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Wademan DT, Saule Z, Marthinus A, Viljoen L, Nortier E, Hughes J, Courtney I, Palmer M, Garcia-Prats AJ, Hesseling AC, Hoddinott G. Acceptability of clofazimine capsules in children and adolescents with rifampicin-resistant TB. Int J Tuberc Lung Dis 2024; 28:256-258. [PMID: 38659140 DOI: 10.5588/ijtld.23.0517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Affiliation(s)
- D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Z Saule
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A Marthinus
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - L Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E Nortier
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - J Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - I Courtney
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa;, University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, USA
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa;, University of Wisconsin-Madison, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, USA
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Calvert C, Scott R, Palmer M, Dube A, Marston M, Wellings K, Slaymaker E. Rates of sexual partner acquisition from nationally representative surveys: variation between countries and by age, sex, wealth, partner and HIV status. Sex Health 2024; 21:NULL. [PMID: 38105237 DOI: 10.1071/sh23134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Knowing levels and determinants of partnership acquisition will help inform interventions that try to reduce transmission of sexually transmitted infections (STIs) including HIV. METHODS We used population-based, cross-sectional data from 47 Demographic and Health Surveys to calculate rates of partner acquisition among men and women (15-49years), and identified socio-demographic correlates for partner acquisition. Partner acquisition rates were estimated as the total number of acquisitions divided by the person-time in the period covered by the survey. For each survey and by sex, we estimated age-specific partner acquisition rates and used age-adjusted piecewise exponential survival models to explore whether there was any association between wealth, HIV status and partner status with partner acquisition rates. RESULTS Across countries, the median partner acquisition rates were 30/100 person-years for men (interquartile range 21-45) and 13/100 person-years for women (interquartile range 6-18). There were substantial variations in partner acquisition rates by age. Associations between wealth and partner acquisition rates varied across countries. People with a cohabiting partner were less likely to acquire a new one, and this effect was stronger for women than men and varied substantially between countries. Women living with HIV had higher partner acquisition rates than HIV-negative women but this association was less apparent for men. At a population level, partner acquisition rates were correlated with HIV incidence. CONCLUSIONS Partner acquisition rates are variable and are associated with important correlates of STIs and thus could be used to identify groups at high risk of STIs.
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Affiliation(s)
- Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rachel Scott
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Palmer
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Albert Dube
- Malawi Epidemiological and Intervention Research Unit, Lilongwe, Malawi
| | - Milly Marston
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Emma Slaymaker
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Palmer M, Kleiner DE, Goodman Z, Brunt E, Avigan MI, Regev A, Hayashi PH, Lewis JH, Mehta R, Harrison SA, Siciliano M, McWherter CA, Vuppalanchi R, Behling C, Miller V, Chalasani N, Sanyal AJ. Liver biopsy for assessment of suspected drug-induced liver injury in metabolic dysfunction-associated steatohepatitis clinical trials: Expert consensus from the Liver Forum. Aliment Pharmacol Ther 2024; 59:201-216. [PMID: 37877759 DOI: 10.1111/apt.17762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 05/25/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Causality assessment of suspected drug-induced liver injury (DILI) during metabolic dysfunction-associated steatohepatitis (MASH) clinical trials can be challenging, and liver biopsies are not routinely performed as part of this evaluation. While the field is moving away from liver biopsy as a diagnostic and prognostic tool, information not identified by non-invasive testing may be provided on histology. AIM To address the appropriate utilisation of liver biopsy as part of DILI causality assessment in this setting. METHODS From 2020 to 2022, the Liver Forum convened a series of webinars on issues pertaining to liver biopsy during MASH trials. The Histology Working Group was formed to generate a series of consensus documents addressing these challenges. This manuscript focuses on liver biopsy as part of DILI causality assessment. RESULTS Expert opinion, guidance and recommendations on the role of liver biopsy as part of causality assessment of suspected DILI occurring during clinical trials for a drug(s) being developed for MASH are provided. Lessons learned from prior MASH programs are reviewed and gaps identified. CONCLUSIONS Although there are no pathognomonic features, histologic evaluation of suspected DILI during MASH clinical trials may alter patient management, define the pattern and severity of injury, detect findings that favour a diagnosis of DILI versus MASH progression, identify prognostic features, characterise the clinicopathological phenotype of DILI, and/or define lesions that influence decisions about trial discontinuation and further development of the drug.
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Affiliation(s)
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Zachary Goodman
- Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Elizabeth Brunt
- Pathology and Immunology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Mark I Avigan
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Paul H Hayashi
- Division of Hepatology and Nutrition, Food and Drug Administration, Silver Spring, Maryland, USA
| | - James H Lewis
- Division of Gastroenterology, Georgetown University Hospital, Washington, District of Columbia, USA
| | - Ruby Mehta
- Center for Drug Evaluation and Research Office of New Drugs, Office of Inflammation and Immunity, Division of Hepatology and Nutrition, US Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Massimo Siciliano
- Fatebenefratelli Gemelli Isola - Rome, Sacred Heart Catholic Univesity, Rome, Italy
| | - Charles A McWherter
- Research and Development, CymaBay Therapeutics, Inc., Newark, California, USA
| | - Raj Vuppalanchi
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Veronica Miller
- University of California Berkeley, School of Public Health, Forum for Collaborative Research, Washington, District of Columbia, USA
| | - Naga Chalasani
- Indiana University School of Medicine, Indiana University Health, Indianapolis, Indiana, USA
| | - Arun J Sanyal
- Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Zanin-Zhorov A, Chen W, Moretti J, Nyuydzefe MS, Zhorov I, Munshi R, Ghosh M, Serdjebi C, MacDonald K, Blazar BR, Palmer M, Waksal SD. Selectivity matters: selective ROCK2 inhibitor ameliorates established liver fibrosis via targeting inflammation, fibrosis, and metabolism. Commun Biol 2023; 6:1176. [PMID: 37980369 PMCID: PMC10657369 DOI: 10.1038/s42003-023-05552-0] [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: 06/07/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023] Open
Abstract
The pathogenesis of hepatic fibrosis is driven by dysregulated metabolism precipitated by chronic inflammation. Rho-associated coiled-coil-containing protein kinases (ROCKs) have been implicated in these processes, however the ability of selective ROCK2 inhibition to target simultaneously profibrotic, pro-inflammatory and metabolic pathways remains undocumented. Here we show that therapeutic administration of GV101, a selective ROCK2 inhibitor with more than 1000-fold selectivity over ROCK1, attenuates established liver fibrosis induced by thioacetamide (TAA) in combination with high-fat diet in mice. GV101 treatment significantly reduces collagen levels in liver, associated with downregulation of pCofilin, pSTAT3, pAkt, while pSTAT5 and pAMPK levels are increased in tissues of treated mice. In vitro, GV101 inhibits profibrogenic markers expression in fibroblasts, adipogenesis in primary adipocytes and TLR-induced cytokine secretion in innate immune cells via targeting of Akt-mTOR-S6K signaling axis, further uncovering the ROCK2-specific complex mechanism of action and therapeutic potential of highly selective ROCK2 inhibitors in liver fibrosis.
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Affiliation(s)
| | - Wei Chen
- Graviton Bioscience B.V, Amsterdam, 1017 CG, Netherlands
| | - Julien Moretti
- Graviton Bioscience B.V, Amsterdam, 1017 CG, Netherlands
| | | | - Iris Zhorov
- Graviton Bioscience B.V, Amsterdam, 1017 CG, Netherlands
| | | | | | | | - Kelli MacDonald
- QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Bruce R Blazar
- Division of Blood & Marrow Transplant & Cellular Therapies, University of MN, Masonic Cancer Center and Department of Pediatrics, Minneapolis, MN, 55455, USA
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Ter Avest E, Kratz M, Dill T, Palmer M. Invited commentary on "Green HEMS in mountain and remote areas: reduction of carbon footprint through drones?". Scand J Trauma Resusc Emerg Med 2023; 31:73. [PMID: 37932855 PMCID: PMC10629043 DOI: 10.1186/s13049-023-01120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- E Ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill, UK.
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
| | - M Kratz
- Emergency Medical Services, Centre for Prehospital Emergency Care, Department of Emergency, Anaesthesia and Pain Medicine, Tampere University, FinnHEMS 30 & 40, Tampere, Finland
| | - T Dill
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Inselspital, Bern, Switzerland
| | - M Palmer
- Emergency Medical Transfer Retrieval Service- Wales Air Ambulance, Ty Elusen, Ffordd Angel, Llanelli Gate, Dafen, Llanelli, Wales
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Castaldi MT, Palmer M, Con J, Bergamaschi R. Robotic-Assisted Surgery Training (RAST): Assessment of Surgeon Console Ergonomic Skills. J Surg Educ 2023; 80:1723-1735. [PMID: 37770293 DOI: 10.1016/j.jsurg.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/27/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the responsiveness of postgraduate year (PGY) general surgery residents (GSRs) to surgeon console ergonomics within the robotic-assisted surgery training (RAST) program. DESIGN This was a prospective educational study. GSRs were prepared with a pretraining educational video. Faculty provided one-on-one resident hands-on training and testing. Nine proficiency criteria (emergency stop & recover; left side pod adjustments; touchpad controls; footswitch panel; energy control pedals; camera control & focus; arm swap; master & finger clutch; dual console settings control) were assessed with a 5-point Likert-scale. Responsiveness was defined as change in performance over time. The robotic platform was Da Vinci Xi (Intuitive Surgical, Sunnyvale, CA). The Dundee ready educational environment measure (DREEM) inventory was used by GSRs to assess the educational environment. SETTING Tertiary care academic teaching institution. PARTICIPANTS A total of 22 GSRs: 4 PGY 1, 4 PGY 2, 4 PGY 3, 5 PGY 4, 5 PGY 5. RESULTS From June 2022 to March 2023 the hands-on console time decreased at testing when compared to baseline: median 39.0 (range 37-41) vs 20.1 (range 19-22) minutes, respectively. There was no difference in mean hands-on testing scores stratified by PGY: 4.85±0.4 PGY1; 4.98 ± 0.3 PGY2; 4.86 ± 0.4 PGY3, 4.88 ± 0.2 PGY4, and 4.91 ± 0.1 PGY5 (ANOVA test; p = 0.095). The overall DREEM score was 167.1 ± 16.9 with CAC = 0.908 (excellent internal consistency). CONCLUSIONS Training in ergonomics on the surgeon console impacted the responsiveness of the GSRs with 51% console time reduction. There were no differences in hands-on testing scores among PGYs. Perception of the educational environment by the GSRs was high.
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Affiliation(s)
- M T Castaldi
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - M Palmer
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - J Con
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York
| | - R Bergamaschi
- Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York.
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Jardine JE, Palmer M, Mahaffey C, Holt J, Wakelin SL, Düsterhus A, Sharples J, Wihsgott J. Rain triggers seasonal stratification in a temperate shelf sea. Nat Commun 2023; 14:3182. [PMID: 37268608 DOI: 10.1038/s41467-023-38599-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/09/2023] [Indexed: 06/04/2023] Open
Abstract
The North Atlantic Storm Track acts as a conveyor belt for extratropical cyclones that frequently deliver high winds and rainfall to northwest European shelf seas. Storms are primarily considered detrimental to shelf sea stratification due to wind-driven mixing countering thermal buoyancy, but their impact on shelf scale stratification cycles remains poorly understood. Here, we show that storms trigger stratification through enhanced surface buoyancy from rainfall. A multidecadal model confirms that rainfall contributed to triggering seasonal stratification 88% of the time from 1982 to 2015. Stratification could be further modulated by large-scale climate oscillations, such as the Atlantic Multidecadal Variability (AMV), with stratification onset dates being twice as variable during a positive AMV phase than a negative one. Further insights into how changing storm activity will impact shelf seas are discussed beyond the current view of increasing wind-driven mixing, with significant implications for marine productivity and ecosystem function.
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Affiliation(s)
- J E Jardine
- National Oceanography Centre, L3 5DA, Liverpool, UK.
- Department of Earth, Ocean and Ecological Sciences, School of Environmental Sciences, L69 3GP, Liverpool, UK.
| | - M Palmer
- Plymouth Marine Laboratory, PL1 3DH, Plymouth, UK
| | - C Mahaffey
- Department of Earth, Ocean and Ecological Sciences, School of Environmental Sciences, L69 3GP, Liverpool, UK
| | - J Holt
- National Oceanography Centre, L3 5DA, Liverpool, UK
| | - S L Wakelin
- National Oceanography Centre, L3 5DA, Liverpool, UK
| | - A Düsterhus
- Irish Climate Analysis and Research UnitS (ICARUS), Department of Geography, Maynooth University, Co. Kildare, Ireland
| | - J Sharples
- Department of Earth, Ocean and Ecological Sciences, School of Environmental Sciences, L69 3GP, Liverpool, UK
| | - J Wihsgott
- Plymouth Marine Laboratory, PL1 3DH, Plymouth, UK
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ter Avest E, Kratz M, Dill T, Palmer M. Green HEMS: how to make it happen. Scand J Trauma Resusc Emerg Med 2023; 31:23. [PMID: 37143112 PMCID: PMC10158689 DOI: 10.1186/s13049-023-01087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023] Open
Affiliation(s)
- E. ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield, Redhill, Surrey, RH1 5YP UK
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - M. Kratz
- Emergency Medical Services, Centre for Prehospital Emergency Care, Department of Emergency, Anaesthesia and Pain Medicine, Tampere University, FinnHEMS 30 & 40, Tampere, Finland
| | - T. Dill
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Inselspital, Bern, Switzerland
| | - M. Palmer
- Emergency Medical Transfer Retrieval Service- Wales Air Ambulance, Ty Elusen, Ffordd Angel, Llanelli Gate, Dafen, Llanelli UK
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Horan C, Palmer M, Shrestha R, Erlank CP, Church K. The impact of COVID-19 lockdown on abortion care: a time series analysis of data from Marie Stopes Nepal. Sex Reprod Health Matters 2022; 30:2079185. [PMID: 35713504 PMCID: PMC9225672 DOI: 10.1080/26410397.2022.2079185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The COVID-19 pandemic significantly impacted sexual and reproductive health and rights. Nepal implemented a nationwide lockdown in March 2020, limiting population movement and service access. The 36 clinics run by Marie Stopes Nepal (MSN) closed for varying periods at the beginning of lockdown. This study assesses the impact of lockdown and associated clinic closures on abortion services within MSN’s network. An interrupted time-series analysis of clinic-level MSN data compared abortion service use in the pre-closure and post-reopening periods, focusing on the following outcomes: number of abortion care visits, proportion of abortion-related visits, gestational age at time of abortion care and demographics of patients accessing abortion care. Subsequent meta-analyses combined clinic-level results to generate outcome-specific pooled effect estimates. As MSN clinics reopened, during ongoing wider lockdown, weekly visits for abortion care decreased by 37% on average, but abortion increased as a proportion of services post-reopening (OR: 1.53) compared with pre-closure, with no evidence of a change in the proportion of higher gestation abortions. The demographic profile of abortion care clients was altered, with post-reopening clients more likely to have completed primary education (OR: 1.54) and be aged 25 years or older (OR: 1.31) compared with pre-closure clients. COVID-19 lockdown and associated clinic closures reduced the absolute number of abortion services provided within MSN’s network, impacting the composition of service provision. Reductions in safe abortion and wider SRH access will have wide-ranging consequences, curtailing crucial reproductive rights. Policy-makers must ensure ongoing abortion access to protect rights and ensure access.
