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Reaven PD, Newell M, Rivas S, Zhou X, Norman GJ, Zhou JJ. Initiation of Continuous Glucose Monitoring Is Linked to Improved Glycemic Control and Fewer Clinical Events in Type 1 and Type 2 Diabetes in the Veterans Health Administration. Diabetes Care 2023; 46:854-863. [PMID: 36807492 PMCID: PMC10260873 DOI: 10.2337/dc22-2189] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To determine the benefit of starting continuous glucose monitoring (CGM) in adult-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) with regard to longer-term glucose control and serious clinical events. RESEARCH DESIGN AND METHODS A retrospective observational cohort study within the Veterans Affairs Health Care System was used to compare glucose control and hypoglycemia- or hyperglycemia-related admission to an emergency room or hospital and all-cause hospitalization between propensity score overlap weighted initiators of CGM and nonusers over 12 months. RESULTS CGM users receiving insulin (n = 5,015 with T1D and n = 15,706 with T2D) and similar numbers of nonusers were identified from 1 January 2015 to 31 December 2020. Declines in HbA1c were significantly greater in CGM users with T1D (-0.26%; 95% CI -0.33, -0.19%) and T2D (-0.35%; 95% CI -0.40, -0.31%) than in nonusers at 12 months. Percentages of patients achieving HbA1c <8 and <9% after 12 months were greater in CGM users. In T1D, CGM initiation was associated with significantly reduced risk of hypoglycemia (hazard ratio [HR] 0.69; 95% CI 0.48, 0.98) and all-cause hospitalization (HR 0.75; 95% CI 0.63, 0.90). In patients with T2D, there was a reduction in risk of hyperglycemia in CGM users (HR 0.87; 95% CI 0.77, 0.99) and all-cause hospitalization (HR 0.89; 95% CI 0.83, 0.97). Several subgroups (based on baseline age, HbA1c, hypoglycemic risk, or follow-up CGM use) had even greater responses. CONCLUSIONS In a large national cohort, initiation of CGM was associated with sustained improvement in HbA1c in patients with later-onset T1D and patients with T2D using insulin. This was accompanied by a clear pattern of reduced risk of admission to an emergency room or hospital for hypoglycemia or hyperglycemia and of all-cause hospitalization.
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Affiliation(s)
| | | | - Salvador Rivas
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | - Xinkai Zhou
- Medicine and Biostatistics, University of California Los Angeles, Los Angeles, CA
| | | | - Jin J. Zhou
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
- Medicine and Biostatistics, University of California Los Angeles, Los Angeles, CA
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Klimentidis YC, Newell M, van der Zee MD, Bland VL, May-Wilson S, Arani G, Menni C, Mangino M, Arora A, Raichlen DA, Alexander GE, Wilson JF, Boomsma DI, Hottenga JJ, de Geus EJ, Pirastu N. Genome-wide Association Study of Liking for Several Types of Physical Activity in the UK Biobank and Two Replication Cohorts. Med Sci Sports Exerc 2022; 54:1252-1260. [PMID: 35320144 PMCID: PMC9288543 DOI: 10.1249/mss.0000000000002907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION A lack of physical activity (PA) is one of the most pressing health issues today. Our individual propensity for PA is influenced by genetic factors. Stated liking of different PA types may help capture additional and informative dimensions of PA behavior genetics. METHODS In over 157,000 individuals from the UK Biobank, we performed genome-wide association studies of five items assessing the liking of different PA types, plus an additional derived trait of overall PA-liking. We attempted to replicate significant associations in the Netherlands Twin Register (NTR) and TwinsUK. Additionally, polygenic scores (PGS) were trained in the UK Biobank for each PA-liking item and for self-reported PA behavior, and tested for association with PA in the NTR. RESULTS We identified a total of 19 unique significant loci across all five PA-liking items and the overall PA-liking trait, and these showed strong directional consistency in the replication cohorts. Four of these loci were previously identified for PA behavior, including CADM2 , which was associated with three PA-liking items. The PA-liking items were genetically correlated with self-reported ( rg = 0.38-0.80) and accelerometer ( rg = 0.26-0.49) PA measures, and with a wide range of health-related traits. Each PA-liking PGS significantly predicted the same PA-liking item in NTR. The PGS of liking for going to the gym predicted PA behavior in the NTR ( r2 = 0.40%) nearly as well as a PGS based on self-reported PA behavior ( r2 = 0.42%). Combining the two PGS into a single model increased the r2 to 0.59%, suggesting that PA-liking captures distinct and relevant dimensions of PA behavior. CONCLUSIONS We have identified the first loci associated with PA-liking and extended our understanding of the genetic basis of PA behavior.
