1
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Kier C, Kay DM, Langfelder-Schwind E, Goetz DM, Berdella M, DeCelie-Germana JK, Soultan ZN, Caggana M, Fortner CN, Giusti R, Kaslovsky R, Voter K, Welter JJ, Sadeghi H. Variability in evaluation and follow-up of newborns with CRMS/CFSPID in New York State. Pediatr Pulmonol 2024; 59:1511-1513. [PMID: 38426813 DOI: 10.1002/ppul.26928] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Catherine Kier
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Denise M Kay
- Newborn Screening Program, Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | | | - Danielle M Goetz
- University at Buffalo School of Medicine, Buffalo, New York, USA
| | - Maria Berdella
- Lenox Hill Hospital, Northwell Health System, New York, New York, USA
| | | | | | - Michele Caggana
- Newborn Screening Program, Division of Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | | | | | | | - Karen Voter
- Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - John J Welter
- Division of Pediatric Pulmonology, New York Medical College, Valhalla, New York, USA
| | - Hossein Sadeghi
- Columbia University Irving Medical Center, New York, New York, USA
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2
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Keens T, Hoffman V, Topuria I, Elder K, Cerf S, Mulder K, Roberts J, Lysinger J, Del Carmen Reyes M, Berdella M, Cairns AM, Jain M, Ganapathy V, Lou Y, Morcos B, Wu C, Sass L. Real-world effectiveness of elexacaftor/tezacaftor/ivacaftor on the burden of illness in adolescents and adults with cystic fibrosis. Heliyon 2024; 10:e28508. [PMID: 38586424 PMCID: PMC10998118 DOI: 10.1016/j.heliyon.2024.e28508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
Background Elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) has been shown to be safe and efficacious in people with cystic fibrosis (CF) aged ≥2 years. Here, we describe results from an observational study assessing change in burden of illness following initiating ELX/TEZ/IVA in real-world settings. Methods This US-based, multicenter, observational study used data from electronic medical records to evaluate real-world burden of illness before and after ELX/TEZ/IVA initiation in people with CF aged ≥12 years heterozygous for F508del and a minimal function mutation (F/MF) or an uncharacterized CFTR mutation. Endpoints included absolute change from baseline in percent predicted forced expiratory volume in 1 s (ppFEV1), body mass index (BMI) and BMI-for-age z-score, glycated hemoglobin (HbA1c), and numbers of pulmonary exacerbations (PEx). Results Overall, 206 people with CF were enrolled (mean [SD] age 22.5 [11.1] years; 192 [93.2%] with F/MF genotype). Mean follow-up was 15.6 (SD, 1.6) months. Improvements in ppFEV1 (7.3 [95% CI: 5.7, 8.8] percentage points) were observed from baseline through follow-up. Increases in BMI (1.40 [95% CI: 1.07, 1.77] kg/m2) and BMI-for-age z-score (0.14 [95% CI: 0.00, 0.28]) were also observed from baseline at 12 months. The estimated annualized rate of any PEx was 1.31 at baseline and 0.61 over follow-up (rate ratio 0.47 [95% CI: 0.39, 0.55]), with annualized rates of PEx requiring antibiotics and hospitalizations of 0.55 and 0.88 in the baseline period and 0.12 and 0.36 over follow-up (rate ratios 0.22 [95% CI: 0.15, 0.31] and 0.41 [95% CI: 0.32, 0.51]), respectively. Absolute change in HbA1c was -0.22 (95% CI: -0.38, -0.06) from baseline through follow-up. Conclusions ELX/TEZ/IVA treatment was associated with improved lung function, increased BMI, reduced frequency of PEx, and improved (i.e., reduced) HbA1c. These results confirm the broad clinical benefits of ELX/TEZ/IVA seen in clinical trials and show the potential for ELX/TEZ/IVA to improve markers of glucose metabolism.