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Affiliation(s)
- Corrina Horan
- MSc Student in Reproductive and Sexual Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Palmer
- Assistant Professor, London School of Hygiene and Tropical Medicine, London, UK
| | - Raman Shrestha
- Evidence to Action Manager, Sunaulo Parivar Nepal, Kathmandu, Nepal
| | | | - Kathryn Church
- Independent Consultant & Honorary Assistant Professor, London School of Hygiene & Tropical Medicine, London, UK
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Heffernan AJ, Talekar C, Henain M, Purcell L, Palmer M, White H. Comparison of continuous versus intermittent enteral feeding in critically ill patients: a systematic review and meta-analysis. Crit Care 2022; 26:325. [PMID: 36284334 PMCID: PMC9594889 DOI: 10.1186/s13054-022-04140-8] [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: 04/02/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background The enteral route is commonly utilised to support the nutritional requirements of critically ill patients. However, there is paucity of data guiding clinicians regarding the appropriate method of delivering the prescribed dose. Continuous enteral feeding is commonly used; however, a bolus or intermittent method of administration may provide several advantages such as minimising interruptions. The purpose of this meta-analysis is to compare a continuous versus an intermittent or bolus enteral nutrition administration method. Methods A systematic review and meta-analysis were performed with studies identified from the PubMed, EMBASE, Cochrane Library and Web of Science databases. Studies were included if they compared a continuous with either an intermittent or bolus administration method of enteral nutrition in adult patients admitted to the intensive care unit. Study quality was assessed using the PEDro and Newcastle–Ottawa scoring systems. Review Manager was used for performing the random-effects meta-analysis on the outcomes of mortality, constipation, diarrhoea, increased gastric residuals, pneumonia, and bacterial colonisation. Results A total of 5546 articles were identified, and 133 were included for full text review. Fourteen were included in the final analysis. There was an increased risk of constipation with patients receiving continuous enteral nutrition (relative risk 2.24, 95% confidence interval 1.01–4.97, p = 0.05). No difference was identified in other outcome measures. No appreciable bias was identified. Conclusion The current meta-analysis has not identified any clinically relevant difference in most outcome measures relevant to the care of critically ill patients. However, there is a paucity of high-quality randomised controlled clinical trials to guide this decision. Therefore, clinicians may consider either dosing regimen in the context of the patient’s care requirements.
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Affiliation(s)
- Aaron J. Heffernan
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia ,grid.1022.10000 0004 0437 5432School of Medicine and Dentistry, Griffith University, Southport, QLD Australia
| | - C. Talekar
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia ,grid.1022.10000 0004 0437 5432School of Medicine and Dentistry, Griffith University, Southport, QLD Australia
| | - M. Henain
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia ,grid.416100.20000 0001 0688 4634Royal Brisbane and Women’s Hospital, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Brisbane, QLD Australia
| | - L. Purcell
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia
| | - M. Palmer
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia
| | - H. White
- grid.460757.70000 0004 0421 3476Department of Intensive Care Medicine, Logan Hospital, MetroSouth Hospital and Health Service, Meadowbrook, QLD Australia ,grid.1022.10000 0004 0437 5432School of Medicine and Dentistry, Griffith University, Southport, QLD Australia
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Méndez-Sánchez N, Bugianesi E, Gish RG, Lammert F, Tilg H, Nguyen MH, Sarin SK, Fabrellas N, Zelber-Sagi S, Fan JG, Shiha G, Targher G, Zheng MH, Chan WK, Vinker S, Kawaguchi T, Castera L, Yilmaz Y, Korenjak M, Spearman CW, Ungan M, Palmer M, El-Shabrawi M, Gruss HJ, Dufour JF, Dhawan A, Wedemeyer H, George J, Valenti L, Fouad Y, Romero-Gomez M, Eslam M. Global multi-stakeholder endorsement of the MAFLD definition. Lancet Gastroenterol Hepatol 2022; 7:388-390. [PMID: 35248211 DOI: 10.1016/s2468-1253(22)00062-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Nahum Méndez-Sánchez
- National Autonomous University of Mexico, Mexico City, Mexico; Liver Research Unit, Medica Sur Clinic Foundation, Mexico City, Mexico
| | - Elisabetta Bugianesi
- Division of Gastroenterology and Hepatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Robert G Gish
- Liver Transplant Clinic, Loma Linda University, Loma Linda, CA, USA
| | - Frank Lammert
- Department of Medicine II, Hannover Medical School, Hannover, Germany
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA; Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology and Hepatology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gamal Shiha
- European Liver Patients' Association, Brussels, Belgium; World Hepatitis Alliance, London, UK; African Liver Patient Association, Cairo, Egypt; Association of Liver Patients Care, Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; Egyptian Liver Research Institute and Hospital, Sherbin, Egypt
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Ming-Hua Zheng
- MAFLD Research Center, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wah-Kheong Chan
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shlomo Vinker
- World Organization of Family Doctors Europe, Ljublijana, Slovenia; European General Practice Research Network, Maastricht, Netherlands; Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Association of Family Physicians, Tel Aviv, Israel; Leumit Health Services, Tel Aviv, Israel
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Laurent Castera
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yusuf Yilmaz
- Department of Gastroenterology, School of Medicine and Liver Research Unit, Institute of Gastroenterology, Marmara University, Istanbul, Turkey
| | - Marko Korenjak
- European Liver Patients' Association, Brussels, Belgium; Association SLOVENIA HEP, Maribor, Slovenia
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mehmet Ungan
- World Organization of Family Doctors Europe, Ljublijana, Slovenia; European General Practice Research Network, Maastricht, Netherlands; Department of Family Medicine, School of Medicine, Ankara University, Ankara, Turkey
| | - Melissa Palmer
- Gannex-Ascletis Pharma, Beijing, China; Liver Consulting, New York, NY, USA
| | - Mortada El-Shabrawi
- Paediatric Hepatology Unit, Department of Paediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt; The International Society of Tropical Paediatrics, Cairo, Egypt
| | | | - Jean-François Dufour
- Swiss NASH Foundation, Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, Bern, Switzerland; Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, University of Milan, Milan, Italy
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt; The Egyptian MAFLD Research Group, Cairo, Egypt
| | - Manuel Romero-Gomez
- UCM Digestive Diseases, Virgen del Rocio University Hospital, Instituto de Biomedicina de Sevilla (HVR/CSIC/US), CIBER Hepatic and Digestive Diseases, University of Seville, Seville, Spain
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia.
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Cutrone R, Day C, Valentin-Torres A, Palmer M, Mays R, Busch S. Mesenchymal Stem/Stromal Cells: MULTIPOTENT ADULT PROGENITOR CELLS MODULATE MONOCYTE/MACROPHAGE PHENOTYPE, CYTOKINE SECRETION AND FUNCTION. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Fouad Y, Palmer M, Chen M, Regev A, Banerjee R, Myers R, Riccio R, Torstenson R, Younes R, Arora PS, Landgren H, Karsdal MA, Blake M, Shapiro DA, Gruss HJ, Sheikh MY, Attia D, Bollipo S, Smith AD, Freilich B, Gish RG, Schuppan D. Redefinition of Fatty Liver Disease from NAFLD to MAFLD through the Lens of Drug Development and Regulatory Science. J Clin Transl Hepatol 2022; 10:374-382. [PMID: 35528969 PMCID: PMC9039717 DOI: 10.14218/jcth.2021.00408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 12/04/2022] Open
Abstract
Metabolic (dysfunction)-associated fatty liver disease (MAFLD) affects a third of the population and is a leading cause of liver-related death. Since no effective treatments exist, novel approaches to drug development are required. Unfortunately, outdated terminology and definitions of the disease are hampering efforts to develop new drugs and treatments. An international consensus panel has put forth an influential proposal for the disease to be renamed from nonalcoholic fatty liver disease (NAFLD) to MAFLD, including a proposal for how the disease should be diagnosed. As allies with the many stakeholders in MAFLD care-including patients, patients' advocates, clinicians, researchers, nurse and allied health groups, regional societies, and others-we are aware of the negative consequences of the NAFLD term and definition. We share the sense of urgency for change and will act in new ways to achieve our goals. Although there is much work to be done to overcome clinical inertia and reverse worrisome recent trends, the MAFLD initiative provides a firm foundation to build on. It provides a roadmap for moving forward toward more efficient care and affordable, sustainable drug and device innovation in MAFLD care. We hope it will bring promising new opportunities for a brighter future for MAFLD care and improve care and outcomes for patients of one of the globe's largest and costliest public health burdens. From this viewpoint, we have revisited this initiative through the perspectives of drug development and regulatory science.
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Affiliation(s)
- Yasser Fouad
- Department of Gastroenterology, Hepatology, and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
- Correspondence to: Yasser Fouad, Endemic Medicine Department, Minia University, Main Road, Minia 11432, Egypt. Tel: +20-1091318555, Fax: +20-1-114721500, E-mail: ; Detlef Schuppan, Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. Tel: +49-6131-17-7356, Fax: +49-6131-177357, E-mail:
| | - Melissa Palmer
- Gannex/Ascletis Pharma Co Ltd, Beijing, China
- Liver Consulting LLC, New York, NY, USA
| | - Minjun Chen
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, Jefferson, AR, USA
| | - Arie Regev
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Rob Myers
- Gilead Sciences Inc, Foster City, CA, USA
| | | | | | - Ramy Younes
- Boehringer Ingelheim International, GmbH, Ingelheim, Germany
| | | | | | | | | | | | | | | | - Dina Attia
- Gastroenterology and Hepatology Department, Beni-Suef University, Beni Suef, Egypt
| | - Steven Bollipo
- Department of Gastroenterology and Endoscopy, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | | | | | - Robert G. Gish
- Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, CA, USA
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Correspondence to: Yasser Fouad, Endemic Medicine Department, Minia University, Main Road, Minia 11432, Egypt. Tel: +20-1091318555, Fax: +20-1-114721500, E-mail: ; Detlef Schuppan, Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Mainz, Germany; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. Tel: +49-6131-17-7356, Fax: +49-6131-177357, E-mail:
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14
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Fentress M, Henwood PC, Maharaj P, Mitha M, Khan D, Jackpersad R, Pitcher R, Redfern A, Lopez Varela E, van der Zalm MM, Wong EB, Palmer M, Grant AD. Thoracic ultrasound for TB diagnosis in adults and children. Public Health Action 2022; 12:3-6. [DOI: 10.5588/pha.21.0072] [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] [Received: 08/24/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
Thoracic ultrasound is an appealing alternative to chest radiography for the diagnosis of TB. Based on research experience conducting thoracic ultrasound for adults and children in South Africa, three key considerations for potential scale-up were identified. First, thoracic ultrasound
requires a comprehensive training programme for novice users; artificial intelligence may be used to simplify training and interpretation. Second, a robust ultrasound device is needed with good subpleural resolution and a probe suitable for children. Third, comprehensive scanning of the lungs
is time-intensive, and shorter scanning protocols may be more feasible in clinical practice.
