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Kalra A, Kang JK, Wilcox C, Brown P, Rycus P, Anders MM, Zaaqoq AM, Brodie D, Whitman GJR, Cho SM. Impact of Pulse Pressure on Acute Brain Injury in Venoarterial ECMO Patients with Cardiogenic Shock During the First 24 Hours of ECMO Cannulation: Analysis of the Extracorporeal Life Support Organization Registry. Res Sq 2023:rs.3.rs-3646443. [PMID: 38045281 PMCID: PMC10690326 DOI: 10.21203/rs.3.rs-3646443/v1] [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] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background : Low pulse pressure (PP) in venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is a marker of cardiac dysfunction and has been associated with acute brain injury (ABI) as continuous-flow centrifugal pump may lead to endothelial dysregulation. Methods : We retrospectively analyzed adults (≥18 years) on "peripheral" VA-ECMO support for cardiogenic shock in the Extracorporeal Life Support Organization Registry (1/2018-7/2023). Cubic splines were used to establish a threshold (PP≤10 mmHg at 24 hours of ECMO support) for "early low" PP. ABI included central nervous system (CNS) ischemia, intracranial hemorrhage, brain death, and seizures. Multivariable logistic regressions were performed to examine whether PP≤10 mmHg was associated with ABI. Covariates included age, sex, body mass index, pre-ECMO variables (temporary mechanical support, vasopressors, cardiac arrest), on-ECMO variables (pH, PaO 2 , PaCO 2 ), and on-ECMO complications (hemolysis, arrhythmia, renal replacement therapy). Results : Of 9,807 peripheral VA-ECMO patients (median age=57.4 years, 67% male), 8,294 (85%) had PP>10 mmHg vs. 1,513 (15%) had PP≤10 mmHg. Patients with PP≤10 mmHg experienced ABI more frequently vs. PP>10 mmHg (15% vs. 11%, p<0.001). After adjustment, PP≤10 mmHg was independently associated with ABI (adjusted odds ratio [aOR]=1.25, 95% confidence interval [CI]=1.06-1.48, p=0.01). CNS ischemia and brain death were more common in patients with PP≤10 mmHg vs. PP>10 mmHg (8% vs. 6%, p=0.008; 3% vs. 1%, p<0.001). PP≤10 mmHg was associated with CNS ischemia (aOR=1.26, 95%CI=1.02-1.56, p=0.03) but not intracranial hemorrhage (aOR=1.14, 95%CI=0.85-1.54, p=0.38). Conclusions : Early low PP (≤10 mmHg) at 24 hours of ECMO support was associated with ABI, particularly CNS ischemia, in peripheral VA-ECMO patients.
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Brown P, DiVincenti L. A Word from USDA and OLAW. Lab Anim (NY) 2023; 52:217. [PMID: 37758915 DOI: 10.1038/s41684-023-01253-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Louis DiVincenti
- Senior Veterinary Medical Officer - Research, Animal Care National Policy Staff, APHIS, USDA, Riverdale, MD, USA.
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Brown P, DiVincenti L. A Word from OLAW and USDA. Lab Anim (NY) 2023; 52:191. [PMID: 37644302 DOI: 10.1038/s41684-023-01235-9] [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] [Indexed: 08/31/2023]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Louis DiVincenti
- Senior Veterinary Medical Officer - Research, Animal Care National Policy Staff, APHIS, USDA, Riverdale, MD, USA.
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Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Roxanne Mullaney
- Acting Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Brown P, Mullaney R. A Word from OLAW and USDA. Lab Anim (NY) 2023; 52:138. [PMID: 37386159 DOI: 10.1038/s41684-023-01200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Roxanne Mullaney
- Acting Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
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Brown P, Goldentyer B. A Word from OLAW and USDA. Lab Anim (NY) 2023; 52:94. [PMID: 37137977 DOI: 10.1038/s41684-023-01161-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Betty Goldentyer
- Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Shou BL, Ong CS, Premraj L, Brown P, Tonna JE, Dalton HJ, Kim BS, Keller SP, Whitman GJR, Cho SM. Arterial oxygen and carbon dioxide tension and acute brain injury in extracorporeal cardiopulmonary resuscitation patients: Analysis of the extracorporeal life support organization registry. J Heart Lung Transplant 2023; 42:503-511. [PMID: 36435686 PMCID: PMC10050131 DOI: 10.1016/j.healun.2022.10.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [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: 03/14/2022] [Revised: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Acute brain injury (ABI) remains common after extracorporeal cardiopulmonary resuscitation (ECPR). Using a large international multicenter cohort, we investigated the impact of peri-cannulation arterial oxygen (PaO2) and carbon dioxide (PaCO2) on ABI occurrence. METHODS We retrospectively analyzed adult (≥18 years old) ECPR patients in the Extracorporeal Life Support Organization registry from 1/2009 through 12/2020. Composite ABI included ischemic stroke, intracranial hemorrhage (ICH), seizures, and brain death. The registry collects 2 blood gas data pre- (6 hours) and post- (24 hours) cannulation. Blood gas parameters were classified as: hypoxia (<60mm Hg), normoxia (60-119mm Hg), and mild (120-199mm Hg), moderate (200-299mm Hg), and severe hyperoxia (≥300mm Hg); hypocarbia (<35mm Hg), normocarbia (35-44mm Hg), mild (45-54mm Hg) and severe hypercarbia (≥55mm Hg). Missing values were handled using multiple imputation. Multivariable logistic regression analysis was used to assess the relationship of PaO2 and PaCO2 with ABI. RESULTS Of 3,125 patients with ECPR intervention (median age=58, 69% male), 488 (16%) experienced ABI (7% ischemic stroke; 3% ICH). In multivariable analysis, on-ECMO moderate (aOR=1.42, 95%CI: 1.02-1.97) and severe hyperoxia (aOR=1.59, 95%CI: 1.20-2.10) were associated with composite ABI. Additionally, severe hyperoxia was associated with ischemic stroke (aOR=1.63, 95%CI: 1.11-2.40), ICH (aOR=1.92, 95%CI: 1.08-3.40), and in-hospital mortality (aOR=1.58, 95%CI: 1.21-2.06). Mild hypercarbia pre-ECMO was protective of composite ABI (aOR=0.61, 95%CI: 0.44-0.84) and ischemic stroke (aOR=0.56, 95%CI: 0.35-0.89). CONCLUSIONS Early severe hyperoxia (≥300mm Hg) on ECMO was a significant risk factor for ABI and mortality. Careful consideration should be given in early oxygen delivery in ECPR patients who are at risk of reperfusion injury.