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Affiliation(s)
- Thomas Keens
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | | | - Jon Roberts
- Driscoll Children's Hospital, Corpus Christi, TX, USA
| | | | | | | | | | - Manu Jain
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Yiyue Lou
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Bassem Morcos
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Chuntao Wu
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
| | - Laura Sass
- Children's Hospital of The King's Daughter, Norfolk, VA, USA
| | - for the VX19-CFD-003 Study Group
- Children's Hospital of Los Angeles, Los Angeles, CA, USA
- OM1 Incorporated, Boston, MA, USA
- Driscoll Children's Hospital, Corpus Christi, TX, USA
- Billings Clinic Hospital, Billings, MT, USA
- Northwell Health, New York, NY, USA
- Maine Medical Center, Portland, ME, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Vertex Pharmaceuticals Incorporated, Boston, MA, USA
- Children's Hospital of The King's Daughter, Norfolk, VA, USA
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3
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DiFiglia S, Georgiopoulos AM, Portenoy R, Seng E, Berdella M, Friedman D, Kier C, Linnemann RW, Middour-Oxler B, Walker P, Wang J, Yonker LM, Buehler B, Chaudhary N, Esposito C, Frantzen T, Henthorne K, Plachta A, Pollinger S, Stables-Carney T, Trentacoste J, Dhingra L. Palliative care needs among outpatient adults with cystic fibrosis: Baseline data from the Improving Life with CF trial. J Cyst Fibros 2023:S1569-1993(23)01664-8. [PMID: 37951787 DOI: 10.1016/j.jcf.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Little is known about the burden of illness experienced by people with cystic fibrosis (pwCF) since the advent of CF transmembrane conductance regulator (CFTR) modulator therapies. Studies that characterize the nature of illness burden are needed to inform the development and implementation of palliative care programs that can serve this population and address quality of life concerns. METHODS Adults with CF treated at five U.S. CF centers were surveyed to obtain baseline data for the Improving Life with CF primary palliative care implementation trial. Consenting patients completed the Integrated Palliative Care Outcome Scale (IPOS), a multidimensional measure of unmet needs for palliative care. Sociodemographic and clinical information was also obtained. The associations among these variables were examined through bivariate and multivariable analyses. RESULTS Among 256 adults, the most distressing symptoms included not feeling "at peace", communication difficulties with family/friends, anxiety over illness or its treatment, and a lack of energy. In the multivariable analyses, CFTR modulator use was associated with lower IPOS total and physical symptoms scores; female sex and increased hospitalizations were associated with higher scores. Increased age and history of distal intestinal obstructive syndrome were associated with higher IPOS physical symptoms scores. CONCLUSIONS These findings illuminate the nature of illness burden for pwCF in the era of CFTR modulator therapies. Although illness burden is positively affected by modulator therapy, there is a continuing need for palliative care to address physical, emotional, and spiritual distress, and the communication and practical needs experienced by adults with CF.
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Affiliation(s)
- Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States.
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Departments of Family and Social Medicine and Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Elizabeth Seng
- Ferkauf Graduate School of Psychology, New York, NY, United States; Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Maria Berdella
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | - Rachel W Linnemann
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Brandi Middour-Oxler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Patricia Walker
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Janice Wang
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Lael M Yonker
- Pulmonary Division, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Brian Buehler
- Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Christine Esposito
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | - Theresa Frantzen
- Feinstein Institute for Medical Research, New Hyde Park, NY, United States
| | | | - Amy Plachta
- Lenox Hill Hospital Northwell Health, New York, NY, United States
| | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, United States
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4
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DeCelie-Germana JK, Bonitz L, Langfelder-Schwind E, Kier C, Diener BL, Berdella M. Diagnostic and Communication Challenges in Cystic Fibrosis Newborn Screening. Life (Basel) 2023; 13:1646. [PMID: 37629501 PMCID: PMC10455801 DOI: 10.3390/life13081646] [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: 07/07/2023] [Revised: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
As of December 2009, cystic fibrosis (CF) newborn screening (NBS) is performed in all 50 US states and the District of Columbia. Widespread implementation of CF newborn screening (CFNBS) in the US and internationally has brought about new and varied challenges. Immunoreactive trypsinogen (IRT) remains the first, albeit imperfect, biomarker used universally in the screening process. Advances in genetic testing have provided an opportunity for newborn screening programs to add CFTR sequencing tiers to their algorithms. This in turn will enable earlier identification of babies with CF and improve longer-term outcomes through prompt treatment and intervention. CFTR sequencing has led to the ability to identify infants with CF from diverse ethnic and racial backgrounds more equitably while also identifying an increasing proportion of infants with inconclusive diagnoses. Using the evolution of the New York State CF newborn screening program as a guide, this review outlines the basic steps in a universal CF newborn screening program, considers how to reduce bias, highlights challenges, offers guidance to address these challenges and provides recommendations for future consideration.