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Affiliation(s)
- M. Fentress
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - P. Maharaj
- Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - M. Mitha
- Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - D. Khan
- Department of Pulmonology and Critical Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | | | - R. Pitcher
- Division of Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A. Redfern
- Department of Paediatrics & Child Health, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E. Lopez Varela
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, Universidad de Barcelona, Barcelona, Spain, Desmond Tutu TB Centre, Department of Paediatrics & Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - M. M. van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics & Child Health, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E. B. Wong
- Africa Health Research Institute, KwaZulu-Natal, South Africa, Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M. Palmer
- Desmond Tutu TB Centre, Department of Paediatrics & Child Health, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A. D. Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK, Africa Health Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, School
of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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15
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Jerome L, Potter K, McCarthy O, Palmer M, Knight M, Free C. A dynamic and collaborative approach to trial recruitment in safetxt, a UK sexual health randomised controlled trial. Clin Trials 2022; 19:251-258. [PMID: 35253453 PMCID: PMC9203664 DOI: 10.1177/17407745221078882] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background/Aims: Recruiting to target in randomised controlled trials is crucial for providing reliable results, yet many trials struggle to achieve their target sample size. Many trials do not report sufficient, if any, details of their recruitment strategy for others to adapt for their own trials. Furthermore, much of the available evidence describes strategies to improve recruitment aimed at participants, as opposed to strategies aimed at engaging and motivating recruiting staff who are deemed essential for recruitment success. The safetxt trial aimed to recruit 6250 participants, aged 16–24 years, who had either tested positive, or received treatment, for chlamydia/gonorrhoea/non-specific urethritis in the last 2 weeks, from across the United Kingdom into a randomised controlled trial investigating a text message intervention to improve sexual health outcomes. In this article, we describe in detail the recruitment strategies we employed that were primarily aimed at recruiters. Methods: Recruitment began in April 2016. We built on our recruitment methods established in the pilot trial and developed several strategies to increase recruitment as the trial progressed including optimising site set-up, monitoring recruitment progress and identifying issues, facilitating shared learning, tailored recruitment materials, sustaining motivation, and communication. We describe these strategies in detail and provide practical examples for each. Results: We combine our strategies for increasing recruitment into one cyclical approach whereby progress is continuously monitored, and interventions to improve recruitment are implemented. The site initiation visits were used to develop a clear recruitment plan and establish good relationships with local site staff. Screening logs were particularly helpful for monitoring recruitment challenges. We facilitated shared learning by organising meetings with recruiting sites and conducting site visits. Tailored recruitment materials helped to promote the trial in clinic environments, and rewards and goals helped sustain motivation among recruiting staff. Finally, at the centre of the approach is good communication which ensured we maintained good relationships with local site staff. Conclusion: We conducted a large, multi-centre trial and successfully recruited to target. Our dynamic collaborative approach to recruitment described in this paper builds upon previous research by combining suggested good practice into one cyclical approach to recruitment, and providing detailed examples of each strategy. It is not possible to attribute a causal link between our approach and recruitment success overall, or with specific sites or recruiting staff. Nonetheless we describe the processes we used to build a good relationship with recruiting staff and sites, and maintain recruitment of large numbers of participants over the 32 months of the trial. Other researchers can use our approach and adapt our examples for their own trials.
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Affiliation(s)
- Lauren Jerome
- London School of Hygiene and Tropical Medicine, London, UK
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | | | - Ona McCarthy
- London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Palmer
- London School of Hygiene and Tropical Medicine, London, UK
| | - Megan Knight
- London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Free
- London School of Hygiene and Tropical Medicine, London, UK
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16
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Lopez-Varela E, Garcia-Prats AJ, Seddon JA, Draper HR, Winckler J, van der Laan L, Palmer M, Burger WA, Schaaf HS, Hesseling AC. Treatment outcomes and safety in children with rifampicin-resistant TB. Int J Tuberc Lung Dis 2022; 26:133-141. [PMID: 35086625 DOI: 10.5588/ijtld.21.0476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: The treatment of rifampicin-resistant TB (RR-TB) in children is evolving rapidly. As newer regimens are introduced into routine care, it is vital to compare their outcome and safety with well-characterised clinical cohorts treated with historical regimens.METHODS: Study sample comprised a prospective observational cohort of children on routine RR-TB treatment, enrolled from 2011 to 2015 in Cape Town, South Africa. Children were followed for safety, treatment response and outcome.RESULTS: Of 136 children included, 27 (19.9%) were living with HIV and 48 (37.8%) had severe TB. The median time-to-culture conversion in children with bacteriological confirmation (n = 44) was 28.5 days (IQR 14.5-45). Overall, 118/129 (91.5%) had favourable TB treatment outcomes. Of 106 (77.9%) children who received an injectable drug, 9 (8.5%) developed hearing loss and 7/136 (5.1%) developed other Grade 3 or higher adverse events likely related to treatment.CONCLUSIONS: In this cohort with a substantial proportion of children with severe manifestations of TB and with HIV, TB treatment outcomes were excellent. Apart from hearing loss, few children developed severe adverse events related to treatment. This study provides robust reference data for future evaluation of shorter, injectable-sparing regimens.
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Affiliation(s)
- E Lopez-Varela
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universidad de Barcelona, Barcelona, Spain
| | - A J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Paediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Infectious Diseases, Imperial College London, London, UK
| | - H R Draper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Winckler
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L van der Laan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - W A Burger
- Brewelskloof Hospital, Worcester, South Africa
| | - H S Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Hey-Hadavi J, Seekins D, Palmer M, Coffey D, Caminis J, Abdullaev S, Patwardhan M, Tyler H, Raheja R, Stanley AM, Pineda-Salgado L, Bourdet DL, Andrade RJ, Hayashi PH, Dimick-Santos L, Rockey DC, Estilo A. Overview of Causality Assessment for Drug-Induced Liver Injury (DILI) in Clinical Trials. Drug Saf 2021; 44:619-634. [PMID: 33725335 PMCID: PMC8184702 DOI: 10.1007/s40264-021-01051-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
Causality assessment for suspected drug-induced liver injury (DILI) during drug development and following approval is challenging. The IQ DILI Causality Working Group (CWG), in collaboration with academic and regulatory subject matter experts (SMEs), developed this manuscript with the following objectives: (1) understand and describe current practices; (2) evaluate the utility of new tools/methods/practice guidelines; (3) propose a minimal data set needed to assess causality; (4) define best practices; and (5) promote a more structured and universal approach to DILI causality assessment for clinical development. To better understand current practices, the CWG performed a literature review, took a survey of member companies, and collaborated with SMEs. Areas of focus included best practices for causality assessment during clinical development, utility of adjudication committees, and proposals for potential new avenues to improve causality assessment. The survey and literature review provided renewed understanding of the complexity and challenges of DILI causality assessment as well as the use of non-standardized approaches. Potential areas identified for consistency and standardization included role and membership of adjudication committees, standardized minimum dataset, updated assessment tools, and best practices for liver biopsy and rechallenge in the setting of DILI. Adjudication committees comprised of SMEs (i.e., utilizing expert opinion) remain the standard for DILI causality assessment. A variety of working groups continue to make progress in pursuing new tools to assist with DILI causality assessment. The minimum dataset deemed adequate for causality assessment provides a path forward for standardization of data collection in the setting of DILI. Continued progress is necessary to optimize and advance innovative tools necessary for the scientific, pharmaceutical, and regulatory community.
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Affiliation(s)
| | | | - Melissa Palmer
- Takeda, Cambridge, MA, USA
- Liver Consulting LLC, New York City, USA
| | | | | | | | | | - Haifa Tyler
- Otsuka Pharmaceutical Development and Commercialization, Inc., 508 Carnegie Center Dr, Princeton, NJ, 08540, USA
| | | | | | - Liliam Pineda-Salgado
- Otsuka Pharmaceutical Development and Commercialization, Inc., 508 Carnegie Center Dr, Princeton, NJ, 08540, USA
| | | | - Raul J Andrade
- Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Málaga, Spain
| | | | | | - Don C Rockey
- Medical University of South Carolina, Charleston, SC, USA
| | - Alvin Estilo
- Otsuka Pharmaceutical Development and Commercialization, Inc., 508 Carnegie Center Dr, Princeton, NJ, 08540, USA.
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18
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Shukla D, Purcell L, Palmer M, Pillay L. Corrigendum to: DOP01 Exclusive Enteral Nutrition for the Treatment of Adult Crohn's Disease. J Crohns Colitis 2021; 15:516. [PMID: 33129202 DOI: 10.1093/ecco-jcc/jjaa169] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D Shukla
- Department of Gastroenterology, Logan Hospital, Brisbane, Australia
| | - L Purcell
- Department of Gastroenterology, Logan Hospital, Brisbane, Australia
| | - M Palmer
- Department of Gastroenterology, Logan Hospital, Brisbane, Australia
| | - L Pillay
- Department of Gastroenterology, Logan Hospital, Brisbane, Australia
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19
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Treem WR, Palmer M, Lonjon-Domanec I, Seekins D, Dimick-Santos L, Avigan MI, Marcinak JF, Dash A, Regev A, Maller E, Patwardhan M, Lewis JH, Rockey DC, Di Bisceglie AM, Freston JW, Andrade RJ, Chalasani N. Consensus Guidelines: Best Practices for Detection, Assessment and Management of Suspected Acute Drug-Induced Liver Injury During Clinical Trials in Adults with Chronic Viral Hepatitis and Adults with Cirrhosis Secondary to Hepatitis B, C and Nonalcoholic Steatohepatitis. Drug Saf 2021; 44:133-165. [PMID: 33141341 PMCID: PMC7847464 DOI: 10.1007/s40264-020-01014-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 02/07/2023]
Abstract
With the widespread development of new drugs to treat chronic liver diseases (CLDs), including viral hepatitis and nonalcoholic steatohepatitis (NASH), more patients are entering trials with abnormal baseline liver tests and with advanced liver injury, including cirrhosis. The current regulatory guidelines addressing the monitoring, diagnosis, and management of suspected drug-induced liver injury (DILI) during clinical trials primarily address individuals entering with normal baseline liver tests. Using the same laboratory criteria cited as signals of potential DILI in studies involving patients with no underlying liver disease and normal baseline liver tests may result in premature and unnecessary cessation of a study drug in a clinical trial population whose abnormal and fluctuating liver tests are actually due to their underlying CLD. This position paper focuses on defining best practices for the detection, monitoring, diagnosis, and management of suspected acute DILI during clinical trials in patients with CLD, including hepatitis C virus (HCV) and hepatitis B virus (HBV), both with and without cirrhosis and NASH with cirrhosis. This is one of several position papers developed by the IQ DILI Initiative, comprising members from 16 pharmaceutical companies in collaboration with DILI experts from academia and regulatory agencies. It is based on an extensive literature review and discussions between industry members and experts from outside industry to achieve consensus regarding the recommendations. Key conclusions and recommendations include (1) the importance of establishing laboratory criteria that signal potential DILI events and that fit the disease indication being studied in the clinical trial based on knowledge of the natural history of test fluctuations in that disease; (2) establishing a pretreatment value that is based on more than one screening determination, and revising that baseline during the trial if a new nadir is achieved during treatment; (3) basing rules for increased monitoring and for stopping drug for potential DILI on multiples of baseline liver test values and/or a threshold value rather than multiples of the upper limit of normal (ULN) for that test; (4) making use of more sensitive tests of liver function, including direct bilirubin (DB) or combined parameters such as aspartate transaminase:alanine transaminase (AST:ALT) ratio or model for end-stage liver disease (MELD) to signal potential DILI, especially in studies of patients with cirrhosis; and (5) being aware of potential confounders related to complications of the disease being studied that may masquerade as DILI events.
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Affiliation(s)
| | - Melissa Palmer
- Takeda, Cambridge, MA, USA
- Liver Consulting LLC, New York, NY, USA
| | | | | | | | - Mark I Avigan
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | - Ajit Dash
- , Genentech, South San Francisco, CA, USA
| | - Arie Regev
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Eric Maller
- Pfizer, Collegeville, PA, USA
- MEMS Biopharma Consulting, LLC, Wynnewood, PA, USA
| | | | | | - Don C Rockey
- Medical University of South Carolina, Charleston, SC, USA
| | | | - James W Freston
- University of Connecticut Health Center, Farmington, CT, USA
| | - Raul J Andrade
- Unidad de Gestión Clínica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Universidad de Málaga, Málaga, Spain
| | - Naga Chalasani
- Indiana University School of Medicine, Indianapolis, IN, USA.
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20
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van der Zalm MM, Walters E, Claassen M, Palmer M, Seddon JA, Demers AM, Shaw ML, McCollum ED, van Zyl GU, Hesseling AC. High burden of viral respiratory co-infections in a cohort of children with suspected pulmonary tuberculosis. BMC Infect Dis 2020; 20:924. [PMID: 33276721 PMCID: PMC7716283 DOI: 10.1186/s12879-020-05653-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
Background The presentation of pulmonary tuberculosis (PTB) in young children is often clinically indistinguishable from other common respiratory illnesses, which are frequently infections of viral aetiology. As little is known about the role of viruses in children with PTB, we investigated the prevalence of respiratory viruses in children with suspected PTB at presentation and follow-up. Methods In an observational cohort study, children < 13 years were routinely investigated for suspected PTB in Cape Town, South Africa between December 2015 and September 2017 and followed up for 24 weeks. Nasopharyngeal aspirates (NPAs) were tested for respiratory viruses using multiplex PCR at enrolment, week 4 and 8. Results Seventy-three children were enrolled [median age 22.0 months; (interquartile range 10.0–48.0); 56.2% male and 17.8% HIV-infected. Anti-tuberculosis treatment was initiated in 54.8%; of these 50.0% had bacteriologically confirmed TB. At enrolment, ≥1 virus were detected in 95.9% (70/73) children; most commonly human rhinovirus (HRV) (74.0%). HRV was more frequently detected in TB cases (85%) compared to ill controls (60.6%) (p = 0.02). Multiple viruses were detected in 71.2% of all children; 80% of TB cases and 60.6% of ill controls (p = 0.07). At follow-up, ≥1 respiratory virus was detected in 92.2% (47/51) at week 4, and 94.2% (49/52) at week 8. Conclusions We found a high prevalence of viral respiratory co-infections in children investigated for PTB, irrespective of final PTB diagnosis, which remained high during follow up. Future work should include investigating the whole respiratory ecosystem in combination with pathogen- specific immune responses.