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Affiliation(s)
- Benjamin L Shou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chin Siang Ong
- Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Lavienraj Premraj
- Griffith University School of Medicine, Gold Coast, Queensland, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Patricia Brown
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery; Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah
| | - Heidi J Dalton
- Adult and Pediatric Extracorporeal Life Support, INOVA Fairfax Medical Center, Falls Church, Virginia
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven P Keller
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Neuroscience Critical Care, Department of Neurology, Neurosurgery, Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Brown P, Goldentyer B. A Word from OLAW and USDA. Lab Anim (NY) 2023; 52:52. [PMID: 36864298 DOI: 10.1038/s41684-023-01127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Betty Goldentyer
- Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
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Brown P, Merritt A, Skerratt S, Swarbrick M. Recent trends in medicinal chemistry and enabling technologies. Highlights from the Society for Medicines Research Conference. London - December 8, 2022. DRUG FUTURE 2023. [DOI: 10.1358/dof.2023.48.3.3567668] [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: 03/16/2023]
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Brown P, Goldentyer B. A Word from OLAW and USDA. Lab Anim (NY) 2023; 52:2. [PMID: 36600013 DOI: 10.1038/s41684-022-01095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Betty Goldentyer
- Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Courtier N, Williamson K, Brown P, Pope E, Chivers E, Mundy LA. A personal journey to build leadership skills through collaboration to support radiography research and evidence-based practice. J Med Imaging Radiat Sci 2022; 53:S15-S17. [PMID: 35909060 PMCID: PMC9715992 DOI: 10.1016/j.jmir.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/01/2022] [Accepted: 07/13/2022] [Indexed: 12/24/2022]
Abstract
Introduction The Covid-19 pandemic continues to impact on how radiotherapy is delivered, how staff do their job and how patients are cared for. Part of the UK NHS response to the covid-19 crisis was to accelerate final year radiotherapy students into work as therapeutic radiographers. The study objective is to explore the experiences of a cohort of new registrants who started work in May 2020. Methods In depth interviews were conducted remotely with newly qualified therapeutic radiography registrants regarding their first 12 months working in UK NHS cancer centres. Data were analysed within and across cases using a framework analysis and synthesised thematically. Results Eleven radiographers were interviewed, working across six different sites. Key generated themes are the risk of impaired professional socialisation due to incongruence between students’ expectations and the reality in clinical departments. We use Bridges Transitional Model to show how a combination of the disrupted/undefined end to university and a perceived lack of recognition of professional knowledge, skills and values evident in our data may leave participants stuck in a middle stage of the transition process. Slower than expected professional development led to demotivation, which was also associated with rising covid-19 case numbers. Conclusion The covid-19 pandemic accentuated and heightened the existing challenge of professional integration and socialisation faced by new therapeutic radiography staff. Demotivation and potentially attrition are more likely in this environment. Compassionate leadership that fosters the mentorship of junior cohorts as part of a flexible preceptorship package could mitigate these risks.
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Affiliation(s)
- N Courtier
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - K Williamson
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - P Brown
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - E Pope
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - E Chivers
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
| | - LA Mundy
- Department of Radiotherapy & Oncology, Cardiff University, Cardiff. Wales, UK
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Brown P. A Word from OLAW. Lab Anim (NY) 2022; 51:277. [DOI: 10.1038/s41684-022-01073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Matias K, Brown P, Durham D, Godusevic L, Stamper S. 343 Developing cystic fibrosis patient food insecurity education with circle of care partnership. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01033-5] [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: 11/07/2022]
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Lage DE, Johnson PC, Hornstein S, Neckermann I, Schmelkin A, Grayzel C, Brown P, McGrath M, Shulman E, Smith M, Nipp RD, El-Jawahri A. Supportive oncology care at home after discharge for patients with advanced cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.295] [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
295 Background: Patients with advanced cancer often experience frequent and prolonged hospitalizations, and the transition from hospital to home represents a critical period for these individuals, as they prefer to maximize time at home and avoid readmissions. We sought to demonstrate the feasibility and acceptability of a Supportive Oncology Care at Home intervention to address the post-discharge needs of recently hospitalized patients with advanced cancer. Methods: We conducted a single-arm pilot trial at Massachusetts General Hospital (MGH). We enrolled English-speaking adults with advanced solid tumors experiencing their second or later unplanned hospitalization, who were being discharged home without hospice services and residing within a 50 mile radius of MGH. The three-week intervention consisted of: 1) hospital in the home care model for proactive symptom assessment and management, including clinician visits to assess patients, draw labs, administer intravenous medications and hydration, and ensure optimal symptom management; 2) remote monitoring of daily patient-reported symptoms, vital signs, and body weight; and 3) structured communication with the oncology team. The primary endpoint of the study was feasibility, defined as ≥60% of approached and eligible patients enrolling and ≥60% of participants completing daily symptom assessments. After intervention completion, patients rated the helpfulness and convenience of the intervention and symptom monitoring technology. Results: From 12/2021-6/2022, we enrolled 40 out of 66 approached patients (60.6% enrollment rate). Enrolled patients (median age = 58.5 years, 50% female, 75% white, 68% married, 50% gastrointestinal cancers) completed 93.8% of daily symptom assessments. 12 patients (30%) did not complete the intervention due to withdrawal (5), hospice transfer (4), or death (3). Among enrolled patients, 20.0% were enrolled in hospice and 15.4% died at 30 days after hospital discharge. In exit interviews, 100% and 75% rated the intervention and symptom monitoring as helpful, respectively. 83% of patients found the in-home monitoring technology convenient. Conclusions: We found that a three-week Supportive Oncology Care at Home intervention is a feasible approach to providing post-discharge care for high acuity, seriously ill hospitalized patients with advanced cancer. These patients also found the intervention highly acceptable. Future studies will test the efficacy of the intervention for reducing hospital readmissions, improving symptom management and quality of life, and increasing days spent at home near the end of life. Clinical trial information: NCT04637035.
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Brown P, Goldentyer B. A Word from OLAW and USDA. Lab Anim (NY) 2022; 51:245. [DOI: 10.1038/s41684-022-01057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Brown P, Goldentyer B. A Word from OLAW and USDA. Lab Anim (NY) 2022; 51:205. [DOI: 10.1038/s41684-022-01021-z] [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: 11/09/2022]
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Brown P, Goldentyer B. A Word from OLAW and USDA. Lab Anim (NY) 2022; 51:180. [DOI: 10.1038/s41684-022-01002-2] [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: 11/10/2022]
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Ong CS, Brown P, Shou BL, Wilcox C, Cho SM, Mendez-Tellez PA, Kim BS, Whitman GJR. Resting Energy Expenditure of Patients on Venovenous Extracorporeal Membrane Oxygenation for Adult Respiratory Distress Syndrome: A Pilot Study. Crit Care Explor 2022; 4:e0730. [PMID: 35923588 PMCID: PMC9296180 DOI: 10.1097/cce.0000000000000730] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The objectives of this study were to 1) in patients without pulmonary function, determine resting energy expenditure (REE) in venovenous extracorporeal membrane oxygenation (ECMO) acute respiratory distress syndrome (ARDS) patients by paralysis status and 2) determine the threshold tidal volume (TV) associated with meaningful gas exchange as determined by measurable end-tidal carbon dioxide elimination (etV̇co2). DESIGN Retrospective observational study. SETTING A tertiary high ECMO volume academic institution. PATIENTS/SUBJECTS Ten adult ARDS patients on venovenous ECMO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The modified Weir equation, Fick principle, Henderson-Hasselbalch equation, ECMO flow, hemoglobin, and pre and post oxygenator blood gases were used to determine ECMO carbon dioxide production (V̇co2), ECMO oxygen consumption, and REE. REE values were matched to patients' paralysis status based on medication flowsheets and compared using a paired t test. Linear regression was performed to determine the threshold TV normalized to ideal body weight (IBW) associated with measurable ventilator etV̇co2, above which meaningful ventilation occurs. When lungs were not functioning, patients had significantly lower mean REE when paralyzed (23.4 ± 2.8 kcal/kg/d) than when not paralyzed (29.2 ± 5.8 kcal/kg/d) (p = 0.02). Furthermore, mean REE was not similar between patients and varied as much as 1.7 times between patients when paralyzed and as much as 1.4 times when not paralyzed. Linear regression showed that ventilator V̇co2 was measurable and increased linearly when TV was greater than or equal to 0.7 mL/kg. CONCLUSIONS REE is patient-specific and varies significantly with and without patient paralysis. When TV exceeds 0.7 mL/kg IBW, ventilator V̇co2 increases measurably and must be considered in determining total REE.