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Affiliation(s)
- Yann C. Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Michelle Newell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Matthijs D. van der Zee
- Department of Biological Psychology, Vrije Universiteit Amsterdam, THE NETHERLANDS
- Amsterdam Public Health Institute, Amsterdam UMC, THE NETHERLANDS
| | - Victoria L. Bland
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Sebastian May-Wilson
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UNITED KINGDOM
| | - Gayatri Arani
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UNITED KINGDOM
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UNITED KINGDOM
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Foundation Trust, London, UNITED KINGDOM
| | - Amit Arora
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - David A. Raichlen
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, CA
| | - Gene E. Alexander
- Department of Psychology and Psychiatry, University of Arizona, Tucson, AZ
- Neuroscience and Physiological Sciences Graduate Inter-Disciplinary Programs, University of Arizona, Tucson, AZ
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, AZ
- Arizona Alzheimer’s Consortium, AZ
| | - James F. Wilson
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UNITED KINGDOM
- MRC Human Genetics Unit, Institute of Genetic and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UNITED KINGDOM
| | - Dorret I. Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, THE NETHERLANDS
- Amsterdam Public Health Institute, Amsterdam UMC, THE NETHERLANDS
| | - Jouke-Jan Hottenga
- Department of Biological Psychology, Vrije Universiteit Amsterdam, THE NETHERLANDS
- Amsterdam Public Health Institute, Amsterdam UMC, THE NETHERLANDS
| | - Eco J.C. de Geus
- Department of Biological Psychology, Vrije Universiteit Amsterdam, THE NETHERLANDS
- Amsterdam Public Health Institute, Amsterdam UMC, THE NETHERLANDS
| | - Nicola Pirastu
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, UNITED KINGDOM
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Wood AC, Arora A, Newell M, Bland VL, Zhou J, Pirastu N, Ordovas JM, Klimentidis YC. Identification of genetic loci simultaneously associated with multiple cardiometabolic traits. Nutr Metab Cardiovasc Dis 2022; 32:1027-1034. [PMID: 35168826 PMCID: PMC9275655 DOI: 10.1016/j.numecd.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/09/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Cardiometabolic disorders (CMD) arise from a constellation of features such as increased adiposity, hyperlipidemia, hypertension and compromised glucose control. Many genetic loci have shown associations with individual CMD-related traits, but no investigations have focused on simultaneously identifying loci showing associations across all domains. We therefore sought to identify loci associated with risk across seven continuous CMD-related traits. METHODS AND RESULTS We conducted separate genome-wide association studies (GWAS) for systolic and diastolic blood pressure (SBP/DBP), hemoglobin A1c (HbA1c), low- and high- density lipoprotein cholesterol (LDL-C/HDL-C), waist-to-hip-ratio (WHR), and triglycerides (TGs) in the UK Biobank (N = 356,574-456,823). Multiple loci reached genome-wide levels of significance (N = 145-333) for each trait, but only four loci (in/near VEGFA, GRB14-COBLL1, KLF14, and RGS19-OPRL1) were associated with risk across all seven traits (P < 5 × 10-8). We sought replication of these four loci in an independent set of seven trait-specific GWAS meta-analyses. GRB14-COBLL1 showed the most consistent replication, revealing nominally significant associations (P < 0.05) with all traits except DBP. CONCLUSIONS Our analyses suggest that very few loci are associated in the same direction of risk with traits representing the full spectrum of CMD features. We identified four such loci, and an understanding of the pathways between these loci and CMD risk may eventually identify factors that can be used to identify pathologic disturbances that represent broadly beneficial therapeutic targets.
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Affiliation(s)
- Alexis C Wood
- USDA/ARS Children's Nutrition Research Center, 1100 Bates Avenue, Houston, TX, USA.
| | - Amit Arora
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Michelle Newell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Victoria L Bland
- Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jin Zhou
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Nicola Pirastu
- Centre for Global Health Research, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA; IMDEA-Food, Madrid, Spain
| | - Yann C Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA; BIO5 Institute, University of Arizona, Tucson, AZ, USA
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Julian TH, Glascow N, Barry ADF, Moll T, Harvey C, Klimentidis YC, Newell M, Zhang S, Snyder MP, Cooper-Knock J, Shaw PJ. Physical exercise is a risk factor for amyotrophic lateral sclerosis: Convergent evidence from Mendelian randomisation, transcriptomics and risk genotypes. EBioMedicine 2021; 68:103397. [PMID: 34051439 PMCID: PMC8170114 DOI: 10.1016/j.ebiom.2021.103397] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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: 03/19/2021] [Revised: 04/13/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a universally fatal neurodegenerative disease. ALS is determined by gene-environment interactions and improved understanding of these interactions may lead to effective personalised medicine. The role of physical exercise in the development of ALS is currently controversial. Methods First, we dissected the exercise-ALS relationship in a series of two-sample Mendelian randomisation (MR) experiments. Next we tested for enrichment of ALS genetic risk within exercise-associated transcriptome changes. Finally, we applied a validated physical activity questionnaire in a small cohort of genetically selected ALS patients. Findings We present MR evidence supporting a causal relationship between genetic liability to frequent and strenuous leisure-time exercise and ALS using a liberal instrument (multiplicative random effects IVW, p=0.01). Transcriptomic analysis revealed that genes with altered expression in response to acute exercise are enriched with known ALS risk genes (permutation test, p=0.013) including C9ORF72, and with ALS-associated rare variants of uncertain significance. Questionnaire evidence revealed that age of onset is inversely proportional to historical physical activity for C9ORF72-ALS (Cox proportional hazards model, Wald test p=0.007, likelihood ratio test p=0.01, concordance=74%) but not for non-C9ORF72-ALS. Variability in average physical activity was lower in C9ORF72-ALS compared to both non-C9ORF72-ALS (F-test, p=0.002) and neurologically normal controls (F-test, p=0.049) which is consistent with a homogeneous effect of physical activity in all C9ORF72-ALS patients. Interpretation Our MR approach suggests a positive causal relationship between ALS and physical exercise. Exercise is likely to cause motor neuron injury only in patients with a risk-genotype. Consistent with this we have shown that ALS risk genes are activated in response to exercise. In particular, we propose that G4C2-repeat expansion of C9ORF72 predisposes to exercise-induced ALS. Funding We acknowledge support from the Wellcome Trust (JCK, 216596/Z/19/Z), NIHR (PJS, NF-SI-0617-10077; IS-BRC-1215-20017) and NIH (MPS, CEGS 5P50HG00773504, 1P50HL083800, 1R01HL101388, 1R01-HL122939, S10OD025212, P30DK116074, and UM1HG009442).
