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Wilding A, Sutton M, Agboraw E, Munford L, Wilson P. Geographic inequalities in need and provision of social prescribing link workers. Br J Gen Pract 2024:BJGP.2023.0602. [PMID: 38359951 DOI: 10.3399/bjgp.2023.0602] [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: 11/16/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Long-term health conditions are major challenges for care systems. Social prescribing link workers have been introduced via Primary Care Networks (PCNs) across England since 2019 to address the wider determinants of health by connecting individuals to activities, groups, or services within their local community. AIM To assess whether the rollout of social prescribing link workers was in areas with the highest need. DESIGN AND SETTING A retrospective study of social prescribing link workers in England from 2019 to 2023. METHOD We combined workforce, population, survey, and area-level data at the PCN-level from April 2020 to October 2023. We measured population need prior to the rollout of link workers using reported lack of support from local services in the 2019 GP Patient Survey. To assess if rollout reflected need, we used linear regression to relate provision of link workers (measured by full-time equivalent (FTE) per 10,000 patients) in each quarter to population need for support. RESULTS Populations in urban, more deprived areas and with higher proportions of minority ethnicities had the highest reported lack of support. Geographically these were in the North West and London. Initially, there was no association between need and provision; then from July 2022, this became negative and significant. By October 2023, a 10-percentage point higher need for support was associated with a 0.035 (95%CI(-0.634 to -0.066)) lower FTE per 10,000 patients. CONCLUSION Rollout of link workers has not been sufficiently targeted at areas with the highest need. Future deployments should be targeted at those areas.
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Affiliation(s)
- Anna Wilding
- The University of Manchester, Manchester, United Kingdom
| | - Matthew Sutton
- The University of Manchester, Manchester, United Kingdom
| | | | - Luke Munford
- The University of Manchester, Manchester, United Kingdom
| | - Paul Wilson
- The University of Manchester, Centre for Primary Care and Health Services Research | School of Health Sciences, Manchester, United Kingdom
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Urwin S, Lau YS, Grande G, Sutton M. Informal caregiving and the allocation of time: implications for opportunity costs and measurement. Soc Sci Med 2023; 334:116164. [PMID: 37603963 DOI: 10.1016/j.socscimed.2023.116164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/19/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
Informal care requires a considerable time investment from providers that inherently involves trade-offs against various uses of time. We examine what other uses of time are forgone when individuals provide informal care. We further consider how caregiving is linked to a range of rarely explored time use characteristics relating to multitasking, the fragmentation and the timing of activities. We use data from 5670 adults across 11003 diary days from the 2014/15 UK Time Use Survey. Using a 'doubly robust' approach of entropy balancing and regression adjustment, we find carers spend an additional 49.0 min on non-market work, 2.9 min on personal care, 5.8 min on leisure and 2.9 min on miscellaneous activities on weekdays. They spend 46.1 min less on market work and 14.4 min less on sleep. Carers report more time stress, more multitasking, and more fragmented time. We estimate with attribution factors that 16% and 11% of reported household task activity is due to caregiving on weekday and weekend days, respectively. These findings provide evidence on additional opportunity costs faced by carers and possible channels through which carer labour market and health outcomes are realised. The attribution factors we calculate can be applied to total reported caregiving time to avoid overestimation when this is incorporated into economic evaluations.
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Affiliation(s)
- Sean Urwin
- Health Organisation, Policy and Economics Group, School of Health Sciences, University of Manchester, Manchester, UK.
| | - Yiu-Shing Lau
- Health Organisation, Policy and Economics Group, School of Health Sciences, University of Manchester, Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Matthew Sutton
- Health Organisation, Policy and Economics Group, School of Health Sciences, University of Manchester, Manchester, UK; Centre for Health Economics, Monash University, Australia
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Peters JM, Irvine EB, Rosenberg JM, Wadsworth MH, Hughes TK, Sutton M, Nyquist SK, Bromley JD, Mondal R, Roederer M, Seder RA, Darrah PA, Alter G, Flynn JL, Shalek AK, Fortune SM, Bryson BD. Protective intravenous BCG vaccination induces enhanced immune signaling in the airways. bioRxiv 2023:2023.07.16.549208. [PMID: 37502895 PMCID: PMC10370046 DOI: 10.1101/2023.07.16.549208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Intradermal (ID) Bacillus Calmette-Guérin (BCG) is the most widely administered vaccine in the world. However, ID-BCG fails to achieve the level of protection needed in adults to alter the course of the tuberculosis epidemic. Recent studies in non-human primates have demonstrated high levels of protection against Mycobacterium tuberculosis ( Mtb ) following intravenous (IV) administration of BCG. However, the protective immune features that emerge following IV BCG vaccination remain incompletely defined. Here we used single-cell RNA-sequencing (scRNAseq) to transcriptionally profile 157,114 unstimulated and purified protein derivative (PPD)-stimulated bronchoalveolar lavage (BAL) cells from 29 rhesus macaques immunized with BCG across routes of administration and doses to uncover cell composition-, gene expression-, and biological network-level signatures associated with IV BCG-mediated protection. Our analyses revealed that high-dose IV BCG drove an influx of polyfunctional T cells and macrophages into the airways. These macrophages exhibited a basal activation phenotype even in the absence of PPD-stimulation, defined in part by IFN and TNF-α signaling up to 6 months following BCG immunization. Furthermore, intercellular immune signaling pathways between key myeloid and T cell subsets were enhanced following PPD-stimulation in high-dose IV BCG-vaccinated macaques. High-dose IV BCG also engendered quantitatively and qualitatively stronger transcriptional responses to PPD-stimulation, with a robust Th1-Th17 transcriptional phenotype in T cells, and augmented transcriptional signatures of reactive oxygen species production, hypoxia, and IFN-γ response within alveolar macrophages. Collectively, this work supports that IV BCG immunization creates a unique cellular ecosystem in the airways, which primes and enables local myeloid cells to effectively clear Mtb upon challenge.
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Patwardhan S, Sutton M, Morciano M. Effects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study. Age Ageing 2022; 51:6936404. [PMID: 36571782 PMCID: PMC9792077 DOI: 10.1093/ageing/afac222] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/21/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND the structure of care homes markets in England is changing with the emergence of for-profit homes organised in chains and financed by private equity. Previous literature shows for-profit homes were rated lower quality than not-for-profit homes when inspected by the national regulator, but has not considered new forms of financing. OBJECTIVES to examine whether financing and organisation of care homes is associated with regulator assessments of quality. METHODS retrospective observational study of the Care Quality Commission's ratings of 10,803 care homes providing services to older people as of January 2020. We used generalised ordered logistic models to assess whether ratings differed between not-for-profit and for-profit homes categorised into three groups: (i) chained ownership, financed by private equity; (ii) chained ownership, not financed by private equity and (iii) independent ownership. We compared Overall and domain (caring, effective, responsive, safe, well-led) ratings adjusted for care home size, age and location. RESULTS all three for-profit ownership types had lower average overall ratings than not-for-profit homes, especially independent (6.8% points (p.p.) more likely rated as 'Requires Improvement/Inadequate', 95% CI: 4.7-8.9) and private equity chains (6.6 p.p. more likely rated as 'Requires Improvement/Inadequate', 95% CI: 2.9-10.2). Independent homes scored better than private equity chains in the safe, effective and responsive domains but worst in the well-led domain. DISCUSSION private equity financing and independent for-profit ownership are associated with lower quality. The consequences of the changing care homes market structure for quality of services should be monitored.
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Affiliation(s)
- Sharvari Patwardhan
- Health Organization, Policy and Economics (HOPE) research group, School of Health Science, Oxford Road, M13 9PL, Manchester, UK
| | - Matthew Sutton
- Health Organization, Policy and Economics (HOPE) research group, School of Health Science, Oxford Road, M13 9PL, Manchester, UK
| | - Marcello Morciano
- Address correspondence to: Morciano Marcello, The University of Manchester, UK.
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Andreasen JW, Arca E, Bowers JW, Bär M, Breternitz J, Dale PJ, Dimitrievska M, Fermin DJ, Ganose A, Hages CJ, Hobson T, Jaramillo R, Kavanagh SR, Kayastha P, Kondrotas R, Lee J, Major JD, Mandati S, Mitzi DB, Scanlon DO, Schorr S, Scragg JJS, Shin B, Siebentritt S, Smiles M, Sood M, Sopiha KV, Spalatu N, Sutton M, Unold T, Valdes M, Walsh A, Wang M, Wang X, Weiss TP, Woo YW, Woods-Robinson R, Tiwari D. Novel chalcogenides, pnictides and defect-tolerant semiconductors: general discussion. Faraday Discuss 2022; 239:287-316. [PMID: 36250438 DOI: 10.1039/d2fd90057b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Andreasen JW, Bowers JW, Breternitz J, Dale PJ, Dimitrievska M, Fermin DJ, Ganose A, Gurieva G, Hages CJ, Hawkins C, Hobson TDC, Jaramillo R, Kavanagh SR, Major JD, Mandati S, Mitzi DB, Naylor MC, Platzer Björkman C, Scanlon DO, Schorr S, Scragg JJS, Shin B, Siebentritt S, Sood M, Sopiha KV, Sutton M, Tiwari D, Unold T, Valdes M, Wang M, Weiss TP, Woods-Robinson R. Indium-free CIGS analogues: general discussion. Faraday Discuss 2022; 239:85-111. [PMID: 36222895 DOI: 10.1039/d2fd90055f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Chatzi G, Whittaker W, Chandola T, Mason T, Soiland-Reyes C, Sutton M, Bower P. Diabetes Prevention Programme and socioeconomic inequalities in Type 2 Diabetes in England. Eur J Public Health 2022; 32:ckac129.159. [PMCID: PMC9831347 DOI: 10.1093/eurpub/ckac129.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
The National Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing Type 2 Diabetes Mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH, HbA1c 42-47 mmol/mol or 6.0-6.4%). How this programme affects inequalities by age, gender, disability, ethnicity, or deprivation is not known. We used multinomial logistic regression models to compare population characteristics at three stages along the prevention programme pathway: prevalence of NDH [using survey data from UK Household Longitudinal Study (N = 794) and Health Survey for England (N = 1,383)]; identification in primary care and offer of the programme [using administrative data from the National Diabetes Audit (N = 1,267,350)]; and programme participation [using programme provider records (N = 98,024)]). Younger adults (aged under 40) [4% of the NDH population (95% CIs 2%-6%)] and older adults (aged 80 and above) [12% (95%CIs 10%-14%] were both underrepresented amongst DPP participants [2% of DPP participants (95%CIs 1.8%-2.2%) and 8% (95%CIs 7.7%-8.3%) respectively]. People with disabilities were underrepresented in the DPP [15% (95%CIs 14.9%-15.1%) vs 60% (95%CIs 58%-62%)] compared to the general population. People living in more deprived areas were under-represented [14% (95% CIs 13.7%-14.3%) vs 20% (95%CIs 16%-24%) in the general population]. Ethnic minorities were overrepresented [36% (95%CIs 35.8%-36.2%) vs 13% (95%CIs 9%-17%) in the general population] among DPP referrals, though the proportion dropped at programme completion stage [19% (95%CI 18.5%-19.5%)]. The DPP has the potential to reduce ethnic inequalities but may widen socioeconomic, age, and disability-related inequalities in T2DM. Whilst ethnic minority groups are overrepresented at identification and offer stage, efforts are required to support the completion of the programme. Programme providers should target underrepresented groups to ensure equitable access and narrow inequalities in T2DM. Key messages • The DPP intervention may result in a widening of socioeconomic and disability related inequalities amongst people with NDH as the programme had fewer adults in deprived areas and with a disability. • The programme has the potential to reduce ethnic inequalities, but efforts are required to support the completion of the programme by minority ethnic groups.
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Affiliation(s)
- G Chatzi
- Social Statistics, University of Manchester, Manchester, UK
| | - W Whittaker
- Division of Population Health, University of Manchester, Manchester, UK
| | - T Chandola
- Social Statistics, University of Manchester, Manchester, UK
- Sociology, University of Hong Kong, Hong Kong
| | - T Mason
- Division of Population Health, University of Manchester, Manchester, UK
| | - C Soiland-Reyes
- Research and Innovation, Northern Care Alliance NHS Group, Salford, UK
| | - M Sutton
- Centre for Primary Care and Health Services, University of Manchester, Manchester, UK
| | - P Bower
- Centre for Primary Care and Health Services, University of Manchester, Manchester, UK
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Sutton M, Lei B, Michaels H, Freitag M, Robertson N. Rapid and Facile Fabrication of Polyiodide Solid-State Dye-Sensitized Solar Cells Using Ambient Air Drying. ACS Appl Mater Interfaces 2022; 14:43456-43462. [PMID: 36112836 PMCID: PMC9523705 DOI: 10.1021/acsami.2c14299] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/09/2022] [Indexed: 06/15/2023]
Abstract
Dye-sensitized solar cells are promising candidates for low-cost indoor power generation applications. However, they currently suffer from complex fabrication and stability issues arising from the liquid electrolyte. Consequently, the so-called zombie cell was developed, in which the liquid electrolyte is dried out to yield a solid through a pinhole after cell assembly. We report a method for faster, simpler, and potentially more reliable production of zombie cells through direct and rapid drying of the electrolyte on the working electrode prior to cell assembly, using an iodide-triiodide redox couple electrolyte as a basis. These "rapid-zombie" cells were fabricated with power conversion efficiencies reaching 5.0%, which was larger than the 4.5% achieved for equivalent "slow" zombie cells. On a large-area cell of 15.68 cm2, over 2% efficiency was achieved at 0.2 suns. After 12 months of dark storage, the "rapid-zombie" cells were remarkably stable and actually showed a moderate increase in average efficiencies.
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Affiliation(s)
- Matthew Sutton
- School
of Chemistry, The University of Edinburgh, David Brewster Road, Edinburgh EH9 3FJ, U.K.
| | - Bingyu Lei
- School
of Chemistry, The University of Edinburgh, David Brewster Road, Edinburgh EH9 3FJ, U.K.
| | - Hannes Michaels
- Department
of Chemistry, Ångström Laboratory, Uppsala University, P.O. Box 523, SE-75120 Uppsala, Sweden
- School
of Natural and Environmental Science, Bedson Building, Newcastle University, Newcastle upon Tyne NE1 7RU, U.K.
| | - Marina Freitag
- Department
of Chemistry, Ångström Laboratory, Uppsala University, P.O. Box 523, SE-75120 Uppsala, Sweden
- School
of Natural and Environmental Science, Bedson Building, Newcastle University, Newcastle upon Tyne NE1 7RU, U.K.
| | - Neil Robertson
- School
of Chemistry, The University of Edinburgh, David Brewster Road, Edinburgh EH9 3FJ, U.K.