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Affiliation(s)
- Chin Siang Ong
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Surgical Outcomes, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Patricia Brown
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benjamin L Shou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher Wilcox
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sung-Min Cho
- Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD
| | | | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Hess SP, Levin M, Akram F, Woo K, Andersen L, Trenkle K, Brown P, Ouyang B, Fleisher JE. The impact and feasibility of a brief, virtual, educational intervention for home healthcare professionals on Parkinson's Disease and Related Disorders: pilot study of I SEE PD Home. BMC Med Educ 2022; 22:506. [PMID: 35761252 PMCID: PMC9238152 DOI: 10.1186/s12909-022-03430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individuals with advanced Parkinson's Disease (PD) and Parkinson-related disorders (PRD) are frequently referred for home allied therapies and nursing care, yet home healthcare professionals have limited training in PD/PRD. While recognizing the need for such care, patients and families report home healthcare professionals are unfamiliar with these conditions, which may be driven by neurophobia and may contribute to suboptimal care and early termination of services. We sought to determine the feasibility and effects of a virtual, multimodal educational intervention on PD knowledge, confidence, and empathy among home health professionals. METHODS Home health nurses, occupational therapists, physical therapists and physical therapy assistants, and speech-language pathologists participated in a daylong, virtual symposium on advanced PD/PRD, combining focused lectures, discipline-specific breakout sessions, immersive virtual reality vignettes, and interactive panels with both patients and families, and movement disorders and home healthcare experts. Participants completed online pre- and post-symposium surveys including: demographics; PD/PRD knowledge (0-10 points possible); empathy (Interpersonal Reactivity Index); and 10-point scales of confidence with and attitudes towards individuals with PD/PRD, respectively. Pre-post intervention changes and effect sizes were evaluated with paired t-tests and Cohen's d. We performed qualitative analyses of post-symposium free-text feedback using a grounded theory approach to identify participants' intentions to change their practice. RESULTS Participants had a mean improvement of 3.1 points on the PD/PRD knowledge test (p < 0.001, d = 1.97), and improvement in confidence managing individuals with PD/PRD (p = 0.0003, d = .36), and no change in empathy. The interactive, virtual format was rated as effective by 95%. Common themes regarding symposium-motivated practice change included: interdisciplinary collaboration; greater involvement and weighting of the patient and caregiver voice in care plans; attention to visit scheduling in relation to patient function; recognition and practical management of the causes of sudden change in PD/PRD, including infections and orthostatic hypotension. CONCLUSIONS A virtual, multimodal, brief educational pilot intervention improved PD/PRD-specific knowledge and confidence among home healthcare nurses and allied health professionals. Future studies are necessary to test the short- and long-term effects of this intervention more broadly and to investigate the impact of this education on patient and caregiver outcomes.
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Affiliation(s)
- Serena P Hess
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Melissa Levin
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
- Chicago Medical School - Rosalind Franklin University, 3333 Green Bay Road, North Chicago, IL, 60064, USA
| | - Faizan Akram
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Katheryn Woo
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
- Loyola University Chicago College of Arts and Sciences, 1032 W. Sheridan Road, Chicago, IL, 60660, USA
| | - Lauren Andersen
- Department of Physical Therapy, Rush University Medical Center, 1725 W. Harrison Street, Suite 440, Chicago, IL, 60612, USA
- Rush Physical Therapy, Select Medical, 1725 W. Harrison Street, Chicago, IL, 60612, USA
| | - Kristie Trenkle
- Rush Physical Therapy, Select Medical, 1725 W. Harrison Street, Chicago, IL, 60612, USA
- Department of Occupational Therapy, Rush University Medical Center, 1725 W. Harrison Street, Suite 440, Chicago, IL, 60612, USA
| | - Patricia Brown
- Memorycare Corporation, 634 Brooklyn Drive, Aurora, IL, 60502, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Jori E Fleisher
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA.
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Brown P, Goldentyer B. A Word from OLAW and USDA. Lab Anim (NY) 2022; 51:125. [PMID: 35505134 DOI: 10.1038/s41684-022-00964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Betty Goldentyer
- Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Brown P, Goldentyer B. A Word from USDA and OLAW. Lab Anim (NY) 2022; 51:71. [PMID: 35241849 DOI: 10.1038/s41684-022-00927-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Betty Goldentyer
- Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Trivedi S, Stefani L, Byth K, Brown P, Qian P, Kumar S, Thomas S, Thomas L. Left Ventricular Diastolic Dysfunction and Left Atrial Myopathy Independently Predict Atrial Fibrillation Recurrence Post Pulmonary Vein Isolation. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.026] [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: 11/29/2022]
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Trivedi S, Stefani L, Byth K, Brown P, Qian P, Kumar S, Thomas S, Thomas L. Medium-term Maintenance of Sinus Rhythm Post Pulmonary Vein Isolation Results in Significant Cardiac Reverse Remodelling. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.175] [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: 11/29/2022]
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Brown P, Goldentyer B. A Word from the USDA and OLAW. Lab Anim (NY) 2021; 50:298. [PMID: 34697437 DOI: 10.1038/s41684-021-00874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Betty Goldentyer
- Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Brown P, Watts V, Hanna M, Rizk M, Tucker E, Saddlemire A, Peteet B. Two Epidemics and a Pandemic: The Collision of Prescription Drug Misuse and Racism during COVID-19. J Psychoactive Drugs 2021; 53:413-421. [PMID: 34694200 DOI: 10.1080/02791072.2021.1992048] [Citation(s) in RCA: 3] [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] [Indexed: 10/20/2022]
Abstract
The present study investigated the relationship between perceived racial discrimination and prescription drug misuse (PDM) among Asian, Black, and Latinx Americans during the COVID-19 crisis. U.S. racial/ethnic minorities may have been uniquely affected by two national and one global pandemic: the opioid crisis, racism, and COVID-19. Opioid death rates increased among many groups prior to the pandemic. This country witnessed an increase in racialized acts against people of color across the spectrum in the spring and summer months of the world's COVID-19 outbreak. While studies have shown a clear link between perceived racial discrimination and substance abuse outside of the global pandemic, no identified studies have done so against the backdrop of a global health pandemic. Separate hierarchical regressions revealed a significant association between perceived racial discrimination and PDM for Black Americans, Asian Americans, and Latinx individuals. Findings build on the scant literature on PDM in diverse samples and establish a relationship between perceived racial discrimination and PDM, as previously identified for other abused substances. Future post-pandemic substance misuse interventions should consider the influence of perceived racial discrimination as they help individuals recover from the aftermath of this stressful trifecta.
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Affiliation(s)
- P Brown
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - V Watts
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - M Hanna
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - M Rizk
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - E Tucker
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - A Saddlemire
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
| | - B Peteet
- Department of Psychology, Loma Linda University, Loma Linda, California, USA
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Graham K, Gilligan D, Brown P, van Klinken RD, McColl KA, Durr PA. Use of spatio-temporal habitat suitability modelling to prioritise areas for common carp biocontrol in Australia using the virus CyHV-3. J Environ Manage 2021; 295:113061. [PMID: 34348430 DOI: 10.1016/j.jenvman.2021.113061] [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: 10/31/2020] [Revised: 05/09/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
Common carp (Cyprinus carpio) are an invasive species of the rivers and waterways of south-eastern Australia, implicated in the serious decline of many native fish species. Over the past 50 years a variety of control options have been explored, all of which to date have proved either ineffective or cost prohibitive. Most recently the use of cyprinid herpesvirus 3 (CyHV-3) has been proposed as a biocontrol agent, but to assess the risks and benefits of this, as well as to develop a strategy for the release of the virus, a knowledge of the fundamental processes driving carp distribution and abundance is required. To this end, we developed a novel process-based modelling framework that integrates expert opinion with spatio-temporal datasets via the construction of a Bayesian Network. The resulting weekly networks thus enabled an estimate of the habitat suitability for carp across a range of hydrological habitats in south-eastern Australia, covering five diverse catchment areas encompassing in total a drainage area of 132,129 km2 over a period of 17-27 years. This showed that while suitability for adult and subadult carp was medium-high across most habitats throughout the period, nevertheless the majority of habitats were poorly suited for the recruitment of larvae and young-of-year (YOY). Instead, high population abundance was confirmed to depend on a small number of recruitment hotspots which occur in years of favourable inundation. Quantification of the underlying ecological drivers of carp abundance thus makes possible detailed planning by focusing on critical weaknesses in the population biology of carp. More specifically, it permits the rational planning for population reduction using the biocontrol agent, CyHV-3, targeting areas where the total population density is above a "damage threshold" of approximately 100 kg/ha.
