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Turer RW, McDonald SA, Lehmann CU, Thakur B, Dutta S, Taylor RA, Rose CC, Frisch A, Feterik K, Norquist C, Baker CK, Nielson JA, Cha D, Kwan B, Dameff C, Killeen JP, Hall MK, Doerning RC, Rosenbloom ST, Distaso C, Steitz BD. Real-Time Electronic Patient Portal Use Among Emergency Department Patients. JAMA Netw Open 2024; 7:e249831. [PMID: 38700859 PMCID: PMC11069088 DOI: 10.1001/jamanetworkopen.2024.9831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/05/2024] [Indexed: 05/06/2024] Open
Abstract
Importance Patients with inequitable access to patient portals frequently present to emergency departments (EDs) for care. Little is known about portal use patterns among ED patients. Objectives To describe real-time patient portal usage trends among ED patients and compare demographic and clinical characteristics between portal users and nonusers. Design, Setting, and Participants In this cross-sectional study of 12 teaching and 24 academic-affiliated EDs from 8 health systems in California, Connecticut, Massachusetts, Ohio, Tennessee, Texas, and Washington, patient portal access and usage data were evaluated for all ED patients 18 years or older between April 5, 2021, and April 4, 2022. Exposure Use of the patient portal during ED visit. Main Outcomes and Measures The primary outcomes were the weekly proportions of ED patients who logged into the portal, viewed test results, and viewed clinical notes in real time. Pooled random-effects models were used to evaluate temporal trends and demographic and clinical characteristics associated with real-time portal use. Results The study included 1 280 924 unique patient encounters (53.5% female; 0.6% American Indian or Alaska Native, 3.7% Asian, 18.0% Black, 10.7% Hispanic, 0.4% Native Hawaiian or Pacific Islander, 66.5% White, 10.0% other race, and 4.0% with missing race or ethnicity; 91.2% English-speaking patients; mean [SD] age, 51.9 [19.2] years). During the study, 17.4% of patients logged into the portal while in the ED, whereas 14.1% viewed test results and 2.5% viewed clinical notes. The odds of accessing the portal (odds ratio [OR], 1.36; 95% CI, 1.19-1.56), viewing test results (OR, 1.63; 95% CI, 1.30-2.04), and viewing clinical notes (OR, 1.60; 95% CI, 1.19-2.15) were higher at the end of the study vs the beginning. Patients with active portal accounts at ED arrival had a higher odds of logging into the portal (OR, 17.73; 95% CI, 9.37-33.56), viewing test results (OR, 18.50; 95% CI, 9.62-35.57), and viewing clinical notes (OR, 18.40; 95% CI, 10.31-32.86). Patients who were male, Black, or without commercial insurance had lower odds of logging into the portal, viewing results, and viewing clinical notes. Conclusions and Relevance These findings suggest that real-time patient portal use during ED encounters has increased over time, but disparities exist in portal access that mirror trends in portal usage more generally. Given emergency medicine's role in caring for medically underserved patients, there are opportunities for EDs to enroll and train patients in using patient portals to promote engagement during and after their visits.
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Affiliation(s)
- Robert W. Turer
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
| | - Samuel A. McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
| | - Christoph U. Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Bhaskar Thakur
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sayon Dutta
- Department of Emergency Medicine, Mass General Brigham, Boston, Massachusetts
- Mass General Brigham Digital, Boston, Massachusetts
| | - Richard A. Taylor
- Department of Emergency Medicine and Section for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Heath, New Haven, Connecticut
| | - Christian C. Rose
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Adam Frisch
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kristian Feterik
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Craig Norquist
- Department of Emergency Medicine, HonorHealth, Phoenix, Arizona
| | - Carrie K. Baker
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Jeffrey A. Nielson
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - David Cha
- Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Brian Kwan
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - Christian Dameff
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - James P. Killeen
- Department of Emergency Medicine, School of Medicine, University of California, San Diego
| | - Michael K. Hall
- Department of Emergency Medicine, University of Washington, Seattle
| | | | - S. Trent Rosenbloom
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Casey Distaso
- Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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Assadourian JN, Peterson ED, McDonald SA, Gupta A, Navar AM. Health Claims and Doses of Fish Oil Supplements in the US. JAMA Cardiol 2023; 8:984-988. [PMID: 37610733 PMCID: PMC10448371 DOI: 10.1001/jamacardio.2023.2424] [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] [Received: 04/22/2023] [Accepted: 06/09/2023] [Indexed: 08/24/2023]
Abstract
Importance One in 5 US adults older than 60 years takes fish oil supplements often for heart health despite multiple randomized clinical trials showing no data for cardiovascular benefit for supplement-range doses. Statements on the supplement labels may influence consumer beliefs about health benefits. Objectives To evaluate health claims made on the labels of fish oil supplements in the US, and to examine doses of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in commonly available formulations. Design, Setting, and Participants This cross-sectional study used data from labels of on-market fish oil (and nonfish ω-3 fatty acid) supplements obtained from the National Institutes of Health Dietary Supplement Label Database. The study was conducted and data analyzed from February to June 2022. Main Outcome and Measures The frequency and types of health claims made on fish oil labels (US Food and Drug Administration [FDA]-reviewed qualified health claim vs a structure/function claim) and the organ system referenced were evaluated. The total daily doses of combined EPA and DHA (EPA+DHA) were assessed for supplements from 16 leading manufacturers and retailers. Results Across 2819 unique fish oil supplements, 2082 (73.9%) made at least 1 health claim. Of these, only 399 (19.2%) used an FDA-approved qualified health claim; the rest (1683 [80.8%]) made only structure/function claims (eg, "promotes heart health"). Cardiovascular health claims were the most common (1747 [62.0%]). Across 16 leading brands/manufacturers, 255 fish oil supplements were identified. Among these, substantial variability was found in the daily dose of EPA (median [IQR], 340 [135-647] mg/d), DHA (median [IQR], 270 [140-500] mg/d), and total EPA+DHA (median [IQR], 600 [300-1100] mg/d). Only 24 of 255 supplements (9.4%) evaluated contained a daily dose of 2 g or more EPA+DHA. Conclusions Results of this cross-sectional study suggest that the majority of fish oil supplement labels make health claims, usually in the form of structure/function claims, that imply a health benefit across a variety of organ systems despite a lack of trial data showing efficacy. Significant heterogeneity exists in the daily dose of EPA+DHA in available supplements, leading to potential variability in safety and efficacy between supplements. Increasing regulation of dietary supplement labeling may be needed to prevent consumer misinformation.