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Affiliation(s)
- Thomas H Julian
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Nicholas Glascow
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - A Dylan Fisher Barry
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Tobias Moll
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Calum Harvey
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Yann C Klimentidis
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Michelle Newell
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Sai Zhang
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA; Center for Genomics and Personalized Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA; Center for Genomics and Personalized Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Johnathan Cooper-Knock
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK.
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Klimentidis YC, Arora A, Newell M, Zhou J, Ordovas JM, Renquist BJ, Wood AC. Phenotypic and Genetic Characterization of Lower LDL Cholesterol and Increased Type 2 Diabetes Risk in the UK Biobank. Diabetes 2020; 69:2194-2205. [PMID: 32493714 PMCID: PMC7506834 DOI: 10.2337/db19-1134] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/29/2020] [Indexed: 01/03/2023]
Abstract
Although hyperlipidemia is traditionally considered a risk factor for type 2 diabetes (T2D), evidence has emerged from statin trials and candidate gene investigations suggesting that lower LDL cholesterol (LDL-C) increases T2D risk. We thus sought to more comprehensively examine the phenotypic and genotypic relationships of LDL-C with T2D. Using data from the UK Biobank, we found that levels of circulating LDL-C were negatively associated with T2D prevalence (odds ratio 0.41 [95% CI 0.39, 0.43] per mmol/L unit of LDL-C), despite positive associations of circulating LDL-C with HbA1c and BMI. We then performed the first genome-wide exploration of variants simultaneously associated with lower circulating LDL-C and increased T2D risk, using data on LDL-C from the UK Biobank (n = 431,167) and the Global Lipids Genetics Consortium (n = 188,577), and data on T2D from the Diabetes Genetics Replication and Meta-Analysis consortium (n = 898,130). We identified 31 loci associated with lower circulating LDL-C and increased T2D, capturing several potential mechanisms. Seven of these loci have previously been identified for this dual phenotype, and nine have previously been implicated in nonalcoholic fatty liver disease. These findings extend our current understanding of the higher T2D risk among individuals with low circulating LDL-C and of the underlying mechanisms, including those responsible for the diabetogenic effect of LDL-C-lowering medications.
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Affiliation(s)
- Yann C Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
- BIO5 Institute, University of Arizona, Tucson, AZ
| | - Amit Arora
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Michelle Newell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Jin Zhou
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA
- Instituto Madrileño de Estudios Avanzados (IMDEA) Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Benjamin J Renquist
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ
| | - Alexis C Wood
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
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Roberts T, Newell M, Auffermann W, Vidakovic B. Wavelet-based scaling indices for breast cancer diagnostics. Stat Med 2017; 36:1989-2000. [PMID: 28226399 DOI: 10.1002/sim.7264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/10/2022]
Abstract
Mammography is routinely used to screen for breast cancer. However, the radiological interpretation of mammogram images is complicated by the heterogeneous nature of normal breast tissue and the fact that cancers are often of the same radiographic density as normal tissue. In this work, we use wavelets to quantify spectral slopes of breast cancer cases and controls and demonstrate their value in classifying images. In addition, we propose asymmetry statistics to be used in forming features, which improve the classification result. For the best classification procedure, we achieve approximately 77% accuracy (sensitivity=73%, specificity=84%) in classifying mammograms with and without cancer. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- T Roberts
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, 765 Ferst Drive NW, Atlanta, GA, 30332, U.S.A
| | - M Newell
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Suite AT-504, Atlanta, GA, 30322, U.S.A
| | - W Auffermann
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1365 Clifton Road NE, Suite AT-504, Atlanta, GA, 30322, U.S.A
| | - B Vidakovic
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, 765 Ferst Drive NW, Atlanta, GA, 30332, U.S.A
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Subedi K, Yu HM, Newell M, Weselake RJ, Meesapyodsuk D, Qiu X, Shah S, Field CJ. Stearidonic acid-enriched flax oil reduces the growth of human breast cancer in vitro and in vivo. Breast Cancer Res Treat 2014; 149:17-29. [DOI: 10.1007/s10549-014-3212-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/14/2014] [Indexed: 12/24/2022]