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Affiliation(s)
- K Graham
- CSIRO Australian Centre for Disease Preparedness (ACDP), Geelong, VIC, Australia
| | - D Gilligan
- NSW Department of Primary Industries - Fisheries NSW, NSW, Australia
| | - P Brown
- Centre for Freshwater Ecosystems, School of Life Sciences, La Trobe University, Mildura, VIC, Australia; Fisheries and Wetlands Consulting, Portarlington, VIC, Australia
| | | | - K A McColl
- CSIRO Health and Biosecurity, Geelong, VIC, Australia
| | - P A Durr
- CSIRO Australian Centre for Disease Preparedness (ACDP), Geelong, VIC, Australia.
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Gaufberg E, Vyas C, Azoba C, Qian CL, Jaggers J, Weekes CD, Allen JN, Roeland E, Parikh AR, Miller L, Smith M, Bergeron-Noa M, Brown P, Shulman E, Hong TS, Greer JA, Ryan DP, Temel JS, El-Jawahri A, Nipp RD. Supportive oncology care at home intervention for patients with pancreatic cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2020.39.28_suppl.155] [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: 11/20/2022] Open
Abstract
155 Background: Patients with pancreatic cancer receiving chemotherapy often experience substantial symptoms and high healthcare utilization. We sought to determine the feasibility of delivering a Supportive Oncology Care at Home intervention designed to address the needs of patients receiving treatment for pancreatic cancer. Methods: We prospectively enrolled patients with pancreatic cancer who were participating in a parent trial of neoadjuvant FOLFIRINOX and residing in-state, within 50 miles of our hospital. Patients received the Supportive Oncology Care at Home intervention during neoadjuvant treatment (i.e., up to 4 months). The intervention entailed: 1) remote monitoring of daily patient-reported symptoms, daily vital signs, and weekly body weight; 2) a hospital in the home care model for symptom assessment and management; and 3) structured communication with the oncology team. We defined the intervention as feasible if ≥60% of patients enrolled in the study and ≥60% completed the daily assessments within the first two weeks of enrollment. We tracked numbers of phone calls, emails, and home visits generated by the intervention. We conducted exit interviews with patients, caregivers, and oncology clinicians to assess the acceptability of the intervention. We also compared rates of treatment delays, urgent clinic visits, emergency room (ER) visits, and hospitalizations among those who did (n = 20) and did not (n = 24) receive Supportive Oncology Care at Home from the parent trial. Results: From 1/2019-9/2020, we enrolled 80.8% (21/26) of potentially eligible patients. One patient became ineligible following consent due to moving out-of-state, resulting in 20 participants (median age = 67 years [range 55-77]; 60.0% female). In the first two weeks of enrollment, 65.0% of participants completed all daily assessments. Overall, patients reported 96.1% of daily symptoms, 96.1% of daily vital signs, and 92.5% of weekly body weights. Each participant generated an average of 2.22 phone calls (range 0.62-3.77), 2.96 emails (range 1.50-5.88), and 0.15 home visits (range 0-0.69) per week. During exit interviews, > 80% of patients, caregivers, and clinicians found the intervention to be helpful and convenient, and they reported high satisfaction with the communication among patients, clinicians, and the hospital in the home team. Patients receiving the intervention had lower rates of treatment delays (55.0% v 75.0%), urgent clinic visits (10.0% v 25.0%), ER visits or hospitalizations (45.0% v 62.5%), as well as a lower proportion of days spent in urgent clinic, ER, or hospital (2.7% v 7.8%), compared with those not receiving the intervention who were in the same parent trial. Conclusions: These findings demonstrate the feasibility and acceptability of a Supportive Oncology Care at Home intervention. Future work will investigate the efficacy of this intervention for decreasing healthcare use and improving patient outcomes. Clinical trial information: NCT03798769.
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Affiliation(s)
| | - Charu Vyas
- Massachusetts General Hospital, Boston, MA
| | | | | | | | - Colin D. Weekes
- University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Jill N. Allen
- Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Eric Roeland
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | | | | | | | | | - Joseph A. Greer
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Brown P, Goldentyer B. A Word from the USDA and OLAW. Lab Anim (NY) 2021; 50:260. [PMID: 34561674 DOI: 10.1038/s41684-021-00851-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Patricia Brown
- Director, Office of Laboratory Animal Welfare, OER, OD, NIH, HHS, Bethesda, MD, USA.
| | - Betty Goldentyer
- Deputy Administrator, Animal Care, APHIS, USDA, Riverdale, MD, USA.