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Mathew AJ, Sutton M, Pereira D, Gladman DD, Chandran V. POS1093 EFFECT OF DISEASE MODIFYING ANTI-RHEUMATIC DRUGS ON DEPRESSION IN PATIENTS WITH PSORIATIC ARTHRITIS IN A LONGITUDINAL COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3826] [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: 11/04/2022]
Abstract
BackgroundDepression, and its improvement with disease modifying anti-rheumatic drugs (DMARDs) is understudied in psoriatic arthritis (PsA).ObjectivesTo determine the effectiveness of DMARDs on depression in PsA patients.MethodsPatients enrolled from January 2000 to May 2020 in a large PsA cohort were included. Depression was defined as medical outcomes study short form-36 (SF-36) mental component summary score (MCS) ≤ 40 or mental health (MH) subscale score ≤ 56. Primary outcome was resolution of depression within 1 year of DMARDs, defined by two definitions: 1) MCS > 40 and/or MH subscale score of > 56; 2) Increase in MCS by 2.5 and MH subscale score by 5, the minimal clinically important difference (MCID). Baseline medications [non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional or targeted (c/t) DMARDs] were recorded for all patients and stratified into 3 mutually exclusive ordinal categories: I-No treatment/NSAIDs; II-cDMARDs±NSAIDs without tDMARDs; III-tDMARDs±cDMARDs/NSAIDs. Univariable and multivariable logistic regression models were created to determine the association between medications and resolution of depression, after controlling for age, sex, disease duration and baseline MCS/MH subscale score.ResultsBased on the MCS and MH subscale score definitions, 608 (48%) and 655 (52%) of the 1270 patients, respectively were depressed at baseline. 374 (50.8% males) and 399 (52.4% males) patients were followed up in the groups defined by MCS and MH subscales, respectively for 1 year. Patients in both groups had comparable body mass indices, baseline psoriasis area and severity index and active joint count. Mean MCS and MH subscale scores (standard deviation) were 33.2 (5.2) and 46.0 (10.2). A mean of 11.9 and 11.7 months was noted for resolution of depression in the MCS based analysis and MH subscale-based analysis groups, respectively. More patients achieved resolution of depression based on definition 2 (MCS, 64.7%; MH, 62.2%) as compared to definition 1 (MCS, 54.5%; MH, 53.9). The proportion of patients on each category of medications in both models is shown in the Figure 1. Table 1 depicts the univariate and multivariable regression results by both the definitions of primary outcome in the MH subscales model. The global p-value for medication categories showed a trend towards significance in both models using definition 2. There was a trend towards higher likelihood of response when comparing patients in treatment category III vs category I. A significant response was noted when comparing patients in category III with category II as reference (OR 1.71; 95% CI 1.05-2.76; p 0.03). No significant effect of treatment category on depression was noted using definition 1.Table 1.Association between treatment and resolution of depression in the MH Subscale model (n = 399)VariableResolution by MCIDResolution by MH subscale reductionUnivariable modelMultivariable modelUnivariate modelMultivariate modelOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueMale vs. Female0.81 (0.54–1.22)0.310.83 (0.5–1.26)0.391.02 (0.68–1.51)0.940.94 (0.63 –1.42)0.79Baseline age1.01 (1.00 –1.03)0.091.01 (1.00 –1.03)0.161.02 (1.00–1.03)0.051.01 (0.99 –1.03)0.30Baseline PsA duration1.02 (1.00 –1.04)0.121.01 (0.99 –1.03)0.371.02 (1.00– 1.04)0.071.01 (0.99 –1.03)0.22Baseline MH subscale score0.98 (0.96 –1.00)0.030.98 (0.95 –1.00)0.021.04 (1.02– 1.06)<0.00011.04 (1.02 –1.06)<0.0001Medication category0.07*0.09*0.20*0.20* IReference II0.81 (0.48 –1.36)0.420.83 (0.48 –1.41)0.481.09 (0.65– 1.82)0.751.12 (0.66 –1.91)0.67 III1.40 (0.84 –2.36)0.201.41 (0.83 –2.38)0.201.51 (0.92– 2.49)0.101.55 (0.92 –2.59)0.10*global p valueFigure 1.Patients in each drug category.ConclusionIn an observational setting, resolution of depression occurs in majority of patients with PsA within 1 year. Patients on t-DMARDs may experience better improvement in depression compared to other treatments. Future effectiveness studies warrant better definitions of depression and treatment response.AcknowledgementsAJM was supported by the National Psoriasis Foundation Fellowship grant.Disclosure of InterestsAshish Jacob Mathew Speakers bureau: Novartis, IPCA Laboratories, Grant/research support from: Novartis, IPCA Laboratories, Mitchell Sutton: None declared, Daniel Pereira: None declared, Dafna D Gladman Consultant of: AstraZeneca, Grant/research support from: AbbVie, Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen and Eli-Lilly
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Aldabie G, Sutton M, Gladman DD. AB0929 Is there a correlation between skin severity and joint activity in Psoriatic Arthritis (PsA)? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1650] [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: 11/04/2022]
Abstract
BackgroundThe majority if patients with PsA present with skin manifestations first. Few studies have examined the relationship between severity of skin and joint manifestations, but the results have been variable.ObjectivesTo assess the correlation between the extent and severity of skin psoriasis and musculoskeletal manifestations of PsA over time.MethodsThis study is a retrospective analysis of prospectively collected data at a single center cohort study of patients who enrolled within 12 months of PsA diagnosis from 2000-2020. Patients are assessed according to a standard protocol which includes demographics, clinical assessment including skin and joint assessments, laboratory evaluation at 6–12-month intervals and radiographs every 2 years. Skin severity is measured by the PASI score, joint disease severity is measured by the number of tender and swollen joints. Axial disease was defined by the presence of bilateral grade sacroiliitis or unilateral grade 3 or 4. The Bath Ankylosing Spondylitis Metrology Index (BASMI) was also measured. Spearman correlations were calculated between PASI scores and joint counts and BASMI (in patients with axial disease). Multivariable analysis was done using negative binomial model for the joint counts and a linear regression for BASMI. This preliminary analysis includes only the baseline information.Results397 patients were included. Characteristics are shown in the Table 1. There was a correlation significant correlation between PASI score and the active joint count (AJC) (ρ 0.14, p=0.0095), swollen joint count (ρ 0.15, p=0.0071). Among the patients with axial disease there was a strong correlation between the PASI and BASMI scores ((ρ 0.58, p=0.0001).Table 1.Baseline characteristics of 397 patientsVariableMean (SD)*, Number (%)** N=397Age (years)44.97 (13.01)*PsA duration (years)0.43 (0.66)*Psoriasis duration (years)14.64 (13.65)*Married236 (60.5)**Smoker ever193 (48.7)**Alcohol intake246 (62.3)**Employed309 (78.4)**Post secondary education277 (71.0)**BMI29.21 (8.85)*PASI6.11 (9.03)*Nail238 (61.2)**Active joint count (tender ± swollen)7.3 (13/15)*Swollen joint count2.96 (4.93)*Axial disease53 (17.8%)**Treatment level None/NSAIDS only272 (68.2)** DMARDS ± NSAIDs98 (24.7)** Biologics ± DMARDs27 (6.80)**Multivariable analysis for AJC revealed traditional DMARDs (0.85 p=0.000). PASI score when patients were on no therapy (0.02 p=0.01) and those on biologics 0.04 p<0.05) were associated with higher AJC. Similarly for swollen joints the use of traditional DMARDs (0.85 P0.00), and the PASI score in those taking biologic DMARDs (0.07 p=0.003) were associated with higher swollen joint count.In patients with axial disease Age (0/05, p=0.004), PASI score in patients on no treatment (0.06 p=0.000) or those taking biologics (0.28 p=0.000) were associated with higher BASMI scores.ConclusionIn patients presenting within 12 months of diagnosis of PsA, there is a correlation between the severity of skin and joint disease. Further studies will assess whether this correlation persists over time.AcknowledgementsThe Toronto Psoriatic Arthritis Research Program is supported by a grant from the Krembil Foundation.Disclosure of InterestsGhaydaa Aldabie: None declared, Mitchell Sutton: None declared, Dafna D Gladman Consultant of: AstraZeneca
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Finkelstein N, Dayam RM, Law J, Goetgebuer R, Chao G, Abe KT, Sutton M, Stempak JM, Pereira D, Croitoru D, Acheampong L, Rizwan S, Rymaszewski K, Milgrom R, Ganatra D, Batista NV, Girard M, Lau I, Law R, Cheung M, Rathod B, Kitaygorodsky J, Samson R, Hu Q, Haroon N, Inman R, Piguet V, Silverberg M, Grigras AC, Watts TH, Chandran V. POS1217 ANTI-TNF THERAPY FOR IMMUNE MEDIATED INFLAMMATORY DISEASES MAY BE ASSOCIATED WITH LOWER ANTIBODY LEVELS AND VIRUS NEUTRALIZATION EFFICACY FOLLOWING SARS-CoV-2 mRNA VACCINATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1667] [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
BackgroundThe impact of immunosuppressants on COVID-19 vaccination response and durability in patients with immune-mediated inflammatory diseases (IMID) is yet to be fully characterized. Humoral response may be attenuated in these patients especially those on B cell depleting therapy and higher doses of corticosteroids, but data regarding other immunosuppressants are scarce.ObjectivesWe aimed to investigate antibody and T cell responses and durability to SARS-CoV-2 mRNA vaccines (BNT162b and/or mRNA 1273) in IMID patients on immunomodulatory maintenance therapy other than B-cell depleting therapy and corticosteroids.MethodsThis prospective observational cohort study examined the immunogenicity of SARS-CoV-2 mRNA vaccines in adult patients with IMIDs (psoriatic arthritis, psoriasis, inflammatory bowel disease and rheumatoid arthritis) with or without maintenance immunosuppressive therapies (anti-TNF, methotrexate/azathioprine [MTX/AZA], anti-TNF + MTX/AZA, anti IL12/23, anti-IL-17, anti-IL23) compared to healthy controls. Automated ELISA for IgGs to spike trimer, spike receptor binding domain (RBD) and the nucleocapsid (NP) and T-cell release of 9 cytokines (IFNg, IL2, IL4, IL17A, TNF) and cytotoxic molecules (sFasL, GzmA, GzmB, Perforinin) in cell culture supernatants following stimulation with spike or NP peptide arrays were conducted at 4 time points: T1=pre vaccination, T2=median 26 days after dose 1, T3=median 16 days after dose 2 and T4=median 106 days after dose 2. Neutralization assays against four SARS-CoV-2 variants (wild type, delta, beta and gamma) were conducted at T3.ResultsWe followed 150 subjects: 26 healthy controls and 124 IMID patients: 9 untreated, 44 on anti-TNF, 16 on anti-TNF with MTX/AZA, 10 on anti-IL23, 28 on anti-IL12/23, 9 on anti-IL17, 8 on MTX/AZA (Table 1). Most patients mounted antibody and T cell responses with increases from dose 1 to dose 2 (100% seroconversion at T3) and some decline by T4, with variability within groups. Antibody levels and neutralization efficacy was lower in anti-TNFgroups (anti-TNF, anti-TNF + MTX/AZA) compared to controls and waned by T4 (Figure 1). T cell responses were not consistently different between groups. Pooled data showed a higher antibody response to mRNA-1273 compared to BNT162b.Table 1.Baseline characteristics of study participantsControluntreated IMIDAnti- TNFAnti- TNF +MTX/AZAAnti-IL-23Anti -IL-12/23Anti -IL-17MTX/AZAn=26n=9n=44n=16n=10n=28n=9n=8p-valueIMID*N/A IBD9301002704 Psoriasis1318122 PA0732172 AS0830010 RA1100011Age median years [IQR]36 [26-46]33 [27-41]38 [30-51]53 [44-59]48 [45-61]34 [28-47]49 [46-61]42 [31-55]<0.001^Sex male (%)16 (62)5 (56)18 (41)8 (50)5 (50)13 (46)6 (67)4 (50)0.772~BMImedian kg/m2 [IQR]25 [23-28]26 [22-27]22 [24-26]26 [24-28]27 [24-35]22 [21-24]32 [26-34]26[25-33]0.001^Vaccine interval median days [IQR]74 [35-84]54 [31-64]60 [45-69]64 [50-72]74 [35-84]62 [49-69]65 [52-75]58 [21-97]0.372^*multiple IMIDs per patient possibleFigure 1.Antibody responses (A) Anti spike and anti RBD IgG levels at indicated time points. Blue line represents median ratio in convalescent patients. The red line is the seropositivity threshold: the median antibody level of those that pass both a 1% false positive rate and show ≥3SD from the log means of the negative controls. (B) Relative ratio of RBD, spike and NP across time. Black and gray lines indicate median and mean values, respectively. *p≤0.05, **p≤0.01, ***p≤0.001, ****p≤0.0001ConclusionFollowing 2 doses of mRNA vaccination there is 100% seroconversion in IMID patients on maintenance therapy. Antibody levels and neutralization efficacy in anti-TNF group are lower than controls, and wane substantially by 3 months after dose 2. These findings highlight the need for third dose in patients undergoing treatment with anti-TNF therapy and continued monitoring of immunity in these patient groups, taking into consideration newer variants and additional vaccine doses.AcknowledgementsThis work was funded by a donation from Juan and Stefania Speck and by grants VR-1 172711, VS1-175545, FDN-143250, GA1- 177703 and GA2- 177716, from Canadian Institutes of Health Research and COVID Immunity task force and by Sinai Health FoundationDisclosure of InterestsNaomi Finkelstein: None declared, Roya M. Dayam: None declared, Jaclyn Law: None declared, Rogier Goetgebuer: None declared, Gary Chao: None declared, Kento T. Abe: None declared, Mitchell Sutton: None declared, Joanne M. Stempak: None declared, Daniel Pereira: None declared, David Croitoru: None declared, Lily Acheampong: None declared, Saima Rizwan: None declared, Klaudia Rymaszewski: None declared, Raquel Milgrom: None declared, Darshini Ganatra: None declared, Nathalia V. Batista: None declared, Melanie Girard: None declared, Irene Lau: None declared, Ryan Law: None declared, Michelle Cheung: None declared, Bhavisha Rathod: None declared, Julia Kitaygorodsky: None declared, Reuben Samson: None declared, Queenie Hu: None declared, Nigil Haroon: None declared, Robert Inman Consultant of: AbbVie, Janssen, Lilly, Novartis., Grant/research support from: AbbVie, Novartis, Vincent Piguet Consultant of: AbbVie, Almirall, Celgene, Janssen, Kyowa Kirin Co. Ltd, LEO Pharma,Novartis, Pfizer, Sanofi, UCB, and Union Therapeutic, Grant/research support from: Unrestricted educational grants from AbbVie, Bausch Health, Celgene, Janssen, LEO Pharma, Lilly, L’Oréal, NAOS, Novartis, Pfizer, Pierre-Fabre, Sandoz, and Sanofi, Mark Silverberg Speakers bureau: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Consultant of: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Grant/research support from: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Anne-Claude Grigras: None declared, Tania H. Watts: None declared, Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, Eli-Lilly.
