elisabeth Krow-Lucal
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen Zabel
- Maricopa County Department of Public Health, Phoenix, Arizona, USA
| | - Laura Adams
- Arizona Department of Health Services, Phoenix, Arizona, USA
| | | | - Marc Fischer
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Susan L Hills
- Arboviral Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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Santosh P, Adams L, Fiori F, Davidović N, de Girolamo G, Dieleman GC, Franić T, Heaney N, Lievesley K, Madan J, Maras A, Mastroianni M, McNicholas F, Paul M, Purper-Ouakil D, Sagar-Ouriaghli I, Schulze U, Signorini G, Street C, Tah P, Tremmery S, Tuomainen H, Verhulst FC, Warwick J, Wolke D, Singh J, Singh SP. Protocol for the development and validation procedure of the managing the link and strengthening transition from child to adult mental health care (MILESTONE) suite of measures. BMC Pediatr 2020; 20:167. [PMID: 32299401 PMCID: PMC7161143 DOI: 10.1186/s12887-020-02079-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address the significant socioeconomic and societal challenge related to the transition process. This protocol paper describes the development of two MILESTONE transition-related measures: The Transition Readiness and Appropriateness Measure (TRAM), designed to be a decision-making aide for clinicians, and the Transition Related Outcome Measure (TROM), for examining the outcome of transition. Methods The TRAM and TROM have been developed and were validated following the US FDA Guidance for Patient-reported Outcome Measures which follows an incremental stepwise framework. The study gathers information from service users, parents, families and mental health care professionals who have experience working with young people undergoing the transition process from eight European countries. Discussion There is an urgent need for comprehensive measures that can assess transition across the CAMHS/AMHS boundary. This study protocol describes the process of development of two new transition measures: the TRAM and TROM. The TRAM has the potential to nurture better transitions as the findings can be summarised and provided to clinicians as a clinician-decision making support tool for identifying cases who need to transition and the TROM can be used to examine the outcomes of the transition process. Trial registration MILESTONE study registration: ISRCTN83240263 Registered 23-July-2015 - ClinicalTrials.gov NCT03013595 Registered 6 January 2017.
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Affiliation(s)
- P Santosh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK. .,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK. .,HealthTracker Ltd, Gillingham, Kent, UK.
| | - L Adams
- School of Psychology, Plymouth University, Plymouth, UK
| | - F Fiori
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.,HealthTracker Ltd, Gillingham, Kent, UK
| | - N Davidović
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - G de Girolamo
- Unità di Psichiatria Epidemiologica e Valutativa, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - T Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - N Heaney
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - K Lievesley
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - A Maras
- Yulius Academy, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Mastroianni
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - F McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland.,Geary Institute, University College Dublin, Dublin, Republic of Ireland.,Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland.,Lucena Clinic, SJOG, Dublin, Republic of Ireland
| | - M Paul
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D Purper-Ouakil
- CHU Montpellier / University of Montpellier; Saint Eloi Hospital, Médecine Psychlogique de l'enfant et de adolescent (MPEA1), Montpellier, France
| | - I Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - U Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - G Signorini
- Unità di Psichiatria Epidemiologica e Valutativa, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - C Street
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - P Tah
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - S Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium.,Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - H Tuomainen
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - F C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - D Wolke
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Department of Psychology, University of Warwick, Coventry, UK
| | - J Singh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - S P Singh
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
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Venkat H, Krow-Lucal E, Kretschmer M, Sylvester T, Levy C, Adams L, Fitzpatrick K, Laven J, Kosoy O, Sunenshine R, Smith K, Townsend J, Chevinsky J, Hennessey M, Jones J, Komatsu K, Fischer M, Hills S. Comparison of Characteristics of Patients with West Nile Virus or St. Louis Encephalitis Virus Neuroinvasive Disease During Concurrent Outbreaks, Maricopa County, Arizona, 2015. Vector Borne Zoonotic Dis 2020; 20:624-629. [PMID: 32251616 DOI: 10.1089/vbz.2019.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are closely related mosquito-borne flaviviruses that can cause neuroinvasive disease. No concurrent WNV and SLEV disease outbreaks have previously been identified. When concurrent outbreaks occurred in 2015 in Maricopa County, Arizona, we collected data to describe the epidemiology, and to compare features of patients with WNV and SLEV neuroinvasive disease. We performed enhanced case finding, and gathered information from medical records and patient interviews. A case was defined as a clinically compatible illness and laboratory evidence of WNV, SLEV, or unspecified flavivirus infection in a person residing in Maricopa County in 2015. We compared demographic and clinical features of WNV and SLEV neuroinvasive cases; for this analysis, a case was defined as physician-documented encephalitis or meningitis and a white blood cell count >5 cells/mm3 in cerebrospinal fluid. In total, we identified 82 cases, including 39 WNV, 21 SLEV, and 22 unspecified flavivirus cases. The comparative analysis included 21 WNV and 14 SLEV neuroinvasive cases. Among neuroinvasive cases, the median age of patients with SLEV (63 years) was higher than WNV (52 years). Patients had similar symptoms; rash was identified more frequently in WNV (33%) neuroinvasive cases than in SLEV (7%) cases, but this difference was not statistically significant (p = 0.11). In summary, during the first known concurrent WNV and SLEV disease outbreaks, no specific clinical features were identified that could differentiate between WNV and SLEV neuroinvasive cases. Health care providers should consider both infections in patients with aseptic meningitis or encephalitis.