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Kowalchuk R, Mullikin T, Harmsen W, Rose P, Siontis B, Kim D, Costello B, Morris J, Marion J, Johnson-Tesch B, Gao R, Shiraishi S, Lucido J, Trifiletti D, Olivier K, Owen D, Stish B, Waddle M, Laack N, Park S, Brown P, Merrell K. OC-0405 Development and internal validation of an RPA-based pre-treatment decision tool for spinal SBRT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06892-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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DeWees T, Abraha F, Corbin K, Brown P, Hallemeier C, Davis B, Petersen I, Martenson J, Ahmed S, Olivier K, Vern-Gross T, Rule W, Wong W, Vora S, Patel S, Ashman J, Schild S, Trifiletti D, Vargas C, Ma D. PO-1498 Clinical Sensitivity of PROMIS-10 Physical and Mental Quality of Life Domains to Radiation Therapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McNutt D, Julius W, Gorban M, Mattingly B, Brown P, Cleaver G. Geometric surfaces: An invariant characterization of spherically symmetric black hole horizons and wormhole throats. Int J Clin Exp Med 2021. [DOI: 10.1103/physrevd.103.124024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Brown P, Anderson A, Hargreaves B, Morgan A, Isaacs JD, Pratt A. OP0033 REGULATORY T CELL CD39 EXPRESSION AS A PREDICTOR OF EARLY REMISSION-INDUCTION WITH METHOTREXATE IN NEW-ONSET RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The long term outcomes for patients with rheumatoid arthritis (RA) depend on early and effective disease control. Methotrexate remains the key first line disease modifying therapy for the majority of patients, with 40% achieving an ACR50 on monotherapy(1). There are at present no effective biomarkers to predict treatment response, preventing effective personalisation of therapy. A putative mechanism of action of methotrexate, the potentiation of anti-inflammatory adenosine signalling, may inform biomarker discovery. By antagonism of the ATIC enzyme in the purine synthesis pathway, methotrexate has been proposed to increase the release of adenosine moieties from cells, which exert an anti-inflammatory effect through interaction with ADORA2 receptors(2). Lower expression of CD39 (a cell surface 5-’ectonucleotidase required for the first step in the conversion of ATP to adenosine) on circulating regulatory T-Lymphocytes (Tregs) was previously identified in patients already established on methotrexate who were not responding (DAS28 >4.0 vs <3.0)(3). We therefore hypothesised that pre-treatment CD39 expression on these cells may have clinical utility as a predictor of early methotrexate efficacy.Objectives:To characterise CD39 expression in peripheral blood mononuclear cells in RA patients naïve to disease modifying therapy commencing methotrexate, and relate this expression to 4 variable DAS28CRP remission (<2.6) at 6 months.Methods:68 treatment naïve early RA patients starting methotrexate were recruited from the Newcastle Early Arthritis Clinic and followed up for 6 months. Serial blood samples were taken before and during methotrexate therapy with peripheral blood mononuclear cells isolated by density centrifugation. Expression of CD39 by major immune subsets (CD4+ and CD8+ T-cells, B-lymphocytes, natural killer cells and monocytes) was determined by flow cytometry. The statistical analysis used was binomial logistic regression with baseline DAS28CRP used as a covariate due to the significant association of baseline disease activity with treatment response.Results:Higher pre-treatment CD39 expression was observed in circulating CD4+ T-cells of patients who subsequently achieved clinical remission at 6 months versus those who did not (median fluorescence 4854.0 vs 3324.2; p = 0.0108; Figure 1-A). This CD39 expression pattern was primarily accounted for by the CD4+CD25 high sub-population (median fluorescence 9804.7 vs 6455.5; p = 0.0065; Figure 1-B). These CD25 high cells were observed to have higher FoxP3 and lower CD127 expression than their CD39 negative counterparts, indicating a Treg phenotype. No significant associations were observed with any other circulating subset. A ROC curve demonstrates the discriminative utility of differential CD39 expression in the CD4+CD25 high population for the prediction of DAS28CRP remission in this cohort, showing greater specificity than sensitivity for remission prediction(AUC: 0.725; 95% CI: 0.53 - 0.92; Figure 1-C). Longitudinally, no significant induction or suppression of the CD39 marker was observed amongst patients who did or did not achieve remission over the 6 months follow-up period.Figure 1.Six month DAS28CRP remission versus pre-treatment median fluorescence of CD39 expression on CD4+ T-cells (A); CD25 High expressing CD4+ T-cells (B); and ROC curve of predictive utility of pre-treatment CD39 expression on CD25 High CD4+ T-cells (C).Conclusion:These findings support the potential role of CD39 in the mechanism of methotrexate response. Expression of CD39 on circulating Tregs in treatment-naïve RA patients may have particular value in identifying early RA patients likely to respond to methotrexate, and hence add value to evolving multi-parameter discriminatory algorithms.References:[1]Hazlewood GS, et al. BMJ. 2016 21;353:i1777[2]Brown PM, et al. Nat Rev Rheumatol. 2016;12(12):731-742[3]Peres RS, et al. Proc Natl Acad Sci U S A. 2015;112(8):2509-2514Disclosure of Interests:None declared
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d'Amore F, Leppä S, Relander T, Larsen TS, Brown P, Jørgensen J, Mannisto S, Lugtenburg P, Leivonen S, Holte H, Fagerli UM, Lauritzsen GF, Meyer P, Minotti G, Menna P, Liestøl K, Toldbod H. FINAL ANALYSIS OF A NORDIC LYMPHOMA GROUP PHASE IB/IIA TRIAL OF PIXANTRONE, ETOPOSIDE, BENDAMUSTINE AND, IN CD20‐POSITIVE TUMORS, RITUXIMAB IN RELAPSED AGGRESSIVE B‐ OR T‐CELL LYMPHOMAS. Hematol Oncol 2021. [DOI: 10.1002/hon.151_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F d'Amore
- Aarhus University Hospital, Hematology Aarhus N Denmark
| | - S Leppä
- Helsinki University Hospital Oncology Helsinki Finland
| | - T Relander
- Skane University Hospital Oncology Lund Sweden
| | - T. S Larsen
- Odense University Hospital Hematology Odense Denmark
| | - P Brown
- Copenhagen University Hospital Hematology Copenhagen Denmark
| | - J Jørgensen
- Aarhus University Hospital, Hematology Aarhus N Denmark
| | - S Mannisto
- Helsinki University Hospital Oncology Helsinki Finland
| | - P Lugtenburg
- University Medical Center, Erasmus MC Cancer Institute Rotterdam Netherlands
| | - S.‐K Leivonen
- Helsinki University Hospital Oncology Helsinki Finland
| | - H Holte
- Oslo University Hospital Oncology Oslo Norway
| | | | | | - P Meyer
- Stavanger University Hospital Oncology Stavanger Norway
| | - G Minotti
- University Hospital Campus Bio‐Medico Clinical Pharmaclogy Laboratory Rome Italy
| | - P Menna
- University Hospital Campus Bio‐Medico Clinical Pharmaclogy Laboratory Rome Italy
| | - K Liestøl
- University of Oslo Informatics Oslo Norway
| | - H Toldbod
- Aarhus University Hospital, Hematology Aarhus N Denmark