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Choquette D, Chandran V, Laliberté MC, Fournier PA, Girard T, Sutton M, Gladman DD. AB0895 Residual burden and disease activity of Canadian PsA patients treated with advanced therapies: preliminary results from a multiple registry analysis (UNISON-PsA). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1606] [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: 11/04/2022]
Abstract
BackgroundGiven the availability of advanced therapies in PsA with different modes of action, it is of interest to characterize their impact on overall clinical outcomes.ObjectivesTo describe residual disease activity in Canadians with PsA treated with advanced therapies.MethodsMulti-region, observational, retrospective analysis of data from Rhumadata (Quebec) and International Psoriasis and Arthritis Research Team (IPART) Canadian registries was performed. Data from each registry and region were analyzed separately using a common statistical analysis plan to generate descriptive statistics. Patients included in the registries were eligible if they were adults at the time of PsA diagnosis and were treated with an advanced therapy for ≥6 months initiated between January 2010 and December 2019. Residual disease activity was defined as failing to achieve MDA (defined as achieving ≥5 of: TJC ≤1; SJC ≤1; PASI ≤1 or BSA ≤3%; patient pain VAS score of ≤15 mm; patient global disease activity VAS score of ≤20 mm; HAQ score ≤0.5; and tender entheseal points ≤1) (primary endpoint), or DAPSA score ≥14 (secondary endpoint) within 6 months of initiation of an advanced therapy (TNFi, IL-12/23i, IL-17i, PDE4i, CTLA4i or JAKi).Results1,866 subjects (Atlantic [IPART; Newfoundland]: N=83; Quebec [Rhumadata]: N=687; Ontario [IPART]: N=966; West [IPART; British Columbia, Manitoba]: N=130) were included in this preliminary analysis. Baseline characteristics are presented in Table 1. Overall, 899 were receiving their 1st advanced therapy, 464 were receiving their 2nd, and 264 had received ≥3. The most common therapy class was TNFi, followed by IL-17i. 18/21 (85.7%) subjects in the Atlantic region with an assessment, 184/246 (74.8%) in Quebec, 391/571 (68.1%) in Ontario, and 30/43 (69.8%) in Western Canada failed to achieve MDA within 6 months following advanced therapy initiation. Failure to achieve MDA within the allotted period was higher among patients receiving an IL-17i compared with a TNFi. There was no appreciable effect of lines of therapy. Also, 74 of 110 (67.3%) patients with an assessment in Quebec, 201/365 (55.1%) in Ontario and 3/3 (100%) in the West failed to achieve at least low disease activity (LDA; DAPSA ≤14) within 6 months following initiation of an advanced therapy. Data were not available for the Atlantic region. The proportion of patients not achieving LDA by advanced therapy was similar for those receiving a TNFi and IL-17i but increased with line of therapy.Table 1.Patient demographic and baseline characteristics, and response to treatmentAtlantic (N=83)Quebec (N=687)Ontario (N=966)West (N=130)Age (years, mean [SD])50.3 (11.1)50.7 (12.1)49.1 (12.9)46.7 (12.1)Female (n [%])44/83 (53.0)346/687 (50.4)427/966 (44.2)81/128 (62.3)BMI (kg/m2, n, mean [SD])15, 30.8 (3.6)553, 29.6 (6.6)579, 30.6 (6.9)45, 32.8 (10.6)Time since diagnosis (years, N, mean [SD])83, 8.7 (8.7)687, 7.1 (7.9)895, 11.7 (11.1)74, 11.7 (8.9)HLA-B27 positive (n/N [%])N/A58/335 (17.3)86/648 (13.3)N/APresence of EAMs (n/N [%])4/44 (9.1)27/687 (3.9)65/693 (9.4)2/33 (6.1%)Fulfillment of CASPAR (n/N [%])N/A391/687 (56.9)100/100 (100)N/ATherapy class (n [%]):*TNFi66 (79.5)478 (69.6)651 (67.3)104 (80.0)IL-17i11 (13.3)106 (15.4)191 (19.9)21 (16.2)IL-12/23i6 (7.2)33 (4.8)124 (12.9)5 (3.9)PDE4i48 (7.0)Other22 (3.2)Failure to achieve MDA within 6 months of starting therapy (n/N [%])**18/21 (87.5)184/246 (74.8)391/571 (68.1)30/43 (69.8)Failure to achieve DAPSA ≤14 within 6 months of starting therapy (n/N [%])**N/A74/110 (67.3)201/365 (55.1)3/3 (100.0)*Patients may be taking >1 advanced therapy, **Not all patients had assessments of disease activity.ConclusionPreliminary data show approximately three quarters of Canadians with PsA failed to achieve MDA or LDA within 6 months of initiating an advanced therapy. Disease duration is a possible explanation for not achieving MDA or LDA; better therapeutic approaches are needed to achieve these outcomes in patients with PsA.AcknowledgementsThe authors wish to thank Dr. Steve Ramkissoon, for supporting the statistical analysis of the IPART registry. Medical writing and statistical support (funded by Abbvie) were provided by John Howell and Hong Chen, respectively, from McDougall Scientific. Financial support for the study was provided by AbbVie. AbbVie participated in the design of the study, interpretation of data, review, and approval of this publication. All authors contributed to the development of the publication and maintained control over the final content.Disclosure of InterestsDenis Choquette Speakers bureau: Amgen, Abbvie, CIHR, Novartis, Pfizer, Fresenius-Kabi, Eli Lilly, Sandoz, Tevapharm, Consultant of: Amgen, Abbvie, CIHR, Novartis, Pfizer, Fresenius-Kabi, Eli Lilly, Sandoz, Tevapharm, Grant/research support from: Rhumadata is supported through grants and research contracts from Amgen, Abbvie, CIHR, Novartis, Pfizer, Fresenius-Kabi, Eli Lilly, Sandoz, Tevapharm., Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, UCB, Pfizer, Employee of: Spouse is an employee of AstraZeneca, Marie-Claude Laliberté Shareholder of: AbbVie Corp., Employee of: AbbVie Corp., Pierre-André Fournier Shareholder of: AbbVie Corp., Employee of: AbbVie Corp., Tanya Girard Shareholder of: AbbVie Corp., Employee of: AbbVie Corp., Mitchell Sutton: None declared, Dafna D Gladman Consultant of: AbbVie, Amgen, BMS, Galapagos, Gilead, Eli Lilly, Janssen Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB
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Simonson AW, Bucsan AN, Zeppa JJ, Winchell CG, Myers AJ, Sutton M, Ameel CL, Darrah PA, Roederer M, Seder RA, Flynn JL. The role of lymphocyte subsets in preventing tuberculosis following intravenous vaccination with BCG. The Journal of Immunology 2022. [DOI: 10.4049/jimmunol.208.supp.181.11] [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: 01/04/2023]
Abstract
Abstract
Background
We previously demonstrated in non-human primates (NHP) that intravenous (IV) administration of BCG induces substantial T cell responses and often sterilizing immunity against Mycobacterium tuberculosis (Mtb) infection. Here, we investigated the role of T cell populations in this unmatched response in the context of necessary immune mechanisms for protection against tuberculosis (TB).
Methods
Beginning 20 weeks after vaccination and through the end of the study, rhesus macaques were infused with antibodies to deplete CD4, CD8α, or CD8β expressing T cells, or with control IgG/saline. NHPs inoculated with ~15 CFU Mtb Erdman via bronchoscope were monitored for 8 weeks. Granulomas, areas of disease, lung tissue and thoracic lymph nodes (LNs) were harvested at necropsy using FDG PET CT as a map to identify inflamed lesions. Immune responses were analyzed by spectral flow cytometry and homogenates were plated for colony forming unit (CFU) quantification.
Results
Successful depletion of expected cell types was seen in blood, airways, LNs and lung tissue. Depletion of CD4 T cells ablated IV BCG mediated protection in all NHPs. CD8α and CD8β depleted NHPs retained varying levels of protection, leading to mixed outcomes by bacterial burden. Preliminary results indicate the loss of protection following CD8α (both innate and adaptive cells) and CD8β (mainly adaptive cells) depletion is similar, suggesting a key role for conventional CD8 T cells in vaccination.
Conclusions
Our results provide critical insight regarding roles played by CD4 and CD8 T cell populations in terms of defining desired responses for vaccination against progressive TB. Functionality of these cells in immunized NHPs will clarify the purposes of T cell subsets.
Supported by grants from Bill and Melinda Gates Foundation and NIH NIAID (75N93019C00071)
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Affiliation(s)
- Andrew W Simonson
- 1Department of Microbiology and Molecular Genetics and Center for Vaccine Research, Univ. of Pittsburgh Sch. of Med
| | | | - Joseph J Zeppa
- 1Department of Microbiology and Molecular Genetics and Center for Vaccine Research, Univ. of Pittsburgh Sch. of Med
| | - Caylin G Winchell
- 1Department of Microbiology and Molecular Genetics and Center for Vaccine Research, Univ. of Pittsburgh Sch. of Med
| | - Amy J Myers
- 1Department of Microbiology and Molecular Genetics and Center for Vaccine Research, Univ. of Pittsburgh Sch. of Med
| | | | - Cassaundra L Ameel
- 1Department of Microbiology and Molecular Genetics and Center for Vaccine Research, Univ. of Pittsburgh Sch. of Med
| | | | | | | | - JoAnne L Flynn
- 1Department of Microbiology and Molecular Genetics and Center for Vaccine Research, Univ. of Pittsburgh Sch. of Med
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Wilding A, Munford LA, Sutton M. Predictors of social participation: evidence from repeated cross-sectional population surveys in England. J Public Health (Oxf) 2022:6550292. [PMID: 35301537 DOI: 10.1093/pubmed/fdac029] [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: 05/19/2021] [Revised: 10/25/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social participation is linked to better health and well-being. However, there is limited research on the individual and area-level predictors of participation. This study aims to determine the characteristics associated with participation, particularly the impact of community asset availability. METHODS We used data from 34 582 adult respondents to the nationally representative Community Life Survey from 2013 to 2018. We measured social participation by reported participation in 15 types of groups. We used probit and negative binomial regression models and included a wide range of individual, household and area characteristics, and availability of 14 types of community assets. RESULTS The following characteristics were associated with higher levels of participation: being female (+3.0 percentage points (p.p.) (95% CI 1.8 to 4.1p.p.), Black, Asian or Minority Ethnicity (+3.7p.p. (1.9 to 5.5p.p.)), homeownership (+4.1 p.p. (2.7 to 5.6p.p.)) and living in a rural area (+2.1p.p. (0.5 to 3.6p.p)). Respondents from the most deprived areas were less likely to participate than those in average deprivation areas (-3.9p.p. (-5.9 to -1.99p.p.)). Higher availability of community assets was associated with increased participation in groups. The effect of availability on participation varied by type of asset. CONCLUSION Improving community assets infrastructure in high deprivation and urban areas would encourage more social participation in these areas.
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Affiliation(s)
- A Wilding
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - L A Munford
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - M Sutton
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK.,Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, VIC 3010, Australia
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Sutton M, Sugier PE, Truong T, Liquet B. Leveraging pleiotropic association using sparse group variable selection in genomics data. BMC Med Res Methodol 2022; 22:9. [PMID: 34996381 PMCID: PMC8742466 DOI: 10.1186/s12874-021-01491-8] [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: 05/26/2021] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background Genome-wide association studies (GWAS) have identified genetic variants associated with multiple complex diseases. We can leverage this phenomenon, known as pleiotropy, to integrate multiple data sources in a joint analysis. Often integrating additional information such as gene pathway knowledge can improve statistical efficiency and biological interpretation. In this article, we propose statistical methods which incorporate both gene pathway and pleiotropy knowledge to increase statistical power and identify important risk variants affecting multiple traits. Methods We propose novel feature selection methods for the group variable selection in multi-task regression problem. We develop penalised likelihood methods exploiting different penalties to induce structured sparsity at a gene (or pathway) and SNP level across all studies. We implement an alternating direction method of multipliers (ADMM) algorithm for our penalised regression methods. The performance of our approaches are compared to a subset based meta analysis approach on simulated data sets. A bootstrap sampling strategy is provided to explore the stability of the penalised methods. Results Our methods are applied to identify potential pleiotropy in an application considering the joint analysis of thyroid and breast cancers. The methods were able to detect eleven potential pleiotropic SNPs and six pathways. A simulation study found that our method was able to detect more true signals than a popular competing method while retaining a similar false discovery rate. Conclusion We developed feature selection methods for jointly analysing multiple logistic regression tasks where prior grouping knowledge is available. Our method performed well on both simulation studies and when applied to a real data analysis of multiple cancers.
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Affiliation(s)
- Matthew Sutton
- Queensland University of Technology Centre for Data Science, Brisbane, Australia.
| | - Pierre-Emmanuel Sugier
- Laboratoire De Mathématiques et de leurs Applications de PAU E2S UPPA, CNRS, Pau, France.,University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Team "Exposome and Heredity", Villejuif, France
| | - Therese Truong
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, Team "Exposome and Heredity", Villejuif, France
| | - Benoit Liquet
- Laboratoire De Mathématiques et de leurs Applications de PAU E2S UPPA, CNRS, Pau, France.,Department of Mathematics and Statistics, Macquarie University, Sydney, Australia
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Goodwin M, Whittaker W, Walsh T, Emsley R, Sutton M, Tickle M, Kelly M, Pretty I. Recruitment and Consent in an observational study. Community Dent Health 2020; 37:287-292. [PMID: 33026721 DOI: 10.1922/cdh_000682020goodwin06] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The study sought to explore the consent rate and associated potential bias across a cohort in a large longitudinal population based study. RESEARCH DESIGN Data were taken from a study designed to examine the effects of the reintroduction of community water fluoridation on children's oral health over a five-year period. Children were recruited from a fluoridated and non-fluoridated area in Cumbria, referred to as Group 1 and Group 2. RESULTS Data were available for 3138 individuals. The consent rate was 12.91 percentage points lower in Group 2 than Group 1 (95% CI -16.27 to -9.56, p⟨0.001). The population in Group 2 was more deprived (higher Index of Multiple Deprivation (IMD)) than Group 1 before consent was taken. Consent was not associated with deprivation in either group. CONCLUSION The cohort appeared to be unaffected by IMD-related non-consent. However there was a difference in consent rate between the two groups. With the population in Group 1 being more deprived than Group 2, it will be important to incorporate these differences into the analysis at the end of this longitudinal study.
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Affiliation(s)
- M Goodwin
- University of Manchester, School of Dentistry, UK
| | - W Whittaker
- University of Manchester, Population Health, Health Services Research & Primary Care, UK
| | - T Walsh
- University of Manchester, School of Dentistry, UK
| | - R Emsley
- King's College London, Psychiatry, Psychology & Neuroscience, UK
| | - M Sutton
- University of Manchester, Population Health, Health Services Research & Primary Care, UK
| | - M Tickle
- University of Manchester, School of Dentistry, UK
| | - M Kelly
- University of Cambridge, Public Health, UK
| | - I Pretty
- University of Manchester, School of Dentistry, UK
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Chatzi G, Mason T, Chandola T, Whittaker W, Howarth E, Cotterill S, Ravindrarajah R, McManus E, Sutton M, Bower P. Sociodemographic disparities in non-diabetic hyperglycaemia and the transition to type 2 diabetes: evidence from the English Longitudinal Study of Ageing. Diabet Med 2020; 37:1536-1544. [PMID: 32531074 DOI: 10.1111/dme.14343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 01/05/2023]
Abstract
AIM To explore whether there are social inequalities in non-diabetic hyperglycaemia (NDH) and in transitions to type 2 diabetes mellitus and NDH low-risk status in England. METHODS Some 9143 men and women aged over 50 years were analysed from waves 2, 4, 6 and 8 (2004-2016) of the English Longitudinal Study of Ageing (ELSA). Participants were categorized as: NDH 'low-risk' [HbA1c < 42 mmol/mol (< 6.0%)], NDH [HbA1c 42-47 mmol/mol (6.0-6.4%)] and type 2 diabetes [HbA1c > 47 mmol/mol (> 6.4%)]. Logistic regression models estimated the association between sociodemographic characteristics and NDH, and the transitions from NDH to diagnosed or undiagnosed type 2 diabetes and low-risk status in future waves. RESULTS NDH was more prevalent in older participants, those reporting a disability, those living in deprived areas and in more disadvantaged social classes. Older participants with NDH were less likely to progress to undiagnosed type 2 diabetes [odds ratio (OR) 0.27, 95% confidence interval (CI) 0.08, 0.96]. NDH individuals with limiting long-standing illness (OR 1.72, 95% CI 1.16, 2.53), who were economically inactive (OR 1.60, 95% CI 1.02, 2.51) or from disadvantaged social classes (OR 1.63, 95% CI 1.02, 2.61) were more likely to progress to type 2 diabetes. Socially disadvantaged individuals were less likely (OR 0.64, 95% CI 0.41, 0.98) to progress to NDH low-risk status. CONCLUSIONS There were socio-economic differences in NDH prevalence, transition to type 2 diabetes and transition to NDH low-risk status. Disparities in transitions included the greater likelihood of disadvantaged social groups with NDH developing type 2 diabetes and greater likelihood of advantaged social groups with NDH becoming low-risk. These socio-economic differences should be taken into account when targeting prevention initiatives.