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Daunt F, Reed TE, Newell M, Burthe S, Phillips RA, Lewis S, Wanless S. Longitudinal bio-logging reveals interplay between extrinsic and intrinsic carry-over effects in a long-lived vertebrate. Ecology 2014; 95:2077-83. [DOI: 10.1890/13-1797.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Williams R, Asrress K, Yousuff M, Goodwin C, Lumley M, Khawaja M, Myat A, Arri S, Patterson T, Lockie T, Nagel E, Perera D, Marber M, Chiribiri A, Redwood S, Plein S, Feistritzer H, Klug G, Reinstadler S, Mair J, Schocke M, Franz W, Metzler B, McGraw S, Mirza O, Bauml M, Gonzalez R, Dickens C, Farzaneh-Far A, McAlindon E, Vizzi V, Strange J, Edmond J, Johnson T, Baumbach A, Bucciarelli-Ducci C, Pharithi R, Meela M, Conway M, Kropmans T, Newell M, Aquaro G, Frijia F, Positano V, Santarelli M, Wiesinger F, Lionetti V, Giovannetti G, Schulte R, Landini L, Menichetti L, Amzulescu M, Rousseau M, Ahn S, de Ravenstein C, Vancraeynest D, Pasquet A, Vanoverschelde J, Pouleur A, Gerber B, Pfaffenberger S, Fandl T, Marzluf B, Babayev J, Juen K, Schenk P, Binder T, Vonbank K, Mascherbauer J, Almeida A, Sa A, Brito D, David C, Marques J, Almeida A, Silva D, de Sousa J, Diogo A, Pinto F, Masci P, Del Torto A, Barison A, Aquaro G, Chiappino S, Vergaro G, Passino C, Emdin M, Saba S, Sachdev V, Hannoush H, Axel L, Arai A, Mykhailova L, Kravchun P, Lapshina L. These abstracts have been selected for moderated presentations on SCREEN A. Please refer to the the PROGRAM and the infos on the screen for more details about schedule, moderators and presenters. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu084] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Amin M, Basu M, Patterson SG, Pinkerton H, Torres MA, Newell M, O'Regan R, McCarthy C, Tarpley R, Gabram SGA. Time interval as a quality measure: What is our baseline prior to nurse navigator implementation? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
208 Background: There are various outcome measures to evaluate the quality of multidisciplinary care for breast cancer patients. The National Consortium of Breast Centers defines quality of breast cancer care as accurate evaluation and appropriate services in a timely manner. In a tertiary academic center a diverse referral pattern possibly influences time to treatment. We choose to examine two outcome measures before the start of a nurse navigator: Time from initial diagnosis to first consultation and if the pretreatment consultation for those receiving neoadjuvant chemotherapy or hormonal therapy included all subspecialists. Methods: Electronic medical records of female patients with breast cancer seen during January-June 2010 were reviewed. Patients with stage IV breast cancer were excluded. Results: 150 patients were divided into 4 categories: external pathology consult (B1), internally diagnosed with a primary care physician (PCP) at our institution (B2), evaluated by a surgical oncologist before the biopsy (B3), and internally diagnosed with PCP outside of the institution (B4). For B2, B3 and B4 we examined the time intervals to first surgical oncology appointment after diagnosis as shown in the table. For all patients (n=10) who received neoadjuvant therapy, 1 patient saw a surgical oncologist, medical oncologist and radiation oncologist, 9 patients saw 2 subspecialties prior to initiation of first treatment. Conclusions: Patients are seen within an average of 2 weeks whether they are diagnosed internally (B2, B3) or externally (B4). The group seen by a surgical oncologist prior to biopsy (B3) were seen sooner. For the patients receiving neoadjuvant therapy, 10% saw all 3 specialties prior to initiation of therapy. In July 2010 a nurse navigator was added to the care team. With this new position, our goal is to decrease the time from biopsy to visit by 33% and have 100% of patients receiving neoadjuvant therapy evaluated by all 3 specialists prior to treatment. Our intent is to quantify the effect of a nurse navigator in a large academic center as a quality metric in improving care. [Table: see text]
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Affiliation(s)
- M. Amin
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - M. Basu
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - S. G. Patterson
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - H. Pinkerton
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - M. A. Torres
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - M. Newell
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - R. O'Regan
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - C. McCarthy
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - R. Tarpley
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
| | - S. G. A. Gabram
- Emory University School of Medicine, Atlanta, GA; Emory University, Atlanta, GA; Emory University, Jackson, MS; Department of Radiation Oncology, Emory University, Atlanta, GA; Georgia Cancer Center for Excellence at Grady Memorial Hospital, Atlanta, GA
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Newell M, Newell J, Grant S. Fluid and electrolyte balance in elite gaelic football players. Ir Med J 2008; 101:236-239. [PMID: 18990952] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of this study was to investigate fluid and electrolyte balance in elite Gaelic Football players (n=20) during a typical training session in a warm environment (16 to 18 degrees C, 82-88% humidity). Pre-training urine samples were used to determine hydration status. Sweat sodium concentration was collected from four body site locations using absorbent patches. The mean sweat rate per hour was 1.39 l x h(-1) and mean body mass loss was 1.1%. Mean sweat sodium concentrations were 35 mmol x l(-1) (range 19-52 mmol x l(-1)). On average, players did not drink enough fluid to match their sweat rates (p<0.001) and this fluid deficit was not related to pre-training hydration status (p= 0.67). A single hydration strategy based on published guidelines may not be suitable for an entire team due to variations in individual sweat rates. Maximising player performance could be better achieved by accurate quantification of individual fluid and electrolyte losses.