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Affiliation(s)
- Joan Kathleen DeCelie-Germana
- Cohen Children’s Medical Center, Division of Pediatric Pulmonary and Cystic Fibrosis, Zucker School of Medicine at Hofstra/Northwell, New York, NY 11040, USA;
| | - Lynn Bonitz
- Cohen Children’s Medical Center, Division of Pediatric Pulmonary and Cystic Fibrosis, Zucker School of Medicine at Hofstra/Northwell, New York, NY 11040, USA;
| | - Elinor Langfelder-Schwind
- The Cystic Fibrosis Center, Department of Pulmonary Medicine, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA; (E.L.-S.); (M.B.)
| | - Catherine Kier
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook, Stony Brook, New York, NY 11794, USA; (C.K.); (B.L.D.)
| | - Barry Lawrence Diener
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook, Stony Brook, New York, NY 11794, USA; (C.K.); (B.L.D.)
| | - Maria Berdella
- The Cystic Fibrosis Center, Department of Pulmonary Medicine, Lenox Hill Hospital, Northwell Health, New York, NY 10075, USA; (E.L.-S.); (M.B.)
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5
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Basile MJ, Dhingra L, DiFiglia S, Polo J, Portenoy R, Wang J, Walker P, Middour-Oxler B, Linnemann RW, Kier C, Friedman D, Berdella M, Abdullah R, Yonker LM, Markovitz M, Hadjiliadis D, Shiffman M, Fischer F, Pollinger S, Hardcastle M, Chaudhary N, Georgiopoulos AM. Development of a Cystic Fibrosis Primary Palliative Care Intervention: Qualitative Analysis of Patient and Family Caregiver Preferences. J Patient Exp 2023; 10:23743735231161486. [PMID: 36936380 PMCID: PMC10021085 DOI: 10.1177/23743735231161486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
To prevent or mitigate chronic illness burden, people with cystic fibrosis (pwCF) and their family caregivers need primary (generalist-level) palliative care from the time of diagnosis forward. We used qualitative methods to explore their preferences about a screening-and-triage model ("Improving Life with CF") developed to standardize this care. We purposively sampled and interviewed 14 pwCF and caregivers from 5 Improving Life with CF study sites. Thematic analysis was guided by a priori codes using the National Consensus Project's Guidelines for Quality Palliative Care. Participants included 7 adults and 2 adolescents with CF (3 with advanced disease), 4 parents, 1 partner (7 women; 5 people of color). Few were familiar with palliative care. Illness burden was described in multiple domains, including physical (e.g., dyspnea, pain), psychological (e.g., anxiety), and social (e.g., family well-being; impact on work/school). Most preferred survey-based screening with care coordination by the CF team. Preferences for screening approaches varied. PwCF and caregivers experience illness burden and are receptive to a CF-team delivered primary palliative care screening-and-triage model with flexible processes.
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Affiliation(s)
- Melissa J Basile
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
- Melissa J Basile, Center for Health
Innovations and Outcomes Research, Feinstein Institutes for Medical Research,
Northwell Health, New York, NY, USA.