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Affiliation(s)
| | | | | | - Anand Gupta
- University of Texas Southwestern Medical Center, Dallas
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Montoy JCC, Ford J, Yu H, Gottlieb M, Morse D, Santangelo M, O’Laughlin KN, Schaeffer K, Logan P, Rising K, Hill MJ, Wisk LE, Salah W, Idris AH, Huebinger RM, Spatz ES, Rodriguez RM, Klabbers RE, Gatling K, Wang RC, Elmore JG, McDonald SA, Stephens KA, Weinstein RA, Venkatesh AK, Saydah S. Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID-19 Testing Status Among Adults - United States, December 2020-March 2023. MMWR Morb Mortal Wkly Rep 2023; 72:859-865. [PMID: 37561663 PMCID: PMC10415002 DOI: 10.15585/mmwr.mm7232a2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration-approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months. Prevalence of any symptom decreased substantially between baseline and the 3-month follow-up, from 98.4% to 48.2% for persons who received a positive SARS-CoV-2 test results (COVID test-positive participants) and from 88.2% to 36.6% for persons who received negative SARS-CoV-2 test results (COVID test-negative participants). Persistent symptoms decreased through 12 months; no difference between the groups was observed at 12 months (prevalence among COVID test-positive and COVID test-negative participants = 18.3% and 16.1%, respectively; p>0.05). Both groups reported symptoms that emerged or reemerged at 6, 9, and 12 months. Thus, these symptoms are not unique to COVID-19 or to post-COVID conditions. Awareness that symptoms might persist for up to 12 months, and that many symptoms might emerge or reemerge in the year after COVID-like illness, can assist health care providers in understanding the clinical signs and symptoms associated with post-COVID-like conditions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut; Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois; Department of Emergency Medicine, University of Washington, Seattle, Washington; Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois; Department of Emergency Medicine, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; National Center for Immunizations and Respiratory Diseases, CDC; Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; UTHealth Houston, Houston, Texas; University of California, Los Angeles, Los Angeles, California; Department of Emergency Medicine, Yale University, New Haven, Connecticut; University of Texas Southwestern Medical Center, Dallas, Texas; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Family Medicine, University of Washington, Seattle, Washington; Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington; Department of Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois; Department of Medicine, Division of Infectious Diseases, Cook County Hospital, Chicago, Illinois; Department of Internal Medicine, Yale University, New Haven, Connecticut
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Saleh SN, McDonald SA, Basit MA, Kumar S, Arasaratnam RJ, Perl TM, Lehmann CU, Medford RJ. Public perception of COVID-19 vaccines through analysis of Twitter content and users. Vaccine 2023; 41:4844-4853. [PMID: 37385887 PMCID: PMC10288320 DOI: 10.1016/j.vaccine.2023.06.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 05/03/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND With the global continuation of the COVID-19 pandemic, the large-scale administration of a SARS-CoV-2 vaccine is crucial to achieve herd immunity and curtail further spread of the virus, but success is contingent on public understanding and vaccine uptake. We aim to understand public perception about vaccines for COVID-19 through the wide-scale, organic discussion on Twitter. METHODS This cross-sectional observational study included Twitter posts matching the search criteria (('covid*' OR 'coronavirus') AND 'vaccine') posted during vaccine development from February 1st through December 11th, 2020. These COVID-19 vaccine related posts were analyzed with topic modeling, sentiment and emotion analysis, and demographic inference of users to provide insight into the evolution of public attitudes throughout the study period. FINDINGS We evaluated 2,287,344 English tweets from 948,666 user accounts. Individuals represented 87.9 % (n = 834,224) of user accounts. Of individuals, men (n = 560,824) outnumbered women (n = 273,400) by 2:1 and 39.5 % (n = 329,776) of individuals were ≥40 years old. Daily mean sentiment fluctuated congruent with news events, but overall trended positively. Trust, anticipation, and fear were the three most predominant emotions; while fear was the most predominant emotion early in the study period, trust outpaced fear from April 2020 onward. Fear was more prevalent in tweets by individuals (26.3 % vs. organizations 19.4 %; p < 0.001), specifically among women (28.4 % vs. males 25.4 %; p < 0.001). Multiple topics had a monthly trend towards more positive sentiment. Tweets comparing COVID-19 to the influenza vaccine had strongly negative early sentiment but improved over time. INTERPRETATION This study successfully explores sentiment, emotion, topics, and user demographics to elucidate important trends in public perception about COVID-19 vaccines. While public perception trended positively over the study period, some trends, especially within certain topic and demographic clusters, are concerning for COVID-19 vaccine hesitancy. These insights can provide targets for educational interventions and opportunity for continued real-time monitoring.
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Affiliation(s)
- Sameh N Saleh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States.
| | - Samuel A McDonald
- Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Mujeeb A Basit
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Sanat Kumar
- Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Lebanon Trail High School, 5151 Ohio Dr, Frisco, TX 75035, United States
| | - Reuben J Arasaratnam
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Trish M Perl
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Departments of Pediatrics, Bioinformatics, Population & Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Richard J Medford
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States; Clinical Informatics Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
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Steitz BD, Turer RW, Lin CT, MacDonald S, Salmi L, Wright A, Lehmann CU, Langford K, McDonald SA, Reese TJ, Sternberg P, Chen Q, Rosenbloom ST, DesRoches CM. Perspectives of Patients About Immediate Access to Test Results Through an Online Patient Portal. JAMA Netw Open 2023; 6:e233572. [PMID: 36939703 PMCID: PMC10028486 DOI: 10.1001/jamanetworkopen.2023.3572] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 09/21/2022] [Accepted: 01/17/2023] [Indexed: 03/21/2023] Open
Abstract
Importance The 21st Century Cures Act Final Rule mandates the immediate electronic availability of test results to patients, likely empowering them to better manage their health. Concerns remain about unintended effects of releasing abnormal test results to patients. Objective To assess patient and caregiver attitudes and preferences related to receiving immediately released test results through an online patient portal. Design, Setting, and Participants This large, multisite survey study was conducted at 4 geographically distributed academic medical centers in the US using an instrument adapted from validated surveys. The survey was delivered in May 2022 to adult patients and care partners who had accessed test results via an online patient portal account between April 5, 2021, and April 4, 2022. Exposures Access to test results via a patient portal between April 5, 2021, and April 4, 2022. Main Outcomes and Measures Responses to questions related to demographics, test type and result, reaction to result, notification experience and future preferences, and effect on health and well-being were aggregated. To evaluate characteristics associated with patient worry, logistic regression and pooled random-effects models were used to assess level of worry as a function of whether test results were perceived by patients as normal or not normal and whether patients were precounseled. Results Of 43 380 surveys delivered, there were 8139 respondents (18.8%). Most respondents were female (5129 [63.0%]) and spoke English as their primary language (7690 [94.5%]). The median age was 64 years (IQR, 50-72 years). Most respondents (7520 of 7859 [95.7%]), including 2337 of 2453 individuals (95.3%) who received nonnormal results, preferred to immediately receive test results through the portal. Few respondents (411 of 5473 [7.5%]) reported that reviewing results before they were contacted by a health care practitioner increased worry, though increased worry was more common among respondents who received abnormal results (403 of 2442 [16.5%]) than those whose results were normal (294 of 5918 [5.0%]). The result of the pooled model for worry as a function of test result normality was statistically significant (odds ratio [OR], 2.71; 99% CI, 1.96-3.74), suggesting an association between worry and nonnormal results. The result of the pooled model evaluating the association between worry and precounseling was not significant (OR, 0.70; 99% CI, 0.31-1.59). Conclusions and Relevance In this multisite survey study of patient attitudes and preferences toward receiving immediately released test results via a patient portal, most respondents preferred to receive test results via the patient portal despite viewing results prior to discussion with a health care professional. This preference persisted among patients with nonnormal results.