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Affiliation(s)
- Heather Venkat
- Arizona Department of Health Services, Phoenix, Arizona, USA.,Maricopa County Department of Public Health, Phoenix, Arizona, USA.,Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elisabeth Krow-Lucal
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | | | - Tammy Sylvester
- Maricopa County Department of Public Health, Phoenix, Arizona, USA
| | - Craig Levy
- Maricopa County Department of Public Health, Phoenix, Arizona, USA
| | - Laura Adams
- Arizona Department of Health Services, Phoenix, Arizona, USA.,Career Epidemiology Field Officer Program, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn Fitzpatrick
- Arizona State Public Health Laboratory, Arizona Department of Health Services, Phoenix, Arizona, USA
| | - Janeen Laven
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Olga Kosoy
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Rebecca Sunenshine
- Maricopa County Department of Public Health, Phoenix, Arizona, USA.,Career Epidemiology Field Officer Program, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kirk Smith
- Vector Control Division, Maricopa County Environmental Services Department, Phoenix, Arizona, USA
| | - John Townsend
- Vector Control Division, Maricopa County Environmental Services Department, Phoenix, Arizona, USA
| | - Jennifer Chevinsky
- Epidemiology Elective Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Morgan Hennessey
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Jefferson Jones
- Arizona Department of Health Services, Phoenix, Arizona, USA.,Maricopa County Department of Public Health, Phoenix, Arizona, USA.,Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ken Komatsu
- Arizona Department of Health Services, Phoenix, Arizona, USA
| | - Marc Fischer
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Susan Hills
- Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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Sarris J, Murphy J, Stough C, Mischoulon D, Bousman C, MacDonald P, Adams L, Nazareth S, Oliver G, Cribb L, Savage K, Menon R, Chamoli S, Berk M, Ng CH, Byrne GJ. S-Adenosylmethionine (SAMe) monotherapy for depression: an 8-week double-blind, randomised, controlled trial. Psychopharmacology (Berl) 2020; 237:209-218. [PMID: 31712971 DOI: 10.1007/s00213-019-05358-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/02/2019] [Indexed: 02/07/2023]
Abstract
RATIONALE Dysregulation of the one carbon cycle is documented in depression. Thereby, S-adenosylmethionine (SAMe), a one-carbon cycle nutraceutical compound with a favourable side effect profile, has a theoretical rationale for efficacy. However, further controlled studies are required to confirm SAMe's efficacy. OBJECTIVES To test the efficacy of SAMe versus placebo in unmedicated DSM-5 diagnosed (major depressive disorder) (MDD) patients with mild-to-moderate levels of depressive symptoms. METHODS We conducted an 8-week, double-blind, randomised controlled trial testing 800 mg/day of SAMe monotherapy versus placebo in 49 patients with MDD (Montgomery-Åsberg Depression Rating Scale [MADRS] score 14-25) who were not currently taking antidepressants. One-carbon cycle biomarkers, brain-derived neurotropic factor (BDNF), and relevant single nucleotide polymorphisms (SNPs) were analysed as potential treatment moderators. RESULTS A clinically relevant differential reduction from baseline to week 8 of 3.76 points occurred on the primary outcome (MADRS) in favour of SAMe. This however was not significant (p = 0.13) on an adjusted linear mixed model, notwithstanding a medium to large effect size of 0.72. A high placebo response rate of 53% occurred (> 50% reduction on MADRS). Exploratory analyses showed that SAMe was however effective in reducing depression amongst participants with milder depression severity (MADRS ≤ 22, p = 0.045). Response was not moderated by BDNF, SNPs, or one-carbon cycle biomarkers, although increased folate concentrations were correlated with improved symptoms in the SAMe group (r = - 0.57, p = 0.026). The treatment was safe and well tolerated. CONCLUSIONS Although a differential reduction in depression symptoms between groups was observed in favour of SAMe, the results of this pilot study were not statistically significant. TRIAL REGISTRATION ANZCTR-Australian New Zealand Clinical Trials Registry; No.: ACTRN12613001299796; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364900.