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | | | - Jennifer Polo
- Feinstein Institutes for Medical Research, Northwell Health, New
York, NY, USA
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, NY,
USA
- Department of Family and Social Medicine, Department of Neurology,
Albert Einstein
College of Medicine, Bronx, NY, USA
| | - Janice Wang
- Division of Pulmonary, Critical Care and Sleep Medicine,
Donald and
Barbara Zucker School of Medicine at
Hofstra/Northwell, New Hyde Park, NY, USA
| | - Patricia Walker
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Brandi Middour-Oxler
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Rachel W Linnemann
- Division of Pulmonary, Asthma, Cystic Fibrosis and Sleep, Department
of Pediatrics, Emory
University, Atlanta, GA, USA
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta,
GA, USA
| | - Catherine Kier
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
| | - Maria Berdella
- Department of Pulmonary Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Robert Abdullah
- Department of Pediatrics, Stony Brook University Medical
Center, Stony Brook, NY, USA
| | - Lael M Yonker
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Pulmonary Division, Massachusetts General Hospital for Children,
Boston, MA, USA
| | - Martha Markovitz
- Keck Medicine of University of Southern California, Los Angeles,
California, USA (retired)
| | - Denis Hadjiliadis
- Division of Pulmonary and Critical Care Medicine, Department of
Medicine, Hospital of
the University of Pennsylvania,
Philadelphia, PA, USA
| | | | | | - Sophie Pollinger
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Nivedita Chaudhary
- Department of Pediatrics, Massachusetts General
Hospital, Boston, MA, USA
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General
Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical
School, Boston, MA, USA
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6
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Kier C, Sadeghi H, Kay D, Langfelder-Schwind E, Berdella M, Joan D, Soultan Z, Caggana M, Dozor A, Fortner C, Giusti R, Goetz D, Kaslovsky R, Stevens C, Voter K, Welter J. 32 Characteristics of 225 infants with cystic fibrosis screen positive, inconclusive diagnosis and cystic fibrosis transmembrane conductance regulator–related metabolic syndrome identified in New York State over a 3-year period. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00723-8] [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: 11/06/2022]
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7
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DiFiglia S, Georgiopoulos A, Portenoy R, Berdella M, Friedman D, Kier C, Linnemann R, Middour-Oxler B, Walker P, Wang J, Buehler B, Chaudhary N, Esposito C, Henthorne K, Hunter E, Plachta A, Pollinger S, Stables-Carney T, Trentacoste J, Dhingra L. 242 Palliative care needs in cystic fibrosis: Baseline data from the Improving Life with Cystic Fibrosis Multi-site Implementation Trial for Primary Palliative Care Intervention. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00932-8] [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: 11/05/2022]
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8
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Langfelder-Schwind E, Kay D, Berdella M, Joan D, Soultan Z, Dozor A, Fortner C, Giusti R, Goetz D, Kaslovsky R, Voter K, Welter J, Caggana M, Sadeghi H, Kier C. 151 Variable genetic counseling access and services for parents of infants who screen positive for cystic fibrosis in New York State. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00842-6] [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: 11/06/2022]
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9
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Simonson JL, Esposito C, Frantzen T, Henthorne K, Espinal A, Romano S, Ramdeo R, Trentacoste J, Tsang D, LaVecchia G, Abdullah R, Berdella M, Bonitz L, Condos R, Constantinescu A, DeCelie-Germana JK, DiMango E, Draine M, Gimeli T, Giusti R, Guzman J, Hammouda S, Keating C, Kier C, Lennox AT, Liriano C, Messer Z, Plachta A, Sadeghi H, Schwind E, Stables-Carney T, Walker P, Wang J. The clinical impact of the Covid-19 pandemic first wave on patients with cystic fibrosis in New York. J Cyst Fibros 2022; 21:e176-e183. [PMID: 35256307 PMCID: PMC8858720 DOI: 10.1016/j.jcf.2022.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND People with cystic fibrosis (pwCF) may be at risk of complications from COVID-19 but the impact of COVID-19 on pwCF remains unknown. METHODS We conducted a multicenter retrospective cohort study to assess the impact of the COVID-19 pandemic first wave on pwCF in the New York metropolitan area (NY) from March 1, 2020 to August 31, 2020. Objectives were to determine (1) the prevalence of COVID-19 by PCR and IgG antibody testing, (2) the clinical characteristics of COVID-19, (3) delay in routine outpatient care, and (4) the effect on anxiety and depression in pwCF. RESULTS There were 26 COVID-19 cases diagnosed by PCR or antibody testing among the study cohort of 810 pwCF. The prevalence of COVID-19 by PCR (1.6%) and IgG antibody (12.2%) testing was low. 58% of cases were asymptomatic and 82% were managed at home. 8% were hospitalized and 1 person died. 89% of pwCF experienced delay in care. The prevalence of anxiety increased from 43% baseline to 58% during the pandemic (P<0.01). In post-hoc analysis, the proportion of patients with diabetes (38% versus 16%, P<0.01) and pancreatic insufficiency (96% versus 66%, P<0.01) were higher while CFTR modulator use was lower (46% versus 65%, P = 0.05) in pwCF who tested positive for COVID-19. CONCLUSIONS The prevalence of COVID-19 among pwCF in NY during the pandemic first wave was low and most cases were managed at home. CFTR modulators may be protective. PwCF experienced delay in routine care and increased anxiety.