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Affiliation(s)
- Bryan D. Steitz
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert W. Turer
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Scott MacDonald
- Department of Clinical Informatics, University of California Davis Health, Sacramento
| | - Liz Salmi
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christoph U. Lehmann
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas
| | - Karen Langford
- Department of Insights and Operations, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samuel A. McDonald
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas
| | - Thomas J. Reese
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul Sternberg
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Catherine M. DesRoches
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Joseph C, Cooper J, Sikka R, Zagrodzky J, Turer RW, McDonald SA, Kulstad E, Daniels J. Improved hospital discharge and cost savings with esophageal cooling during left atrial ablation. J Med Econ 2023; 26:158-167. [PMID: 36537305 DOI: 10.1080/13696998.2022.2160596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Left atrial ablation to obtain pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is a technologically intensive procedure utilizing innovative and continually improving technology. Changes in the technology utilized for PVI can in turn lead to changes in procedure costs. Because of the proximity of the esophagus to the posterior wall of the left atrium, various technologies have been utilized to protect against thermal injury during ablation. The impact on hospital costs during PVI ablation from utilization of different technologies for esophageal protection during ablation has not previously been evaluated. OBJECTIVE To compare the costs of active esophageal cooling to luminal esophageal temperature (LET) monitoring during left atrial ablation. METHODS We performed a time-driven activity-based costing (TDABC) analysis to determine costs for PVI procedures. Published data and literature review were utilized to determine differences in procedure time and same-day discharge rates using different esophageal protection technologies and to determine the cost impacts of same-day discharge versus overnight hospitalization after PVI procedures. The total costs were then compared between cases using active esophageal cooling to those using LET monitoring. RESULTS The effect of implementing active esophageal cooling was associated with up to a 24.7% reduction in mean total procedure time, and an 18% increase in same-day discharge rate. TDABC analysis identified a $681 reduction in procedure costs associated with the use of active esophageal cooling after including the cost of the esophageal cooling device. Factoring in the 18% increase in same-day discharge resulted in an increased cost savings of $2,135 per procedure. CONCLUSIONS The use of active esophageal cooling is associated with significant cost-savings when compared to traditional LET monitoring, even after accounting for the additional cost of the cooling device. These savings originate from a per-patient procedural time savings and a per-population improvement in same-day discharge rate.
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Affiliation(s)
| | - Julie Cooper
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rishi Sikka
- Policy and Practice, Brown University School of Public Health, Providence, RI, USA
- Lifeforce Capital, San Francisco, CA, USA
| | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David's South Austin Medical Center, Austin, TX, USA
| | - Robert W Turer
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Daniels
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Wisk LE, Gottlieb MA, Spatz ES, Yu H, Wang RC, Slovis BH, Saydah S, Plumb ID, O’Laughlin KN, Montoy JCC, McDonald SA, Lin Z, Lin JMS, Koo K, Idris AH, Huebinger RM, Hill MJ, Gentile NL, Chang AM, Anderson J, Hota B, Venkatesh AK, Weinstein RA, Elmore JG, Nichol G. Association of Initial SARS-CoV-2 Test Positivity With Patient-Reported Well-being 3 Months After a Symptomatic Illness. JAMA Netw Open 2022; 5:e2244486. [PMID: 36454572 PMCID: PMC9716377 DOI: 10.1001/jamanetworkopen.2022.44486] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Long-term sequelae after symptomatic SARS-CoV-2 infection may impact well-being, yet existing data primarily focus on discrete symptoms and/or health care use. OBJECTIVE To compare patient-reported outcomes of physical, mental, and social well-being among adults with symptomatic illness who received a positive vs negative test result for SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a planned interim analysis of an ongoing multicenter prospective longitudinal registry study (the Innovative Support for Patients With SARS-CoV-2 Infections Registry [INSPIRE]). Participants were enrolled from December 11, 2020, to September 10, 2021, and comprised adults (aged ≥18 years) with acute symptoms suggestive of SARS-CoV-2 infection at the time of receipt of a SARS-CoV-2 test approved by the US Food and Drug Administration. The analysis included the first 1000 participants who completed baseline and 3-month follow-up surveys consisting of questions from the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29; 7 subscales, including physical function, anxiety, depression, fatigue, social participation, sleep disturbance, and pain interference) and the PROMIS Short Form-Cognitive Function 8a scale, for which population-normed T scores were reported. EXPOSURES SARS-CoV-2 status (positive or negative test result) at enrollment. MAIN OUTCOMES AND MEASURES Mean PROMIS scores for participants with positive COVID-19 tests vs negative COVID-19 tests were compared descriptively and using multivariable regression analysis. RESULTS Among 1000 participants, 722 (72.2%) received a positive COVID-19 result and 278 (27.8%) received a negative result; 406 of 998 participants (40.7%) were aged 18 to 34 years, 644 of 972 (66.3%) were female, 833 of 984 (84.7%) were non-Hispanic, and 685 of 974 (70.3%) were White. A total of 282 of 712 participants (39.6%) in the COVID-19-positive group and 147 of 275 participants (53.5%) in the COVID-19-negative group reported persistently poor physical, mental, or social well-being at 3-month follow-up. After adjustment, improvements in well-being were statistically and clinically greater for participants in the COVID-19-positive group vs the COVID-19-negative group only for social participation (β = 3.32; 95% CI, 1.84-4.80; P < .001); changes in other well-being domains were not clinically different between groups. Improvements in well-being in the COVID-19-positive group were concentrated among participants aged 18 to 34 years (eg, social participation: β = 3.90; 95% CI, 1.75-6.05; P < .001) and those who presented for COVID-19 testing in an ambulatory setting (eg, social participation: β = 4.16; 95% CI, 2.12-6.20; P < .001). CONCLUSIONS AND RELEVANCE In this study, participants in both the COVID-19-positive and COVID-19-negative groups reported persistently poor physical, mental, or social well-being at 3-month follow-up. Although some individuals had clinically meaningful improvements over time, many reported moderate to severe impairments in well-being 3 months later. These results highlight the importance of including a control group of participants with negative COVID-19 results for comparison when examining the sequelae of COVID-19.