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Affiliation(s)
- Jerome Sarris
- NICM Health Research Institute, Westmead, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia.
| | - Jenifer Murphy
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - David Mischoulon
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chad Bousman
- Departments of Medical Genetics, Psychiatry, and Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
| | - Patricia MacDonald
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
| | - Laura Adams
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
| | - Sonia Nazareth
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
| | - Georgina Oliver
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Lachlan Cribb
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Karen Savage
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Ranjit Menon
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Suneel Chamoli
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
| | - Michael Berk
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
- IMPACT SRC, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
- Orygen, The Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Chee H Ng
- Professorial Unit, The Melbourne Clinic, Department of Psychiatry, Melbourne University, Melbourne, Australia
| | - Gerard J Byrne
- Faculty of Medicine, Discipline of Psychiatry, Centre for Clinical Research, Royal Brisbane & Women's Hospital, Herston, The University of Queensland, Brisbane, Australia
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Smith D, Adams L, du Randt R, Degen J, Gall S, Joubert N, Müller I, Nqweniso S, Pühse U, Steinmann P, Utzinger J, Walter C, Gerber M. Physical fitness and nutritional anthropometric status of children from disadvantaged communities in the Nelson Mandela Bay region. S Afr J Sports Med 2020; 32:v32i1a8158. [PMID: 36818972 PMCID: PMC9924534 DOI: 10.17159/2078-516x/2020/v32i1a8158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Information about the relationships between physical fitness, body composition and nutrition has increased in recent years; however, little is known about physical fitness and the coexistence of under-/overnutrition among children living in disadvantaged areas. Objectives To determine the physical fitness status and its association with body composition, growth and selected socio-demographics in primary schoolchildren from disadvantaged communities in the Nelson Mandela Bay region. Methods Nine hundred and sixty-five children (49% girls, M=9.5 years) participated in this cross-sectional study. Height and weight were measured to establish body mass index, and height-for-age z-scores. Physical fitness was assessed using tests from the Eurofit Physical Fitness test battery (flexibility, upper/lower body muscular strength and cardiorespiratory fitness). Between-group differences and cross-sectional associations were examined with univariate (Chi2-tests, analyses of variance) and multivariate methods (mixed linear/logistic regression). Results Most children had normal weight (76.7%), while 4.5% were underweight and 18.7% were overweight/obese. Underweight children and children with stunted growth (11.5%) had lower average upper body strength (p<0.001). Overweight/obese children had lower scores in weight-bearing activities (p<0.001). Children with higher socio-economic status were more likely to be overweight and obese (p<0.001). In the multivariate analyses, sex, age, body mass index, and stunting were associated with children's physical fitness. Conclusion Fitness assessments seem to be a relevant measure of the current health status of children in disadvantaged settings. Compared to international norms, the children in this study had relatively low scores for both upper- and lower body muscular strength. Therefore, effective school-based intervention programmes should be developed to improve children's physical fitness in disadvantaged schools.
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Affiliation(s)
- D Smith
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth,
South Africa
| | - L Adams
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth,
South Africa
| | - R du Randt
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth,
South Africa
| | - J Degen
- Department of Sport, Exercise and Health, University of Basel, Basel,
Switzerland
| | - S Gall
- Department of Sport, Exercise and Health, University of Basel, Basel,
Switzerland
| | - N Joubert
- Swiss Tropical and Public Health Institute, Basel,
Switzerland,University of Basel, Basel,
Switzerland
| | - I Müller
- Department of Sport, Exercise and Health, University of Basel, Basel,
Switzerland,Swiss Tropical and Public Health Institute, Basel,
Switzerland
| | - S Nqweniso
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth,
South Africa
| | - U Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel,
Switzerland
| | - P Steinmann
- Swiss Tropical and Public Health Institute, Basel,
Switzerland,University of Basel, Basel,
Switzerland
| | - J Utzinger
- Swiss Tropical and Public Health Institute, Basel,
Switzerland,University of Basel, Basel,
Switzerland
| | - C Walter
- Department of Human Movement Science, Nelson Mandela University, Port Elizabeth,
South Africa
| | - M Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel,
Switzerland
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Adams L, Creamer D. Controlling oral hemorrhages in Steven-Johnson syndrome/toxic epidermal necrolysis. J Am Acad Dermatol 2019; 82:e3-e4. [PMID: 31279017 DOI: 10.1016/j.jaad.2019.06.1299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 11/26/2022]