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Affiliation(s)
- M M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - E Walters
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Paediatrics, Great North Children's Hospital, Newcastle-Upon-Tyne Health Trust, Newcastle upon Tyne, UK
| | - M Claassen
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Infectious Diseases, Imperial College London, London, UK
| | - A M Demers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M L Shaw
- Department of Medical Biosciences, University of the Western Cape, Cape Town, South Africa.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, USA.,Global Program in Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA.,Health Systems Program, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - G U van Zyl
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Acuti Martellucci C, Nomura S, Yoneoka D, Ueda P, Brotherton J, Canfell K, Palmer M, Manzoli L, Giorgi Rossi P, De Togni A, Palmonari C, Califano A, Saito E, Hashizume M, Shibuya K. Human papillomavirus vaccine effectiveness within a cervical cancer screening programme: cohort study. BJOG 2020; 128:532-539. [PMID: 32779381 DOI: 10.1111/1471-0528.16429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the effectiveness of an HPV vaccination programme in reducing the risk of cervical abnormalities identified at subsequent screening. DESIGN Retrospective cohort study using administrative health data. SETTING General population of Ferrara Province, Italy. POPULATION Female residents born in 1986-1993 and participating in the organized cervical screening programme in 2011-2018, who were eligible for HPV vaccination in catch-up cohorts. METHODS Logistic regression to evaluate the potential association between abnormal cervical cytology and one, two, three or at least one dose of HPV vaccine. MAIN OUTCOME MEASURES Cervical abnormalities, as predicted by low-grade or high-grade cytology, by number of vaccine doses, stratified by age. RESULTS The sample consisted of 7785 women (mean age 27.5 years, SD 2.3). Overall, 391 (5.0%) were vaccinated with ≥1 dose and 893 (11.5%) had abnormal cytology. Women receiving at least one vaccine dose were significantly less likely to have an abnormal cytology (adjusted odds ratio 0.52; 95% confidence interval 0.34-0.79). Similar results were observed for women receiving a single dose, for both bivalent and quadrivalent vaccines, and applying buffer periods (excluding cytological outcomes within 1 month, 6 months and 1 year of the first dose). CONCLUSIONS In the context of an organised cervical screening programme in Italy, catch-up HPV vaccination almost halved the risk of cytological abnormalities. TWEETABLE ABSTRACT Among Ferrara women, vaccination against human papillomavirus halved the risk of screening cervical abnormalities.
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Affiliation(s)
- C Acuti Martellucci
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - S Nomura
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - D Yoneoka
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan.,Division of Biostatistics and Bioinformatics, Graduate School of Public Health, St. Luke's International University, Chuo City, Tokyo, Japan
| | - P Ueda
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - Jml Brotherton
- VCS Foundation, Carlton, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - K Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, Australia.,Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - M Palmer
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan.,Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - L Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - P Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale - IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - A De Togni
- Epidemiology and Public Health Department, Azienda Unità Sanitaria Locale Ferrara, Ferrara, Italy
| | - C Palmonari
- Epidemiology and Public Health Department, Azienda Unità Sanitaria Locale Ferrara, Ferrara, Italy
| | - A Califano
- Epidemiology and Public Health Department, Azienda Unità Sanitaria Locale Ferrara, Ferrara, Italy
| | - E Saito
- Division of Cancer Statistics Integration, Centre for Cancer Control and Information Services, National Cancer Center, Chuo City, Tokyo, Japan
| | - M Hashizume
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan
| | - K Shibuya
- Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Bunkyo City, Tokyo, Japan
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22
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Payne SR, Fowler S, Mundy AR, Alhasso A, Almallah Y, Anderson P, Andrich D, Baird A, Biers S, Browning A, Chapple C, Cherian J, Clarke L, Conn I, Dickerson D, Doble A, Dorkin T, Duggan B, Eardley I, Garaffa G, Greenwell T, Hadway P, Harding C, Hilmy M, Inman R, Kayes O, Kirchin V, Krishnan R, Kumar V, Lemberger J, Malone P, Moore J, Moore K, Mundy A, Noble J, Nurse D, Palmer M, Payne S, Pickard R, Rai J, Rees R, Roux J, Seipp C, Shabbir M, Saxby M, Sharma D, Sinclair A, Summerton D, Tatarov O, Thiruchelvam N, Venn S, Watkin N, Zacherakis E. The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415819894182] [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] [Indexed: 12/24/2022]
Abstract
Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV
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Affiliation(s)
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Anthony R Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
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McCarthy OL, Aliaga C, Torrico Palacios ME, López Gallardo J, Huaynoca S, Leurent B, Edwards P, Palmer M, Ahamed I, Free C. An Intervention Delivered by Mobile Phone Instant Messaging to Increase Acceptability and Use of Effective Contraception Among Young Women in Bolivia: Randomized Controlled Trial. J Med Internet Res 2020; 22:e14073. [PMID: 32568092 PMCID: PMC7338928 DOI: 10.2196/14073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/07/2019] [Accepted: 01/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background Although the most effective methods of contraception are available in Bolivia, unmet need for contraception among women aged 15 to 19 years is estimated to be 38% (2008), and the adolescent fertility rate is 71 per 1000 women (2016). Mobile phones are a popular mode to deliver health behavior support. We developed a contraceptive behavioral intervention for young Bolivian women delivered by mobile phone and guided by behavioral science. The intervention consists of short instant messages sent through an app over 4 months. Objective This trial aimed to evaluate the effect of the intervention on young Bolivian women’s use of and attitudes toward the effective contraceptive methods available in Bolivia. Methods This was a parallel group, individually randomized superiority trial with a 1:1 allocation ratio. Women were eligible if they were aged 16 to 24 years, owned a personal Android mobile phone, lived in La Paz or El Alto, reported an unmet need for contraception, and could read Spanish. The target sample size was 1310 participants. Participants allocated to the intervention had access to an app with standard family planning information and intervention messages. Participants allocated to the control group had access to the same app and control messages. Coprimary outcomes were use of effective contraception and acceptability of at least one method of effective contraception at 4 months. Secondary outcomes were use of effective contraception during the study, acceptability of the individual methods, service uptake, unintended pregnancy, and abortion. Process outcomes included knowledge, perceived norms, personal agency, and intention. Outcomes were analyzed using logistic and linear regression. We also asked participants about physical violence. Results A total of 640 participants were enrolled, and 67.0% (429) of them contributed follow-up data for the coprimary outcome, the use of effective contraception. There was no evidence that use differed between the groups (33% control vs 37% intervention; adjusted odds ratio [OR] 1.19, 95% CI 0.80 to 1.77; P=.40). There was a borderline significant effect regarding acceptability (63% control vs 72% intervention; adjusted OR 1.49, 95% CI 0.98 to 2.28; P=.06). There were no statistically significant differences in any of the secondary or process outcomes. The intervention dose received was low. In the control group, 2.8% (6/207) reported experiencing physical violence compared with 1.9% (4/202) in the intervention group (Fisher exact test P=.75). Conclusions This trial was unable to provide definitive conclusions regarding the effect of the intervention on use and acceptability of effective contraception because of under recruitment. Although we cannot strongly recommend implementation, the results suggest that it would be safe and may increase the acceptability of effective contraception if the intervention messages were offered alongside the download of the app. Trial Registration ClinicalTrials.gov NCT02905526; https://clinicaltrials.gov/ct2/show/NCT02905526
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Affiliation(s)
- Ona L McCarthy
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Silvia Huaynoca
- International Planned Parenthood Federation/Western Hemisphere Region, New York, NY, United States
| | - Baptiste Leurent
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Phil Edwards
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Melissa Palmer
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Irrfan Ahamed
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Caroline Free
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hussein A, Ralph D, Potter B, Abbruzzese B, Hershey R, Repp K, Shakhtra H, Goel M, Palmer M, Kissling A, Hartings C, Blue M, Rosol M. THU0540 A PHASE 2B STUDY OF INTRAVENOUSLY (IV) ADMINISTERED TC 99M TILMANOCEPT TO DETERMINE DIFFERENTIAL UPTAKE, REPRODUCIBILITY OVER TIME AND IMAGE STABILITY IN HEALTHY SUBJECTS AND IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA) ON STABLE TREATMENT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6077] [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
Background:At present, there are no reliable noninvasive means to directly monitor disease activity in RA patients. Activated macrophages are a critical component of the inflammatory etiology of RA due to their role in prolonged RA joint inflammation and destruction through the release of pro-inflammatory cytokines and chemokines. Tc 99m tilmanocept is a radiopharmaceutical imaging agent that binds with high affinity to the macrophage mannose receptor CD206 that resides on activated macrophages. Previous clinical trials demonstrated safety and tolerability of Tc 99m tilmanocept, as well as a determination of optimal clinical dose and timeframe for RA imaging.Objectives:The current phase 2b study aims to evaluate reproducibility and stability of imaging and will assess quantitative Tc 99m tilmanocept uptake cut points that reliably enable discrimination between joints of healthy people and RA patients.Methods:The analysis cohort contained 18 healthy controls (HC) clinically free of inflammatory joint disease and 12 subjects with clinically diagnosed RA who are on stable anti-inflammatory and/or anti-rheumatic therapy. Each subject received a 150-mcg dose of tilmanocept radiolabeled with 10 mCi of Tc 99m in a 3mL IV injection. Injection was followed by planar imaging at 60 and 180 minutes for both HC and RA subjects on study Day 0 and repeated in RA subjects on Day 8. Images were quantitatively assessed to detect localization within synovial spaces of bilateral hands and wrists by determining average pixel intensity in each region of interest relative to average pixel intensity in a joint-specific reference region.Results:Data obtained from the interim analysis support the hypothesis that Tc 99m tilmanocept imaging can provide robust quantitative imaging in HC and RA subjects. Repeat images within and between days demonstrate root mean squared differences that are approximately 10% or less of the observed localization of Tc 99m tilmanocept. Qualitatively, images of HC indicated no disease-related site-specific localization, whereas localization is present in RA subjects at levels expected given the difference in macrophage number and density in different pathotypes of RA. Notably, images from patients with active RA exhibit the same localization patterns on images taken in a test-retest fashion on the same day as well as in subjects with images acquired on Day 0 and Day 8 (see Figure 1). These results show low imaging readout variability, enabling reliable quantification of joints with RA-involved macrophage-mediated inflammation. Analysis of the HC and RA images was used to determine initial quantitative “cut-points” to differentiate between joints with and without the inflammation typically seen in RA.Figure 1.Tilmanocept consistently localizes in areas of macrophage-driven inflammation, demonstrating low variability. RA patients exhibit reproducible localization over a 1-week period. Typical of healthy subjects, no evidence of inflammation-related Tc 99m tilmanocept uptake was observed in the healthy control. Images on the right show same patient imaged on 2 different days.Conclusion:Tc 99m tilmanocept imaging of the joints in healthy subjects as well as in patients with active RA under stable treatment is reproducible and stable over time. The results confirmed that the signal in joints of healthy subjects and RA patients can be quantified and used to establish cut points to distinguish inflamed and non-inflamed joints on a joint-by-joint basis. These results provide the foundation for a noninvasive, objective method to monitor activity in macrophage-driven inflammation in joints of patients with RA.Disclosure of Interests:Ayah Hussein Employee of: Currently employed by Navidea Biopharmaceuticals, David Ralph Consultant of: Previous consultant for Navidea Biopharmaceuticals, Employee of: Currently employed by Navidea Biopharmaceuticals, Beth Potter Employee of: Currently employed by Navidea Biopharmaceuticals, Bonnie Abbruzzese Employee of: Currently employed by Navidea Biopharmaceuticals, Rachael Hershey Employee of: Currently employed by Navidea Biopharmaceuticals, Katherine Repp Employee of: Previously employed by Navidea Biopharmaceuticals, Haya Shakhtra Employee of: Currently employed by Navidea Biopharmaceuticals, Mehak Goel Employee of: Currently employed by Navidea Biopharmaceuticals, Madison Palmer Employee of: Currently employed by Navidea Biopharmaceuticals, Allison Kissling Employee of: Previously employed by Navidea Biopharmaceuticals, Carley Hartings Employee of: Previously employed by Navidea Biopharmaceuticals, Michael Blue Employee of: Currently employed by Navidea Biopharmaceuticals, Michael Rosol Employee of: Currently employed by Navidea Biopharmaceuticals
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25
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Weinstein J, El-Gabalawy F, Sarwar A, Brook O, Faintuch S, Hsu M, DeBacker SS, Berkowitz S, Palmer M, Ahmed M. Abstract No. 465 Threshold analysis for determining number of movements in the kinematic analysis of hand motion in interventional radiology. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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26
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Weinstein J, El-Gabalawy F, Sarwar A, Brook O, Faintuch S, Palmer M, DeBacker SS, Hsu M, Berkowitz S, Ahmed M. Abstract No. 451 Analysis of kinematic differences in hand motion between the dominant and nondominant hand of interventional radiology trainees performing simulated radial artery access. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Rogers JE, Xiao L, Trail A, Blum Murphy M, Palmer M, Ajani JA. Nivolumab in Combination with Irinotecan and 5-Fluorouracil (FOLFIRI) for Refractory Advanced Gastroesophageal Cancer. Oncology 2020; 98:289-294. [PMID: 32097933 DOI: 10.1159/000505974] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/10/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Advanced unresectable gastroesophageal cancers continue to confer a dismal patient prognosis. Limited options remain once the cancer is refractory to cytotoxics/biologics (like irinotecan, taxane, and ramucirumab). Recently, anti-programmed death-1 (anti-PD-1) inhibitors have been used with limited efficacy in select patients with adenocarcinoma. Similarly, irinotecan-based therapy has marginal efficacy. We combined irinotecan plus a fluoropyrimidine with an anti-PD-1 antibody, nivolumab, with hopes of having a higher advantage for patients. OBJECTIVES Primary objective was to assess safety judged by toxicities, dose delays, or dose reductions. Secondary endpoints included the assessment of response, overall survival (OS), and progression-free survival (PFS). METHODS We treated 15 patients with this combination during July 2017 to April 2019. Patients were included if they had follow-up at our institution. RESULTS Median doses given were nivolumab 240 mg + irinotecan 120 mg/m2 + 5-FU 2,000 mg/m2 over 46-48 h (or capecitabine 1,250 mg/m2/day; 7 days on, 7 days off) given every 2 weeks. Median age of the patients was 55 years, and all patients had an ECOG performance status of 0-1. The patients had a median of 1 prior therapy. Slightly over half of the patients had PD-L1 expression. The median number of cycles was 7. Five patients (33%) had a dose delay or dose adjustment. The most common reason for dose delay or adjustment was grade 2 fatigue. Disease control (response or stability) on first scan was 73.3% (n = 11). Median PFS and OS for the entire group was 7 and 13.3 months, respectively. CONCLUSION In this small cohort of patients, we conclude that this combination is quite feasible and resulted in prolonged stability in some patients. Further development of this regimen is warranted.