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Affiliation(s)
- Lauren E. Wisk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles
- Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles, Los Angeles
| | - Michael A. Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Erica S. Spatz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Huihui Yu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Ralph C. Wang
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Benjamin H. Slovis
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sharon Saydah
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ian D. Plumb
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelli N. O’Laughlin
- Department of Emergency Medicine, University of Washington, Seattle
- Department of Global Health, University of Washington, Seattle
| | - Juan Carlos C. Montoy
- Department of Emergency Medicine, University of California, San Francisco, San Francisco
| | - Samuel A. McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas
| | - Zhenqiu Lin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Jin-Mann S. Lin
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katherine Koo
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Ahamed H. Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ryan M. Huebinger
- Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas
| | - Mandy J. Hill
- Department of Emergency Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas
| | - Nicole L. Gentile
- Department of Family Medicine, University of Washington, Seattle
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jill Anderson
- Department of Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle
| | | | - Arjun K. Venkatesh
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Robert A. Weinstein
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
- Division of Infectious Diseases, Cook County Health, Chicago, Illinois
| | - Joann G. Elmore
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles
- Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles, Los Angeles
| | - Graham Nichol
- Department of Emergency Medicine, University of Washington, Seattle
- Department of Medicine, Harborview Center for Prehospital Emergency Care, University of Washington, Seattle
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8
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Cooper J, Joseph C, Zagrodzky J, Woods C, Metzl M, Turer RW, McDonald SA, Kulstad E, Daniels J. Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update. Expert Rev Med Devices 2022; 19:949-957. [PMID: 36413154 PMCID: PMC9839561 DOI: 10.1080/17434440.2022.2150930] [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] [Received: 08/07/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Radiofrequency (RF) ablation of the left atrium of the heart is increasingly used to treat atrial fibrillation (AF). Unfortunately, inadvertent thermal injury to the esophagus can occur during this procedure, potentially creating an atrioesophageal fistula (AEF) which is 80% fatal. The ensoETM (Attune Medical, Chicago, IL), is an esophageal cooling device that has been shown to reduce thermal injury to the esophagus during RF ablation. AREAS COVERED This review summarizes growing evidence related to active esophageal cooling during RF ablation for the treatment of AF. The review presents data demonstrating improved outcomes related to patient safety and procedural efficiency and suggests directions for future research. EXPERT OPINION The use of active esophageal cooling during RF ablation reduces esophageal injury, reduces or eliminates fluoroscopy requirements, reduces procedure duration and post-operative pain, and increases long-term freedom from arrhythmia. These effects in turn increase patient same-day discharge rates, decrease operator cognitive load, and reduce cost. These findings are likely to further accelerate the adoption of active esophageal cooling.
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Affiliation(s)
- Julie Cooper
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | | | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David’s South Austin Medical Center, Austin, TX 78704
| | | | - Mark Metzl
- NorthShore University Health System, 2650 Ridge Avenue, Evanston, IL 60201
| | - Robert W. Turer
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | | | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - James Daniels
- University of Texas Southwestern Medical Center, Dallas, TX 75390
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9
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Turer RW, Martin KR, Courtney DM, Diercks DB, Chu L, Willett DL, Thakur B, Hughes A, Lehmann CU, McDonald SA. Real-Time Patient Portal Use Among Emergency Department Patients: An Open Results Study. Appl Clin Inform 2022; 13:1123-1130. [PMID: 36167337 PMCID: PMC9713300 DOI: 10.1055/a-1951-3268] [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] [Received: 06/14/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES We characterized real-time patient portal test result viewing among emergency department (ED) patients and described patient characteristics overall and among those not enrolled in the portal at ED arrival. METHODS Our observational study at an academic ED used portal log data to trend the proportion of adult patients who viewed results during their visit from May 04, 2021 to April 04, 2022. Correlation was assessed visually and with Kendall's τ. Covariate analysis using binary logistic regression assessed result(s) viewed as a function of time accounting for age, sex, ethnicity, race, language, insurance status, disposition, and social vulnerability index (SVI). A second model only included patients not enrolled in the portal at arrival. We used random forest imputation to account for missingness and Huber-White heteroskedasticity-robust standard errors for patients with multiple encounters (α = 0.05). RESULTS There were 60,314 ED encounters (31,164 unique patients). In 7,377 (12.2%) encounters, patients viewed results while still in the ED. Patients were not enrolled for portal use at arrival in 21,158 (35.2%) encounters, and 927 (4.4% of not enrolled, 1.5% overall) subsequently enrolled and viewed results in the ED. Visual inspection suggests an increasing proportion of patients who viewed results from roughly 5 to 15% over the study (Kendall's τ = 0.61 [p <0.0001]). Overall and not-enrolled models yielded concordance indices (C) of 0.68 and 0.72, respectively, with significant overall likelihood ratio χ 2 (p <0.0001). Time was independently associated with viewing results in both models after adjustment. Models revealed disparate use between age, race, ethnicity, SVI, sex, insurance status, and disposition groups. CONCLUSION We observed increased portal-based test result viewing among ED patients over the year since the 21st Century Cures act went into effect, even among those not enrolled at arrival. We observed disparities in those who viewed results.