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Murphy R, Adams L, Brown A, Cleator C, Gurjal D, Stebbing J, Kenny L, Rehman F. Impact of Routine Use of CDK4/6 Inhibitor Therapy on Breast Cancer Outpatient Clinic Workload and Patient Experience. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2019.03.029] [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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Venkat H, Yaglom HD, Adams L. Knowledge, attitudes, and practices relevant to zoonotic disease reporting and infection prevention practices among veterinarians - Arizona, 2015. Prev Vet Med 2019; 169:104711. [PMID: 31311640 DOI: 10.1016/j.prevetmed.2019.104711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/27/2022]
Abstract
Veterinarians play a crucial role in zoonotic disease detection in animals and prevention of disease transmission; reporting these zoonoses to public health officials is an important first step to protect human and animal health. Evidence suggests veterinarians and their staff are at higher risk for exposure to zoonoses because of possible interactions with infected animals. We examined the knowledge, attitudes, and practices of veterinarians regarding zoonotic disease reporting to public health agencies and associated infection prevention (IP) practices such as personal protective equipment (PPE) use, and the need for targeted education and outreach for veterinarians in Arizona. An online questionnaire was developed and distributed by email in September 2015 and was available through November 2015 to all 1,100 members of the Arizona Veterinary Medical Association. Chi-square and logistic regression analyses were performed. In total, 298 (27%) veterinarians from all 15 Arizona counties completed the survey; the majority (70%) were female, practiced small animal medicine (84%), and reported practicing veterinary medicine for ≥10 years (75%). Only 57% reported they knew when to report a suspected zoonotic disease and 60% reported they knew how to make that type of report. The majority said they would report rabies (97%), plague (96%), and highly pathogenic avian influenza (91%) to a state agency. Most respondents reported using PPE (e.g., masks, face shields, and gloves) when performing a surgical procedure (96%) or necropsy (94%), although fewer reported using PPE for handling clinically ill animals (37%) or healthy animals (17%). Approximately 70% reported always using PPE when in contact with animal birthing fluids, urine, or feces, and 47% for contact with animal blood, saliva, or other body fluids. Veterinarians who agreed that they knew the appropriate actions to protect themselves from zoonotic disease exposures were more likely to report always washing their hands before eating or drinking at work (OR = 3.81, 95% confidence interval (CI) [1.97-7.35], P < 0.01). Responses for when to make a report and how to report were not significantly different by gender, years of practice, or holding additional degrees, but did differ by practice type, age, and number of veterinarians in the practice. Small animal veterinarians were less likely to report knowing when to make a report compared to other veterinarians (P < 0.01). Respondents demonstrated suboptimal zoonotic disease reporting and IP practices, including PPE use. Public health agencies should improve outreach and education to veterinarians to facilitate better zoonotic disease prevention practices and reporting.
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Affiliation(s)
- Heather Venkat
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA; Arizona Department of Health Services, 150 N 18th Ave Suite 140, Phoenix, AZ, 85007, USA; Career Epidemiology Field Officer, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA.
| | - Hayley D Yaglom
- Arizona Department of Health Services, 150 N 18th Ave Suite 140, Phoenix, AZ, 85007, USA.
| | - Laura Adams
- Arizona Department of Health Services, 150 N 18th Ave Suite 140, Phoenix, AZ, 85007, USA; Career Epidemiology Field Officer, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, USA.
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Ruberto I, Yaglom H, Erhart LM, Plante L, Weiss J, Golenko C, Casal M, McCotter O, Adams L, Ernst K, Komatsu K. Dengue Knowledge, Attitudes, and Practices Among Arizona Health Care Providers, 2014-2015. Vector Borne Zoonotic Dis 2019; 19:434-440. [PMID: 30802177 DOI: 10.1089/vbz.2018.2370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Detection of local dengue transmission requires an aware and engaged medical community, as health care providers are the front line of public health surveillance. To assess the knowledge, attitude, and practice about dengue, an online survey was distributed among Arizona health care providers during 2014 and 2015. Materials and Methods: The survey consisted of a total of 10 knowledge, attitude, and practice questions divided as follows: 5 knowledge questions, 2 attitude questions, and 3 practice questions. The link to the Qualtrics survey was distributed through the Arizona Health Alert Network to a total of 4582 e-mail addresses, of which 335 participants opened the survey, and 196 completed and submitted their responses. Results: Less than half the respondents reported choosing the right dengue diagnostic test (40.4%) or understanding the epidemiology of dengue in Arizona (40.9%). Slightly more than half the respondents reported frequently asking for travel history (59%), and three-fourth of them would notify the local health department on suspicion of a dengue patient (76.1%). Survey score was associated with providers specialized in infectious diseases (1.88, 95% CI: 0.42-3.33, p = 0.01), medical doctors or doctors of osteopathic medicine (1.82, 95% CI: 0.98-2.65, p < 0.0001), and respondents who reported to have heard about the increase in dengue cases in Sonora (Mexico) in fall 2014 (1.51, 95% CI: 0.67-2.34, p = 0.0005), indicating better survey performance. Conclusions: These results indicate that education for health care providers on dengue should be improved particularly among general practice noninfectious disease providers who might be the first point of care for dengue patients. Findings suggest that additional training on clinical management, asking travel history, and notifying the local health department on suspicion of a dengue patient are needed.