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Affiliation(s)
- Jane E Rogers
- Pharmacy Clinical Programs, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Lianchun Xiao
- Department of Biostatistics, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Allison Trail
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Mariela Blum Murphy
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Melissa Palmer
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, U.T. M.D. Anderson Cancer Center, Houston, Texas, USA,
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Kenderdine T, Nemati R, Baker A, Palmer M, Ujma J, FitzGibbon M, Deng L, Royzen M, Langridge J, Fabris D. High-resolution ion mobility spectrometry-mass spectrometry of isomeric/isobaric ribonucleotide variants. J Mass Spectrom 2020; 55:e4465. [PMID: 31697854 PMCID: PMC8363168 DOI: 10.1002/jms.4465] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/13/2019] [Accepted: 10/22/2019] [Indexed: 06/01/2023]
Abstract
In this report, we explored the benefits of cyclic ion mobility (cIM) mass spectrometry in the analysis of isomeric post-transcriptional modifications of RNA. Standard methyl-cytidine samples were initially utilized to test the ability to correctly distinguish different structures sharing the same elemental composition and thus molecular mass. Analyzed individually, the analytes displayed characteristic arrival times (tD ) determined by the different positions of the modifying methyl groups onto the common cytidine scaffold. Analyzed in mixture, the widths of the respective signals resulted in significant overlap that initially prevented their resolution on the tD scale. The separation of the four isomers was achieved by increasing the number of passes through the cIM device, which enabled to fully differentiate the characteristic ion mobility behaviors associated with very subtle structural variations. The placement of the cIM device between the mass-selective quadrupole and the time-of-flight analyzer allowed us to perform gas-phase activation of each of these ion populations, which had been first isolated according to a common mass-to-charge ratio and then separated on the basis of different ion mobility behaviors. The observed fragmentation patterns confirmed the structures of the various isomers thus substantiating the benefits of complementing unique tD information with specific fragmentation data to reach more stringent analyte identification. These capabilities were further tested by analyzing natural mono-nucleotide mixtures obtained by exonuclease digestion of total RNA extracts. In particular, the combination of cIM separation and post-mobility dissociation allowed us to establish the composition of methyl-cytidine and methyl-adenine components present in the entire transcriptome of HeLa cells. For this reason, we expect that this technique will benefit not only epitranscriptomic studies requiring the determination of identity and expression levels of RNA modifications, but also metabolomics investigations involving the analysis of natural extracts that may possibly contain subsets of isomeric/isobaric species.
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Affiliation(s)
| | | | - A. Baker
- Waters Corporation, Wilmslow SK9 4AX, UK
| | - M. Palmer
- Waters Corporation, Wilmslow SK9 4AX, UK
| | - J. Ujma
- Waters Corporation, Wilmslow SK9 4AX, UK
| | - M FitzGibbon
- University at Albany, Albany, NY 12222
- University of California San Diego, La Jolla, CA 92093
| | - L. Deng
- University at Albany, Albany, NY 12222
| | - M. Royzen
- University at Albany, Albany, NY 12222
| | | | - D. Fabris
- University at Albany, Albany, NY 12222
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Palmer M, Regev A, Lindor K, Avigan MI, Dimick‐Santos L, Treem W, Marcinak JF, Lewis JH, Anania FA, Seekins D, Shneider BL, Chalasani N. Consensus guidelines: best practices for detection, assessment and management of suspected acute drug-induced liver injury occurring during clinical trials in adults with chronic cholestatic liver disease. Aliment Pharmacol Ther 2020; 51:90-109. [PMID: 31762074 PMCID: PMC6972572 DOI: 10.1111/apt.15579] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/03/2019] [Accepted: 10/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Improved knowledge of the molecular pathophysiology and immunopathogenesis of cholestatic liver diseases in recent years has led to an increased interest in developing novel therapies. Patients with cholestatic liver disease often require different approaches to assessment and management of suspected drug-induced liver injury (DILI) compared to those with healthy livers and those with parenchymal liver diseases. At present, there are no regulatory guidelines or society position papers, that systematically address best practices pertaining to detection of DILI in these patients. AIMS To outline best practices for detection, assessment and management of suspected acute DILI during clinical trials in adults with the cholestatic liver diseases - Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC). METHODS This is one of the several papers developed by the IQ DILI Initiative, which is comprised of members from 16 pharmaceutical companies, in collaboration with DILI experts from academia and regulatory agencies. The contents are the result of an extensive literature review, as well as in-depth discussions among industry, regulatory and academic DILI experts, to achieve consensus recommendations on DILI-related issues occurring during clinical trials for cholestatic liver diseases. RESULTS Recommended best practices are outlined pertaining to hepatic eligibility criteria, monitoring of liver tests, approach to a suspected DILI signal, and hepatic discontinuation rules. CONCLUSIONS This paper provides a framework for the approach to detection, assessment and management of suspected acute DILI occurring during clinical trials in adults with cholestatic liver disease.
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Wademan DT, Busakwe L, Nicholson TJ, van der Zalm M, Palmer M, Workman J, Turkova A, Crook AM, Thomason MJ, Gibb DM, Seeley J, Hesseling A, Hoddinott G. Acceptability of a first-line anti-tuberculosis formulation for children: qualitative data from the SHINE trial. Int J Tuberc Lung Dis 2019; 23:1263-1268. [PMID: 31931909 PMCID: PMC6903808 DOI: 10.5588/ijtld.19.0115] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/12/2019] [Indexed: 12/24/2022] Open
Abstract
SETTING: We conducted a qualitative exploration into the palatability and acceptability of a novel fixed-dose combination (FDC) anti-tuberculosis drug. This study was nested in the SHINE (Shorter treatment for minimal TB in children) trial, which compares the safety and efficacy of treating non-severe drug-susceptible tuberculosis (TB) with a 6 vs. 4 months anti-tuberculosis regimen in children aged 0-16 years. Participants were recruited in Cape Town, South Africa.OBJECTIVE: To describe the palatability and acceptability of a FDC of rifampicin, isoniazid and pyrazinamide among South African children and their caregivers in the SHINE trial.METHODS: We conducted 20 clinic observations of treatment administration, during which we conducted 16 semi-structured interviews with children and their caregivers. Data were organised thematically to report on experiences with administering and ingesting the FDC.RESULTS: Children and caregivers' experiences varied from delight to disgust. In general, participants said that the FDC compared favourably to other formulations. Pragmatic challenges such as dissolving the FDC and the time required to administer the FDC impeded caregivers' ability to integrate treatment into their daily routines. Drug manipulation was common among caregivers to improve TB treatment administration.CONCLUSION: This novel FDC appears acceptable for children, albeit with practical challenges to administration. Scale-up of FDC use should include supplementary intervention components to support caregivers.
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Affiliation(s)
- D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - L Busakwe
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - T J Nicholson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - M Palmer
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - J Workman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - A Turkova
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London
| | - A M Crook
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London
| | - M J Thomason
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London
| | - D M Gibb
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London
| | - J Seeley
- Department of Global Health, London School of Hygiene & Tropical Medicine, London, UK
| | - A Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
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Lee D, Subbiah V, Gainor J, Taylor M, Zhu V, Doebele R, Lopes G, Baik C, Garralda E, Gadgeel S, Kim DW, Turner C, Palmer M, Miller S, Curigliano G. Treatment with pralsetinib (formerly BLU-667), a potent and selective RET inhibitor, provides rapid clearance of ctDNA in patients with RET-altered non-small cell lung cancer (NSCLC) and medullary thyroid cancer (MTC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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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Putz EJ, Putz AM, Boettcher A, Charley S, Sauer M, Palmer M, Phillips R, Hostetter J, Loving CL, Cunnick JE, Tuggle CK. Successful development of methodology for detection of hapten-specific contact hypersensitivity (CHS) memory in swine. PLoS One 2019; 14:e0223483. [PMID: 31596901 PMCID: PMC6785115 DOI: 10.1371/journal.pone.0223483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022] Open
Abstract
Hapten contact hypersensitivity (CHS) elicits a well-documented inflammation response that can be used to illustrate training of immune cells through hapten-specific CHS memory. The education of hapten-specific memory T cells has been well-established, recent research in mice has expanded the “adaptive” characteristic of a memory response from solely a function of the adaptive immune system, to innate cells as well. To test whether similar responses are seen in a non-rodent model, we used hapten-specific CHS to measure the ear inflammation response of outbred pigs to dinitrofluorobenzene (DNFB), oxazolone (OXA), or vehicle controls. We adapted mouse innate memory literature protocols to the domestic pig model. Animals were challenged up to 32 days post initial sensitization exposure to the hapten, and specific ear swelling responses to this challenge were significant for 7, 21, and 32 days post-sensitization. We established hapten-specific CHS memory exists in a non-rodent model. We also developed a successful protocol for demonstrating these CHS responses in a porcine system.
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Affiliation(s)
- E. J. Putz
- Iowa State University, Department of Animal Science, Ames, IA, United States of America
| | - A. M. Putz
- Iowa State University, Department of Animal Science, Ames, IA, United States of America
| | - A. Boettcher
- Iowa State University, Department of Animal Science, Ames, IA, United States of America
| | - S. Charley
- Iowa State University, Department of Animal Science, Ames, IA, United States of America
| | - M. Sauer
- Iowa State University, Department of Animal Science, Ames, IA, United States of America
| | - M. Palmer
- USDA-ARS-National Animal Disease Center, Infectious Bacterial Diseases of Livestock Research Unit, Ames, IA, United States of America
| | - R. Phillips
- Iowa State University College of Veterinary Medicine, Department of Veterinary Pathology Science, Ames, IA, United States of America
| | - J. Hostetter
- Iowa State University College of Veterinary Medicine, Department of Veterinary Pathology Science, Ames, IA, United States of America
| | - C. L. Loving
- USDA-ARS-National Animal Disease Center, Food Safety and Enteric Pathogens Research Unit, Ames, IA, United States of America
| | - J. E. Cunnick
- Iowa State University, Department of Animal Science, Ames, IA, United States of America
| | - C. K. Tuggle
- Iowa State University, Department of Animal Science, Ames, IA, United States of America
- * E-mail:
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Curigliano G, Subbiah V, Gainor J, Lee D, Taylor M, Zhu V, Doebele R, Lopes G, Baik C, Garralda E, Gadgeel S, Kim DW, Turner C, Palmer M, Miller S. Treatment with BLU-667, a potent and selective RET inhibitor, provides rapid clearance of ctDNA in patients with RET-altered non-small cell lung cancer (NSCLC) and thyroid cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.093] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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Salic K, Kleemann R, Wilkins-Port C, McNulty J, Verschuren L, Palmer M. Apical sodium-dependent bile acid transporter inhibition with volixibat improves metabolic aspects and components of non-alcoholic steatohepatitis in Ldlr-/-.Leiden mice. PLoS One 2019; 14:e0218459. [PMID: 31233523 PMCID: PMC6590809 DOI: 10.1371/journal.pone.0218459] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
Interruption of bile acid recirculation through inhibition of the apical sodium-dependent bile acid transporter (ASBT) is a promising strategy to alleviate hepatic cholesterol accumulation in non-alcoholic steatohepatitis (NASH), and improve the metabolic aspects of the disease. Potential disease-attenuating effects of the ASBT inhibitor volixibat (5, 15, and 30 mg/kg) were investigated in high-fat diet (HFD)-fed Ldlr-/-.Leiden mice over 24 weeks. Plasma and fecal bile acid levels, plasma insulin, lipids, and liver enzymes were monitored. Final analyses included liver histology, intrahepatic lipids, mesenteric white adipose tissue mass, and liver gene profiling. Consistent with its mechanism of action, volixibat significantly increased the total amount of bile acid in feces. At the highest dose, volixibat significantly attenuated the HFD-induced increase in hepatocyte hypertrophy, hepatic triglyceride and cholesteryl ester levels, and mesenteric white adipose tissue deposition. Non-alcoholic fatty liver disease activity score (NAS) was significantly lower in volixibat-treated mice than in the HFD controls. Gene profiling showed that volixibat reversed the inhibitory effect of the HFD on metabolic master regulators, including peroxisome proliferator-activated receptor-γ coactivator-1β, insulin receptor, and sterol regulatory element-binding transcription factor 2. Volixibat may have beneficial effects on physiological and metabolic aspects of NASH pathophysiology.