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Affiliation(s)
- M Newell
- Institute of Biomedical and Life Sciences, University of Glasgow, Scotland
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13
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White RG, Moodley P, McGrath N, Hosegood V, Zaba B, Herbst K, Newell M, Sturm WA, Hayes RJ. Low effectiveness of syndromic treatment services for curable sexually transmitted infections in rural South Africa. Sex Transm Infect 2008; 84:528-34. [PMID: 18708485 PMCID: PMC2584238 DOI: 10.1136/sti.2008.032011] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [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: 11/26/2022] Open
Abstract
Objectives: Syndromic sexually transmitted infection (STI) treatment remains a cost-saving HIV prevention intervention in many countries in Africa. We estimate the effectiveness of syndromic treatment for curable STIs in rural KwaZulu-Natal, South Africa, and the trend in STI prevalences before and after the introduction of syndromic treatment in 1995. Methods: Data were available from various clinical studies, surveys of public and private health providers, the general population and women attending antenatal, family planning and child immunisation clinics in rural northern KwaZulu-Natal between 1987 and 2004. Overall effectiveness was defined as the estimated proportion of the annual number of symptomatic curable STI episodes cured by syndromic treatment based on separate estimates for six curable STI aetiologies by gender. Results: Median overall effectiveness was 13.1% (95% CI 8.9 to 17.8%) of symptomatic curable STI episodes cured. Effectiveness increased to 25.0% (95% CI 17.3 to 33.8%), 47.6% (95% CI 44.5 to 50.8%) or 14.3% (95% CI 9.9 to 19.4%) if 100% treatment seeking, 100% correct treatment provision or 100% cure were assumed, respectively. Time-trends were difficult to assess formally but there was little evidence of decreasing STI prevalences. Including incurable but treatable herpes simplex virus (HSV)-2 ulcers in the effectiveness calculation would halve the proportion of ulcers cured or correctly treated, but this reduction could be entirely countered by including episodic antiviral treatment in the national guidelines. Conclusion: Overall effectiveness of syndromic treatment for curable STIs in rural KwaZulu-Natal remains low and there is little evidence of reduced curable STI prevalences. As syndromic treatment is likely to be a cost-saving HIV prevention intervention in South Africa, innovative strategies are urgently needed to increase rates of treatment seeking and correct treatment provision.
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Affiliation(s)
- R G White
- Infectious Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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14
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Newell M, Grant S, Henry A, Newell J. Incidence of injury in elite Gaelic footballers. Ir Med J 2006; 99:269-71. [PMID: 17144235] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The purpose of this study was to undertake a comprehensive prospective epidemiological study of injuries sustained by elite Gaelic Football players over one season. The pattern of injury is strikingly similar across all teams with 47% of all injuries occurring in the final quarter of games and training. Injuries to the lower limb, particularly the hamstrings muscles accounted for the majority of injuries. 65% of players were unable to participate fully in Gaelic Football activity for between one and three weeks as a result of injury. The high incidence of injury especially hamstrings injuries in the latter stages of training and games warrants further investigation.
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Affiliation(s)
- M Newell
- University of Glasgow, Institute of Biomedical and Life Sciences, Glasgow
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15
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Affiliation(s)
- M Newell
- Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, WC1N 1EH, London, UK.
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16
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Scott SM, Knowles CH, Newell M, Garvie N, Williams NS, Lunniss PJ. Scintigraphic assessment of colonic transit in women with slow-transit constipation arising de novo and following pelvic surgery or childbirth. Br J Surg 2001; 88:405-11. [PMID: 11260108 DOI: 10.1046/j.1365-2168.2001.01699.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Colonic transit has not been compared between patients with slow-transit constipation (STC) arising de novo (idiopathic) and those whose symptoms followed pelvic surgery or childbirth (acquired). METHODS In 48 women, with either idiopathic (n = 36) or acquired (n = 12) STC, 111In-radiolabelled diethylene-triamine penta-acetic acid colonic scintigraphy was performed to determine patterns of delay (generalized or left sided), the 'severity' of transit disturbance between subgroups, and the association with age or duration of symptoms. Results were compared with those in healthy women. Patterns of colonic transit disturbance were assessed using previously defined criteria. In those with a generalized delay, variables reflecting the overall rate of isotope progression throughout the colon were calculated: gradient of geometric centre of isotope progression and estimated evacuation time of the isotope. RESULTS The pattern of transit delay was similar between the subgroups, but the 'severity' of the transit abnormality was significantly worse in those with chronic idiopathic symptoms. In the chronic idiopathic STC subgroup only, there was a significant correlation between both age and duration of symptoms and severity of transit disturbance. CONCLUSION This study demonstrates that differences in colonic transit exist between subgroups of patients with STC. These might be explained by differences in duration of symptoms or differences in aetiology.
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Affiliation(s)
- S M Scott
- Academic Department of Surgery (Gastrointestinal Physiology Unit), St Bartholomew's and The Royal London School of Medicine and Dentistry, London, UK.
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17
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Muench J, Verdieck A, Lopez-Vasquez A, Newell M. Crossing diagnostic borders: herpes encephalitis complicated by cultural and language barriers. J Am Board Fam Pract 2001; 14:46-50. [PMID: 11206692] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The patient who complains of vague mental status changes requires extra vigilance in that the underlying condition might itself affect the patient's ability to communicate well and relate a medical history. The differential diagnosis of delirium is broad, ranging from the benign to the potentially fatal. The diagnostic uncertainty inherent in primary care is compounded when language and cultural differences interfere with physician-patient communication. METHODS We undertook a MEDLINE-assisted review of the medical literature concerning herpes simplex encephalitis. Additionally, we performed an Internet search of several government Web sites to find current legal and federal guidelines concerning the use of medical interpreters. RESULTS AND CONCLUSIONS We recount the case of a young Eastern European immigrant who complained initially of vague mental status changes and was found to have herpes simplex encephalitis. Diagnosis could have been made sooner had the physician been familiar with the patient's baseline mental status or had cultural and language barriers not stood between the physician and the patient and his mother. Herpes simplex encephalitis is a rare, but specific, cause of delirium for which prompt diagnosis and treatment with intravenous acyclovir can prevent death or serious sequelae.