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Affiliation(s)
- G Chatzi
- Manchester Centre for Health Economics, University of , Manchester, UK
| | - T Mason
- Manchester Centre for Health Economics, University of , Manchester, UK
| | - T Chandola
- Cathie Marsh Institute for Social Research, University of Manchester, Manchester, UK
| | - W Whittaker
- Manchester Centre for Health Economics, University of , Manchester, UK
| | - E Howarth
- Manchester Centre for Health Economics, University of , Manchester, UK
| | - S Cotterill
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - R Ravindrarajah
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - E McManus
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - M Sutton
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - P Bower
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Lal J, Lurio LB, Liang D, Narayanan S, Darling SB, Sutton M. Universal dynamics of coarsening during polymer-polymer thin-film spinodal dewetting kinetics. Phys Rev E 2020; 102:032802. [PMID: 33076025 DOI: 10.1103/physreve.102.032802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
The dewetting dynamics of a supported bilayer polymer thin film on a solid substrate is investigated using grazing incidence x-ray photon correlation spectroscopy. We find that the top layer dewets via the spinodal mechanism. The kinetics of the dewetting is studied by monitoring the time evolution of the surface diffuse x-ray scattering intensity. We study the time evolution of fluctuations about the average surface structure by measuring the two-time x-ray intensity fluctuation correlation functions. Using these two-time correlation functions we quantify the crossover from early-time diffusive dynamics to hydrodynamics. The early diffusive regime satisfies dynamic universality. The two-time correlation functions also quantify the onset of hydrodynamic effects. The hydrodynamic regime is observed during the spinodal dewetting process as these interactions are not screened.
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Affiliation(s)
- J Lal
- Materials Science Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
- Intense Pulsed Neutron Source, Argonne National Laboratory, Argonne, Illinois 60439, USA
- Department of Physics, Northern Illinois University, DeKalb, Illinois 60115, USA
| | - L B Lurio
- Department of Physics, Northern Illinois University, DeKalb, Illinois 60115, USA
| | - D Liang
- Intense Pulsed Neutron Source, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - S Narayanan
- X-ray Science Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - S B Darling
- Chemical Sciences and Engineering, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - M Sutton
- Physics Department, McGill University, Montréal, H3A 2T8, Canada
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Bower P, Grigoroglou C, Anselmi L, Kontopantelis E, Sutton M, Ashworth M, Evans P, Lock S, Smye S, Abel K. Is health research undertaken where the burden of disease is greatest? Observational study of geographical inequalities in recruitment to research in England 2013-2018. BMC Med 2020; 18:133. [PMID: 32418543 PMCID: PMC7232839 DOI: 10.1186/s12916-020-01555-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 03/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Research is fundamental to high-quality care, but concerns have been raised about whether health research is conducted in the populations most affected by high disease prevalence. Geographical distribution of research activity is important for many reasons. Recruitment is a major barrier to research delivery, and undertaking recruitment in areas of high prevalence could be more efficient. Regional variability exists in risk factors and outcomes, so research done in healthier populations may not generalise. Much applied health research evaluates interventions, and their impact may vary by context (including geography). Finally, fairness dictates that publically funded research should be accessible to all, so that benefits of participating can be fairly distributed. We explored whether recruitment of patients to health research is aligned with disease prevalence in England. METHODS We measured disease prevalence using the Quality and Outcomes Framework in England (total long-term conditions, mental health and diabetes). We measured research activity using data from the NIHR Clinical Research Network. We presented descriptive data on geographical variation in recruitment rates. We explored associations between the recruitment rate and disease prevalence rate. We calculated the share of patient recruitment that would need to be redistributed to align recruitment with prevalence. We assessed whether associations between recruitment rate and disease prevalence varied between conditions, and over time. RESULTS There was significant geographical variation in recruitment rates. When areas were ranked by disease prevalence, recruitment was not aligned with prevalence, with disproportionately low recruitment in areas with higher prevalence of total long-term and mental health conditions. At the level of 15 local networks, analyses suggested that around 12% of current recruitment activity would need to be redistributed to align with disease prevalence. Overall, alignment showed little change over time, but there was variation in the trends over time in individual conditions. CONCLUSIONS Geographical variations in recruitment do not reflect the suitability of the population for research. Indicators should be developed to assess the fit between research and need, and to allow assessment of interventions among funders, researchers and patients to encourage closer alignment between research activity and burden.
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Affiliation(s)
- Peter Bower
- NIHR Clinical Research Network, University of Manchester, Manchester, UK.
| | | | - Laura Anselmi
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | | | - Matthew Sutton
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, Manchester, UK
| | - Philip Evans
- General Practice and Primary Care, College of Medicine and Health, University of Exeter, Manchester, UK.,NIHR CRN National Specialty Lead for Primary Care and Cluster C Lead, Kings College, London, UK
| | - Stephen Lock
- NIHR Clinical Research Network Business Intelligence, Manchester, UK
| | - Stephen Smye
- NIHR CRN Specialty Cluster Lead, CRN National Coordinating Centre (CRNCC), NIHR Clinical Research Network (CRN), Kings College London, London, UK
| | - Kathryn Abel
- NIHR Clinical Research Network, University of Manchester, Manchester, UK
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20
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Zeppa JJ, Darrah PA, Sutton M, Pokkali S, Scanga CA, Maiello P, Lin PL, Roederer M, Seder RA, Flynn JL. Vaccine-Elicited T cells are Important for Intravenous BCG Mediated Protection in a Rhesus macaque Model of Tuberculosis. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.168.4] [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: 01/03/2023]
Abstract
Abstract
Our laboratories have shown that intravenous (IV) vaccination with Bacille Calmette-Guerin (BCG; 5×107 CFU) provides robust protection against low-dose Mycobacterium tuberculosis (Mtb) infection in rhesus macaques (9/10 protected [<50 thoracic Mtb CFU]; 100,000-fold reduction compared to intradermal [ID] BCG). IV BCG also resulted in a 100-fold increase in mycobacterium--specific T cells in the airways of animals compared to ID or aerosol administration. To investigate the role of T cells in this protective model, we employed two methodologies: 1. Vaccination with decreasing doses of BCG to stimulate lower-magnitude T cell responses and; 2. Antibody-mediated CD4 and CD8a T cell depletion post-vaccination but pre-infection. Animals were vaccinated for 6 months followed by a 2–3 month low-dose Mtb challenge. Surprisingly, even at low doses of BCG (0.4–2 × 105), a subset of animals was protected, with a range of outcomes across the doses. In the second study, depletion was successful in blood, airways and tissue. Interestingly, depletion of either T cell subset resulted in an intermediate total thoracic CFU phenotype. In both studies, correlates of immunity will be assessed comparing protection (CFU) to BAL and tissue resident immune responses. Our data supports that sterilizing protection is observed across the BCG IV dose spectrum and that T cells are important, but are likely not the only factors involved in this protection. Our findings are critical for identifying correlates of protection and generating a safe and effective vaccine against TB.
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21
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Björklund E, Pallaroni L, Holst CV, Unglaub W, Bosch J, Calderon-Alvarez F, Costa J, Cowles J, Gaede W, Krause M, Marmo S, Pecoraro S, Reaney S, Sutton M, Thiele D, Wolf C. Method of Determination of Appropriate Heat Treatment of Animal Meal by Immunoassay Developed for Detection of Cooked Beef: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.6.1839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
An interlaboratory trial was conducted for the validation of an enzyme-linked immunosorbent assay (ELISA) method for determination of appropriate heat treatment of animal meal. A commercially available ELISA test kit developed for the identification of beef in cooked food was used in the study. Twelve laboratories from 7 European countries examined 2 different analytical protocols to establish the most appropriate analytical method. Three different samples were used, 2 animal waste materials sterilized at 129 and 134°C (wet conditions), respectively, and a meat and bone meal material processed at dry conditions (maximum temperature, 140°C). Statistical evaluation applying t-statistics showed that the animal meal treated according to European legislation (>133°C) was clearly distinguishable from the 2 other test materials at a 99% confidence level using both analytical protocols. This method can be considered as a complementary test to the immunoassay developed for the detection of pork in cooked food that is already applied in routine analysis for the surveillance of rendering plants.
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Affiliation(s)
- Erland Björklund
- European Commission, Joint Research Centre, Food Products and Consumer Goods Unit, I-21020 Ispra (VA), Italy
| | - Lea Pallaroni
- European Commission, Joint Research Centre, Food Products and Consumer Goods Unit, I-21020 Ispra (VA), Italy
| | - Christoph von Holst
- European Commission, Joint Research Centre, Food Products and Consumer Goods Unit, I-21020 Ispra (VA), Italy
| | - Wolfgang Unglaub
- Staatliches Tieraerztliches Untersuchungsamt Aulendorf, Centre for Diagnostic Baden-Wuerttemberg, Loewenbreitestrasse 18-20, D-88326 Aulendorf, Germany
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22
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Lipp M, Anklam E, Stave JW, Bahrs-Windsberger J, Barreto Crespo MT, Benvenuto E, Berben G, Brignon P, Busch U, Cordes C, Eklund E, El Jaziri M, Engel KH, Eriksen F, Eriksson S, Felinger A, Fogher C, Folch I, Garrett S, Hischenhuber C, Hörtner H, Jany KD, Krska R, Kruse L, Kuiper HA, Lobre C, Miraglia M, Mhller W, Nunes Costa JM, Oliveira L, Patel P, Pietsch K, Pöpping B, Remler P, Rentsch J, Schulze M, Sutton M, van Duijn G, van Kan F, Wurz A. Validation of an Immunoassay for Detection and Quantitation of a Genetically Modified Soybean in Food and Food Fractions Using Reference Materials: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/83.4.919] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
An immunoassay for detection of a specific genetically modified soybean (Roundup-Ready®) was validated on dried soybean powder in an interlaboratory study. Different percentages of genetically modified soybeans in nonmodified soybean matrix were evaluated in a blind study. Thirty-eight laboratories from 13 countries participated. The immunoassay was evaluated for 2 endpoints: (1) To give a semiquantitative result, i.e., determination of a given sample above or below a given threshold, or (2) to compute a quantitative result, i.e., percentage of genetically modified soybeans in the sample. Semiquantitative results showed that a given sample which contained <2% genetically modified soybeans was identified as below 2% with a 99% confidence level. Quantitative use of the assay resulted in a repeatability (r) and reproducibility (R) that were computed to be RSDr = 7% and RSDR = 10%, respectively, for a sample containing 2% genetically modified soybeans. Application of this method depends on availability of appropriate reference materials for a specific food matrix. Only matrix-matched reference materials can be used for analysis of food or food fractions.
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Affiliation(s)
- Markus Lipp
- European Commission, Joint Research Center, Institute for Health and Consumer Protection, Food Products and Consumer Goods Unit, T.P. 260, I-21020 Ispra (Va), Italy
| | - Elke Anklam
- European Commission, Joint Research Center, Institute for Health and Consumer Protection, Food Products and Consumer Goods Unit, T.P. 260, I-21020 Ispra (Va), Italy
| | - James W Stave
- Strategic Diagnostics, Inc., 111 Pencader Dr, Newark, DE 19702-3322
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23
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Thompson AJ, Sutton M, Payne K. Estimating Joint Health Condition Utility Values. Value Health 2019; 22:482-490. [PMID: 30975400 DOI: 10.1016/j.jval.2018.09.2843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/03/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To predict health state utility values (HSUVs) for individuals with up to 4 conditions simultaneously. METHODS Person-level data were taken from the General Practice Patient Survey, a national survey of adult patients registered with general practices in England. Individuals reported whether they had any 1 of 16 chronic conditions and completed the 3-level EuroQol 5-dimensional questionnaire. Four nonparametric methods (additive, multiplicative, minimum, and the adjusted decrement estimator) and 1 parametric estimator (the linear index) were used to predict HSUVs for individuals with a joint health condition (JHC). Predicted and actual utility scores were compared for precision using root mean square error and mean absolute error. Bias was assessed using mean error. RESULTS The analysis included 929,565 individuals, of which 30.5% had at least 2 conditions. Of the nonparametric estimators, the multiplicative approach produced estimates with the lowest bias and most precision for 2 JHCs. For populations with a long-term mental health condition within the JHC, the multiplicative approach overestimated utility scores. All nonparametric methods produced biased results when estimating HSUVs for 3 or 4 JHCs. The linear index generally produced unbiased results with the highest precision. CONCLUSIONS The multiplicative approach was the best nonparametric estimator when estimating HSUVs for 2 JHCs. None of the nonparametric approaches for estimating HSUVs can be recommended with more than 2 JHCs. The linear index was found to have good predictive properties but needs external validation before being recommended for routine use.
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Affiliation(s)
- Alexander J Thompson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK.
| | - Matthew Sutton
- Health Organisation, Policy and Economics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
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25
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Sutton M, Mengersen K, Liquet B. [HDDA] sparse subspace constrained partial least squares. J STAT COMPUT SIM 2018. [DOI: 10.1080/00949655.2018.1555830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Matthew Sutton
- School of Mathematical Sciences, ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences, ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
| | - Benoit Liquet
- School of Mathematical Sciences, ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
- Laboratory of Mathematics and Their Applications, University of Pau and Pays de lAdour, Pau, France
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26
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Ruggeri M, Drago C, Moramarco V, Coretti S, Köppen J, Islam MK, Gibson J, Busse R, van Exel J, Sutton M, Askildsen JE, Bond CM, Elliott RF. New professional roles and patient satisfaction: Evidence from a European survey along three clinical pathways. Health Policy 2018; 122:1078-1084. [PMID: 30227975 DOI: 10.1016/j.healthpol.2018.07.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/23/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
This paper reports the results of an empirical analysis exploring the impact of new professions (eg a physician associate) and new professional roles on patient experiences of and satisfaction with care. A sub set of data from a patient survey conducted as part of the MUNROS programme of work was used. The overall survey aim was to describe and quantify the use of new professionals and new roles for established health care professionals other than medical doctors, in primary and secondary care sectors in three care pathways in nine European countries Ordered logit models were used to investigate the association between: (1) patient satisfaction with the last visit; (2) with their care provider; (3) with the information provided and a set of covariates explaining the involvement of new professional roles in three clinical pathways: type 2 diabetes, heart disease and breast cancer. For patients with breast cancer, high levels of satisfaction are associated with the involvement of new professions/professional roles in the provision of conditions specific education and monitoring. For patients with heart disease, the involvement of new professions/professional roles is likely to have a negative impact on satisfaction. For patients with Type 2 diabetes results are ambivalent. Patients belonging to countries experiencing innovative models of healthcare delivery and with high levels of involvement of new professions/professional roles are generally more satisfied. In conclusion, the introduction of new professions does not affect patient satisfaction negatively, therefore introducing new health professional roles is a pursuable strategy from a patient satisfaction perspective, at least for breast cancer and type 2 diabetes.
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27
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Sutton M, Thiébaut R, Liquet B. Sparse partial least squares with group and subgroup structure. Stat Med 2018; 37:3338-3356. [PMID: 29888397 DOI: 10.1002/sim.7821] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/08/2018] [Accepted: 04/19/2018] [Indexed: 11/07/2022]
Abstract
Integrative analysis of high dimensional omics datasets has been studied by many authors in recent years. By incorporating prior known relationships among the variables, these analyses have been successful in elucidating the relationships between different sets of omics data. In this article, our goal is to identify important relationships between genomic expression and cytokine data from a human immunodeficiency virus vaccine trial. We proposed a flexible partial least squares technique, which incorporates group and subgroup structure in the modelling process. Our new method accounts for both grouping of genetic markers (eg, gene sets) and temporal effects. The method generalises existing sparse modelling techniques in the partial least squares methodology and establishes theoretical connections to variable selection methods for supervised and unsupervised problems. Simulation studies are performed to investigate the performance of our methods over alternative sparse approaches. Our R package sgspls is available at https://github.com/matt-sutton/sgspls.