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Affiliation(s)
- Kanita Salic
- TNO, Department of Metabolic Health Research, Leiden, Netherlands
| | - Robert Kleemann
- TNO, Department of Metabolic Health Research, Leiden, Netherlands
| | - Cynthia Wilkins-Port
- Shire LLC, now part of Takeda, Cambridge, Massachusetts, United States of America
| | - John McNulty
- Shire LLC, now part of Takeda, Cambridge, Massachusetts, United States of America
| | - Lars Verschuren
- TNO, Department of Microbiology and Systems Biology, Zeist, Netherlands
| | - Melissa Palmer
- Shire LLC, now part of Takeda, Cambridge, Massachusetts, United States of America
- * E-mail:
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McCarthy OL, Zghayyer H, Stavridis A, Adada S, Ahamed I, Leurent B, Edwards P, Palmer M, Free C. A randomized controlled trial of an intervention delivered by mobile phone text message to increase the acceptability of effective contraception among young women in Palestine. Trials 2019; 20:228. [PMID: 31014358 PMCID: PMC6477750 DOI: 10.1186/s13063-019-3297-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 08/24/2018] [Accepted: 03/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background Research has shown that mobile phone contraceptive behavioral interventions can increase knowledge and use of contraception, but other studies have failed to demonstrate a beneficial effect. The objective of this trial was to estimate the effect of a contraceptive behavioral intervention delivered by mobile phone text message on young Palestinian women’s attitudes towards effective contraception. Methods We conducted a randomized controlled trial among women aged 18–24 years living in the West Bank, who were not using an effective method of contraception. The intervention group received zero to three messages per day (113 messages for female-not married and 120 messages for female-married) for 120 days. The control group received 16 messages over 120 days about trial participation. The primary outcome was acceptability of at least one method of effective contraception at 4 months. Secondary outcomes were use of effective contraception at 4 months and any use during the study, acceptability of individual methods, service uptake, unintended pregnancy and abortion. Process outcomes included knowledge, perceived norms, personal agency and intention. All outcomes were self-reported. We analyzed the outcomes using logistic and linear regression. Results A total of 578 participants were enrolled and 464 (80%) completed follow up at 4 months. Intervention group participants were more likely to find at least one method of effective contraception acceptable (31% in the intervention group versus 17% in the control group, adjusted OR 2.34, 95% CI 1.48–3.68, p < 0.001). They had a higher mean knowledge score, were more likely to find the intrauterine device, injection, implant and patch acceptable, to agree that their friends would use an effective method and to intend to use an effective method, compared to participants in the control group. While in the direction of intervention benefit, there were no differences between the groups in the use of effective contraception at 4 months and any use during the study, pill acceptability, service uptake, unintended pregnancy and induced abortion. Conclusions The intervention can improve attitudes, knowledge-perceived norms and intention to use effective contraception among young women in Palestine. Research is needed to evaluate the efficacy of the intervention for contraceptive behavioral outcomes in Palestine. Trial registration ClinicalTrials.gov, NCT02905461. Registered on 14 September 2016. World Health Organization Trial Registration Data Set: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=NCT02905461 Electronic supplementary material The online version of this article (10.1186/s13063-019-3297-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ona L McCarthy
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Hanadi Zghayyer
- Palestinian Family Planning & Protection Association, Industrial Zone, Wadi Al-Joze, Jerusalem, Palestine
| | - Amina Stavridis
- Palestinian Family Planning & Protection Association, Industrial Zone, Wadi Al-Joze, Jerusalem, Palestine
| | - Samia Adada
- International Planned Parenthood Federation, Arab World Regional Office, 2 Place Virgile, Notre Dame, 1082, Tunis, Tunisia
| | - Irrfan Ahamed
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Baptiste Leurent
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Phil Edwards
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Melissa Palmer
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Regev A, Palmer M, Avigan MI, Dimick‐Santos L, Treem WR, Marcinak JF, Seekins D, Krishna G, Anania FA, Freston JW, Lewis JH, Sanyal AJ, Chalasani N. Consensus: guidelines: best practices for detection, assessment and management of suspected acute drug-induced liver injury during clinical trials in patients with nonalcoholic steatohepatitis. Aliment Pharmacol Ther 2019; 49:702-713. [PMID: 30761572 PMCID: PMC6593464 DOI: 10.1111/apt.15153] [Citation(s) in RCA: 22] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/22/2018] [Accepted: 01/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The last decade has seen a rapid growth in the number of clinical trials enrolling patients with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH). Due to the underlying chronic liver disease, patients with NASH often require different approaches to the assessment and management of suspected drug-induced liver injury (DILI) compared to patients with healthy livers. However, currently no regulatory guidelines or position papers systematically address best practices pertaining to DILI in NASH clinical trials. AIMS This publication focuses on best practices concerning the detection, monitoring, diagnosis and management of suspected acute DILI during clinical trials in patients with NASH. METHODS This is one of several papers developed by the IQ DILI Initiative, comprised of members from 15 pharmaceutical companies, in collaboration with DILI experts from academia and regulatory agencies. This paper is based on extensive literature review, and discussions between industry members with expertise in drug safety and DILI experts from outside industry to achieve consensus on common questions related to this topic. RESULTS Recommended best practices are outlined pertaining to hepatic inclusion and exclusion criteria, monitoring of liver tests, DILI detection, approach to a suspected DILI signal, causality assessment and hepatic discontinuation rules. CONCLUSIONS This paper provides a framework for the approach to assessment and management of suspected acute DILI during clinical trials in patients with NASH.
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Gadjev I, Sudar N, Babzien M, Duris J, Hoang P, Fedurin M, Kusche K, Malone R, Musumeci P, Palmer M, Pogorelsky I, Polyanskiy M, Sakai Y, Swinson C, Williams O, Rosenzweig JB. An inverse free electron laser acceleration-driven Compton scattering X-ray source. Sci Rep 2019; 9:532. [PMID: 30679471 PMCID: PMC6345986 DOI: 10.1038/s41598-018-36423-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/16/2018] [Indexed: 11/09/2022] Open
Abstract
The generation of X-rays and γ-rays based on synchrotron radiation from free electrons, emitted in magnet arrays such as undulators, forms the basis of much of modern X-ray science. This approach has the drawback of requiring very high energy, up to the multi-GeV-scale, electron beams, to obtain the required photon energy. Due to the limit in accelerating gradients in conventional particle accelerators, reaching high energy typically demands use of instruments exceeding 100’s of meters in length. Compact, less costly, monochromatic X-ray sources based on very high field acceleration and very short period undulators, however, may enable diverse, paradigm-changing X-ray applications ranging from novel X-ray therapy techniques to active interrogation of sensitive materials, by making them accessible in energy reach, cost and size. Such compactness and enhanced energy reach may be obtained by an all-optical approach, which employs a laser-driven high gradient accelerator based on inverse free electron laser (IFEL), followed by a collision point for inverse Compton scattering (ICS), a scheme where a laser is used to provide undulator fields. We present an experimental proof-of-principle of this approach, where a TW-class CO2 laser pulse is split in two, with half used to accelerate a high quality electron beam up to 84 MeV through the IFEL interaction, and the other half acts as an electromagnetic undulator to generate up to 13 keV X-rays via ICS. These results demonstrate the feasibility of this scheme, which can be joined with other techniques such as laser recirculation to yield very compact photon sources, with both high peak and average brilliance, and with energies extending from the keV to MeV scale. Further, use of the IFEL acceleration with the ICS interaction produces a train of high intensity X-ray pulses, thus enabling a unique tool synchronized with a laser pulse for ultra-fast strobe, pump-probe experimental scenarios.
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Affiliation(s)
- I Gadjev
- UCLA Department of Physics and Astronomy, 405 Hilgard Ave., Los Angeles, CA, 90095, USA.
| | - N Sudar
- UCLA Department of Physics and Astronomy, 405 Hilgard Ave., Los Angeles, CA, 90095, USA
| | - M Babzien
- Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - J Duris
- UCLA Department of Physics and Astronomy, 405 Hilgard Ave., Los Angeles, CA, 90095, USA
| | - P Hoang
- UCLA Department of Physics and Astronomy, 405 Hilgard Ave., Los Angeles, CA, 90095, USA
| | - M Fedurin
- Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - K Kusche
- Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - R Malone
- Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - P Musumeci
- UCLA Department of Physics and Astronomy, 405 Hilgard Ave., Los Angeles, CA, 90095, USA
| | - M Palmer
- Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - I Pogorelsky
- Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - M Polyanskiy
- Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - Y Sakai
- UCLA Department of Physics and Astronomy, 405 Hilgard Ave., Los Angeles, CA, 90095, USA
| | - C Swinson
- Brookhaven National Laboratory, Upton, NY, 11973, USA
| | - O Williams
- UCLA Department of Physics and Astronomy, 405 Hilgard Ave., Los Angeles, CA, 90095, USA
| | - J B Rosenzweig
- UCLA Department of Physics and Astronomy, 405 Hilgard Ave., Los Angeles, CA, 90095, USA
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Porter C, Coleman E, Ross L, Palmer M. Do stroke patients screened as lower-nutritional-risk still receive dietitian assessment if indicated? A retrospective evaluation of two dietetic models of care for adult stroke patients. J Hum Nutr Diet 2019; 32:267-275. [PMID: 30666773 DOI: 10.1111/jhn.12619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Dietetic models of care at Logan Hospital changed from all patients with a confirmed stroke receiving dietitian assessment (Old pathway) to only those patients screened as high-nutritional-risk (Modified pathway). However, it was unknown whether all low-nutritional-risk patients who were indicated for dietitian assessment for nutrition support actually received assessment. This pre-post retrospective study evaluated whether the Old pathway and the Modified pathway were equally effective in identifying low-nutritional-risk stroke patients who were indicated for dietitian assessment and compared the time spent providing Dietetic care. METHODS For both pathways, medical charts were reviewed for low-nutritional-risk patients admitted between December 2012 and November 2017 with a confirmed stroke, who were given a standard food and fluid diet code and scored MST < 2 (Malnutrition Screening Tool) on admission. Data collected included demographics, anthropometrics, malnutrition assessment, dietetic intervention and time spent caring for patients. Malnutrition-related clinical indicators were used to classify patients as either Dietitian Assessment for Nutrition Support Indicated or Not Indicated. RESULTS Low-nutritional-risk patients were similar on the Old (n = 180) and Modified (n = 206) pathways [mean (SD) 66 (13) years, 63% male, 4% malnutrition]. Those classified as Dietitian Assessment for Nutrition Support Indicated (n = 61 of 180) were older, had a longer length of stay (P < 0.05), and were all identified by the Dietitian on both pathways. Ten minutes less dietetic time per patient was required on the Modified pathway (P < 0.001). CONCLUSIONS The Modified Nutrition Stroke pathway performed more efficiently than the Old pathway and was equally effective at ensuring that stroke patients who were determined as being low-nutritional-risk received dietitian assessment during admission if indicated.
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Affiliation(s)
- C Porter
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - E Coleman
- Nutrition and Dietetics Department, Logan Hospital, Meadowbrook, Queensland, Australia
| | - L Ross
- Nutrition and Dietetics, School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - M Palmer
- Nutrition and Dietetics Department, Logan Hospital, Meadowbrook, Queensland, Australia
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Elton L, Palmer M, Macdowall W. Birth order and parental and sibling involvement in sex education. A nationally-representative analysis. Sex Educ 2018; 19:162-179. [PMID: 30828263 PMCID: PMC6377085 DOI: 10.1080/14681811.2018.1509305] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 08/02/2018] [Indexed: 06/09/2023]
Abstract
This analysis set out to identify associations between birth order and sexual health outcomes, focusing on family involvement in sex education and early sexual experiences. The third National Survey of Sexual Attitudes and Lifestyles is a stratified probability sample survey of 15 162 men and women aged 16-74 in Britain. Logistic regression was conducted to identify odds ratios for the association between birth order and sexual health outcomes. Multiple logistic regression was performed adjusting for socio-demographic factors and sibling number. Middle-born and last-born men had lower odds of reporting ease talking to parents about sex around age 14 and learning about sex from their mothers. Last-born women had lower odds of reporting a parental main source of sex education or having learned about sex from their mother. Findings represent an exploratory analysis in an under-researched area, and provide the basis for further research on the association between birth order and parental involvement in sex education, as well as the role and impact of sex education provided by older siblings.
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Affiliation(s)
- Lotte Elton
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Wendy Macdowall
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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Siebers N, Palmer M, Silberg DG, Jennings L, Bliss C, Martin PT. Absorption, Distribution, Metabolism, and Excretion of [ 14C]-Volixibat in Healthy Men: Phase 1 Open-Label Study. Eur J Drug Metab Pharmacokinet 2018; 43:91-101. [PMID: 28702877 PMCID: PMC5794849 DOI: 10.1007/s13318-017-0429-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Objectives Volixibat is a potent inhibitor of the apical sodium-dependent bile acid transporter in development for the treatment of nonalcoholic steatohepatitis. This phase 1, open-label study investigated the absorption, distribution, metabolism, and excretion of [14C]-volixibat in heathy men. Methods Eligible men (n = 8) aged 18–50 years (body mass index 18.0–30.0 kg/m2; weight >50 kg) received a single oral dose of [14C]-volixibat 50 mg containing ~5.95 µCi radioactivity. The primary objectives were to assess the pharmacokinetics of [14C]-volixibat and to determine the total radioactivity in whole blood, plasma, urine, and feces at pre-selected time points over 6 days. The secondary objectives were to characterize metabolites and to assess the safety and tolerability. Results Low concentrations of volixibat (range 0–0.179 ng/mL) were detected in plasma up to 8 h following administration; the pharmacokinetic parameters could not be calculated. No radioactivity was observed in plasma or whole blood. The percentage (mean ± standard deviation) of total radioactivity in urine was 0.01 ± 0.007%. The vast majority (92.3 ± 5.25%) of volixibat was recovered in feces (69.2 ± 33.1% within 24 h). Unchanged volixibat was the only radioactive component detected in feces. Adverse events were mild in severity and mostly gastrointestinal. Changes in laboratory values were not clinically meaningful. Conclusions Following oral administration, [14C]-volixibat was excreted unchanged from the parent compound almost exclusively via fecal excretion, indicating that the drug is minimally absorbed. Consistent with other studies, adverse events were primarily gastrointestinal in nature. ClinicalTrials.gov identifier NCT02571192. Electronic supplementary material The online version of this article (doi:10.1007/s13318-017-0429-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicholas Siebers
- Covance Clinical Research Unit, 3402 Kinsman Boulevard, Madison, WI, 53704, USA.