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Affiliation(s)
- J Muench
- Department of Family Medicine, Orgeon Health Sciences University, Portland 97201, USA
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18
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Kirkegaard JA, Sarwar M, Wong PTW, Mead A, Howe G, Newell M. Field studies on the biofumigation of take-all by Brassica break crops. ACTA ACUST UNITED AC 2000. [DOI: 10.1071/ar99106] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Biofumigation refers to the suppression of soil-borne pathogens and pests by
biocidal compounds released by Brassica crops when
glucosinolates (GSL) in their residues decay in soil. We conducted field
studies at 2 sites to investigate the hypothesis that biofumigation by
Brassica break crops would reduce inoculum of the
take-all fungus Gaeumannomyces graminis var.
tritici (Ggt) to lower levels than
non-Brassica break crops, and thereby reduce Ggt
infection and associated yield loss in subsequent wheat crops. High and
uniform levels of Ggt were established at the sites in the first year of the
experiments by sowing wheat with sterilised ryegrass seed infested with Ggt.
Ggt inoculum declined more rapidly under Brassica crops
than under linola and this reduction coincided with the period of root decay
and reduced root glucosinolate concentrations around crop maturity. There was
no consistent difference in inoculum reduction between canola
(Brassica napus) and Indian mustard
(Brassica juncea), nor between cultivars with high and
low root GSL within each species. Despite significant inoculum reduction
attributable to biofumigation, there were no differences in the expression of
disease and associated impacts on the yield of subsequent wheat crops across
the sites. Seasonal conditions, in particular the distribution of rainfall in
both the summer–autumn fallow following the break crops and during the
subsequent wheat crop, influenced inoculum survival and subsequent disease
development. In wet summers, inoculum declined to low levels following all
break crops and no extra benefit from biofumigation was evident. In dry
summers the lower inoculum levels following brassicas persisted until the
following wheat crops were sown but subsequent development of the disease was
influenced more by seasonal conditions than by initial inoculum levels.
Significant extra benefits of biofumigation were observed in one experiment
where wheat was sown within the break crops to simulate grass weed hosts of
Ggt. Under these circumstances there was greater reduction in Ggt inoculum
under canola than linseed and an associated decrease in disease development.
For host-dependent pathogens such as Ggt, we hypothesise that the benefits of
biofumigation to subsequent wheat crops will therefore be restricted to
specific circumstances in which inoculum is preserved during and after the
break crops (i.e. dry conditions, grass hosts present) and where conditions in
the following wheat crop lead to significant disease development (early
sowing, wet autumn and spring, dry periods during grain filling).
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19
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Newell M, Milliken S, Goldstein D, Lewis C, Boyle M, Dolan G, Ryan S, Cooper DA. A phase II study of liposomal doxorubicin in the treatment of HIV-related Kaposi's sarcoma. Aust N Z J Med 1998; 28:777-83. [PMID: 9972406 DOI: 10.1111/j.1445-5994.1998.tb01553.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the toxicity and clinical efficacy of liposomal encapsulated doxorubicin (DOX-SL) in the treatment of HIV-related Kaposi's sarcoma (KS). METHODS DOX-SL 20-40mg/m2 was administered by intravenous infusion over 30-60 minutes every two weeks. Toxicity was assessed in all patients and response assessed in patients who completed two or more cycles of therapy. RESULTS Twenty-five patients with KS were enrolled. Nine had received previous KS chemotherapy but only one prior anthracycline therapy. Eighteen patients had CD4 counts < 50/mm3. Eight had pulmonary and/or visceral KS. A total of 191 cycles were given, median 6, range 1-33. Twenty patients completed two or more cycles and were considered evaluable for efficacy. A defined response occurred in 11 patients, nine achieving a partial response and two a complete response. The median duration of response was 120 days and the median time to disease progression was 187 days. Acute toxicity was minimal, except in one patient who had generalised erythema, hypotension and diaphoresis within ten minutes of starting DOX-SL infusion. Grade 3 or 4 neutropenia occurred in 13.6 and 3.7% of cycles respectively. Neutropenic sepsis secondary to drug therapy was not reported. Alopecia and gastrointestinal symptoms were mild and infrequent. No cardiac toxicity was seen. Nine/25 patients developed HIV-associated illnesses while on study (three Pneumocystis carinii pneumonia, two systemic Cytomegalovirus infection, three cryptosporidiosis, one Mycobacterium avium intracellulare--(MAC) infection). Median survival in the evaluable patients was 219 days. CONCLUSIONS DOX-SL is an effective and well tolerated palliative therapy in AIDS-related KS.
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Affiliation(s)
- M Newell
- National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Sydney
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20
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Newell M, Pinardo M. Career goal setting for emerging nurse leaders. Medsurg Nurs 1998; 7:302-3. [PMID: 10036432] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- M Newell
- Achievement Dynamics Institute, Cherry Hill, NJ, USA
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21
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Goldstein D, Hertzog P, Tomkinson E, Couldwell D, McCarville S, Parrish S, Cunningham P, Newell M, Owens M, Cooper DA. Administration of imiquimod, an interferon inducer, in asymptomatic human immunodeficiency virus-infected persons to determine safety and biologic response modification. J Infect Dis 1998; 178:858-61. [PMID: 9728559 DOI: 10.1086/515343] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A phase I study to determine safety, maximum tolerated dose, and biologic response during multiple once-a-week administration of oral imiquimod, an immune response modifier, was conducted in 12 adults with early human immunodeficiency virus (HIV) infection. All completed the dose-escalation phase of weekly dosing at 100-mg increments and received at least one maintenance dose, 100 mg below the patient's toxic dose, for 12 weeks. Dose-limiting toxicity occurred in 3 patients at 200-mg, 5 at 300-mg, and 3 at 400-mg dose levels. One tolerated the 500-mg dose without dose-limiting toxicity. Dose-limiting toxicities included fatigue, fever, malaise, increased transaminases, hypotension, vomiting, and depression. Seven of 12 completed 12 weeks of maintenance. At > or = 200 mg of imiquimod, all patients had biologic responses, measured by elevations in serum interferon, beta2-microglobulin, and neopterin levels. Imiquimod induced pronounced levels of circulating interferon in asymptomatic HIV-infected persons, with variable effect on virus load.