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Jurado Zapata S, Maurits M, Abraham Y, Van den Akker E, Barton A, Brown P, Cope A, González-Álvaro I, Goodyear C, van der Helm - van Mil A, Hu X, Huizinga T, Johannesson M, Klareskog L, Lendrem D, McInnes I, Morton F, Paterson C, Porter D, Pratt A, Rodriguez Rodriguez L, Sieghart D, Studenic P, Verstappen S, Padyukov L, Winkler A, Isaacs JD, Knevel R. POS0348 GENETIC SUSCEPTIBILITY VARIANTS FOR RHEUMATOID ARTHRITIS ARE NOT ASSOCIATED WITH EARLY REMISSION; A MULTI-COHORT STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients who achieve remission promptly could have a specific genetic risk profile that supports regaining immune tolerance. The identification of these genes could provide novel drug targets.Objectives:To test the association between RA genetic risk variants with achieving remission at 6 months.Methods:We computed genetic risk scores (GRS) comprising of the RA susceptibility variants1 and HLA-SE status separately in 4425 patients across eight datasets from inception cohorts. Remission was defined as DAS28CRP<2.6 at 6 months. Missing DAS28CRP values in patients were imputed using predictive mean matching by MICE. We first tested whether baseline DAS28CRP changed with increasing GRS using linear regression. Next, we calculated odds ratios for GRS and HLA-SE on remission using logistic regression. Heterogeneity of the outcome between datasets was mitigated by running inverse variance meta-analysis.Results:Evaluation of the complete dataset, baseline clinical variables did not differ between patients achieving remission and those who did not (Table 1). Distribution of GRS was consistent between datasets. Neither GRS nor HLA-SE was associated with baseline DAS2DAS (OR1.01; 95% CI 0.99-1.04). A fixed effect meta-analysis (Figure 1.) showed no significant effect of the GRS (OR 0.99; 95% CI 0.94-1.03) or HLA-SE (OR 0.8CRP87; 95% CI 0.75-1.01) on remission at 6 months.Table 1.Summary of the data separated by disease activity after 6 months.allRemission at 6 monthsNo remission at 6 monthsN4425*15582430Age, mean (sd)55.38 (13.87)5517 (14.09)55.62 (13.59)Female %68.98%65.43%70.73%ACPA+ %61.94%63.53%61.67%Baseline DAS28, mean (sd)4.76 (1.22)4.47 (1.23)5.1 (1.15)*not all patients had 6 months dataConclusion:In these combined cohorts, RA genetics risk variants are not associated with early disease remission. At baseline there was no difference in genetic risk between patients achieving remission or not. Studies encompassing other genetic variants are needed to elucidate the genetics of RA remission.References:[1]Knevel R et al. Sci Transl Med. 2020;12(545):eaay1548.Acknowledgements:This project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777357, RTCure.This project has received funding from Pfizer Inc.Disclosure of Interests:Samantha Jurado Zapata: None declared, Marc Maurits: None declared, Yann Abraham Employee of: Pfizer, Erik van den Akker: None declared, Anne Barton: None declared, Philip Brown: None declared, Andrew Cope: None declared, Isidoro González-Álvaro: None declared, Carl Goodyear: None declared, Annette van der Helm - van Mil: None declared, Xinli Hu Employee of: Pfizer, Thomas Huizinga: None declared, Martina Johannesson: None declared, Lars Klareskog: None declared, Dennis Lendrem: None declared, Iain McInnes: None declared, Fraser Morton: None declared, Caron Paterson: None declared, Duncan Porter: None declared, Arthur Pratt: None declared, Luis Rodriguez Rodriguez: None declared, Daniela Sieghart: None declared, Paul Studenic: None declared, Suzanne Verstappen: None declared, Leonid Padyukov: None declared, Aaron Winkler Employee of: Pfizer, John D Isaacs: None declared, Rachel Knevel Grant/research support from: Pfizer
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Jørgensen GØ, Favero F, Schmidt Jespersen J, Tulstrup MR, Rodriguez‐Gonzalez FG, Nielsen AF, Sørensen B, Ebbesen LH, Bæch J, Haastrup EK, Nielsen C, Josefsson PL, Thorsgaard M, El‐Galaly TC, Brown P, Weischenfeldt JL, Larsen TS, Grønbæk K, Husby S. CLINICAL IMPACT OF T‐CELL RECEPTOR REPERTOIRE DIVERSITY IN PATIENTS WITH LYMPHOMA UNDERGOING AUTOLOGOUS STEM CELL TRANSPLANTATION. Hematol Oncol 2021. [DOI: 10.1002/hon.1_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - F Favero
- Finsen laboratory Hematology‐Oncology, Rigshospitalet Copenhagen Denmark
| | | | | | | | - A. F Nielsen
- Rigshospitalet Dept. of Clinical Immunology Copenhagen Denmark
| | - B Sørensen
- Aarhus University Hospitalet Clinical Immunology Aarhus Denmark
| | - L. H Ebbesen
- Aarhus University Hospital Clinical Immunology Aarhus Denmark
| | - J Bæch
- Aalborg University Hospital Clinical Immunology Aalborg Denmark
| | - E. K Haastrup
- Rigshospitalet Dept. of Clinical Immunology Copenhagen Denmark
| | - C Nielsen
- Odense University Hospital Dept. of Clinical Immunology Copenhagen Denmark
| | | | - M Thorsgaard
- Aarhus University Hospital Hematology Aarhus Denmark
| | | | - P Brown
- Rigshospitalet Hematology Copenhagen N Denmark
| | - J. L Weischenfeldt
- Finsen laboratory Hematology‐Oncology, Rigshospitalet Copenhagen Denmark
| | - T. S Larsen
- Odense University Hospital Hematology Odense Denmark
| | - K Grønbæk
- Rigshospitalet Hematology Copenhagen N Denmark
| | - S Husby
- Rigshospitalet Hematology Copenhagen N Denmark
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Nipp RD, Gaufberg E, Vyas C, Azoba C, Qian CL, Jaggers J, Weekes CD, Allen JN, Roeland E, Parikh AR, Miller L, Smith M, Bergeron-Noa M, Brown P, Shulman E, Hong TS, Greer JA, Ryan DP, Temel J, El-Jawahri A. Supportive oncology care at home intervention for patients with pancreatic cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6558 Background: Patients with pancreatic cancer receiving chemotherapy often experience substantial symptoms and high healthcare utilization. We sought to determine the feasibility of delivering a Supportive Oncology Care at Home intervention designed to address the needs of patients receiving treatment for pancreatic cancer. Methods: We prospectively enrolled patients with pancreatic cancer who were participating in a parent trial of neoadjuvant FOLFIRINOX and residing in-state, within 50 miles of our hospital. Patients received the Supportive Oncology Care at Home intervention during neoadjuvant treatment (i.e., up to 4 months). The intervention entailed: 1) remote monitoring of daily patient-reported symptoms, daily vital signs, and weekly body weight; 2) a hospital in the home care model for symptom assessment and management; and 3) structured communication with the oncology team. We defined the intervention as feasible if ≥60% of patients enrolled in the study and ≥60% completed the daily assessments within the first two weeks of enrollment. We tracked numbers of phone calls, emails, and home visits generated by the intervention. We conducted exit interviews with patients, caregivers, and oncology clinicians to assess the acceptability of the intervention. In addition, we compared rates of treatment delays, urgent clinic visits, emergency room (ER) visits, and hospitalizations among those who did (n = 20) and did not (n = 24) receive Supportive Oncology Care at Home from the parent trial. Results: From 1/2019-9/2020, we enrolled 80.8% (21/26) of potentially eligible patients. One patient became ineligible following consent due to moving out-of-state, resulting in 20 participants (median age = 67 years [range 55-77]; 60.0% female). Within the first two weeks of enrollment, 65.0% completed all the daily assessments, with participants reporting 96.1% of daily symptoms, 96.1% of daily vital signs, and 92.5% of weekly body weights. Each participant generated an average of 2.22 phone calls (range 0.62-3.77), 2.96 emails (range 1.50-5.88), and 0.15 home visits (range 0-0.69) per week. During exit interviews, > 80% of patients, caregivers, and clinicians found the intervention to be helpful and convenient, and they reported high satisfaction with the communication among patients, clinicians, and the hospital in the home team. Patients receiving the intervention had lower rates of treatment delays (55.0% v 75.0%), urgent clinic visits (10.0% v 25.0%), ER visits or hospitalizations (45.0% v 62.5%), as well as a lower proportion of days spent in urgent clinic, ER, or hospital (2.7% v 7.8%), compared with those not receiving the intervention who were in the same parent trial. Conclusions: These findings demonstrate the feasibility and acceptability of a Supportive Oncology Care at Home intervention. Future work will investigate the efficacy of this intervention for decreasing healthcare use and improving patient outcomes. Clinical trial information: NCT03798769.