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French RS, Geary R, Jones K, Glasier A, Mercer CH, Datta J, Macdowall W, Palmer M, Johnson AM, Wellings K. Where do women and men in Britain obtain contraception? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ Sex Reprod Health 2018:jfprhc-2017-101728. [PMID: 29972362 DOI: 10.1136/bmjsrh-2017-101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/13/2017] [Accepted: 08/16/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION To estimate the prevalence of use of different sources of contraceptive supplies in Britain and its variation by key demographic and behavioural characteristics. METHODS Cross-sectional probability sample survey of women and men aged 16-74 years, resident in Britain, interviewed between 2010 and 2012. Analyses reported here were of 4571 women and 3142 men aged 16-44 years who reported having vaginal sex in the past year. Those relying exclusively on sterilisation (including hysterectomy) were excluded. Sources of contraceptive supplies were categorised as: general practice, community clinic, retail and other. Prevalence of use of these sources was estimated, and associated factors examined. RESULTS Some 87.0% of women and 73.8% of men accessed at least one source of contraceptive supplies in the previous year. Most women (59.1%) used general practice and most men (54.6%) used retail outlets. Community clinics were less commonly used, by 23.0% of women and 21.3% of men, but these users were younger and at greater sexual health risk. These associations were also observed among the 27.3% of women and 30.6% of men who used more than one source category (general practice, community clinic or retail) for contraceptive supplies. CONCLUSIONS People in Britain use a variety of sources to obtain contraceptive supplies and some sources are more commonly used by those more vulnerable to poorer sexual health. Our findings suggest that national policy changes to increase access to contraceptive methods have had an effect on the diversity of services used.
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Affiliation(s)
- Rebecca S French
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Geary
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kyle Jones
- Research Department of Infection and Population Health, University College London, London, UK
| | - Anna Glasier
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jessica Datta
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Wendy Macdowall
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Palmer
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kaye Wellings
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
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McCarthy O, Ahamed I, Kulaeva F, Tokhirov R, Saibov S, Vandewiele M, Standaert S, Leurent B, Edwards P, Palmer M, Free C. Correction to: A randomized controlled trial of an intervention delivered by mobile phone app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan. Reprod Health 2018; 15:52. [PMID: 29580246 PMCID: PMC5870208 DOI: 10.1186/s12978-018-0496-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
After publication of the original article [1], it came to the authors' attention that there is a typo in the Results section.
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Affiliation(s)
- Ona McCarthy
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Irrfan Ahamed
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Firuza Kulaeva
- Tajik Family Planning Association, 10 Rudaki Avenue, TC 'Sadbarg', 7th floor, Dushanbe, Tajikistan
| | - Ravshan Tokhirov
- Tajik Family Planning Association, 10 Rudaki Avenue, TC 'Sadbarg', 7th floor, Dushanbe, Tajikistan
| | - Salokhiddin Saibov
- Tajik Family Planning Association, 10 Rudaki Avenue, TC 'Sadbarg', 7th floor, Dushanbe, Tajikistan
| | - Marieka Vandewiele
- International Planned Parenthood Federation European Network, Rue Royale 146, 1000, Brussels, Belgium
| | - Sarah Standaert
- International Planned Parenthood Federation European Network, Rue Royale 146, 1000, Brussels, Belgium
| | - Baptiste Leurent
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Phil Edwards
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Melissa Palmer
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Palmer M, Jennings L, Silberg DG, Bliss C, Martin P. A randomised, double-blind, placebo-controlled phase 1 study of the safety, tolerability and pharmacodynamics of volixibat in overweight and obese but otherwise healthy adults: implications for treatment of non-alcoholic steatohepatitis. BMC Pharmacol Toxicol 2018; 19:10. [PMID: 29548345 PMCID: PMC5857122 DOI: 10.1186/s40360-018-0200-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Accumulation of toxic free cholesterol in hepatocytes may cause hepatic inflammation and fibrosis. Volixibat inhibits bile acid reuptake via the apical sodium bile acid transporter located on the luminal surface of the ileum. The resulting increase in bile acid synthesis from cholesterol could be beneficial in patients with non-alcoholic steatohepatitis. This adaptive dose-finding study investigated the safety, tolerability, pharmacodynamics, and pharmacokinetics of volixibat. Methods Overweight and obese adults were randomised 3:1 to double-blind volixibat or placebo, respectively, for 12 days. Volixibat was initiated at a once-daily dose of 20 mg, 40 mg or 80 mg. Based on the assessment of predefined safety events, volixibat dosing was either escalated or reduced. Other dose regimens (titrations and twice-daily dosing) were also evaluated. Assessments included safety, tolerability, stool hardness, faecal bile acid (FBA) excretion, and serum levels of 7α-hydroxy-4-cholesten-3-one (C4) and lipids. Results All 84 randomised participants (volixibat, 63; placebo, 21) completed the study, with no serious adverse events at doses of up to 80 mg per day (maximum assessed dose). The median number of daily bowel evacuations increased from 1 (range 0–4) to 2 (0–8) during volixibat treatment, and stool was looser with volixibat than placebo. Volixibat was minimally absorbed; serum levels were rarely quantifiable at any dose or sampling time point, thereby precluding pharmacokinetic analyses. Mean daily FBA excretion was 930.61 μmol (standard deviation [SD] 468.965) with volixibat and 224.75 μmol (195.403) with placebo; effects were maximal at volixibat doses ≥20 mg/day. Mean serum C4 concentrations at day 12 were 98.767 ng/mL (standard deviation, 61.5841) with volixibat and 16.497 ng/mL (12.9150) with placebo. Total and low-density lipoprotein cholesterol levels decreased in the volixibat group, with median changes of − 0.70 mmol/L (range − 2.8 to 0.4) and − 0.6990 mmol/L (− 3.341 to 0.570), respectively. Conclusions This study indicates that maximal inhibition of bile acid reabsorption, as assessed by FBA excretion, occurs at volixibat doses of ≥20 mg/day in obese and overweight adults, without appreciable change in gastrointestinal tolerability. These findings guided dose selection for an ongoing phase 2 study in patients with non-alcoholic steatohepatitis. Trial registration ClinicalTrials.gov identifier: NCT02287779 (registration first received 6 November 2014). Electronic supplementary material The online version of this article (10.1186/s40360-018-0200-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa Palmer
- Global Development Lead Hepatology, Shire, 300 Shire Way, Lexington, MA, 02421, USA.
| | - Lee Jennings
- Global Development Lead Hepatology, Shire, 300 Shire Way, Lexington, MA, 02421, USA
| | - Debra G Silberg
- Shire International GmbH, Zahlerweg 10, 6301, Zug, Switzerland
| | - Caleb Bliss
- Global Development Lead Hepatology, Shire, 300 Shire Way, Lexington, MA, 02421, USA
| | - Patrick Martin
- Global Development Lead Hepatology, Shire, 300 Shire Way, Lexington, MA, 02421, USA
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Sudar N, Musumeci P, Gadjev I, Sakai Y, Fabbri S, Polyanskiy M, Pogorelsky I, Fedurin M, Swinson C, Kusche K, Babzien M, Palmer M. Demonstration of Cascaded Modulator-Chicane Microbunching of a Relativistic Electron Beam. Phys Rev Lett 2018; 120:114802. [PMID: 29601767 DOI: 10.1103/physrevlett.120.114802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Indexed: 06/08/2023]
Abstract
We present results of an experiment showing the first successful demonstration of a cascaded microbunching scheme. Two modulator-chicane prebunchers arranged in series and a high power mid-IR laser seed are used to modulate a 52 MeV electron beam into a train of sharp microbunches phase locked to the external drive laser. This configuration is shown to greatly improve matching of the beam into the small longitudinal phase space acceptance of short-wavelength accelerators. We demonstrate trapping of nearly all (96%) of the electrons in a strongly tapered inverse free-electron laser accelerator, with an order-of-magnitude reduction in injection losses compared to the classical single-buncher scheme. These results represent a critical advance in laser-based longitudinal phase space manipulations and find application in high gradient advanced acceleration as well as in high peak and average power coherent radiation sources.
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Affiliation(s)
- N Sudar
- Department of Physics and Astronomy, Particle Beam Physics Laboratory, University of California, Los Angeles, California 90095, USA
| | - P Musumeci
- Department of Physics and Astronomy, Particle Beam Physics Laboratory, University of California, Los Angeles, California 90095, USA
| | - I Gadjev
- Department of Physics and Astronomy, Particle Beam Physics Laboratory, University of California, Los Angeles, California 90095, USA
| | - Y Sakai
- Department of Physics and Astronomy, Particle Beam Physics Laboratory, University of California, Los Angeles, California 90095, USA
| | - S Fabbri
- Department of Physics and Astronomy, Particle Beam Physics Laboratory, University of California, Los Angeles, California 90095, USA
| | - M Polyanskiy
- Accelerator Test Facility, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - I Pogorelsky
- Accelerator Test Facility, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Fedurin
- Accelerator Test Facility, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - C Swinson
- Accelerator Test Facility, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - K Kusche
- Accelerator Test Facility, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Babzien
- Accelerator Test Facility, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M Palmer
- Accelerator Test Facility, Brookhaven National Laboratory, Upton, New York 11973, USA
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McCarthy O, Ahamed I, Kulaeva F, Tokhirov R, Saibov S, Vandewiele M, Standaert S, Leurent B, Edwards P, Palmer M, Free C. A randomized controlled trial of an intervention delivered by mobile phone app instant messaging to increase the acceptability of effective contraception among young people in Tajikistan. Reprod Health 2018; 15:28. [PMID: 29433506 PMCID: PMC5809875 DOI: 10.1186/s12978-018-0473-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unintended pregnancy is associated with poorer health outcomes for women and their families. In Tajikistan, around 26% of married 15-24 year old women have an unmet need for contraception. There is some evidence that interventions delivered by mobile phone can affect contraceptive-related behaviour and knowledge. We developed an intervention delivered by mobile phone app instant messaging to improve acceptability of effective contraceptive methods among young people in Tajikistan. METHODS This was a randomized controlled trial among Tajik people aged 16-24. Participants allocated to the intervention arm had access to an app plus intervention messages. Participants allocated to the control arm had access to the app plus control messages. The primary outcome was acceptability of at least one method of effective contraception at 4 months. Secondary outcomes were use of effective contraception at 4 months and during the study, acceptability of individual methods, service uptake, unintended pregnancy and induced abortion. Process outcomes were knowledge, perceived norms, personal agency and intention. Outcomes were analysed using logistic and linear regression. We conducted a pre-specified subgroup analysis and a post-hoc analysis of change in acceptability from baseline to follow-up. RESULTS Five hundred and seventy-three participants were enrolled. Intervention content was included on the app, causing contamination. Four hundred and seventy-two (82%) completed follow-up for the primary outcome. There was no evidence of a difference in acceptability of effective contraception between the groups (66% in the intervention arm vs 64% in the control arm, adjusted OR 1.21, 95% CI .80-1.83, p = 0.36). There were no differences in the secondary or process outcomes between groups. There was some evidence that the effect of the intervention was greater among women compared to men (interaction test p = 0.03). There was an increase in acceptability of effective contraception from baseline to follow-up (2% to 65%, p < 0.001). CONCLUSIONS The whole intervention delivered by instant messaging provided no additional benefit over a portion of the intervention delivered by app pages. The important increase in contraceptive acceptability from baseline to follow-up suggests that the intervention content included on the app may influence attitudes. Further research is needed to establish the effect of the intervention on attitudes towards and use of effective contraception among married/sexually active young people. TRIAL REGISTRATION Clinicaltrial.gov NCT02905513 . Date of registration: 14 September 2016.