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Affiliation(s)
- D Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia.
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22
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Newell M. Transitioning the critical care nurse from ICU to high-tech homecare. Crit Care Nurs Clin North Am 1998; 10:259-66. [PMID: 9855889] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Critical care nurses are in a good position to take advantage of the changes in health care. They can build a career that will be on the cutting edge of the changes in technology and care delivery if they are willing to learn some new skills and practice in a more autonomous environment. Nurses who are new to the homecare setting need to know more about insurance systems, diagnosis coding, and outcomes tools and prepare themselves for the rapid growth of computer assisted technologies that are being introduced into the practice of homecare. They also need to take the whole continuum of care into consideration when planning care for patients in the home and to be aware of community and family supports that can enhance the patient's health related quality of life.
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Affiliation(s)
- M Newell
- Managed Care Consultants, Merchantville, New Jersey, USA
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23
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Abstract
To obtain information about the bone scintigraphic appearance of a hydroxyapatite (HA)-coated proximal femoral implant, this examination was performed on 24 patients with a clinically and radiologically successful femoral implant in hip arthroplasty. The prosthesis had a proximal HA coating for supplementary fixation. The patients' mean age was 50.3 years (range, 28-65 years) at operation. The interval from the operation to the scintigraphy ranged from 6 months to 5.5 years (mean, 2.2 years). Scintigraphy was performed using 99mTc-medronic acid. Quantitative counts were recorded in 4 zones: 3 along the length of the implant (trochanteric region with HA coating, midprosthesis, and distal tip) and 1 below the prosthesis. The results were expressed as ratios using the nonoperated femur as a control value. The results demonstrated that the mean activities in all 4 zones were increased relative to the untreated side. The highest activity was observed in the region around the prosthetic tip, with an elevation of 46% above the control value. This activity showed a significant decline over time. The counts recorded in the trochanteric region, where the implant was coated with HA, were 20% above the control value and similar to those seen in its adjacent noncoated midprosthetic region. In the trochanteric region, however, the activity did not show a decline over the follow-up period.
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Affiliation(s)
- T Moilanen
- Tampere University Hospital, Department of Surgery, Finland
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24
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Newell M, Goldstein D, Milliken S, Lewis C, Hoy J, Thomson B, Cooper D. Phase I/II trial of filgrastim (r-metHuG-CSF), CEOP chemotherapy and antiretroviral therapy in HIV-related non-Hodgkin's lymphoma. Ann Oncol 1996; 7:1029-36. [PMID: 9037361 DOI: 10.1093/oxfordjournals.annonc.a010495] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A phase I/II trial determined the maximum tolerated dose (MTD) of CEOP for AIDS-related non-Hodgkin's lymphoma (NHL) with concurrent filgrastim and antiretroviral therapy. PATIENTS AND METHODS Fourteen AIDS-NHL patients, chemotherapy naïve and ECOG performance status < 2 received filgrastim 1.0 microgram/kg s.c. daily for 3-7 days to assess neutrophil response, followed by CEOP with filgrastim support 10 micrograms/kg s.c. daily, day 2-14, continued if the absolute neutrophil count (ANC) < 1.2 x 10(9)/l. Two CEOP dose cohorts were used: cohort 1 (5 patients) - cyclophosphamide (C) 500 mg/m2, epirubicin (E) 37.5 mg/m2, vincristine (O) 2 mg and prednisolone (P) 75 mg/m2 daily on days 1-5; cohort 2 (9 patients) - C 750 mg/m2, E 50 mg/m2, same doses of O and P. Antiretroviral therapy was maintained (zidovudine-10, ddI-3, both-1). RESULTS In cohort 1, 4/5 patients received at least 3 courses of CEOP with one complete response after five cycles and four progressions. Four have died (3-21 months after entry) with 1 alive at 40 months. Dose limiting toxicity (DLT - grade IV febrile neutropenia in cycle 1) occurred in 1 patient. In cohort 2, 5/9 completed > or = 5 cycles with 6 complete responses, 1 partial response and 2 progressions, 6 deaths and 3 alive at > 33 months. DLT (evaluable in 8 patients) occurred in two patients. Median survival for both cohorts was 17 months. Mean relative dose intensity was > 85%. CONCLUSIONS The dosages of CEOP in cohort 1 defined the MTD however, the cohort 2 doses with filgrastim and antiretroviral therapy gave an encouraging response, acceptable toxicities and merit further study.
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Affiliation(s)
- M Newell
- National Center in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Sydney, Australia
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25
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Law M, Cooper S, Newell M. Regarding Stelzer and Griffin, IJROBP 27:1057-1061; 1993. Oncology Working Group. Int J Radiat Oncol Biol Phys 1995; 32:276-7. [PMID: 7721634 DOI: 10.1016/0360-3016(95)90312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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26
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McGregor JM, Newell M, Ross J, Kirkham N, McGibbon DH, Darley C. Cutaneous malignant melanoma and human immunodeficiency virus (HIV) infection: a report of three cases. Br J Dermatol 1992; 126:516-9. [PMID: 1610694 DOI: 10.1111/j.1365-2133.1992.tb11828.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Cutaneous malignant melanoma was diagnosed in three patients suffering from human immunodeficiency virus (HIV) infection. Staging at presentation inversely correlated with absolute CD4 count. In addition, a notably sparse lymphocytic inflammatory response to the melanoma was observed in two cases. Established data on melanoma in non-HIV immunosuppressed patients suggests a poor prognosis for melanoma in HIV disease.