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Affiliation(s)
- Matthew Sutton
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
| | - Rodolphe Thiébaut
- Inria, SISTM, Talence and Inserm, U1219 Bordeaux University, Bordeaux, France
- Vaccine Research Institute, Creteil, France
| | - Benoît Liquet
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
- Université de Pau et des Pays de l'Adour, Laboratoire de Mathematiques et de leurs Applications, UMR CNRS 5142, Pau, France
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28
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O’Connor M, Deeks HM, Dawn E, Metatla O, Roudaut A, Sutton M, Thomas LM, Glowacki BR, Sage R, Tew P, Wonnacott M, Bates P, Mulholland AJ, Glowacki DR. Sampling molecular conformations and dynamics in a multiuser virtual reality framework. Sci Adv 2018; 4:eaat2731. [PMID: 29963636 PMCID: PMC6025904 DOI: 10.1126/sciadv.aat2731] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/18/2018] [Indexed: 05/28/2023]
Abstract
We describe a framework for interactive molecular dynamics in a multiuser virtual reality (VR) environment, combining rigorous cloud-mounted atomistic physics simulations with commodity VR hardware, which we have made accessible to readers (see isci.itch.io/nsb-imd). It allows users to visualize and sample, with atomic-level precision, the structures and dynamics of complex molecular structures "on the fly" and to interact with other users in the same virtual environment. A series of controlled studies, in which participants were tasked with a range of molecular manipulation goals (threading methane through a nanotube, changing helical screw sense, and tying a protein knot), quantitatively demonstrate that users within the interactive VR environment can complete sophisticated molecular modeling tasks more quickly than they can using conventional interfaces, especially for molecular pathways and structural transitions whose conformational choreographies are intrinsically three-dimensional. This framework should accelerate progress in nanoscale molecular engineering areas including conformational mapping, drug development, synthetic biology, and catalyst design. More broadly, our findings highlight the potential of VR in scientific domains where three-dimensional dynamics matter, spanning research and education.
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Affiliation(s)
- Michael O’Connor
- Centre for Computational Chemistry, School of Chemistry, University of Bristol, Cantock’s Close, Bristol BS8 1TS, UK
- Department of Computer Science, University of Bristol, Merchant Venturer’s Building, Bristol BS8 1UB, UK
- Pervasive Media Studio, Watershed, 1 Canons Road, Bristol BS1 5TX, UK
| | - Helen M. Deeks
- Centre for Computational Chemistry, School of Chemistry, University of Bristol, Cantock’s Close, Bristol BS8 1TS, UK
- Department of Computer Science, University of Bristol, Merchant Venturer’s Building, Bristol BS8 1UB, UK
| | - Edward Dawn
- Centre for Computational Chemistry, School of Chemistry, University of Bristol, Cantock’s Close, Bristol BS8 1TS, UK
| | - Oussama Metatla
- Department of Computer Science, University of Bristol, Merchant Venturer’s Building, Bristol BS8 1UB, UK
| | - Anne Roudaut
- Department of Computer Science, University of Bristol, Merchant Venturer’s Building, Bristol BS8 1UB, UK
| | - Matthew Sutton
- Department of Computer Science, University of Bristol, Merchant Venturer’s Building, Bristol BS8 1UB, UK
| | - Lisa May Thomas
- Centre for Computational Chemistry, School of Chemistry, University of Bristol, Cantock’s Close, Bristol BS8 1TS, UK
- Department of Computer Science, University of Bristol, Merchant Venturer’s Building, Bristol BS8 1UB, UK
- Pervasive Media Studio, Watershed, 1 Canons Road, Bristol BS1 5TX, UK
- Department of Theatre, University of Bristol, Cantock’s Close, Bristol BS8 1UP, UK
| | - Becca Rose Glowacki
- Pervasive Media Studio, Watershed, 1 Canons Road, Bristol BS1 5TX, UK
- School of Art and Design, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK
| | - Rebecca Sage
- Pervasive Media Studio, Watershed, 1 Canons Road, Bristol BS1 5TX, UK
- Interactive Scientific, Engine Shed, Station Approach, Bristol BS1 6QH, UK
| | - Philip Tew
- Pervasive Media Studio, Watershed, 1 Canons Road, Bristol BS1 5TX, UK
- Interactive Scientific, Engine Shed, Station Approach, Bristol BS1 6QH, UK
| | - Mark Wonnacott
- Interactive Scientific, Engine Shed, Station Approach, Bristol BS1 6QH, UK
| | - Phil Bates
- Oracle Cloud Development Centre, Tower Wharf, Cheese Lane, Bristol BS2 2JJ, UK
| | - Adrian J. Mulholland
- Centre for Computational Chemistry, School of Chemistry, University of Bristol, Cantock’s Close, Bristol BS8 1TS, UK
| | - David R. Glowacki
- Centre for Computational Chemistry, School of Chemistry, University of Bristol, Cantock’s Close, Bristol BS8 1TS, UK
- Department of Computer Science, University of Bristol, Merchant Venturer’s Building, Bristol BS8 1UB, UK
- Pervasive Media Studio, Watershed, 1 Canons Road, Bristol BS1 5TX, UK
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29
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Kenning C, Lovell K, Hann M, Agius R, Bee PE, Chew-Graham C, Coventry PA, van der Feltz-Cornelis CM, Gilbody S, Hardy G, Kellett S, Kessler D, McMillan D, Reeves D, Rick J, Sutton M, Bower P. Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial. Public Health Res 2018. [DOI: 10.3310/phr06020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Cassandra Kenning
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Penny E Bee
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Gillian Hardy
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Stephen Kellett
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - David Reeves
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Joanne Rick
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Matthew Sutton
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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Walker T, Edge D, Shaw J, Wilson H, McNair L, Mitchell H, Gutridge K, Senior J, Sutton M, Meacock R, Abel K. Contemporary women's secure psychiatric services in the United Kingdom: A qualitative analysis of staff views. J Psychiatr Ment Health Nurs 2017; 24:660-670. [PMID: 28783204 DOI: 10.1111/jpm.12416] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Three pilot UK-only Women's Enhanced Medium Secure Services (WEMSS) was opened in 2007 to support women's movement from high secure care and provide a bespoke, women-only service. Evidence suggests that women's secure services are particularly challenging environments to work in and staffing issues (e.g., high turnover) can cause difficulties in establishing a therapeutic environment. Research in this area has focused on the experiences of service users. Studies which have examined staff views have focused on their feelings towards women in their care and the emotional burden of working in women's secure services. No papers have made a direct comparison between staff working in different services. WHAT DOES THIS STUDY ADD TO EXISTING KNOWLEDGE?: This is the first study to explore the views and experiences of staff in the three UK WEMSS pilot services and contrast them with staff from women's medium secure services. Drawing upon data from eighteen semi-structured interviews (nine WEMSS, nine non-WEMSS), key themes cover staff perceptions of factors important for women's recovery and their views on operational aspects of services. This study extends our understanding of the experiences of staff working with women in secure care and bears relevance for staff working internationally, as well as in UK services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study reveals the importance of induction and training for bank and agency staff working in women's secure services. Further, regular clinical supervision should be mandatory for all staff so they are adequately supported. ABSTRACT Introduction Women's Enhanced Medium Secure Services (WEMSS) is bespoke, gender-sensitive services which opened in the UK in 2007 at three pilot sites. This study is the first of its kind to explore the experiences of WEMSS staff, directly comparing them to staff in a standard medium secure service for women. The literature to date has focused on the experiences of service users or staff views on working with women in secure care. Aim This qualitative study, embedded in a multimethod evaluation of WEMSS, aimed to explore the views and experiences of staff in WEMSS and comparator medium secure services. Methods Qualitative interviews took place with nine WEMSS staff and nine comparator medium secure staff. Interviews focused on factors important for recovery, barriers to facilitating recovery and operational aspects of the service. Discussion This study provides a rare insight into the perspectives of staff working in UK women's secure services, an under-researched area in the UK and internationally. Findings suggest that the success of services, including WEMSS, is compromised by operational factors such as the use of bank staff. Implications for practice Comprehensive training and supervision should be mandatory for all staff, so best practice is met and staff adequately supported.
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Affiliation(s)
- T Walker
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - D Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Offender Health Research Network, University of Manchester, Manchester, UK
| | - H Wilson
- Lancashire Care NHS Foundation Trust, Preston, UK
| | - L McNair
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - H Mitchell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - K Gutridge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Senior
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Offender Health Research Network, University of Manchester, Manchester, UK
| | - M Sutton
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - R Meacock
- Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - K Abel
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Centre for Women's Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Britteon P, Cullum N, Sutton M. Association between psychological health and wound complications after surgery. Br J Surg 2017; 104:769-776. [DOI: 10.1002/bjs.10474] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/29/2016] [Accepted: 11/30/2016] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Surgical wound complications remain a major cause of morbidity, leading to higher costs and reduced quality of life. Although psychological health is widely considered to affect wound healing, the evidence on wound outcomes after surgery is mixed. Studies generally focus on small samples of patients undergoing a specific procedure and have limited statistical power.
Methods
This study investigated the relationship between three different measures of anxiety and/or depression and seven adverse surgical outcomes using observational data collected before and after surgery between 2009 and 2011. A wide range of confounding factors was adjusted for, including patient demographics, physical co-morbidities, health-related behaviours, month of operation, procedure complexity and treating hospital.
Results
The estimation sample included 176 827 patients undergoing 59 410 hip replacements, 64 145 knee replacements, 38 328 hernia repairs and 14 944 varicose vein operations. Patients with moderate anxiety or depression had an increased probability of wound complications after a hip replacement (odds ratio (OR) 1·17, 95 per cent c.i. 1·11 to 1·24). They were more likely to be readmitted for a wound complication (OR 1·20, 1·02 to 1·41) and had an increased duration of hospital stay by 0·19 (95 per cent c.i. 0·15 to 0·24) days. Estimated associations were consistent across all four types of operation and for each measure of anxiety and/or depression.
Conclusion
Preoperative psychological health is a significant risk factor for adverse wound outcomes after surgery for four of the procedures most commonly performed in England.
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Affiliation(s)
- P Britteon
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - N Cullum
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - M Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
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Mason T, Lau YS, Sutton M. Is the distribution of care quality provided under pay-for-performance equitable? Evidence from the Advancing Quality programme in England. Int J Equity Health 2016; 15:156. [PMID: 27658387 PMCID: PMC5034568 DOI: 10.1186/s12939-016-0434-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The limited number of existing previous studies of the distribution of quality under NHS Pay-for-performance (P4P) by income deprivation have not analysed the relationship at the individual level and have been restricted to assessing P4P in the primary care setting. In this study, we set out to examine how achievement of P4P 'quality measures' for which NHS hospitals were paid was distributed by income deprivation. METHODS Design: Retrospective analysis of performance data reported by hospitals, examining how the probability of receiving 23 indicators varied by patients' area deprivation using logistic regression controlling for age and gender. SAMPLE We use anonymised observational data on 73,002 patients admitted to hospitals in the North West of England between October 2008 and March 2010 for the following five reasons: acute myocardial infarction; coronary artery bypass grafting; heart failure; hip and knee replacement; and pneumonia. RESULTS The relationship between quality and deprivation varies depending on the point of delivery in the treatment pathway, and on whether delivered for conditions in scheduled or unscheduled care. For diagnostic tests on arrival, receipt of quality was: pro-rich in scheduled care and pro-poor in unscheduled care. Receipt of quality was pro-poor for pre-surgery measures in scheduled care. Receipt of quality at discharge was pro-rich. CONCLUSION Unlike in primary care, in secondary care quality is not systemically distributed by income deprivation under P4P. Whilst improvements in health inequalities are important system objectives; they may not necessarily be achieved by the adoption of P4P schemes in hospitals.
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Affiliation(s)
- Thomas Mason
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Yiu-Shing Lau
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Sutton
- Centre for Health Economics, University of Manchester, Manchester, UK
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Abstract
BACKGROUND The establishment of minor eye conditions schemes (MECS) within community optometric practices provides a mechanism for the timely assessment of patients presenting with a range of acute eye conditions. This has the potential to reduce waiting times and avoid unnecessary referrals to hospital eye services (HES). OBJECTIVE To evaluate the clinical effectiveness, impact on hospital attendances and patient satisfaction with a minor eye service provided by community optometrists. METHODS Activity and outcome data were collected for 12 months in the Lambeth and Lewisham MECS. A patient satisfaction questionnaire was given to patients at the end of their MECS appointment. A retrospective difference-in-differences analysis of hospital activity compared changes in the volume of referrals by general practitioners (GPs) from a period before (April 2011-March 2013) to after (April 2013-March 2015) the introduction of the scheme in Lambeth and Lewisham relative to a neighbouring area (Southwark) where the scheme had not been commissioned. Appropriateness of case management was assessed by consensus using clinical members of the research team. RESULTS A total of 2123 patients accessed the scheme. Approximately two-thirds of patients (67.5%) were referred by their GP. The commonest reasons for patients attending for a MECS assessment were 'red eye' (36.7% of patients), 'painful white eye' (11.1%) and 'flashes and floaters' (10.2%). A total of 64.1% of patients were managed in optometric practice and 18.9% were referred to the HES; of these, 89.2% had been appropriately referred. First attendances to HES referred by GPs reduced by 26.8% (95% CI -40.5% to -13.1%) in Lambeth and Lewisham compared to Southwark. CONCLUSIONS The Lambeth and Lewisham MECS demonstrates clinical effectiveness, reduction in hospital attendances and high patient satisfaction and represents a successful collaboration between commissioners, local HES units and primary healthcare providers.
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Affiliation(s)
- E Konstantakopoulou
- Centre for Public Health Research, School of Health Sciences, City University London, London, UK
| | - D F Edgar
- Centre for Public Health Research, School of Health Sciences, City University London, London, UK
| | - R A Harper
- Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - H Baker
- Centre for Public Health Research, School of Health Sciences, City University London, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - M Sutton
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | - S Janikoun
- Ophthalmology Department, St Thomas’ Hospital, London, UK
| | - G Larkin
- Ophthalmology Department, King's College Hospital, London, UK
| | - J G Lawrenson
- Centre for Public Health Research, School of Health Sciences, City University London, London, UK
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Bond C, Bruhn H, de Bont A, van Exel J, Busse R, Sutton M, Elliott R. The iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals: a study protocol for MUNROS. BMJ Open 2016; 6:e010511. [PMID: 27118286 PMCID: PMC4853978 DOI: 10.1136/bmjopen-2015-010511] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/29/2016] [Accepted: 03/21/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The size and composition of the European Union healthcare workforce are key drivers of expenditure and performance; it now includes new health professions and enhanced roles for established professions. This project will systematically analyse how this has contributed to health service redesign, integration and performance in 9 European countries (Scotland, England, Netherlands, Germany, Italy, Czech Republic, Poland, Norway, and Turkey(i)). This paper describes the protocol for collection of survey data in 3 distinct care pathways, and sets it in the context of the wider programme. METHODS Questionnaires will be distributed to healthcare professionals (n=14,580), managers (n=3564) and patients (n=19,440) in 3 care pathways (breast cancer; type 2 diabetes; and coronary heart disease) within 12 hospitals and associated primary care settings in each country. Questionnaire topics will include demography, the different professionals working on the care pathway, the tasks they do and the time taken, their decision-making abilities when considering skill mix, specialisation and integration of care. Patient satisfaction, healthcare utilisation and preferences will be explored. In later work, register data and data from patient records will be used to record clinical outcomes. Data will also be collected on workforce and procedure costs. Descriptive analysis will identify the different models of care and multivariate analysis will establish the most clinically and cost-effective models. ETHICS AND DISSEMINATION This protocol was approved by ethical committees in each country. Findings will be disseminated through national/international clinical, health services research and health workforce conferences, and publications in national/international peer-reviewed journals.