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Affiliation(s)
- Ona McCarthy
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Irrfan Ahamed
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Firuza Kulaeva
- Tajik Family Planning Association, 10 Rudaki Avenue, TC 'Sadbarg', 7th floor, Dushanbe, Tajikistan
| | - Ravshan Tokhirov
- Tajik Family Planning Association, 10 Rudaki Avenue, TC 'Sadbarg', 7th floor, Dushanbe, Tajikistan
| | - Salokhiddin Saibov
- Tajik Family Planning Association, 10 Rudaki Avenue, TC 'Sadbarg', 7th floor, Dushanbe, Tajikistan
| | - Marieka Vandewiele
- International Planned Parenthood Federation European Network, Rue Royale 146, 1000, Brussels, Belgium
| | - Sarah Standaert
- International Planned Parenthood Federation European Network, Rue Royale 146, 1000, Brussels, Belgium
| | - Baptiste Leurent
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Phil Edwards
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Melissa Palmer
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Caroline Free
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Free C, McCarthy O, French RS, Wellings K, Michie S, Roberts I, Devries K, Rathod S, Bailey J, Syred J, Edwards P, Hart G, Palmer M, Baraitser P. Can text messages increase safer sex behaviours in young people? Intervention development and pilot randomised controlled trial. Health Technol Assess 2018; 20:1-82. [PMID: 27483185 DOI: 10.3310/hta20570] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Younger people bear the heaviest burden of sexually transmitted infections (STIs). Partner notification, condom use and STI testing can reduce infection but many young people lack the knowledge, skills and confidence needed to carry out these behaviours. Text messages can provide effective behavioural support. The acceptability and feasibility of a randomised controlled trial of safer sex support delivered by text message are not known. OBJECTIVES To assess the acceptability and feasibility of a randomised controlled trial of a safer sex intervention delivered by text message for young people aged 16-24 years. DESIGN (1) Intervention development; (2) follow-up procedure development; (3) a pilot, parallel-arm randomised controlled trial with allocation via remote automated randomisation (ratio of 1 : 1) (participants were unmasked, whereas researchers analysing samples and data were masked); and (4) qualitative interviews. SETTING Participants were recruited from sexual health services in the UK. PARTICIPANTS Young people aged 16-24 years diagnosed with chlamydia or reporting unprotected sex with more than one partner in the last year. INTERVENTIONS A theory- and evidence-based safer sex intervention designed, with young people's input, to reduce the incidence of STIs by increasing the correct treatment of STIs, partner notification, condom use and STI testing before unprotected sex with a new partner. The intervention was delivered via automated mobile phone messaging over 12 months. The comparator was a monthly text message checking contact details. MAIN OUTCOME MEASURES (1) Development of the intervention based on theory, evidence and expert and user views; (2) follow-up procedures; (3) pilot trial primary outcomes: full recruitment within 3 months and follow-up rate for the proposed primary outcomes for the main trial; and (4) participants' views and experiences regarding the acceptability of the intervention. RESULTS In total, 200 participants were randomised in the pilot trial, of whom 99 were allocated to the intervention and 101 were allocated to the control. We fully recruited early and achieved an 81% follow-up rate for our proposed primary outcome of the cumulative incidence of chlamydia at 12 months. There was no differential follow-up between groups. In total, 97% of messages sent were successfully delivered to participants' mobile phones. Recipients reported that the tone, language, content and frequency of messages were appropriate. Messages reportedly increased knowledge of and confidence in how to use condoms and negotiate condom use and reduced stigma about STIs, enabling participants to tell a partner about a STI. CONCLUSIONS Our research shows that the intervention is acceptable and feasible to deliver. Our pilot trial demonstrated that a main trial is feasible. It remains unclear which behaviour change techniques and elements of the intervention or follow-up procedures are associated with effectiveness. A further limitation is that in the trial one person entering data and the participants were unmasked. A randomised controlled trial to establish the effects of the intervention on STIs at 12 months is needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN02304709. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 57. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Caroline Free
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ona McCarthy
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca S French
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan Michie
- Faculty of Population Sciences, University College London, London, UK
| | - Ian Roberts
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Karen Devries
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sujit Rathod
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Bailey
- Faculty of Population Sciences, University College London, London, UK
| | - Jonathan Syred
- Sexual Health Research Group, King's College London, London, UK
| | - Phil Edwards
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Graham Hart
- Faculty of Population Sciences, University College London, London, UK
| | - Melissa Palmer
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Paula Baraitser
- Sexual Health Research Group, King's College London, London, UK
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Tiessen RG, Kennedy CA, Keller BT, Levin N, Acevedo L, Gedulin B, van Vliet AA, Dorenbaum A, Palmer M. Safety, tolerability and pharmacodynamics of apical sodium-dependent bile acid transporter inhibition with volixibat in healthy adults and patients with type 2 diabetes mellitus: a randomised placebo-controlled trial. BMC Gastroenterol 2018; 18:3. [PMID: 29304731 PMCID: PMC5756385 DOI: 10.1186/s12876-017-0736-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/22/2017] [Indexed: 12/12/2022] Open
Abstract
Background Pathogenesis in non-alcoholic steatohepatitis (NASH) involves abnormal cholesterol metabolism and hepatic accumulation of toxic free cholesterol. Apical sodium-dependent bile acid transporter (ASBT) inhibition in the terminal ileum may facilitate removal of free cholesterol from the liver by reducing recirculation of bile acids (BAs) to the liver, thereby stimulating new BA synthesis from cholesterol. The aim of this phase 1 study in adult healthy volunteers (HVs) and patients with type 2 diabetes mellitus (T2DM) was to assess the safety, tolerability, pharmacokinetics and pharmacodynamics of ASBT inhibition with volixibat (SHP626; formerly LUM002). Methods Participants were randomised 3:1 to receive once-daily oral volixibat (0.5 mg, 1 mg, 5 mg or 10 mg) or placebo for 28 days in two cohorts (HV and T2DM). Assessments included safety, faecal BA and serum 7α-hydroxy-4-cholesten-3-one (C4; BA synthesis biomarker). Results Sixty-one individuals were randomised (HVs: placebo, n = 12; volixibat, n = 38; T2DM: placebo, n = 3; volixibat, n = 8). No deaths or treatment-related serious adverse events were reported. Mild or moderate gastrointestinal adverse events were those most frequently reported with volixibat. With volixibat, mean total faecal BA excretion on day 28 was ~1.6–3.2 times higher in HVs (643.73–1239.3 μmol/24 h) and ~8 times higher in T2DM (1786.0 μmol/24 h) than with placebo (HVs: 386.93 μmol/24 h; T2DM: 220.00 μmol/24 h). With volixibat, mean C4 concentrations increased by ~1.3–5.3-fold from baseline to day 28 in HVs and by twofold in T2DM. Conclusions Volixibat was generally well tolerated. Increased faecal BA excretion and serum C4 levels support the mechanistic rationale for exploring ASBT inhibition in NASH. The study was registered with the Dutch clinical trial authority (Centrale Commissie Mensgebonden Onderzoek; trial registration number NL44732.056.13; registered 24 May 2013). Electronic supplementary material The online version of this article (10.1186/s12876-017-0736-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Renger G Tiessen
- Early Development Services, Pharmaceutical Research Associates (PRA) Health Sciences, Van Swietenlaan 6, 9728 NZ Groningen, PO Box 8144, 9702, Groningen, KC, Netherlands.
| | - Ciara A Kennedy
- Lumena Pharmaceuticals Inc. (part of the Shire group of companies), 12531 High Bluff Drive, Suite 110, San Diego, CA, 92130, USA
| | - Bradley T Keller
- Lumena Pharmaceuticals Inc. (part of the Shire group of companies), 12531 High Bluff Drive, Suite 110, San Diego, CA, 92130, USA
| | - Nancy Levin
- Lumena Pharmaceuticals Inc. (part of the Shire group of companies), 12531 High Bluff Drive, Suite 110, San Diego, CA, 92130, USA
| | - Lisette Acevedo
- Lumena Pharmaceuticals Inc. (part of the Shire group of companies), 12531 High Bluff Drive, Suite 110, San Diego, CA, 92130, USA
| | - Bronislava Gedulin
- Lumena Pharmaceuticals Inc. (part of the Shire group of companies), 12531 High Bluff Drive, Suite 110, San Diego, CA, 92130, USA
| | - Andre A van Vliet
- Early Development Services, Pharmaceutical Research Associates (PRA) Health Sciences, Van Swietenlaan 6, 9728 NZ Groningen, PO Box 8144, 9702, Groningen, KC, Netherlands
| | - Alejandro Dorenbaum
- Lumena Pharmaceuticals Inc. (part of the Shire group of companies), 12531 High Bluff Drive, Suite 110, San Diego, CA, 92130, USA
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Palmer M, Sutherland J, Barnard S, Wynne A, Rezel E, Doel A, Grigsby-Duffy L, Edwards S, Russell S, Hotopf E, Perel P, Free C. The effectiveness of smoking cessation, physical activity/diet and alcohol reduction interventions delivered by mobile phones for the prevention of non-communicable diseases: A systematic review of randomised controlled trials. PLoS One 2018; 13:e0189801. [PMID: 29304148 PMCID: PMC5755775 DOI: 10.1371/journal.pone.0189801] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We conducted a systematic review to assess the effectiveness of smoking cessation, physical activity (PA), diet, and alcohol reduction interventions delivered by mobile technology to prevent non-communicable diseases (NCDs). METHODS We searched for randomised controlled trials (RCTs) of mobile-based NCD prevention interventions using MEDLINE, EMBASE, Global Health, CINAHL (Jan 1990-Jan 2016). Two authors extracted data. FINDINGS 71 trials were included: smoking cessation (n = 18); PA (n = 15), diet (n = 3), PA and diet (n = 25); PA, diet, and smoking cessation (n = 2); and harmful alcohol consumption (n = 8). 4 trials had low risk of bias. The effect of SMS-based smoking cessation support on biochemically verified continuous abstinence was pooled relative risk [RR] 2.19 [95% CI 1.80-2.68], I2 = 0%) and on verified 7 day point prevalence of smoking cessation was pooled RR 1.51 [95% CI 1.06-2.15], I2 = 0%, with no reported adverse events. There was no difference in peak oxygen intake at 3 months in a trial of an SMS-based PA intervention. The effect of SMS-based diet and PA interventions on: incidence of diabetes was pooled RR 0.67 [95% CI 0.49, 0.90], I2 = 0.0%; end-point weight was pooled MD -0.99Kg [95% CI -3.63, 1.64] I2 = 29.4%; % change in weight was pooled MD -3.1 [95%CI -4.86- -1.3] I2 0.3%; and on triglyceride levels was pooled MD -0.19 mmol/L [95% CI -0.29, -0.08], I2 = 0.0%. The results of other pooled analyses of the effect of SMS-based diet and PA interventions were heterogenous (I2 59-90%). The effects of alcohol reduction interventions were inconclusive. CONCLUSIONS Smoking cessation support delivered by SMS increases quitting rates. Trials of PA interventions reporting outcomes ≥3 months showed no benefits. There were at best modest benefits of diet and PA interventions. The effects of the most promising SMS-based smoking, diet and PA interventions on morbidity and mortality in high-risk groups should be established in adequately powered RCTs.
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Affiliation(s)
- Melissa Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Jennifer Sutherland
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sharmani Barnard
- King's Centre for Global Health and Health Partnerships, King’s College London, London, United Kingdom
| | - Aileen Wynne
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emma Rezel
- King's Centre for Global Health and Health Partnerships, King’s College London, London, United Kingdom
| | - Andrew Doel
- Division of Women's Health, King’s College London, London, United Kingdom
| | - Lily Grigsby-Duffy
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sophie Russell
- Notre Dame Catholic Sixth Form College, Leeds, United Kingdom
| | | | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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French RS, Geary R, Jones K, Glasier A, Mercer CH, Datta J, Macdowall W, Palmer M, Johnson AM, Wellings K. Where do women and men in Britain obtain contraception? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ Sex Reprod Health 2018; 44:16-26. [PMID: 29103003 PMCID: PMC6283328 DOI: 10.1136/jfprhc-2017-101728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/13/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION To estimate the prevalence of use of different sources of contraceptive supplies in Britain and its variation by key demographic and behavioural characteristics. METHODS Cross-sectional probability sample survey of women and men aged 16-74 years, resident in Britain, interviewed between 2010 and 2012. Analyses reported here were of 4571 women and 3142 men aged 16-44 years who reported having vaginal sex in the past year. Those relying exclusively on sterilisation (including hysterectomy) were excluded. Sources of contraceptive supplies were categorised as: general practice, community clinic, retail and other. Prevalence of use of these sources was estimated, and associated factors examined. RESULTS Some 87.0% of women and 73.8% of men accessed at least one source of contraceptive supplies in the previous year. Most women (59.1%) used general practice and most men (54.6%) used retail outlets. Community clinics were less commonly used, by 23.0% of women and 21.3% of men, but these users were younger and at greater sexual health risk. These associations were also observed among the 27.3% of women and 30.6% of men who used more than one source category (general practice, community clinic or retail) for contraceptive supplies. CONCLUSIONS People in Britain use a variety of sources to obtain contraceptive supplies and some sources are more commonly used by those more vulnerable to poorer sexual health. Our findings suggest that national policy changes to increase access to contraceptive methods have had an effect on the diversity of services used.
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Affiliation(s)
- Rebecca S French
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca Geary
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kyle Jones
- Research Department of Infection and Population Health, University College London, London, UK
| | - Anna Glasier
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, University College London, London, UK
| | - Jessica Datta
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Wendy Macdowall
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Palmer
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, University College London, London, UK
| | - Kaye Wellings
- Department of Social & Environmental Health Research, Centre for Sexual and Reproductive Health Research, London School of Hygiene and Tropical Medicine, London, UK
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Lewis R, Tanton C, Mercer CH, Mitchell KR, Palmer M, Macdowall W, Wellings K. Heterosexual Practices Among Young People in Britain: Evidence From Three National Surveys of Sexual Attitudes and Lifestyles. J Adolesc Health 2017; 61:694-702. [PMID: 29169520 PMCID: PMC5723633 DOI: 10.1016/j.jadohealth.2017.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/10/2017] [Accepted: 07/13/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe time trends and current patterns in sexual practices with opposite-sex partners among men and women aged 16-24 years in Britain. METHODS Complex survey analyses of cross-sectional probability survey data from three British National Surveys of Sexual Attitudes and Lifestyles (Natsal), conducted approximately decennially 1990-2012, involving interviews with 45,199 people in total. RESULTS Birth cohort analysis showed a decline in the median age at first sexual experience and first intercourse since the midtwentieth century and a narrowing of the interval between these events. Comparison of data from Natsals 1, 2, and 3 showed increases in the prevalence of ever experience of oral and anal sex among 16- to 24-year-olds, which were more marked among older respondents in this age group between Natsals 1 and 2, and among younger respondents between Natsals 2 and 3. Among the sexually active, vaginal and oral sex remained the most common combination of practices reported in the past year. The proportion reporting a past-year repertoire of vaginal, oral, and anal sex rose from approximately one in 10 in 1990-1991 to approximately one in four men and one in five women in 2010-2012. In the latest survey, heterosexual experience of practices was positively associated with bisexual attraction among women. CONCLUSIONS Recent decades have seen an earlier age at initiation of partnered sexual experiences and increased diversity in heterosexual practices among young people. Keeping pace with trends in sexual practices is necessary to safeguard young people's health and to support them in increasing their sexual well-being.
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Affiliation(s)
- Ruth Lewis
- Centre for Sexual and Reproductive Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clare Tanton
- Centre for Sexual Health & HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Catherine H. Mercer
- Centre for Sexual Health & HIV Research, Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Kirstin R. Mitchell
- Centre for Sexual and Reproductive Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom,MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Melissa Palmer
- Centre for Sexual and Reproductive Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wendy Macdowall
- Centre for Sexual and Reproductive Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kaye Wellings
- Centre for Sexual and Reproductive Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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