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Affiliation(s)
- Robert W. Turer
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Katherine R. Martin
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Daniel Mark Courtney
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Deborah B. Diercks
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Ling Chu
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
| | - DuWayne L. Willett
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Bhaskar Thakur
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Amy Hughes
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Christoph U. Lehmann
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
- Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, United States
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, United States
- Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Samuel A. McDonald
- Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
- Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
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10
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Joseph C, Cooper J, Turer RW, McDonald SA, Kulstad EB, Daniels J. Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation. J Vis Exp 2022. [PMID: 36094261 DOI: 10.3791/64417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Various methods are utilized during radiofrequency (RF) pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) to protect the esophagus from inadvertent thermal injury. Active esophageal cooling is increasingly being used over traditional luminal esophageal temperature (LET) monitoring, and each approach may influence procedure times and the variability around those times. The objective of this study is to measure the effects on procedure time and variability in procedure time of two different esophageal protection strategies utilizing advanced informatics techniques to facilitate data extraction. Trained clinical informaticists first performed a contextual inquiry in the catheterization laboratory to determine laboratory workflows and observe the documentation of procedural data within the electronic health record (EHR). These EHR data structures were then identified in the electronic health record reporting database, facilitating data extraction from the EHR. A manual chart review using a REDCap database created for the study was then performed to identify additional data elements, including the type of esophageal protection used. Procedure duration was then compared using summary statistics and standard measures of dispersion. A total of 164 patients underwent radiofrequency PVI over the study timeframe; 63 patients (38%) were treated with LET monitoring, and 101 patients (62%) were treated with active esophageal cooling. The mean procedure time was 176 min (SD of 52 min) in the LET monitoring group compared to 156 min (SD of 40 min) in the esophageal cooling group (P = 0.012). Thus, active esophageal cooling during PVI is associated with reduced procedure time and reduced variation in procedure time when compared to traditional LET monitoring.
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Affiliation(s)
- Christopher Joseph
- Department of Emergency Medicine, University of Texas Southwestern Medical Center
| | - Julie Cooper
- Department of Internal Medicine, University of Texas Southwestern Medical Center
| | - Robert W Turer
- Department of Emergency Medicine and Clinical Informatics Center, University of Texas Southwestern Medical Center
| | - Samuel A McDonald
- Department of Emergency Medicine and Clinical Informatics Center, University of Texas Southwestern Medical Center
| | | | - James Daniels
- Department of Electrophysiology, University of Texas Southwestern Medical Center
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11
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McDonald SA, Peterson ED. The HEART Pathway: Just a HEART score permutation or the future of clinical decision rules? Acad Emerg Med 2022; 29:1037-1039. [PMID: 35635767 DOI: 10.1111/acem.14542] [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] [Received: 04/29/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Samuel A McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Eric D Peterson
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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12
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Ramaswamy P, Gong JJ, Saleh SN, McDonald SA, Blumberg S, Medford RJ, Liu X. Developing a COVID-19 WHO Clinical Progression Scale inpatient database from electronic health record data. J Am Med Inform Assoc 2022; 29:1279-1285. [PMID: 35289912 PMCID: PMC9196693 DOI: 10.1093/jamia/ocac041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/05/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE There is a need for a systematic method to implement the World Health Organization's Clinical Progression Scale (WHO-CPS), an ordinal clinical severity score for coronavirus disease 2019 patients, to electronic health record (EHR) data. We discuss our process of developing guiding principles mapping EHR data to WHO-CPS scores across multiple institutions. MATERIALS AND METHODS Using WHO-CPS as a guideline, we developed the technical blueprint to map EHR data to ordinal clinical severity scores. We applied our approach to data from 2 medical centers. RESULTS Our method was able to classify clinical severity for 100% of patient days for 2756 patient encounters across 2 institutions. DISCUSSION Implementing new clinical scales can be challenging; strong understanding of health system data architecture was integral to meet the clinical intentions of the WHO-CPS. CONCLUSION We describe a detailed blueprint for how to apply the WHO-CPS scale to patient data from the EHR.
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Affiliation(s)
- Priya Ramaswamy
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Jen J Gong
- Center of Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sameh N Saleh
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Section of Hospital Medicine, Division of General Internal Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Department of Biomedical & Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Samuel A McDonald
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Emergency Medicine, University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.,Centers of Disease Control's Modeling infectious Diseases (MInD) Healthcare Program, USA.,Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Richard J Medford
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| | - Xinran Liu
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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13
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Turer RW, Smith GC, Mehkri Do F, Chou A, Fowler R, Idris AH, Lehmann CU, McDonald SA. Improving Emergency Medical Services Information Exchange: Methods for Automating Entity Resolution. Stud Health Technol Inform 2022; 291:17-26. [PMID: 35593755 DOI: 10.3233/shti220004] [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] [Indexed: 11/15/2022]
Abstract
The 21st century has seen an enormous growth in emergency medical services (EMS) information technology systems, with corresponding accumulation of large volumes of data. Despite this growth, integration efforts between EMS-based systems and electronic health records, and public-sector databases have been limited due to inconsistent data structure, data missingness, and policy and regulatory obstacles. Efforts to integrate EMS systems have benefited from the evolving science of entity resolution and record linkage. In this chapter, we present the history and fundamentals of record linkage techniques, an overview of past uses of this technology in EMS, and a look into the future of record linkage techniques for integrating EMS data systems including the use of machine learning-based techniques.