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Affiliation(s)
- Joseph L Simonson
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Christine Esposito
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Theresa Frantzen
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Katherine Henthorne
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Aileen Espinal
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Serena Romano
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Ramona Ramdeo
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Jessica Trentacoste
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Donna Tsang
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Geralyn LaVecchia
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
| | - Robert Abdullah
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States.
| | - Maria Berdella
- Division of Pediatric Pulmonology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10003, United States.
| | - Lynn Bonitz
- Division of Pediatric Pulmonology, The Steven and Alexandra Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY 11042, United States.
| | - Rany Condos
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, NY 10016, United States.
| | - Andrei Constantinescu
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, United States.
| | - Joan K DeCelie-Germana
- Division of Pediatric Pulmonology, The Steven and Alexandra Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY 11042, United States.
| | - Emily DiMango
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, United States.
| | - Myah Draine
- Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, NY 10016, United States.
| | - Tara Gimeli
- Division of Pediatric Pulmonology, The Steven and Alexandra Cohen Children's Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY 11042, United States.
| | - Robert Giusti
- Division of Pediatric Pulmonary Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, NY 10016, United States.
| | - Jessenia Guzman
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, United States.
| | - Soumia Hammouda
- Division of Pediatric Pulmonary Medicine, NYU Langone Health, New York University Grossman School of Medicine, New York, NY 10016, United States.
| | - Claire Keating
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, United States.
| | - Catherine Kier
- Department of Pediatrics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States.
| | - Alison T Lennox
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College, Valhalla, NY 10595, United States.
| | - Carmen Liriano
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, United States.
| | - Zachary Messer
- Division of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, New York Medical College, Valhalla, NY 10595, United States.
| | - Amy Plachta
- Division of Pediatric Pulmonology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10003, United States.
| | - Hossein Sadeghi
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, United States.
| | - Elinor Schwind
- Division of Pediatric Pulmonology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10003, United States.
| | - Teresa Stables-Carney
- Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY 11794, United States.
| | - Patricia Walker
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY 10003, United States.
| | - Janice Wang
- Division of Pulmonary, Critical Care and Sleep Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States.