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Affiliation(s)
- Irene Ruberto
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Hayley Yaglom
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Laura M Erhart
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Lydia Plante
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Joli Weiss
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Catherine Golenko
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Mariana Casal
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
| | - Orion McCotter
- 2 Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura Adams
- 2 Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kacey Ernst
- 3 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Ken Komatsu
- 1 Office of Infectious Disease Services, Arizona Department of Health Services, Phoenix, Arizona
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Whitman M, Jenkins C, Sabapathy S, Adams L. Are Rate Pressure Product and Age Predicted Maximum Heart Rate Predictors of Future Cardiovascular Events During Dobutamine Stress Echocardiography? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Whitman M, Jenkins C, Sabapathy S, Adams L. Rate Pressure Product Versus Age Predicted Maximum Heart Rate as Predictors Of Cardiovascular Events in Intermediate Risk Patients During Exercise Stress Echocardiography. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.419] [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: 11/24/2022]
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Van Dyne EA, Neaterour P, Rivera A, Bello-Pagan M, Adams L, Munoz-Jordan J, Baez P, Garcia M, Waterman SH, Reyes N, Richardson LC, Rivera-Garcia B, Sharp TM. Incidence and Outcome of Severe and Nonsevere Thrombocytopenia Associated With Zika Virus Infection-Puerto Rico, 2016. Open Forum Infect Dis 2018; 6:ofy325. [PMID: 30631791 DOI: 10.1093/ofid/ofy325] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/29/2018] [Indexed: 12/28/2022] Open
Abstract
Background Zika virus (ZIKV) infection has been associated with severe thrombocytopenia. We describe the incidence, clinical manifestations, and outcomes of patients with ZIKV infection and thrombocytopenia. Methods We reviewed medical records of patients with ZIKV infection and thrombocytopenia (platelet count <100 ×109 cells/L) in Puerto Rico during 2016. Severe thrombocytopenia was defined by platelet count <20 ×109/L or a platelet count <50 ×109/L and treatment for immune thrombocytopenia (ITP). Results Of 37 878 patients with ZIKV infection, 47 (0.1%) had thrombocytopenia in the absence of an alternative etiology (1.4 cases/100 000 population), including 12 with severe thrombocytopenia. Most patients with thrombocytopenia were adult (77%) and male (53%). Platelet nadir occurred a median (range) of 6 (1-16) and 5 (0-34) days after symptom onset for patients with severe and nonsevere thrombocytopenia, respectively. Among patients with severe thrombocytopenia, all had bleeding, 33% were admitted to the intensive care unit, and 8% died; 50% were treated for ITP. Among 5 patients with severe thrombocytopenia who received intravenous immunoglobulin, the median platelet count increase (range) was 112 (65-202) ×109/L. In contrast, among 4 patients who received platelet transfusion, the median increase in platelet count (range) was 8.5 (-6 to 52) ×109/L. Conclusions Patients with severe thrombocytopenia and ZIKV infection experienced prominent acute morbidity. Consistent with recommended management, administration of ITP treatments to such patients may be more efficacious than platelet transfusion in resolving thrombocytopenia. Severe thrombocytopenia should be considered a rare outcome of ZIKV infection.
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Affiliation(s)
- Elizabeth A Van Dyne
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,United States Public Health Service, Silver Springs, Maryland
| | - Paige Neaterour
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Aidsa Rivera
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Laura Adams
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Jorge Munoz-Jordan
- Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Myriam Garcia
- Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Stephen H Waterman
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | - Nimia Reyes
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Tyler M Sharp
- United States Public Health Service, Silver Springs, Maryland.,Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Adams L, Basu TN, Orrin E. Subcutaneous fat necrosis in a newborn. Assoc Med J 2018. [DOI: 10.1136/bmj.k4062] [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: 11/04/2022]
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