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Affiliation(s)
- Robert W Turer
- University of Texas Southwestern Medical Center, Department of Emergency Medicine. Dallas, TX, USA.,University of Texas Southwestern Medical Center, Clinical Informatics Center. Dallas, TX, USA
| | - Graham C Smith
- University of Michigan Medical School, Department of Emergency Medicine. Ann Arbor, MI, USA
| | - Faroukh Mehkri Do
- University of Texas Southwestern Medical Center, Department of Emergency Medicine. Dallas, TX, USA
| | - Andrew Chou
- University of Texas Southwestern Medical Center, Department of Emergency Medicine. Dallas, TX, USA
| | - Ray Fowler
- University of Texas Southwestern Medical Center, Department of Emergency Medicine. Dallas, TX, USA
| | - Ahamed H Idris
- University of Texas Southwestern Medical Center, Department of Emergency Medicine. Dallas, TX, USA
| | - Christoph U Lehmann
- University of Texas Southwestern Medical Center, Clinical Informatics Center. Dallas, TX, USA.,University of Texas Southwestern Medical Center, Department of Pediatrics. Dallas, TX, USA
| | - Samuel A McDonald
- University of Texas Southwestern Medical Center, Department of Emergency Medicine. Dallas, TX, USA.,University of Texas Southwestern Medical Center, Clinical Informatics Center. Dallas, TX, USA
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14
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O’Laughlin KN, Thompson M, Hota B, Gottlieb M, Plumb ID, Chang AM, Wisk LE, Hall AJ, Wang RC, Spatz ES, Stephens KA, Huebinger RM, McDonald SA, Venkatesh A, Gentile N, Slovis BH, Hill M, Saydah S, Idris AH, Rodriguez R, Krumholz HM, Elmore JG, Weinstein RA, Nichol G. Study protocol for the Innovative Support for Patients with SARS-COV-2 Infections Registry (INSPIRE): A longitudinal study of the medium and long-term sequelae of SARS-CoV-2 infection. PLoS One 2022; 17:e0264260. [PMID: 35239680 PMCID: PMC8893622 DOI: 10.1371/journal.pone.0264260] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/05/2022] [Indexed: 12/26/2022] Open
Abstract
Background Reports on medium and long-term sequelae of SARS-CoV-2 infections largely lack quantification of incidence and relative risk. We describe the rationale and methods of the Innovative Support for Patients with SARS-CoV-2 Registry (INSPIRE) that combines patient-reported outcomes with data from digital health records to understand predictors and impacts of SARS-CoV-2 infection. Methods INSPIRE is a prospective, multicenter, longitudinal study of individuals with symptoms of SARS-CoV-2 infection in eight regions across the US. Adults are eligible for enrollment if they are fluent in English or Spanish, reported symptoms suggestive of acute SARS-CoV-2 infection, and if they are within 42 days of having a SARS-CoV-2 viral test (i.e., nucleic acid amplification test or antigen test), regardless of test results. Recruitment occurs in-person, by phone or email, and through online advertisement. A secure online platform is used to facilitate the collation of consent-related materials, digital health records, and responses to self-administered surveys. Participants are followed for up to 18 months, with patient-reported outcomes collected every three months via survey and linked to concurrent digital health data; follow-up includes no in-person involvement. Our planned enrollment is 4,800 participants, including 2,400 SARS-CoV-2 positive and 2,400 SARS-CoV-2 negative participants (as a concurrent comparison group). These data will allow assessment of longitudinal outcomes from SARS-CoV-2 infection and comparison of the relative risk of outcomes in individuals with and without infection. Patient-reported outcomes include self-reported health function and status, as well as clinical outcomes including health system encounters and new diagnoses. Results Participating sites obtained institutional review board approval. Enrollment and follow-up are ongoing. Conclusions This study will characterize medium and long-term sequelae of SARS-CoV-2 infection among a diverse population, predictors of sequelae, and their relative risk compared to persons with similar symptomatology but without SARS-CoV-2 infection. These data may inform clinical interventions for individuals with sequelae of SARS-CoV-2 infection.
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Affiliation(s)
- Kelli N. O’Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, United States of America
| | - Bala Hota
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Ian D. Plumb
- Division of Viral Diseases, Centers for Disease Control and Prevention, Respiratory Viruses Branch, Atlanta, GA, United States of America
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia PA, United States of America
| | - Lauren E. Wisk
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Aron J. Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Respiratory Viruses Branch, Atlanta, GA, United States of America
| | - Ralph C. Wang
- Department of Emergency Medicine, University of California, San Francisco, CA, United States of America
| | - Erica S. Spatz
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington, Seattle, WA, United States of America
| | - Ryan M. Huebinger
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Samuel A. McDonald
- Department of Emergency Medicine and Clinical Informatics Center, UT Southwestern, Dallas, TX, United States of America
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Nikki Gentile
- Department of Family Medicine, University of Washington, Seattle, WA, United States of America
| | - Benjamin H. Slovis
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia PA, United States of America
| | - Mandy Hill
- Department of Emergency Medicine, UTHealth McGovern Medical School, Houston, TX, United States of America
| | - Sharon Saydah
- Division of Viral Diseases, Centers for Disease Control and Prevention, Respiratory Viruses Branch, Atlanta, GA, United States of America
| | - Ahamed H. Idris
- Department of Emergency Medicine and Clinical Informatics Center, UT Southwestern, Dallas, TX, United States of America
| | - Robert Rodriguez
- Department of Emergency Medicine, University of California, San Francisco, CA, United States of America
| | - Harlan M. Krumholz
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Joann G. Elmore
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Robert A. Weinstein
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America
- Department of Medicine, Cook County Health, Chicago, IL, United States of America
| | - Graham Nichol
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States of America
- Departments of Medicine, University of Washington, Seattle, WA, United States of America
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15
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Rawson SD, Bayram V, McDonald SA, Yang P, Courtois L, Guo Y, Xu J, Burnett TL, Barg S, Withers PJ. Tailoring the Microstructure of Lamellar Ti 3C 2T x MXene Aerogel by Compressive Straining. ACS Nano 2022; 16:1896-1908. [PMID: 35130692 PMCID: PMC8867911 DOI: 10.1021/acsnano.1c04538] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Aerogels are attracting increasing interest due to their functional properties, such as lightweight and high porosity, which make them promising materials for energy storage and advanced composites. Compressive deformation allows the nano- and microstructure of lamellar freeze-cast aerogels to be tailored toward the aforementioned applications, where a 3D nanostructure of closely spaced, aligned sheets is desired. Quantitatively characterizing their microstructural evolution during compression is needed to allow optimization of manufacturing, understand in-service structural changes, and determine how aerogel structure relates to functional properties. Herein we have developed methods to quantitatively analyze lamellar aerogel domains, sheet spacing, and sheet orientation in 3D and to track their evolution as a function of increasing compression through synchrotron phase contrast X-ray microcomputed tomography (μCT). The as-cast domains are predominantly aligned with the freezing direction with random orientation in the orthogonal plane. Generally the sheets rotate toward flat and their spacing narrows progressively with increasing compression with negligible lateral strain (zero Poisson's ratio). This is with the exception of sheets close to parallel with the loading direction (Z), which maintain their orientation and sheet spacing until ∼60% compression, beyond which they exhibit buckling. These data suggest that a single-domain, fully aligned as-cast aerogel is not necessary to produce a post-compression aligned lamellar structure and indicate how the spacing can be tailored as a function of compressive strain. The analysis methods presented herein are applicable to optimizing freeze-casting process and quantifying lamellar microdomain structures generally.
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Affiliation(s)
- Shelley D. Rawson
- Henry
Royce Institute, Department of Materials, The University of Manchester, Manchester M13 9PL, U.K.
| | - Vildan Bayram
- Department
of Materials, University of Manchester, Manchester M13 9PL, U.K.
| | | | - Pei Yang
- Department
of Materials, University of Manchester, Manchester M13 9PL, U.K.
| | | | - Yi Guo
- Department
of Materials, Imperial College London, London SW7 2BU, U.K.
| | - Jiaqi Xu
- Henry
Royce Institute, Department of Materials, The University of Manchester, Manchester M13 9PL, U.K.
| | - Timothy L. Burnett
- Henry
Royce Institute, Department of Materials, The University of Manchester, Manchester M13 9PL, U.K.
| | - Suelen Barg
- Department
of Materials, University of Manchester, Manchester M13 9PL, U.K.