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Affiliation(s)
- Ryan David Nipp
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA
| | | | - Charu Vyas
- Massachusetts General Hospital, Boston, MA
| | | | | | | | - Colin D. Weekes
- University of Colorado Comprehensive Cancer Center, Aurora, CO
| | | | - Eric Roeland
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Aparna Raj Parikh
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | - Joseph A. Greer
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Gupta A, Brown P, Houchens N, Harrod M, Ridenour J, Hausman MS, Saint S. The Non-Veteran Experience at Veterans Affairs Medical Centers During the COVID-19 Pandemic: a Survey-Based Study. J Gen Intern Med 2021; 36:1473-1475. [PMID: 33620627 PMCID: PMC7901508 DOI: 10.1007/s11606-021-06643-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/26/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Ashwin Gupta
- Veterans Affairs Ann Arbor Healthcare System, MI, Ann Arbor, USA. .,Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Patricia Brown
- Medicine Service, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA.,Division of Infectious Disease, Department of Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nathan Houchens
- Veterans Affairs Ann Arbor Healthcare System, MI, Ann Arbor, USA.,Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Molly Harrod
- Veterans Affairs Ann Arbor Healthcare System, MI, Ann Arbor, USA
| | | | - Mark S Hausman
- Veterans Affairs Ann Arbor Healthcare System, MI, Ann Arbor, USA.,Department of Anesthesiology, University of Michigan Medical School, MI, Ann Arbor, USA
| | - Sanjay Saint
- Veterans Affairs Ann Arbor Healthcare System, MI, Ann Arbor, USA.,Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Courtier N, Brown P, Mundy L, Pope E, Chivers E, Williamson K. Expectations of therapeutic radiography students in Wales about transitioning to practice during the Covid-19 pandemic as registrants on the HCPC temporary register. Radiography (Lond) 2021; 27:316-321. [PMID: 32943355 PMCID: PMC7476453 DOI: 10.1016/j.radi.2020.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The Covid-19 crisis continues to profoundly impact on radiotherapy practice in the UK. We explore the views of therapeutic radiographer students on entering their first post in unique circumstances as a means to evaluate the support that may minimise negative impacts on their transition to practitioners. METHOD Focus groups were conducted outside of students' final year educational programme and immediately prior to them starting work. Qualitative data were analysed using a framework analysis. RESULTS Emergent themes from the eleven participants were: Covid-19 as a layer on top of underlying anxieties; Degree of readiness for imminent psychological, emotional and practical challenges; Feeling valued as a health professional/radiographer at this time; A mixed student and qualified staff professional identity as HCPC temporary registrants. CONCLUSION Uncertainties related to Covid-19 were seen to add a destabilising component to existing anxieties and challenges. In this context, there are significant risks of impaired professional socialisation due to incongruence between students' expectations and the reality in clinical departments. IMPLICATIONS FOR PRACTICE Informed academic support and flexible clinical preceptorship that address anxieties and congruence barriers are vital to guide new practitioners through a health crisis that presents significant challenges but also opportunity for professional development.
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Affiliation(s)
- N Courtier
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK.
| | - P Brown
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
| | - L Mundy
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
| | - E Pope
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
| | - E Chivers
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
| | - K Williamson
- Cardiff University School of Healthcare Sciences, Ty Dewi Sant, University Hospital Wales, Heath Campus, Cardiff, CF14 4XN, UK
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Brown P. Abstract SP020: Beyond Hormones: Newer Pharmacologic Approaches. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-sp20] [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: 11/16/2022]
Abstract
Abstract
It is now possible to prevent many breast cancers inhigh-risk women using anti-estrogen hormonal drugs. Several Phase III breast cancer preventiontrials demonstrated that hormonal drugs such as the “selective estrogenreceptor modulators” tamoxifen and raloxifene, and aromatase inhibitors preventthe development of 50% of ER-positive breast cancers in women. However, mostwomen at high risk of breast cancer do not use these cancer preventive drugsdue to concerns about their side effects. To overcome this problem, recent studies havefocused on testing novel approaches for the prevention of breast cancer. Results of preclinical and clinical studiestesting targeted drugs and vaccines for breast cancer prevention show that itis possible to prevent breast cancer with reduced toxicity. Studies seeking to prevent all forms ofbreast cancer, including ER-positive, HER2-positive, and “triple-negative”breast cancer, will be presented and discussed. Novel approaches testing targeted therapies including signalinginhibitors, combinations of preventive agents, and vaccines, will be presented. Many of these interventions prevent breastcancer in animal models, and are now being tested in human clinicaltrials. Results from studies testing novel drugdelivery approaches will also be discussed. Topical gels containing anti-estrogen drugs are being used to reducebreast cell growth and mammographic density in Phase II clinical trials. This topical approach has the potential toprevent ER-positive breast cancers without the toxicity of oral hormonaldrugs. All of these novel preventive measuresoffer great promise to effectively prevent all forms of breast cancer withminimal toxicity.
Citation Format: P Brown. Beyond Hormones: Newer Pharmacologic Approaches [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SP020.
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Affiliation(s)
- P Brown
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Kamaledeen S, Brown P, Gangi A, Pantelidou M, Chan N. Survey of research participation amongst UK radiology trainees: aspirations, barriers, solutions and the Radiology Academic Network for Trainees (RADIANT). Clin Radiol 2021; 76:302-309. [PMID: 33583566 DOI: 10.1016/j.crad.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
AIM To inform the activity of the newly formed Radiology Academic Network for Trainees (RADIANT) regarding the current level of interest, engagement, and barriers experienced by UK radiology trainees to undertake research. MATERIALS AND METHODS A web-based survey containing nine questions was sent to the UK radiology training programme directors for distribution to trainees. The survey was also distributed to all trainee members of the RADIANT network. This led to 224 responses over a period of 2 months. RESULTS A large proportion of respondents indicated a desire to participate in research in the next 12 months 72.3% (n=162). The most frequently reported barriers to research were lack of time (60.7%, n=136), lack of awareness of local/departmental opportunities (53.6%, n=120), and limited experience in research statistics (46%, n=103). The most favoured factor that would improve access to research was structured research training opportunities, qualified as a project with clear goals and timeline (71%, n=159), protected time for research (68.8%, n=154), and local or national trainee research networks (40.2%, n=90 and 37.1%, n=83, respectively). CONCLUSION Many radiology trainees would like to participate in research, but multiple barriers exist. The formation of RADIANT is seen as a key part of a multifaceted approach to improving access to quality research activity alongside support from local and regional training bodies.
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Affiliation(s)
- S Kamaledeen
- Department of Radiology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - P Brown
- Leeds and West Yorkshire Radiology Academy, Leeds General Infirmary, Great George St, Leeds, UK
| | - A Gangi
- Department of Radiology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - M Pantelidou
- Department of Radiology, Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - N Chan
- Department of Neuroradiology, King's College Hospital, London, UK.
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Brown P, Dimarco A, Bradley J, Nucifora G, Miller C, Schmitt M. Risk stratification and prognostic value of CMR in DCM; parametric mapping and GLS- value beyond EF and LGE? Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Dr Pamela Brown was suppoerted by funding from Alliance Medical.
Background; Arrhythmia risk stratification and device implantation in dilated cardiomyopathy (DCM) poses significant challenges and as demonstrated by the DANISH trial appears to have reached the asymptote of clinical efficacy. A body of evidence now demonstrates that risk stratification of and device selection for DCM patients may be enhanced by inclusion of patients" LGE-status. Furthermore, it has been suggested that CMR based parametric mapping and strain analysis may further advance risk stratification.
Methods; 703 patients with DCM undergoing clinically indicated CMR scans and prospectively enrolled into the UHSM-CMR study (NCT02326324) between 03/2015-12/2018 were analysed. Multivariable Cox proportional hazard models and Youden index driven C-statistics were used to assess additive prognostic value of GLS, T1 and ECV mapping on the combined endpoint of cardiovascular death, cardiac transplantation, LVAD insertion or hospitalisation for heart failure in models incorporating NHYA class, EF and LGE status. Additionally. the value of GLS, T1, and ECV on predicting significant arrhythmic events (SAV) (ventricular arrhythmia (VA), resuscitated cardiac arrest (rCA) or sudden cardiac death (SCD)) was assessed.
Results; Patients (mean age 59, 66% male, 60% ≥NYHA II, mean EF 42%, mean GLS -12%, mean ECV 27%) were on good medical therapy (beta blocker 74%%, ACE 79%, MRA 38%, Entresto 5%, CRT 23%). Mean follow-up was 21 months; the combined endpoint occurred in 34 patients (5%). On univariate analysis NYHA class (HR 2.44 (1.67-3.57), p < 0.001), ECV (HR 1.14 (1.05-1.22), p < 0.001), GLS% (HR 1.14 (1.07-1.21) p < 0.001,) T1 (HR 1.06 (1.005-1.1), p = 0.03), RVEF (HR 0.95 (0.93-0.98), p < 0.001), LVEF (HR 0.92 (0.9-0.95), p < 0.001) were all significantly associated with outcome. On multivariate analysis only EF and NYHA class was associated with outcome.