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Affiliation(s)
- J M McGregor
- Department of Dermatology, St Thomas' Hospital, London, UK
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27
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Studd JW, Dooley MM, Welch CC, Vijayakanthan K, Mowat JM, Wade A, Newell M. Comparative clinical trial of fenticonazole ovule (600 mg) versus clotrimazole vaginal tablet (500 mg) in the treatment of symptomatic vaginal candidiasis. Curr Med Res Opin 1989; 11:477-84. [PMID: 2680285 DOI: 10.1185/03007998909110458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A multi-centre, randomized, single-blind, parallel-group clinical trial was undertaken in 50 patients (26 fenticonazole, 24 clotrimazole) with symptomatic vaginal candidiasis to compare the antifungal efficacy and tolerability of single-dose intra-vaginal treatment with a fenticonazole ovule (600 mg) or a clotrimazole vaginal tablet (500 mg). Assessment was by laboratory mycological investigation and symptomatic assessments for a period of 3 weeks from the day of treatment. Of the 50 patients, 43 (23 fenticonazole, 20 clotrimazole) returned for assessment 1 week after drug administration and 32 (17 fenticonazole, 15 clotrimazole) were re-assessed 3 weeks after drug administration. Both treatments resulted in very similar and highly significant improvements in symptoms, associated with disappearance of detectable Candida in approximately 70% of patients. There were no significant differences between treatments and no appreciable incidence of relapse during the 3-week period of observation. At the end of this period, 10 (59%) of 17 fenticonazole patients were totally disease-free, as compared with 10 (67%) of 15 patients after clotrimazole treatment. The cure rate observed was somewhat less than that previously seen when intra-vaginal cream formulations of the same two drugs were given on a multiple-dose basis. Both drugs were very well tolerated, with no reports of appreciable local or systemic adverse reactions to either drug.
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Affiliation(s)
- J W Studd
- King's College Hospital, London, England
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28
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Chapman HW, Butler DG, Newell M. The route of liquids administered to calves by esophageal feeder. Can J Vet Res 1986; 50:84-7. [PMID: 3742363 PMCID: PMC1255164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
An esophageal feeder and a rubber nasoesophageal tube were used to administer fluids to calves. Radio-opaque fluids were given and their destination determined by fluoroscopy and radiography. Fluids containing glucose and xylose were also given and plasma glucose and xylose concentrations measured. In at least 93% of calves, the radio-opaque fluids entered the reticulum, indicating that the reticular groove did not close. Oral administration of sodium bicarbonate, copper sulfate and guanidine HCl did not influence groove closure in calves that received fluids through an esophageal feeder. As administration of the fluids continued, overflow to the abomasum occurred after about 400 mL had been given. When 2.0 L of glucose and electrolyte solution was given by esophageal feeder, plasma glucose levels rose significantly (p less than 0.01), showing that absorption had occurred. Plasma xylose levels rose in seven out of eight calves 30 minutes after a second 2.0 L dose (containing xylose) had been administered. Thus, even though esophageal feeders do not cause reticular groove closure, they can be used to administer fluids for enteric absorption, provided large quantities are given.
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29
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Coles M, Thompson G, Newell M. Plasma protein changes in inflammatory states. Pathology 1978. [DOI: 10.1016/s0031-3025(16)39818-x] [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: 11/17/2022]
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Abstract
Five cases of granulomatous disease of the male genitalia are presented. Of these, 3 cases involved foreign-body reactions in which some form of hydrocarbon was the causative agent. In the other 2 cases, idiopathic granulomatous processes were found, and this condition may be secondary to endogenous lipoid degenerative processes.
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Hays EF, Craddock CG, Haskett D, Newell M. In vitro colony-forming cells in the marrow of leukemic and preleukemic mice. Blood 1976; 47:603-10. [PMID: 177133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In vitro colony-forming cells (CFUc) were evaluated in preleukemic and leukemic AK mice. Increased concentrations of CFUc were found in normal appearing marrow of superinfected animals 2-3 wk prior to the onset of lymphoma. CFUc were present in marrows of mice with virus-accelerated, spontaneous, and transplanted lymphoma. CFUc concentration was often increased in mice with advanced disease and marrow replacement by lymphoblasts. When calculated on the basis of CFUc per normal marrow cells, this increase was marked. The colonies developed only in the presence of added colony-stimulating activity (CSA) and had the morphologic features of colonies from normal marrow. Leukemic cells did not form colonies. Lymphoma cells, from virus accelerated, spontaneous and transplanted lymphoma, did not produce CSA in feeder layers or conditioned medium. Leukemic and nonleukemic AK bone were found to produce similar small amounts of CSA. These studies showed that the preleukemic state as well as marrow replacement by lymphoblasts resulted in increased marrow CFUc's. No evidence for increased local production of CSA by lymphoblasts or the marrow microenvironment was found to account for this.
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32
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Puritz EM, Yount WJ, Newell M, Utsinger PD. Immunoglobulin classes and IgG subclasses of human antinuclear antibodies. A correlation of complement fixation and the nephritis of systemic lupus erythematosus. Clin Immunol Immunopathol 1973; 2:98-113. [PMID: 4149506 DOI: 10.1016/0090-1229(73)90040-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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