- Institute
of Materials Resource Management, Augsburg
University, Augsburg 86159, Germany
| | - Philip J. Withers
- Henry
Royce Institute, Department of Materials, The University of Manchester, Manchester M13 9PL, U.K.
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16
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Furmaga J, Courtney DM, Lehmann CU, Green W, O'Connell E, Diercks DB, Ott J, McDonald SA. Improving emergency department documentation with noninterruptive clinical decision support: An open-label, randomized clinical efficacy trial. Acad Emerg Med 2022; 29:228-230. [PMID: 34431159 DOI: 10.1111/acem.14379] [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] [Received: 07/13/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Jakub Furmaga
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - D Mark Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Departments of Pediatrics, Bioinformatics, Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Walter Green
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ellen O'Connell
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Deborah B Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jason Ott
- University of Texas Southwestern Health System, Dallas, Texas, USA
| | - Samuel A McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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17
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Beiser DG, Jarou ZJ, Kassir AA, Puskarich MA, Vrablik MC, Rosenman ED, McDonald SA, Meltzer AC, Courtney DM, Kabrhel C, Kline JA. Predicting 30-day return hospital admissions in patients with COVID-19 discharged from the emergency department: A national retrospective cohort study. J Am Coll Emerg Physicians Open 2021; 2:e12595. [PMID: 35005705 PMCID: PMC8716570 DOI: 10.1002/emp2.12595] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/09/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Identification of patients with coronavirus disease 2019 (COVID-19) at risk for deterioration after discharge from the emergency department (ED) remains a clinical challenge. Our objective was to develop a prediction model that identifies patients with COVID-19 at risk for return and hospital admission within 30 days of ED discharge. METHODS We performed a retrospective cohort study of discharged adult ED patients (n = 7529) with SARS-CoV-2 infection from 116 unique hospitals contributing to the National Registry of Suspected COVID-19 in Emergency Care. The primary outcome was return hospital admission within 30 days. Models were developed using classification and regression tree (CART), gradient boosted machine (GBM), random forest (RF), and least absolute shrinkage and selection (LASSO) approaches. RESULTS Among patients with COVID-19 discharged from the ED on their index encounter, 571 (7.6%) returned for hospital admission within 30 days. The machine-learning (ML) models (GBM, RF, and LASSO) performed similarly. The RF model yielded a test area under the receiver operating characteristic curve of 0.74 (95% confidence interval [CI], 0.71-0.78), with a sensitivity of 0.46 (95% CI, 0.39-0.54) and a specificity of 0.84 (95% CI, 0.82-0.85). Predictive variables, including lowest oxygen saturation, temperature, or history of hypertension, diabetes, hyperlipidemia, or obesity, were common to all ML models. CONCLUSIONS A predictive model identifying adult ED patients with COVID-19 at risk for return for return hospital admission within 30 days is feasible. Ensemble/boot-strapped classification methods (eg, GBM, RF, and LASSO) outperform the single-tree CART method. Future efforts may focus on the application of ML models in the hospital setting to optimize the allocation of follow-up resources.
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Affiliation(s)
- David G. Beiser
- Section of Emergency MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Zachary J. Jarou
- Department of Emergency MedicineSt. Joseph Mercy Ann Arbor HospitalUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Alaa A. Kassir
- Section of Emergency MedicineUniversity of ChicagoChicagoIllinoisUSA
| | - Michael A. Puskarich
- Department of Emergency MedicineHennepin County Medical CenterMinneapolisMinnesotaUSA
| | - Marie C. Vrablik
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Samuel A. McDonald
- Department of Emergency MedicineUT Southwestern Medical CenterDallasTexasUSA
| | - Andrew C. Meltzer
- Department of Emergency MedicineGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - D. Mark Courtney
- Department of Emergency MedicineUT Southwestern Medical CenterDallasTexasUSA
| | - Christopher Kabrhel
- Department of Emergency MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Jeffrey A. Kline
- Department of Emergency MedicineIndiana UniversityIndianapolisIndianaUSA
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18
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McDonald SA, McAuley A, Hickman M, Bird SM, Weir A, Templeton K, Gunson R, Hutchinson SJ. Increasing drug-related mortality rates over the last decade in Scotland are not just due to an ageing cohort: A retrospective longitudinal cohort study. Int J Drug Policy 2021; 96:103286. [PMID: 34011449 DOI: 10.1016/j.drugpo.2021.103286] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/18/2020] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND In Europe, North America, and Australia, mortality due to drug-related (DR) causes amongst people who inject drugs (PWID) is a major issue. Our objective was to characterise temporal trends in DR mortality rates in a large cohort of PWID in Scotland over the past decade, all of whom had been diagnosed with hepatitis C virus (HCV) infection, and to investigate factors associated with DR mortality. METHODS Retrospective longitudinal cohort study linking Scotland's national HCV Diagnosis Database and deaths registry. The study cohort consisted of all individuals with likely injection drug use-related route of HCV acquisition, who had been diagnosed with HCV between 1991 and 2018, and were alive and aged under 65 years on 1 January 2009. We used Lexis expansion to adjust for ageing cohort effects and calculated the mortality rate from an underlying/contributing DR cause over the period 2009-2018. We fitted Poisson regression models to estimate the temporal trend adjusting for attained age, sex, referral setting, region, and viraemic status at baseline. RESULTS Amongst the study population (n = 35,065; 236,914 person-years), a total of 1900 DR deaths occurred; the DR mortality rate increased from 5.6/1000 [101 deaths] in 2009 to 12.4/1000 [342] person-years in 2018. Increasing trends were observed for all age-groups except 55-64 years. The overall DR mortality rate was highest for referrals for HCV testing from prison (11.0/1000) and hospital settings (10.0/1000). Mortality increased with calendar time period, with significantly raised adjusted rate ratios (RRs) from 2015 (RR=1.40, 95% CI:1.16-1.69) to 2018 (RR=2.23, 95% CI:1.88-2.64), compared with 2011-2012, for older age (35-44: RR=1.37, 95% CI:1.20-1.56; 45-54: RR=1.32, CI:1.14-1.53) compared with <35 years, for persons diagnosed with HCV since 2009 (RR=1.34, 95% CI:1.21-1.49), and for prison and hospital referrals (RRs of 1.30, 1.37) compared with GP referrals. CONCLUSION Increasing DR mortality rates in Scotland over the past decade are not just due to an ageing cohort. Harm reduction services will likely need to expand and adapt to reverse the recent upward trends in DR mortality in PWID.