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Affiliation(s)
- Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Hanne Bruhn
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Antoinette de Bont
- Institute of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Job van Exel
- Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Matthew Sutton
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Robert Elliott
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Goodwin M, Emsley R, Kelly M, Rooney E, Sutton M, Tickle M, Wagstaff R, Walsh T, Whittaker W, Pretty IA. The CATFISH study protocol: an evaluation of a water fluoridation scheme. BMC Oral Health 2016; 16:8. [PMID: 26831505 PMCID: PMC4736087 DOI: 10.1186/s12903-016-0169-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/19/2015] [Accepted: 01/25/2016] [Indexed: 11/16/2022] Open
Abstract
Background Tooth decay is the commonest disease of childhood. We have known for over 90 years that fluoride can prevent tooth decay; it is present in nearly all toothpastes and can be provided in mouthwashes, gels and varnishes. The oldest method of applying fluoride is via the water supply at a concentration of 1 part per million. The two most important reviews of water fluoridation in the United Kingdom (the York Review and MRC Report on water fluoridation and health) concluded that whilst there was evidence to suggest water fluoridation provided a benefit in caries reduction, there was a need to improve the evidence base in several areas. Methods/Design This study will use a natural experiment to assess the incidence of caries in two geographical areas, one in which the water supply is returned to being fluoridated following a discontinuation of fluoridation and one that continues to have a non-fluoridated water supply. The oral health of two discrete study populations will be evaluated - those born 9 months after the water fluoridation was introduced, and those who were in their 1st year of school after the introduction of fluoridated water. Both populations will be followed prospectively for 5 years using a census approach in the exposed group along with matched numbers recruitment in a non-exposed control. Parents of the younger cohort will complete questionnaires every 6 months with child clinical examination at ages 3 and 5, whilst the older cohort will have clinical examinations only, at approximately 5, 7 and 11 years old. Discussion This project provides a unique opportunity to conduct a high quality evaluation of the reintroduction of a water fluoridation scheme, which satisfies the inclusion criteria stipulated by the York systematic review and can address the design issues identified in the MRC report. The research will make a major contribution to the understanding of the costs and effects of water fluoridation in the UK in the 21st Century. Its findings will help inform UK policy on this important public health intervention and may have a significant impact on public health policy in other developed countries. There is currently true equipoise in relation to the effectiveness of water fluoridation in contemporary populations and while the biological plausibility is well established, there is a need to examine impact on the changing epidemiological status of dental decay.
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Affiliation(s)
- Michaela Goodwin
- The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 1.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Michael Kelly
- Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 OSR, UK.
| | - Eric Rooney
- Dental Observatory, NHS Central Lancashire, Preston Business Centre, Watling Street Road, Fulwood, PR2 8DY, UK.
| | - Matthew Sutton
- Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Martin Tickle
- , Coupland 3 Building, Oxford Road, Manchester, M15 6FH, UK.
| | - Rebecca Wagstaff
- Public Health England, North West, 1st Floor, York House, Ackhurst Business Park, Foxhole Road, Chorley, PR7 1NY, UK.
| | - Tanya Walsh
- , Coupland 3 Building, Oxford Road, Manchester, M15 6FH, UK.
| | | | - Iain A Pretty
- The Dental Health Unit, School of Dentistry, The University of Manchester, Williams House, Manchester Science Park, Manchester, M15 6SE, UK.
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Mason T, Sutton M, Whittaker W, McSweeney T, Millar T, Donmall M, Jones A, Pierce M. The impact of paying treatment providers for outcomes: difference-in-differences analysis of the 'payment by results for drugs recovery' pilot. Addiction 2015; 110:1120-8. [PMID: 26058447 DOI: 10.1111/add.12920] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/28/2014] [Accepted: 03/09/2015] [Indexed: 11/26/2022]
Abstract
AIMS To estimate the effect on drug misuse treatment completion of a pilot scheme to pay service providers according to rates of recovery. DESIGN A controlled, quasi-experimental (difference-in-differences) observational study using multi-level random effects logistic regression. SETTING Drug misuse treatment providers in all 149 commissioning areas in England in the financial years 2011-12 and 2012-13. PARTICIPANTS Service users treated in England in 2011-12 and 2012-13. INTERVENTION AND COMPARATORS Linkage of provider payments to performance indicators in eight pilot commissioning areas in England compared with all 141 non-pilot commissioning areas in England. MEASUREMENTS Recovery was measured by successful completion of treatment (free from drugs of dependence) and engagement with services was measured by rates of declining to continue with treatment. FINDINGS Following the introduction of the pilot scheme, service users treated in pilot areas were 1.3 percentage points [odds ratio (OR) = 0.859; 95% confidence interval (CI) = 0.788, 0.937] less likely to complete treatment compared with those treated in comparison areas. Service users treated in pilot areas were 0.9 percentage points (OR = 2.934; 95% CI = 2.094, 4.113) more likely to decline to continue with treatment compared with those treated in comparison areas. CONCLUSIONS In the first year of the pilot 'Payment by Results for Drugs Recovery' scheme in England, linking payments to outcomes reduced the probability of completing drug misuse treatment and increased the proportion service users declining to continue with treatment.
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Affiliation(s)
- Thomas Mason
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - William Whittaker
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Tim McSweeney
- Institute for Criminal Policy Research, Birkbeck, University of London
| | - Tim Millar
- National Drug Evidence Centre, University of Manchester, Manchester, UK
| | - Michael Donmall
- National Drug Evidence Centre, University of Manchester, Manchester, UK
| | - Andrew Jones
- National Drug Evidence Centre, University of Manchester, Manchester, UK
| | - Matthias Pierce
- National Drug Evidence Centre, University of Manchester, Manchester, UK
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Duckett J, Hunt K, Munro N, Sutton M. The impact of distrust in clinics on hospital utilisation in China 2012-13. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku165.108] [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: 11/13/2022] Open
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Abstract
BACKGROUND A pay-for-performance program based on the Hospital Quality Incentive Demonstration was introduced in all hospitals in the northwest region of England in 2008 and was associated with a short-term (18-month) reduction in mortality. We analyzed the long-term effects of this program, called Advancing Quality. METHODS We analyzed 30-day in-hospital mortality among 1,825,518 hospital admissions for eight conditions, three of which were covered by the financial-incentive program. The hospitals studied included the 24 hospitals in the northwest region that were participating in the program and 137 elsewhere in England that were not participating. We used difference-in-differences regression analysis to compare risk-adjusted mortality for an 18-month period before the program was introduced with subsequent mortality in the short term (the first 18 months of the program) and the longer term (the next 24 months). RESULTS Throughout the short-term and the long-term periods, the performance of hospitals in the incentive program continued to improve and mortality for the three conditions covered by the program continued to fall. However, the reduction in mortality among patients with these conditions was greater in the control hospitals (those not participating in the program) than in the hospitals that were participating in the program (by 0.7 percentage points; 95% confidence interval [CI], 0.3 to 1.2). By the end of the 42-month follow-up period, the reduced mortality in the participating hospitals was no longer significant (-0.1 percentage points; 95% CI, -0.6 to 0.3). From the short term to the longer term, the mortality for conditions not covered by the program fell more in the participating hospitals than in the control hospitals (by 1.2 percentage points; 95% CI, 0.4 to 2.0), raising the possibility of a positive spillover effect on care for conditions not covered by the program. CONCLUSIONS Short-term relative reductions in mortality for conditions linked to financial incentives in hospitals participating in a pay-for-performance program in England were not maintained.
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Affiliation(s)
- Søren Rud Kristensen
- From the Manchester Centre for Health Economics, Institute of Population Health (S.R.K., R. Meacock, A.J.T., M.S.), and Manchester Business School (R.B.), University of Manchester, Manchester, the Warwick Business School, University of Warwick, Warwick (R. McDonald), and the Cambridge Centre for Health Services Research, University of Cambridge, Cambridge (M.R.) - all in the United Kingdom
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Shofty B, Bokstein F, Ram Z, Ben-Sira L, Freedman S, Kesler A, Constantini S, Shofty B, Mauda-Havakuk M, Ben-Bashat D, Dvir R, Pratt LT, Weizman L, Joskowicz L, Tal M, Ravid L, Ben-Sira L, Constantini S, Dodgshun A, Maixner W, Sullivan M, Hansford J, Ma J, Wang B, Toledano H, Muhsinoglu O, Luckman J, Michowiz S, Goldenberg-Cohen N, Schroeder K, Rosenfeld A, Grant G, McLendon R, Cummings T, Becher O, Gururangan S, Aguilera D, Mazewski C, Janss A, Castellino RC, Schniederjan M, Hayes L, Brahma B, MacDonald T, Osugi Y, Kiyotani C, Sakamoto H, Yanagisawa T, Kanno M, Kamimura S, Kosaka Y, Hirado J, Takimoto T, Nakazawa A, Hara J, Hwang E, Mun A, Kilburn L, Chi S, Knipstein J, Oren M, Dvir R, Hardy K, Rood B, Packer R, Kandels D, Schmidt R, Geh M, Breitmoser-Greiner S, Gnekow AK, Bergthold G, Bandopadhayay P, Rich B, Chan J, Santagata S, Hoshida Y, Ramkissoon S, Ramkissoon L, Golub T, Tabak B, Ferrer-Luna R, Weng PY, Stiles C, Grill J, Kieran MW, Ligon KL, Beroukhim R, Fisher MJ, Levin MH, Armstrong GT, Broad JH, Zimmerman R, Bilaniuk LT, Feygin T, Liu GT, Gan HW, Phipps K, Spoudeas HA, Kohorst M, Warad D, Keating G, Childs S, Giannini C, Wetjen N, Rao; AN, Nakamura H, Makino K, Hide T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Rush S, Madden J, Hemenway M, Foreman N, Sie M, den Dunnen WFA, Lourens HJ, Meeuwsen-de Boer TGJ, Scherpen FJG, Kampen KR, Hoving EW, de Bont ESJM, Gnekow AK, Kandels D, Walker DA, Perilongo G, Grill J, Stokland T, Sehested AM, van Schouten AYN, de Paoli A, de Salvo GL, Pache-Leschhorn S, Geh M, Schmidt R, Gnekow AK, Gass D, Rupani K, Tsankova N, Stark E, Anderson R, Feldstein N, Garvin J, Deel M, McLendon R, Becher O, Karajannis M, Wisoff J, Muh C, Schroeder K, Gururangan S, del Bufalo F, Carai A, Macchiaiolo M, Messina R, Cacchione A, Palmiero M, Cambiaso P, Mastronuzzi A, Anderson M, Leary S, Sun Y, Buhrlage S, Pilarz C, Alberta J, Stiles C, Gray N, Mason G, Packer R, Hwang E, Biassoni V, Schiavello E, Bergamaschi L, Chiaravalli S, Spreafico F, Massimino M, Krishnatry R, Kroupnik T, Zhukova N, Mistry M, Zhang C, Bartels U, Huang A, Adamski J, Dirks P, Laperriere N, Silber J, Hawkins C, Bouffet E, Tabori U, Riccardi R, Rizzo D, Chiaretti A, Piccardi M, Dickmann A, Lazzareschi I, Ruggiero A, Guglielmi G, Salerni A, Manni L, Colosimo C, Falsini B, Rosenfeld A, Etzl M, Miller J, Carpenteri D, Kaplan A, Sieow N, Hoe R, Tan AM, Chan MY, Soh SY, Orphanidou-Vlachou E, MacPherson L, English M, Auer D, Jaspan T, Arvanitis T, Grundy R, Peet A, Bandopadhayay P, Bergthold G, Sauer N, Green A, Malkin H, Dabscheck G, Marcus K, Ullrich N, Goumnerova L, Chi S, Beroukhim R, Kieran M, Manley P, Donson A, Kleinschmidt-DeMasters B, Aisner D, Bemis L, Birks D, Mulcahy-Levy J, Smith A, Handler M, Rush S, Foreman N, Davidson A, Figaji A, Pillay K, Kilborn T, Padayachy L, Hendricks M, van Eyssen A, Parkes J, Gass D, Dewire M, Chow L, Rose SR, Lawson S, Stevenson C, Jones B, Pai A, Sutton M, Pruitt D, Fouladi M, Hummel T, Cruz O, de Torres C, Sunol M, Morales A, Santiago C, Alamar M, Rebollo M, Mora J, Sauer N, Dodgshun A, Malkin H, Bergthold G, Manley P, Chi S, Ramkissoon S, MacGregor D, Beroukhim R, Kieran M, Sullivan M, Ligon K, Bandopadhayay P, Hansford J, Messina R, De Benedictis A, Carai A, Mastronuzzi A, Rebessi E, Palma P, Procaccini E, Marras CE, Aguilera D, Castellino RC, Janss A, Schniederjan M, McNall R, Kim S, MacDOnald T, Mazewski C, Zhukova N, Pole J, Mistry M, Fried I, Krishnatry R, Stucklin AG, Bartels U, Huang A, Laperriere N, Dirks P, Zelcer S, Sylva M, Johnston D, Scheinemann K, An J, Hawkins C, Nathan P, Greenberg M, Bouffet E, Malkin D, Tabori U, Kiehna E, Da Silva S, Margol A, Robison N, Finlay J, McComb JG, Krieger M, Wong K, Bluml S, Dhall G, Ayyanar K, Moriarty T, Moeller K, Farber D. LOW GRADE GLIOMAS. Neuro Oncol 2014; 16:i60-i70. [PMCID: PMC4046289 DOI: 10.1093/neuonc/nou073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
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Affiliation(s)
- Tim Doran
- Department of Health Sciences, University of York, York YO10 5DD, UK
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Newton W, Sutton M, Asher GN. The elephant in the room. Fam Med 2014; 46:85-87. [PMID: 24573513] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Warren Newton
- Department of Family Medicine, University of North Carolina
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O'Sullivan S, Sutton M, Fitzpatrick G. Prevalence of elevated cardiac troponin T in ICU patients using the high-sensitivity assay and the relationship with mortality. Crit Care 2014. [PMCID: PMC4068376 DOI: 10.1186/cc13383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ryan A, Sutton M, Doran T. Does winning a pay-for-performance bonus improve subsequent quality performance? Evidence from the Hospital Quality Incentive Demonstration. Health Serv Res 2013; 49:568-87. [PMID: 23909992 DOI: 10.1111/1475-6773.12097] [Citation(s) in RCA: 24] [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] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To test whether receiving a financial bonus for quality in the Premier Hospital Quality Incentive Demonstration (HQID) stimulated subsequent quality improvement. DATA Hospital-level data on process-of-care quality from Hospital Compare for the treatment of acute myocardial infarction (AMI), heart failure, and pneumonia for 260 hospitals participating in the HQID from 2004 to 2006; receipt of quality bonuses in the first 3 years of HQID from the Premier Inc. website; and hospital characteristics from the 2005 American Hospital Association Annual Survey. STUDY DESIGN Under the HQID, hospitals received a 1 percent bonus on Medicare payments for scoring between the 80th and 90th percentiles on a composite quality measure, and a 2 percent bonus for scoring at the 90th percentile or above. We used a regression discontinuity design to evaluate whether hospitals with quality scores just above these payment thresholds improved more in the subsequent year than hospitals with quality scores just below the thresholds. In alternative specifications, we examined samples of hospitals scoring within 3, 5, and 10 percentage point "bandwidths" of the thresholds. We used a Generalized Linear Model to estimate whether the relationship between quality and lagged quality was discontinuous at the lagged thresholds required for quality bonuses. PRINCIPAL FINDINGS There were no statistically significant associations between receipt of a bonus and subsequent quality performance, with the exception of the 2 percent bonus for AMI in 2006 using the 5 percentage point bandwidth (0.8 percentage point increase, p<.01), and the 1 percent bonus for pneumonia in 2005 using all bandwidths (3.7 percentage point increase using the 3 percentage point bandwidth, p<.05). CONCLUSIONS We found little evidence that hospitals' receipt of quality bonuses was associated with subsequent improvement in performance. This raises questions about whether winning in pay-for-performance programs, such as Hospital Value-Based Purchasing, will lead to subsequent quality improvement.