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Choudhary S, Giusti R, Goetz D, Kaslovsky R, Berdella M, Sadeghi H, DeCelie-Germana J, Welter J, Kier C, Fortner C, Voter K, Kay D, Hammouda S. 80: New York Cystic Fibrosis Newborn Screening Consortium quality improvement: Focus on parent and pediatrician education and development of a statewide standard of care for CF-related metabolic syndrome infants. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01505-8] [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: 10/20/2022]
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Middour-Oxler B, Dhingra L, Georgiopoulos A, Wang J, Friedman D, Shiffman M, Portenoy R, DiFiglia S, Fischer F, Abdullah R, Berdella M, Hadjiliadis D, Kier C, Markovitz M, Walker P, Yonker L, Linnemann R. 219: Improving assessment for CF pediatric palliative care: Initial development of the ADAPT-CF communication guide with children and caregivers. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01644-1] [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: 12/01/2022]
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Dhingra L, Walker P, Berdella M, Plachta A, Chen J, Fresenius A, Balzano J, Barrett M, Bookbinder M, Wilder K, Glajchen M, Langfelder-Schwind E, Portenoy RK. Addressing the burden of illness in adults with cystic fibrosis with screening and triage: An early intervention model of palliative care. J Cyst Fibros 2019; 19:262-270. [PMID: 31471264 DOI: 10.1016/j.jcf.2019.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/24/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Novel models that improve generalist-level palliative care for cystic fibrosis (CF) are needed to address the burden of this illness. A screening-and-triage model has the potential to identify clinical problems requiring immediate follow-up by CF professionals. This study describes such a model and its immediate impact on care delivery for CF patients during a two-year period. METHODS Eligible adults completed monthly online screening for sources of distress. If results revealed one or more "indicators of concern" on two consecutive screenings, this triggered an attempted triage by a social worker. Completed triages led to prompt follow-up by CF professionals for clinical problems, if indicated. Process data were summarized and generalized linear mixed models were used to evaluate baseline patient characteristics (symptom distress, quality of life, and sociodemographics) associated with the need for prompt follow-up. RESULTS A total of 1,015 monthly surveys were completed by 74 patients; 634 (66 patients) had >1 indicators of concern; and 164 surveys (46 patients) had >1 indicators for two consecutive surveys (e.g., global distress, pain, dyspnea, and psychological symptoms). The 164 attempted triages yielded 84 completed triages (51.2%), of which 39 (46.4%) required prompt follow-up. In multivariable analyses, older patients and those with higher symptom distress at baseline were more likely to require prompt follow-up (p < .05). CONCLUSIONS Web-based screening that assesses varied domains of distress or burden can identify a subset of CF patients whose clinical problems may benefit from immediate medical or psychological attention. Additional investigations should improve screening efficiency.
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Affiliation(s)
- Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA.
| | - Patricia Walker
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Maria Berdella
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Amy Plachta
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Jack Chen
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Ashley Fresenius
- Southern Nevada Adult Mental Health Services, 6161 W. Charleston Blvd, Las Vegas, NV 89146, USA
| | - Julie Balzano
- James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA
| | - Malcolm Barrett
- University of Southern California, Los Angeles, CA 90007, USA
| | - Marilyn Bookbinder
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Kenya Wilder
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Myra Glajchen
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
| | - Elinor Langfelder-Schwind
- The Cystic Fibrosis Center, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003, USA