SAV occurred as the first manifestation of disease or during follow up in 27 patients (4%). At univariate analysis LGE, ECV, GLS, EF and NYHA class were all associated with SAV. However, on multivariable analysis only EF, LGE and ECV (HR 1.11 (1.01-1.22), p = 0.03) but not GLS remained independently predictive in a model already incorporating EF, NYHA and LGE.
Conclusion
Optimally treated DCM populations have very low event rates. CMR based assessment of fibrosis status/burden with both LGE and ECV assessment has the potential to enhance patient selection for ICD therapy. Whilst GLS is increasingly recognised as a sensitive imaging biomarker of early disease detection it provides no additive value, likely because of it’s high co-linearity with EF, in models already containing EF, NYHA class and LGE status.
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Affiliation(s)
- P Brown
- Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - A Dimarco
- Hospital Universitari de Bellvitge, Cardiology, Barcelona, Spain
| | - J Bradley
- Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - G Nucifora
- Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - C Miller
- Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - M Schmitt
- Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland
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Zada M, Klimis H, Brown P, Zecchin R, Altman M, Thomas L. Prospective Analysis of Demographic and Echocardiographic Determinants of Exercise Capacity Following ST-Elevation Myocardial Infarction (STEMI). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ferkh A, Stefani L, Trivedi S, Brown P, Altman M, Thomas L. Comparison of 2-Dimensional Single Plane, Biplane and Triplane With 3-Dimensional Left Atrial Strain. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.198] [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: 11/27/2022]
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Alavijeh M, Brown P, Butterworth S, Macdonald G. Advances in Genetic Medicine. Highlights from The Society for Medicines Research Online Meeting. Virtual -December 3, 2020. DRUG FUTURE 2021. [DOI: 10.1358/dof.2021.46.3.3277085] [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: 10/22/2022]
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Brown P. Review: Meeting the Challenge of Teaching Information Literacy. CIL 2020. [DOI: 10.15760/comminfolit.2020.14.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Khamisse E, Dunoyer C, Ar Gouilh M, Brown P, Meurens F, Meyer G, Monchatre-Leroy E, Pavio N, Simon G, Le Poder S. Opinion paper: Severe Acute Respiratory Syndrome Coronavirus 2 and domestic animals: what relation? Animal 2020; 14:2221-2224. [PMID: 32638677 PMCID: PMC7308594 DOI: 10.1017/s1751731120001639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- E Khamisse
- Direction de l'évaluation des risques, ANSES, 94700Maisons-Alfort, France
| | - C Dunoyer
- Direction de l'évaluation des risques, ANSES, 94700Maisons-Alfort, France
| | - M Ar Gouilh
- Groupe de Recherche sur l'Adaptation Microbienne, Normandie Université, 14000Caen, France
- Service de Virologie, CHU de Caen, 14000Caen, France
| | - P Brown
- Laboratoire de Ploufragan-Plouzané-Niort, ANSES, 22440Ploufragan, France
| | - F Meurens
- BIOEPAR, Oniris, INRAE, 44307Nantes, France
| | - G Meyer
- ENVT, INRAE, 31076Toulouse, France
| | - E Monchatre-Leroy
- Laboratoire de la rage et de la faune sauvage, ANSES, 54220Malzéville, France
| | - N Pavio
- UMR Virologie, ENVA, INRAE, ANSES Laboratoire de santé animale, 94700Maisons-Alfort, France
| | - G Simon
- Laboratoire de Ploufragan-Plouzané-Niort, ANSES, 22440Ploufragan, France
| | - S Le Poder
- UMR Virologie, ENVA, INRAE, ANSES Laboratoire de santé animale, 94700Maisons-Alfort, France
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Ambrosini S, Montecucco F, Akhmedov A, Mohammed S, Brown P, Rossi F, Kiss A, Luscher T, Costantino S, Paneni F. Methylation of the hippo signalling effector YAP by SETD7 drives myocardial ischemic injury. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Myocardial ischemia/reperfusion (I/R) injury is one of the most deleterious cardiovascular conditions and a leading cause of mortality. The Hippo pathway effector YAP critically regulates cardiomyocyte proliferation and survival during myocardial I/R injury. However, the mechanisms regulating YAP activation in this setting remain poorly understood. Post-translational modifications of proteins, namely methylation, modulate pathways implicated in myocardial I/R injury. The methyltransferase SETD7 is emerging as a regulator of cell survival via methylation of histone and non-histone proteins. Whether SETD7 participates to myocardial I/R injury remains elusive.
Purpose
To investigate the role of SETD7 in regulating Hippo signaling during myocardial I/R injury.
Methods
Neonatal rat ventricular myocytes (NRVM) were exposed to normal glucose levels or glucose deprivation (GD) for 15 h, in the presence of the selective SETD7 inhibitor [(R)-PFI-2] or its inactive enantiomer [(S)-PFI-2]. Western blot and real time PCR were employed to investigate the effects of energy stress on SETD7 and the Hippo pathway, while apoptosis was assessed by Caspase-3 activity assay. YAP activity was assessed through chromatin immunoprecipitation assay (ChIP), its localization was examined by confocal microscopy while mono-methylation was assessed by immunoblotting. SETD7 knockout (SETD7−/−) mice and wild-type (WT) littermates (male, 8–12 weeks old) underwent 1 h of left anterior descending (LAD) coronary artery ligation followed by 24 h of reperfusion. Infarct size was assessed by TTC staining and shown as infarct size per ventricle surface (I/V). Cardiac function was investigated at 24h by conventional and Tissue Doppler Imaging (TDI) echocardiography.
Results
GD in NRVMs led to upregulation of SETD7 and physical interaction with the pro-survival transcriptional cofactor YAP, resulting in its direct mono-methylation. Furthermore SETD7-dependent methylation of YAP led to its cytosolic retention and subsequent reduction of YAP binding to the promoter of pro-survival genes. Of note, pharmacological inhibition of SETD7 by (R)-PFI-2 blunted YAP mono-methylation while restoring its nuclear retention. Mechanistically, SETD7 inhibition promoted YAP binding to catalase and superoxide dismutase (SOD) gene promoters, thus preventing GD-induced mitochondrial oxidative stress and apoptosis. In line with our in vitro findings, SETD7−/− mice showed decreased infarct size as compared to WT littermates and preserved cardiac systolic (ejection fraction, fractional shortening) and diastolic function, as assessed by both conventional and TDI echocardiography.
Conclusions
We show that SETD7-dependent methylation of YAP is required for its inactivation, thus leading to myocyte oxidative stress and apoptosis. Pharmacological modulation of SETD7 by (R)-PFI-2 may represent a new therapeutic approach to prevent myocardial ischemic damage through modulation of the Hippo pathway.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss Heart Foundation
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Affiliation(s)
- S Ambrosini
- University of Zurich, Schlieren, Switzerland
| | | | - A Akhmedov
- University of Zurich, Schlieren, Switzerland
| | | | - P Brown
- University of Toronto, Toronto, Canada
| | - F Rossi
- University of British Columbia, Vancouver, Canada
| | - A Kiss
- Medical University of Vienna, Vienna, Austria
| | - T.F Luscher
- University of Zurich, Schlieren, Switzerland
| | | | - F Paneni
- University of Zurich, Schlieren, Switzerland
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