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Affiliation(s)
- Andrew Ryan
- Public Health Department, Weill Cornell Medical College, New York, NY
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Sutton M, Pavord D, Sansourekidou P, Allen C. SU-E-P-12: RayStation Commissioning: A Clinical Implementation Experience. Med Phys 2013. [DOI: 10.1118/1.4814086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Birch S, Mason T, Sutton M, Whittaker W. Not enough doctors or not enough needs? Refocusing health workforce planning from providers and services to populations and needs. J Health Serv Res Policy 2013; 18:1355819612473592. [PMID: 23615568 DOI: 10.1177/1355819612473592] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The importance of allocating services in accordance with population needs is well-established. Needs-based approaches to geographical resource allocation were established in the National Health Service in the UK in the 1970s, but the role of population needs has not extended to planning for the quantity and mix of health care services or for the providers required to deliver these services. We present a framework that integrates health service and workforce planning focused on responding to population needs. Using data from the General Household Survey for England over the period 1985-2006, we illustrate trends in health needs and service use per capita. Despite needs per capita falling, service use has increased. Rates of increase in service use are greater among those with less needs illustrating that, in the absence of appropriate planning methods, increases in service use may result from supplier influence rather than policy decisions.
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Affiliation(s)
- Stephen Birch
- Professor, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada and Professor, Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
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Bie L, Ju Y, Jin Z, Donovan L, Birks S, Grunewald L, Zmuda F, Pilkington G, Kaul A, Chen YH, Dahiya S, Emnett R, Gianino S, Gutmann D, Poschl J, Bianchi E, Bockstaller M, Neumann P, Schuller U, Gevorgian A, Morozova E, Kazantsev I, Iukhta T, Safonova S, Punanov Y, Zheludkova O, Afanasyev B, Buss M, Remke M, Gandhi K, Kool M, Northcott P, Pfister S, Taylor M, Castellino R, Thompson J, Margraf L, Donahue D, Head H, Murray J, Burger P, Wortham M, Reitman Z, He Y, Bigner D, Yan H, Lee C, Triscott J, Foster C, Manoranjan B, Pambid MR, Fotovati A, Berns R, Venugopal C, O'Halloran K, Narendran A, Northcott P, Taylor MD, Singh SK, Singhal A, Rassekh R, Maxwell CA, Dunham C, Dunn SE, Pambid MR, Berns R, Hu K, Adomat H, Moniri M, Chin MY, Hessein M, Zisman N, Maurer N, Dunham C, Guns E, Dunn S, Koks C, De Vleeschouwer S, Graf N, Van Gool S, D'Asti E, Huang A, Korshunov A, Pfister S, Rak J, Gump W, Moriarty T, Gump W, Skjei K, Karkare S, Castelo-Branco P, Choufani S, Mack S, Gallagher D, Zhang C, Merino D, Wasserman J, Kool M, Jones DT, Croul S, Kreitzer F, Largaespada D, Conklin B, Taylor M, Weiss W, Garzia L, Morrissy S, Zayne K, Wu X, Dirks P, Hawkins C, Dick J, Stein L, Collier L, Largaespada D, Dupuy A, Taylor M, Rampazzo G, Moraes L, Paniago M, Oliveira I, Hitzler J, Silva N, Cappellano A, Cavalheiro S, Alves MT, Cerutti J, Toledo S, Liu Z, Zhao X, Mao H, Baxter P, Wang JCY, Huang Y, Yu L, Su J, Adekunle A, Perlaky L, Hurwitz M, Hurwitz R, Lau C, Chintagumpala M, Blaney S, Baruchel S, Li XN, Zhang J, Hariono S, Hashizume R, Fan Q, James CD, Weiss WA, Nicolaides T, Madsen PJ, Slaunwhite ES, Dirks PB, Ma JF, Henn RE, Hanno AG, Boucher KL, Storm PB, Resnick AC, Lourdusamy A, Rogers H, Ward J, Rahman R, Malkin D, Gilbertson R, Grundy R, Lourdusamy A, Rogers H, Ward J, Rahman R, Gilbertson R, Grundy R, Karajannis M, Fisher M, Pfister S, Milla S, Cohen K, Legault G, Wisoff J, Harter D, Merkelson A, Bloom M, Dhall G, Jones D, Korshunov A, Taylor MD, Pfister S, Eberhart C, Sievert A, Resnick A, Zagzag D, Allen J, Hankinson T, Gump J, Serrano-Almeida C, Torok M, Weksberg R, Handler M, Liu A, Foreman N, Garancher A, Rocques N, Miquel C, Sainte-Rose C, Delattre O, Bourdeaut F, Eychene A, Tabori U, Pouponnot C, Danielpour M, Levy R, Antonuk CD, Rodriguez J, Aravena JM, Kim GB, Gate D, Bannykh S, Svendsen C, Huang X, Town T, Breunig J, Amakye D, Robinson D, Rose K, Cho YJ, Ligon KL, Sharp T, Ando Y, Geoerger B, He Y, Doz F, Ashley D, Hargrave D, Casanova M, Tawbi H, Heath J, Bouffet E, Brandes AA, Chisholm J, Rodon J, Dubuc AM, Thomas A, Mita A, MacDonald T, Kieran M, Eisenstat D, Song X, Danielpour M, Levy R, Antonuk CD, Rodriguez J, Hashizume R, Aravena JM, Kim GB, Gate D, Bannykh S, Svendsen C, Town T, Breunig J, Morrissy AS, Mayoh C, Lo A, Zhang W, Thiessen N, Tse K, Moore R, Mungall A, Wu X, Van Meter TE, Cho YJ, Collins VP, MacDonald TJ, Li XN, Stehbens S, Fernandez-Lopez A, Malkin D, Marra MA, Taylor MD, Karajannis M, Legault G, Hagiwara M, Vega E, Merkelson A, Wisoff J, Younger S, Golfinos J, Roland JT, Allen J, Antonuk CD, Levy R, Kim GB, Town T, Danielpour M, Breunig J, Pak E, Barshow S, Zhao X, Ponomaryov T, Segal R, Levy R, Antonuk CD, Aravena JM, Kim GB, Svendsen C, Town T, Danielpour M, Zhu S, Breunig J, Chi S, Cohen K, Fisher M, Biegel J, Bowers D, Fangusaro J, Manley P, Janss A, Zimmerman MA, Wu X, Kieran M, Sayour E, Pham C, Sanchez-Perez L, Snyder D, Flores C, Kemeny H, Xie W, Cui X, Bigner D, Taylor MD, Sampson J, Mitchell D, Bandopadhayay P, Nguyen B, Masoud S, Vue N, Gholamin S, Yu F, Schubert S, Bergthold G, Weiss WA, Mitra S, Qi J, Bradner J, Kieran M, Beroukhim R, Cho YJ, Reddick W, Glass J, Ji Q, Paulus E, James CD, Gajjar A, Ogg R, Vanner R, Remke M, Aviv T, Lee L, Zhu X, Clarke I, Taylor M, Dirks P, Shuman MA, Hamilton R, Pollack I, Calligaris D, Liu X, Feldman D, Thompson C, Ide J, Buhrlage S, Gray N, Kieran M, Jan YN, Stiles C, Agar N, Remke M, Cavalli FMG, Northcott PA, Kool M, Pfister SM, Taylor MD, Project MAGIC, Rakopoulos P, Jan LY, Pajovic S, Buczkowicz P, Morrison A, Bouffet E, Bartels U, Becher O, Hawkins C, Truffaux N, Puget S, Philippe C, Gump W, Castel D, Taylor K, Mackay A, Le Dret L, Saulnier P, Calmon R, Boddaert N, Blauwblomme T, Sainte-Rose C, Jones C, Mutchnick I, Grill J, Liu X, Ebling M, Ide J, Wang L, Davis E, Marchionni M, Stuart D, Alberta J, Kieran M, Li KKW, Stiles C, Agar N, Remke M, Cavalli FMG, Northcott PA, Kool M, Pfister SM, Taylor MD, Project MAGIC, Tien AC, Pang JCS, Griveau A, Rowitch D, Ramkissoon L, Horowitz P, Craig J, Ramkissoon S, Rich B, Bergthold G, Tabori U, Taha H, Ng HK, Bowers D, Hawkins C, Packer R, Eberhart C, Goumnerova L, Chan J, Santagata S, Pomeroy S, Ligon A, Kieran M, Jackson S, Beroukhim R, Ligon K, Kuan CT, Chandramohan V, Keir S, Pastan I, Bigner D, Zhou Z, Ho S, Voss H, Patay Z, Souweidane M, Salloum R, DeWire M, Fouladi M, Goldman S, Chow L, Hummel T, Dorris K, Miles L, Sutton M, Howarth R, Stevenson C, Leach J, Griesinger A, Donson A, Hoffman L, Birks D, Amani V, Handler M, Foreman N, Sangar MC, Pai A, Pedro K, Ditzler SH, Girard E, Olson J, Gustafson WC, Meyerowitz J, Nekritz E, Charron E, Matthay K, Hertz N, Onar-Thomas A, Shokat K, Weiss W, Hanaford A, Raabe E, Eberhart C, Griesinger A, Donson A, Hoffman L, Amani V, Birks D, Gajjar A, Handler M, Mulcahy-Levy J, Foreman N, Olow AK, Dasgupta T, Yang X, Mueller S, Hashizume R, Kolkowitz I, Weiss W, Broniscer A, Resnick AC, Sievert AJ, Nicolaides T, Prados MD, Berger MS, Gupta N, James CD, Haas-Kogan DA, Flores C, Pham C, Dietl SM, Snyder D, Sanchez-Perez L, Bigner D, Sampson J, Mitchell D, Prakash V, Batanian J, Guzman M, Geller T, Pham CD, Wolfl M, Pei Y, Flores C, Snyder D, Bigner DD, Sampson JH, Wechsler-Reya RJ, Mitchell DA, Van Ommeren R, Venugopal C, Manoranjan B, Beilhack A, McFarlane N, Hallett R, Hassell J, Dunn S, Singh S, Dasgupta T, Olow A, Yang X, Hashizume R, Mueller S, Riedel S, Nicolaides T, Kolkowitz I, Weiss W, Prados M, Gupta N, James CD, Haas-Kogan D, Zhao H, Li L, Picotte K, Monoranu C, Stewart R, Modzelewska K, Boer E, Picard D, Huang A, Radiloff D, Lee C, Dunn S, Hutt M, Nazarian J, Dietl S, Price A, Lim KJ, Warren K, Chang H, Eberhart CG, Raabe EH, Persson A, Huang M, Chandler-Militello D, Li N, Vince GH, Berger M, James D, Goldman S, Weiss W, Lindquist R, Tate M, Rowitch D, Alvarez-Buylla A, Hoffman L, Donson A, Eyrich M, Birks D, Griesinger A, Amani V, Handler M, Foreman N, Meijer L, Walker D, Grundy R, O'Dowd S, Jaspan T, Schlegel PG, Dineen R, Fotovati A, Radiloff D, Coute N, Triscott J, Chen J, Yip S, Louis D, Toyota B, Hukin J, Weitzel D, Rassekh SR, Singhal A, Dunham C, Dunn S, Ahsan S, Hanaford A, Taylor I, Eberhart C, Raabe E, Sun YG, Ashcraft K, Stiles C, Han L, Zhang K, Chen L, Shi Z, Pu P, Dong L, Kang C, Cordero F, Lewis P, Liu C, Hoeman C, Schroeder K, Allis CD, Becher O, Gururangan S, Grant G, Driscoll T, Archer G, Herndon J, Friedman H, Li W, Kurtzberg J, Bigner D, Sampson J, Mitchell D, Yadavilli S, Kambhampati M, Becher O, MacDonald T, Bellamkonds R, Packer R, Buckley A, Nazarian J, DeWire M, Fouladi M, Stewart C, Wetmore C, Hawkins C, Jacobs C, Yuan Y, Goldman S, Fisher P, Rodriguez R, Rytting M, Bouffet E, Khakoo Y, Hwang E, Foreman N, Gilbert M, Gilbertson R, Gajjar A, Saratsis A, Yadavilli S, Wetzel W, Snyder K, Kambhampati M, Hall J, Raabe E, Warren K, Packer R, Nazarian J, Thompson J, Griesinger A, Foreman N, Spazojevic I, Rush S, Levy JM, Hutt M, Karajannis MA, Shah S, Eberhart CG, Raabe E, Rodriguez FJ, Gump J, Donson A, Tovmasyan A, Birks D, Handler M, Foreman N, Hankinson T, Torchia J, Khuong-Quang DA, Ho KC, Picard D, Letourneau L, Chan T, Peters K, Golbourn B, Morrissy S, Birks D, Faria C, Foreman N, Taylor M, Rutka J, Pfister S, Bouffet E, Hawkins C, Batinic-Haberle I, Majewski J, Kim SK, Jabado N, Huang A, Ladner T, Tomycz L, Watchmaker J, Yang T, Kaufman L, Pearson M, Dewhirst M, Ogg RJ, Scoggins MA, Zou P, Taherbhoy S, Jones MM, Li Y, Glass JO, Merchant TE, Reddick WE, Conklin HM, Gholamin S, Gajjar A, Khan A, Kumar A, Tye GW, Broaddus WC, Van Meter TE, Shih DJH, Northcott PA, Remke M, Korshunov A, Mitra S, Jones DTW, Kool M, Pfister SM, Taylor MD, Mille F, Levesque M, Remke M, Korshunov A, Izzi L, Kool M, Richard C, Northcott PA, Taylor MD, Pfister SM, Charron F, Yu F, Masoud S, Nguyen B, Vue N, Schubert S, Tolliday N, Kong DS, Sengupta S, Weeraratne D, Schreiber S, Cho YJ, Birks D, Jones K, Griesinger A, Amani V, Handler M, Vibhakar R, Achrol A, Foreman N, Brown R, Rangan K, Finlay J, Olch A, Freyer D, Bluml S, Gate D, Danielpour M, Rodriguez J, Shae JJ, Kim GB, Levy R, Bannykh S, Breunig JJ, Town T, Monje-Deisseroth M, Cho YJ, Weissman I, Cheshier S, Buczkowicz P, Rakopoulos P, Bouffet E, Morrison A, Bartels U, Becher O, Hawkins C, Dey A, Kenney A, Van Gool S, Pauwels F, De Vleeschouwer S, Barszczyk M, Buczkowicz P, Castelo-Branco P, Mack S, Nethery-Brokx K, Morrison A, Taylor M, Dirks P, Tabori U, Hawkins C, Chandramohan V, Keir ST, Bao X, Pastan IH, Kuan CT, Bigner DD, Bender S, Jones D, Kool M, Sturm D, Korshunov A, Lichter P, Pfister SM, Chen M, Lu J, Wang J, Keir S, Zhang M, Zhao S, Mook R, Barak L, Lyerly HK, Chen W, Ramachandran C, Nair S, Escalon E, Khatib Z, Quirrin KW, Melnick S, Kievit F, Stephen Z, Wang K, Silber J, Ellenbogen R, Zhang M, Hutzen B, Studebaker A, Bratasz A, Powell K, Raffel C, Guo C, Chang CC, Wortham M, Chen L, Kernagis D, Qin X, Cho YW, Chi JT, Grant G, McLendon R, Yan H, Ge K, Papadopoulos N, Bigner D, He Y, Cristiano B, Venkataraman S, Birks DK, Alimova I, Harris PS, Dubuc A, Taylor MD, Foreman NK, Vibhakar R, Ichimura K, Fukushima S, Totoki Y, Suzuki T, Mukasa A, Saito N, Kumabe T, Tominaga T, Kobayashi K, Nagane M, Iuchi T, Mizoguchi M, Sasaki T, Tamura K, Sugiyama K, Narita Y, Shibui S, Matsutani M, Shibata T, Nishikawa R, Northcott P, Zichner