| | - Russell K Portenoy
- MJHS Institute for Innovation in Palliative Care, 39 Broadway, 3rd Floor, New York, NY 10006, USA
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Morgan WJ, VanDevanter DR, Pasta DJ, Foreman AJ, Wagener JS, Konstan MW, Liou T, McColley S, McMullen A, Quittner A, Regelmann W, Ren C, Rosenfeld M, Sawicki G, Schechter M, VanDevanter D, Wagener J, Woo M, Brasfield D, Lyrene R, Sindel L, Roberts D, Carroll J, Warren R, Nassri L, Anderson P, Brown M, Silverthorn A, Radford P, Gong G, Legris G, Greene G, Sudhakar R, Platzker A, Nickerson B, Hardy K, Harwood I, Shay G, Quick B, Lieberthal A, Moss R, Landon C, Fanous Y, Lieberman J, Spiritus E, Chipps B, McDonald R, Pian M, Cropp G, Lewis N, Nielson D, Shapiro B, Wagener J, Accurso F, Saavedra M, Daigle K, Hen J, Palazzo R, Dodds K, Pad-man R, Goodill J, Winnie G, Davies L, Kriseman T, Sallent J, Chiaro J, Kubiet M, Goldfinger S, Schwartzman M, Diaz C, Maupin K, Riff E, Geller D, Livingston F, Mavunda K, Birriel J, Faverio L, Rosenberg D, Schaeffer D, Sherman J, Wagner M, Light M, Schnapf B, Montgomery G, Kirchner K, Weatherly M, Caplan D, Guill M, Hudson V, Akhter J, Davison D, Boas S, McColley S, Chung Y, Latner R, Aljadeff G, Chan Y, Kraut J, Stone A, Still JL, Sharma G, Eagleton L, Hopkins P, Chatrath U, Lester L, Kim YJ, Anthony V, Eigan H, Howenstine M, James P, Gergesha E, Harris J, Plant R, Zivkovich V, Collins A, Nassif E, Ahrens R, Doornbos D, Kanarek J, Leff R, Shaw P, Demoss E, Riva M, Sullivan L, Anstead M, Kanga J, Eid N, Morton R, Hilman B, Jones K, Davis S, Harder R, Lever T, Cairns AM, Caldwell E, Zuckerman J, Mogayzel P, Rosenstein B, McQuestion J, Perry D, Rosenberg S, Gerstle R, Colin A, Wohl ME, Lapey A, Yee W, O'Sullivan B, Zwerdling R, Abdulhamid I, O'Hagan A, Schuen J, Kurlandsky L, Honicky R, Homnick D, Marks J, Pichurko B, Maxvold N, Nasr S, Simon R, Tsai W, Kissner D, McNamara J, Henry N, Marker S, Pryor M, Regelmann W, Walker L, Woodward J, Mizell L, Miller S, Rosenbluth D, Black P, McCubbin M, Cohen A, Ferkol T, Mallory G, Rejent A, Rubin B, Graff G, Konig P, Colombo J, Murphy P, Boyle W, Parker W, Patton C, Zanni R, Atlas A, Turcios N, Laraya-Cuasay L, Bisberg D, Aguila H, Allen S, James D, Perkett E, Thompson M, Budhecha S, Diaz R, Rosen J, Kaslovsky R, Percciacante R, Borowitz D, Cronin J, McMahon C, Quittell L, Giusti R, Cohen R, DeCelie-Germana J, Gorvoy J, Patel K, Kattan M, Dozor A, DiMango E, Berdella M, Anbar R, Ianuzzi D, Sexton J, Tayag-Kier C, McBride J, Ren C, Voter K, Dimaio M, Georgitis J, Majure JM, Martinez M, McIntosh C, Leigh M, Schechter M, Black H, Hughes J, Kantak A, Wilmott R, Omlor G, Stone R, McCoy K, Acton J, Doershuk C, Konstan M, Fink R, Steffan M, Vauthy P, Joseph P, Reyes S, Kramer J, Royall J, Eisenberg J, Wall M, Fiel S, Scanlin T, Phadke S, Winnie G, Weinberg J, Sexauer W, Wolf S, Holsclaw D, Klein D, Warren S, Kinsey R, Perez C, Ganeshanathan M, Shinnick J, Panitch H, Varlotta L, Robinson C, Santana JR, Passero MA, Gwinn J, Baker R, Bowman M, Flume P, Brown D, Marville R, Wallace J, Parry R, Ellenburg D, Rogers J, Mohon R, Ledbetter J, Hanissian A, Schoumacher R, Campbell P, Harris C, Slovis B, Stokes D, Hale K, Katz M, Seilheimer D, Sockrider M, Frank A, Daniel J, Cunningham J, Browning I, Bray J, Dove A, Mandujano F, Tremper L, Morse M, Willey-Courand D, Copenhaver S, Pohl J, McWilliams B, Martine-Logvinoff M, Wallace M, Klein R, Amaro R, Couch L, Brown M, Prestidge C, Inscore S, Lipton A, Chatfield B, Liou T, Marshall B, Lahiri T, Swartz D, Whittaker L, Karlson K, Ropoll I, Rubio T, Schmidt J, Thomas D, Osborn J, Froh D, Gaston B, Elliott G, Gibson R, Ramsey B, McCarthy M, Larson L, Ricker D, Robbins M, Aitken M, Emerson J, Aronoff S, Moffett K, Biller J, Splaingard M, Sullivan B, Pritchard P, Adair S, Holzwarth P, Dopico G, Meyer K, Green C, Rock M. Forced Expiratory Volume in 1 Second Variability Helps Identify Patients with Cystic Fibrosis at Risk of Greater Loss of Lung Function. J Pediatr 2016; 169:116-21.e2. [PMID: 26388208 DOI: 10.1016/j.jpeds.2015.08.042] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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] [Received: 12/31/2014] [Revised: 07/15/2015] [Accepted: 08/20/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate several alternative measures of forced expiratory volume in 1 second percent predicted (FEV1 %pred) variability as potential predictors of future FEV1 %pred decline in patients with cystic fibrosis. STUDY DESIGN We included 13,827 patients age ≥6 years from the Epidemiologic Study of Cystic Fibrosis 1994-2002 with ≥4 FEV1 %pred measurements spanning ≥366 days in both a 2-year baseline period and a 2-year follow-up period. We predicted change from best baseline FEV1 %pred to best follow-up FEV1 %pred and change from baseline to best in the second follow-up year by using multivariable regression stratified by 4 lung-disease stages. We assessed 5 measures of variability (some as deviations from the best and some as deviations from the trend line) both alone and after controlling for demographic and clinical factors and for the slope and level of FEV1 %pred. RESULTS All 5 measures of FEV1 %pred variability were predictive, but the strongest predictor was median deviation from the best FEV1 %pred in the baseline period. The contribution to explanatory power (R(2)) was substantial and exceeded the total contribution of all other factors excluding the FEV1 %pred rate of decline. Adding the other variability measures provided minimal additional value. CONCLUSIONS Median deviation from the best FEV1 %pred is a simple metric that markedly improves prediction of FEV1 %pred decline even after the inclusion of demographic and clinical characteristics and the FEV1 %pred rate of decline. The routine calculation of this variability measure could allow clinicians to better identify patients at risk and therefore in need of increased intervention.
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Affiliation(s)
- Wayne J Morgan
- Department of Pediatrics, University of Arizona, Tucson, AZ.
| | - Donald R VanDevanter
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | - Jeffrey S Wagener
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Michael W Konstan
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH
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Dimango E, Walker P, Keating C, Berdella M, Robinson N, Langfelder-Schwind E, Levy D, Liu X. Effect of esomeprazole versus placebo on pulmonary exacerbations in cystic fibrosis. BMC Pulm Med 2014; 14:21. [PMID: 24528942 PMCID: PMC3931289 DOI: 10.1186/1471-2466-14-21] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 02/13/2014] [Indexed: 02/08/2023] Open
Abstract
Background Gastro esophageal reflux (GER) is common in cystic fibrosis (CF) and may contribute to lung disease. Approximately 50% of patients with cystic fibrosis are being treated with proton pump inhibitors (PPIs). Methods In a randomized controlled study in adults, we compared treatment with esomeprazole 40 mg twice daily versus placebo in patients with CF and frequent respiratory exacerbations over a thirty-six week treatment period to determine effect on time to first exacerbation and other health related outcomes. Results 17 patients without symptoms of GER were randomized and 15 completed the study. 13 subjects underwent 24 hour ambulatory pH probe monitoring; 62% had pH probe evidence of GER. Forty one percent of subjects had a pulmonary exacerbation during the study. There was no significant difference in time to first pulmonary exacerbation (log rank test p = 0.3169). Five of nine subjects in the esomeprazole group compared with 2 of eight subjects in the placebo group experienced exacerbations (esomeprazole vs. placebo: odds ratio = 3.455, 95% CI = (0.337, 54.294), Fisher’s exact test: p = 0.334). There was no change in Forced Expiratory Volume in one second, Gastroesophageal Symptom Assessment Score or CF Quality of Life score between the two treatment groups. Conclusions There was a trend to earlier exacerbation and more frequent exacerbations in subjects randomized to esomeprazole compared with placebo. The effect of proton pump inhibitors on pulmonary exacerbations in CF warrants further investigation. Clinical trials registration Clinicaltrials.gov, NCT01983774
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Affiliation(s)
- Emily Dimango
- Columbia University Medical Center Department of Medicine, 622 West 168th Street, New York, NY 10032, USA.
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