T, Jones D, Kool M, Jager N, Feychting M, Lannering B, Tynes T, Wesenberg F, Hauser P, Ra YS, Zitterbart K, Jabado N, Chan J, Fults D, Mueller S, Grajkowska W, Lichter P, Korbel J, Pfister S, Kool M, Jones DTW, Jaeger N, Northcott PA, Pugh T, Hovestadt V, Markant SL, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schueller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Keir S, Pegram C, Lipp E, Rasheed A, Chandramohan V, Kuan CT, Kwatra M, Yan H, Bigner D, Chornenkyy Y, Buczkowicz P, Agnihotri S, Becher O, Hawkins C, Rogers H, Mayne C, Kilday JP, Coyle B, Grundy R, Sun T, Warrington N, Luo J, Brooks M, Dahiya S, Sengupta R, Rubin J, Erdreich-Epstein A, Robison N, Ren X, Zhou H, Ji L, Margo A, Jones D, Pfister S, Kool M, Sposto R, Asgharzadeh S, Clifford S, Gustafsson G, Ellison D, Figarella-Branger D, Doz F, Rutkowski S, Lannering B, Pietsch T, Broniscer A, Tatevossian R, Sabin N, Klimo P, Dalton J, Lee R, Gajjar A, Ellison D, Garzia L, Dubuc A, Pitcher G, Northcott P, Mariampillai A, Chan T, Skowron P, Wu X, Yao Y, Hawkins C, Peacock J, Zayne K, Croul S, Rutka J, Kenney A, Huang A, Yang V, Baylin S, Salter M, Taylor M, Ward S, Sengupta R, Rubin J, Garzia L, Morrissy S, Skowron P, Jelveh S, Lindsay P, Largaespada D, Collier L, Dupuy A, Hill R, Taylor M, Lulla RR, Laskowski J, Fangusaro J, DiPatri AJ, Alden T, Vanin EF, Tomita T, Goldman S, Soares MB, Rajagopal MU, Lau LS, Hathout Y, Gordish-Dressman H, Rood B, Datar V, Bochare S, Singh A, Khatau S, Fangusaro J, Goldman S, Lulla R, Rajaram V, Gopalakrishnan V, Morfouace M, Shelat A, Jaccus M, Freeman B, Zindy F, Robinson G, Guy K, Stewart C, Gajjar A, Roussel M, Krebs S, Chow K, Yi Z, Brawley V, Ahmed N, Gottschalk S, Lerner R, Harness J, Yoshida Y, Santos R, Torre JDL, Nicolaides T, Ozawa T, James D, Petritsch C, Vitte J, Chareyre F, Stemmer-Rachamimov A, Giovannini M, Hashizume R, Yu-Jen L, Tom M, Ihara Y, Huang X, Waldman T, Mueller S, Gupta N, James D, Shevtsov M, Yakovleva L, Nikolaev B, Dobrodumov A, Onokhin K, Bychkova N, Mikhrina A, Khachatryan W, Guzhova I, Martynova M, Bystrova O, Ischenko A, Margulis B, Martin A, Nirschl C, Polanczyk M, Cohen K, Pardoll D, Drake C, Lim M, Crowther A, Chang S, Yuan H, Deshmukh M, Gershon T, Meyerowitz JG, Gustafson WC, Nekritz EA, Swartling F, Shokat KM, Ruggero D, Weiss WA, Bergthold G, Rich B, Bandopadhayay P, Chan J, Santaga S, Hoshida Y, Golub T, Tabak B, Ferrer-Luna R, Grill J, Wen PY, Stiles C, Kieran M, Ligon K, Beroukhim R, Lulla RR, Laskowski J, Gireud M, Fangusaro J, Goldman S, Gopalakrishnan V, Merino D, Shlien A, Pienkowska M, Tabori U, Gilbertson R, Malkin D, Mueller S, Hashizume R, Yang X, Kolkowitz I, Olow A, Phillips J, Smirnov I, Tom M, Prados M, Berger M, Gupta N, Haas-Kogan D, Beez T, Sarikaya-Seiwert S, Janssen G, Felsberg J, Steiger HJ, Hanggi D, Marino AM, Baryawno N, Johnsen JI, Ostman A, Wade A, Engler JR, Robinson AE, Phillips JJ, Witt H, Sill M, Mack SC, Wani KM, Lambert S, Tzaridis T, Bender S, Jones DT, Milde T, Northcott PA, Kool M, von Deimling A, Kulozik AE, Witt O, Lichter P, Collins VP, Aldape K, Taylor MD, Korshunov A, Pfister SM, Hatcher R, Das C, Datar V, Taylor P, Singh A, Lee D, Fuller G, Ji L, Fangusaro J, Rajaram V, Goldman S, Eberhart C, Gopalakrishnan V, Griveau A, Lerner R, Ihrie R, Sugiarto S, Ihara Y, Reichholf B, Huillard E, Mcmahon M, James D, Phillips J, Buylla AA, Rowitch D, Petritsch C, Snuderl M, Batista A, Kirkpatrick N, de Almodovar CR, Riedemann L, Knevels E, Schmidt T, Peterson T, Roberge S, Bais C, Yip S, Hasselblatt M, Rossig C, Ferrara N, Klagsbrun M, Duda D, Fukumura D, Xu L, Carmeliet P, Jain R, Nguyen A, Pencreach E, Lasthaus C, Lobstein V, Guerin E, Guenot D, Entz-Werle N, Diaz R, Golbourn B, Faria C, Shih D, MacKenzie D, Picard D, Bryant M, Smith C, Taylor M, Huang A, Rutka J, Gromeier M, Desjardins A, Sampson JH, Threatt SJE, Herndon JE, Friedman A, Friedman HS, Bigner DD, Cavalli FMG, Morrissy AS, Li Y, Chu A, Remke M, Thiessen N, Mungall AJ, Bader GD, Malkin D, Marra MA, Taylor MD, Manoranjan B, Wang X, Hallett R, Venugopal C, Mack S, McFarlane N, Nolte S, Scheinemann K, Gunnarsson T, Hassell J, Taylor M, Lee C, Triscott J, Foster C, Dunham C, Hawkins C, Dunn S, Singh S, McCrea HJ, Bander E, Venn RA, Reiner AS, Iorgulescu JB, Puchi LA, Schaefer PM, Cederquist G, Greenfield JP, Tsoli M, Luk P, Dilda P, Hogg P, Haber M, Ziegler D, Mack S, Agnihotri S, Witt H, Shih D, Wang X, Ramaswamy V, Zayne K, Bertrand K, Massimi L, Grajkowska W, Lach B, Gupta N, Weiss W, Guha A, Zadeh G, Rutka J, Korshunov A, Pfister S, Taylor M, Mack S, Witt H, Jager N, Zuyderduyn S, Nethery-Brokx K, Garzia L, Zayne K, Wang X, Barszczyk M, Wani K, Bouffet E, Weiss W, Hawkins C, Rutka J, Bader G, Aldape K, Dirks P, Pfister S, Korshunov A, Taylor M, Engler J, Robinson A, Wade A, Molinaro A, Phillips J, Ramaswamy V, Remke M, Bouffet E, Faria C, Shih D, Gururangan S, McLendon R, Schuller U, Ligon K, Pomeroy S, Jabado N, Dunn S, Fouladi M, Rutka J, Hawkins C, Tabori U, Packer R, Pfister S, Korshunov A, Taylor M, Faria C, Dubuc A, Golbourn B, Diaz R, Agnihotri S, Sabha N, Luck A, Leadly M, Reynaud D, Wu X, Remke M, Ramaswamy V, Northcott P, Pfister S, Croul S, Kool M, Korshunov A, Smith C, Taylor M, Rutka J, Pietsch T, Doerner E, Muehlen AZ, Velez-Char N, Warmuth-Metz M, Kortmann R, von Hoff K, Friedrich C, Rutkowski S, von Bueren A, Lu YJ, James CD, Hashizume R, Mueller S, Phillips J, Gupta N, Sturm D, Northcott PA, Jones DTW, Korshunov A, Picard D, Lichter P, Huang A, Pfister SM, Kool M, Ward J, Teague C, Shriyan B, Grundy R, Rahman R, Taylor K, Mackay A, Morozova O, Butterfield Y, Truffaux N, Philippe C, Vinci M, de Torres C, Cruz O, Mora J, Hargrave D, Puget S, Yip S, Jones C, Grill J, Smith S, Ward J, Tan C, Grundy R, Rahman R, Bjerke L, Mackay A, Nandhabalan M, Burford A, Jury A, Popov S, Bax D, Carvalho D, Taylor K, Vinci M, Bajrami I, McGonnell I, Lord C, Reis R, Hargrave D, Ashworth A, Workman P, Jones C, Carvalho D, Mackay A, Burford A, Bjerke L, Chen L, Kozarewa I, Lord C, Ashworth A, Hargrave D, Reis R, Jones C, Marigil M, Jauregui PJ, Alonso M, Chan TS, Hawkins C, Picard D, Henkin J, Huang A, Trubicka J, Kucharczyk M, Pelc M, Chrzanowska K, Ciara E, Perek-Polnik M, Grajkowska W, Piekutowska-Abramczuk D, Jurkiewicz D, Luczak S, Borucka-Mankiewicz M, Kowalski P, Krajewska-Walasek M, de Mola RML, Laskowski J, Fangusaro J, Costa FF, Vanin EF, Goldman S, Soares MB, Lulla RR, Mann A, Venugopal C, Vora P, Singh M, van Ommeren R, McFarlane N, Manoranjan B, Qazi M, Scheinemann K, MacDonald P, Delaney K, Whitton A, Dunn S, Singh S, Sievert A, Lang SS, Boucher K, Madsen P, Slaunwhite E, Choudhari N, Kellet M, Storm P, Resnick A, Agnihotri S, Burrell K, Fernandez N, Golbourn B, Clarke I, Barszczyk M, Sabha N, Dirks P, Jones C, Rutka J, Zadeh G, Hawkins C, Murphy B, Obad S, Bihannic L, Ayrault O, Zindy F, Kauppinen S, Roussel M, Golbourn B, Agnihotri S, Cairns R, Mischel P, Aldape K, Hawkins C, Zadeh G, Rutka J, Rush S, Donson A, Kleinschmidt-DeMasters B, Bemis L, Birks D, Chan M, Smith A, Handler M, Foreman N, Gronych J, Jones DTW, Zuckermann M, Hutter S, Korshunov A, Kool M, Ryzhova M, Reifenberger G, Pfister SM, Lichter P, Jones DTW, Hovestadt V, Picelli S, Wang W, Northcott PA, Kool M, Jager N, Reifenberger G, Rutkowski S, Pietsch T, Sultan M, Yaspo ML, Landgraf P, Eils R, Korshunov A, Zapatka M, Pfister SM, Radlwimmer B, Lichter P, Huang Y, Mao H, Wang Y, Kogiso M, Zhao X, Baxter P, Man C, Wang Z, Zhou Y, Li XN, Chung AH, Crabtree D, Schroeder K, Becher OJ, Panosyan E, Wang Y, Lasky J, Liu Z, Zhao X, Wang Y, Mao H, Huang Y, Kogiso M, Baxter P, Adesina A, Su J, Picard D, Huang A, Perlaky L, Chintagumpala M, Lau C, Blaney S, Li XN, Huang M, Persson A, Swartling F, Moriarity B. Abstracts. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not047] [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: 11/13/2022] Open
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Morrison J, Anderson MJ, Mac Donald S, Maxwell M, Munoz-Arroyo R, Power A, Smith M, Sutton M, Wilson P. Relationship between antidepressant and anxiolytic/hypnotic prescribing: a mixed-methods study. Eur J Gen Pract 2013; 14:129-35. [PMID: 19107642 DOI: 10.1080/13814780802632683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Antidepressant prescribing has dramatically increased in Scotland, and the cause is unknown. OBJECTIVE To investigate if the increase in antidepressant prescribing coincided with a reduction in prescribing of anxiolytics and hypnotics; to investigate this relationship at practice level; and to explore whether general practitioners (GPs) explain the increase by their increased use for anxiety. METHODS STUDY DESIGN analysis of routine prescribing data and interviews with GPs. SETTING Scottish general practices. PARTICIPANTS 942 practices included in the analysis. Sixty-three GPs in 30 practices completed interviews. MAIN OUTCOME MEASURES Quantity of antidepressants, anxiolytics, and hypnotics prescribed. Relationship at practice level between anxiolytic/hypnotic and antidepressant prescribing. Spontaneous comments by GPs about prescribing antidepressants for anxiety. RESULTS Antidepressant prescribing increased from 28.9 million defined daily doses (DDDs) in 1992/3 to 128.3 million in 2004/5. Anxiolytic/hypnotic prescribing fell from 64.2 million to 55.1 million DDDs. There was a weak, positive correlation between levels of antidepressant and anxiolytic/hypnotic prescribing (+0.084, p=0.010). GPs treated anxiety with antidepressants, although many described an overlap between anxiety and depression. Some spontaneously identified a relationship with benzodiazepine prescribing when asked to explain the increase in antidepressant prescribing. CONCLUSION A small part of the increase in antidepressant prescribing is due to substitution for benzodiazepines to treat anxiety.
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Affiliation(s)
- Jill Morrison
- Section of General Practice, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow, Glasgow, UK.
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Hruszkewycz SO, Sutton M, Fuoss PH, Adams B, Rosenkranz S, Ludwig KF, Roseker W, Fritz D, Cammarata M, Zhu D, Lee S, Lemke H, Gutt C, Robert A, Grübel G, Stephenson GB. High contrast x-ray speckle from atomic-scale order in liquids and glasses. Phys Rev Lett 2012; 109:185502. [PMID: 23215295 DOI: 10.1103/physrevlett.109.185502] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 06/14/2012] [Indexed: 05/20/2023]
Abstract
The availability of ultrafast pulses of coherent hard x rays from the Linac Coherent Light Source opens new opportunities for studies of atomic-scale dynamics in amorphous materials. Here, we show that single ultrafast coherent x-ray pulses can be used to observe the speckle contrast in the high-angle diffraction from liquid Ga and glassy Ni(2)Pd(2)P and B(2)O(3). We determine the thresholds above which the x-ray pulses disturb the atomic arrangements. Furthermore, high contrast speckle is observed in scattering patterns from the glasses integrated over many pulses, demonstrating that the source and optics are sufficiently stable for x-ray photon correlation spectroscopy studies of dynamics over a wide range of time scales.
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Affiliation(s)
- S O Hruszkewycz
- Materials Science Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
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Sutton M, Mounsey AL, Russell RG. FPIN's Clinical Inquiries. Treatment of motion sickness. Am Fam Physician 2012; 86:192-5. [PMID: 22962932] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Matthew Sutton
- University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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