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Affiliation(s)
- S A McDonald
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK.
| | - A McAuley
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK
| | - M Hickman
- University of Bristol, Bristol BS8 1TL, UK
| | - S M Bird
- MRC Biostatistics Unit, Robinson Way, Cambridge CB2 OSR, UK
| | - A Weir
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK
| | - K Templeton
- Edinburgh Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA, UK
| | - R Gunson
- West of Scotland Specialist Virology Centre, 8-16 Alexandra Parade, Glasgow G31 2ER, UK
| | - S J Hutchinson
- Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK; Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK
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19
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Furmaga J, McDonald SA. Impact of Rapid Medical Evaluation on Patient Flow in an Urban Emergency Department. J Med Syst 2021; 45:63. [PMID: 33905000 DOI: 10.1007/s10916-021-01741-8] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
Rapid Medical Evaluation (RME) is a new Emergency Department (ED) process that initiates testing while patients are in the Waiting Room. Primary goal of this study is to assess the effectiveness of RME pathway on the patient flow through the ED. This was a retrospective, single site, cohort study of patients presenting to the ED 12 months before (PRE group) and 12 months after (POST group) RME implementation. The POST group was divided into those that underwent RME and those managed using standard care pathway (SCP). Data was collected from Electronic Health Record (EHR) database using SQL and consisted of time stamp data for discrete ED patient events. The following metrics were calculated for all ED encounters: Active ED Room Time, Boarding Time, Total ED Room Time, Total ED Time, and Door-to-Provider Time. Patients undergoing RME on average spent 90-min less in ED Treatment Room compared to SCP group and were evaluated by a provider 151 min earlier than if they had waited for an available ED Treatment Room. Implementation of RME helped reduce time patients spend in ED Treatment Room, improved patient throughput, and decreased Door-to-Provider time during the busiest times in the ED.
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Affiliation(s)
- Jakub Furmaga
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Samuel A McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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20
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Furmaga J, McDonald SA, Hall HM, Muthukumar A, Willett K, Basit M, Diercks DB. Impact of High-sensitivity Troponin Testing on Operational Characteristics of an Urban Emergency Department. Acad Emerg Med 2021; 28:114-116. [PMID: 32153064 DOI: 10.1111/acem.13956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jakub Furmaga
- From the Department of Emergency Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Samuel A. McDonald
- From the Department of Emergency Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Hurst M. Hall
- and the Department of Internal Medicine–Cardiology University of Texas Southwestern Medical Center Dallas TX
| | - Alagarraju Muthukumar
- and the Department of Pathology University of Texas Southwestern Medical Center Dallas TX
| | - Kyle Willett
- From the Department of Emergency Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Mujeeb Basit
- and the Department of Internal Medicine–Cardiology University of Texas Southwestern Medical Center Dallas TX
| | - Deborah B. Diercks
- From the Department of Emergency Medicine University of Texas Southwestern Medical Center Dallas TX
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21
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Gajjar P, Nguyen TTH, Sun J, Styliari ID, Bale H, McDonald SA, Burnett TL, Tordoff B, Lauridsen E, Hammond RB, Murnane D, Withers PJ, Roberts KJ. Crystallographic tomography and molecular modelling of structured organic polycrystalline powders. CrystEngComm 2021. [DOI: 10.1039/d0ce01712d] [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: 01/30/2023]
Abstract
Novel combination of crystallographic tomography and molecular modelling is used to examine the powder packing behaviour and crystal interactions for an organic polycrystalline powder bed.
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22
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McDonald SA, Medford RJ, Basit MA, Diercks DB, Courtney DM. Derivation With Internal Validation of a Multivariable Predictive Model to Predict COVID-19 Test Results in Emergency Department Patients. Acad Emerg Med 2020; 28:206-214. [PMID: 33249683 PMCID: PMC7753649 DOI: 10.1111/acem.14182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/19/2022]
Abstract
Objectives The COVID‐19 pandemic has placed acute care providers in demanding situations in predicting disease given the clinical variability, desire to cohort patients, and high variance in testing availability. An approach to stratifying patients by likelihood of disease based on rapidly available emergency department (ED) clinical data would offer significant operational and clinical value. The purpose of this study was to develop and internally validate a predictive model to aid in the discrimination of patients undergoing investigation for COVID‐19. Methods All patients greater than 18 years presenting to a single academic ED who were tested for COVID‐19 during this index ED evaluation were included. Outcome was defined as the result of COVID‐19 polymerase chain reaction (PCR) testing during the index visit or any positive result within the following 7 days. Variables included chest radiograph interpretation, disease‐specific screening questions, and laboratory data. Three models were developed with a split‐sample approach to predict outcome of the PCR test utilizing logistic regression, random forest, and gradient‐boosted decision tree methods. Model discrimination was evaluated comparing area under the receiver operator curve (AUC) and point statistics at a predefined threshold. Results A total of 1,026 patients were included in the study collected between March and April 2020. Overall, there was disease prevalence of 9.6% in the population under study during this time frame. The logistic regression model was found to have an AUC of 0.89 (95% confidence interval [CI] = 0.84 to 0.94) when including four features: exposure history, temperature, white blood cell count (WBC), and chest radiograph result. Random forest method resulted in AUC of 0.86 (95% CI = 0.79 to 0.92) and gradient boosting had an AUC of 0.85 (95% CI = 0.79 to 0.91). With a consistently held negative predictive value, the logistic regression model had a positive predictive value of 0.29 (0.2–0.39) compared to 0.2 (0.14–0.28) for random forest and 0.22 (0.15–0.3) for the gradient‐boosted method. Conclusion The derived predictive models offer good discriminating capacity for COVID‐19 disease and provide interpretable and usable methods for those providers caring for these patients at the important crossroads of the community and the health system. We found utilization of the logistic regression model utilizing exposure history, temperature, WBC, and chest X‐ray result had the greatest discriminatory capacity with the most interpretable model. Integrating a predictive model‐based approach to COVID‐19 testing decisions and patient care pathways and locations could add efficiency and accuracy to decrease uncertainty.
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Affiliation(s)
- Samuel A. McDonald
- From the Department of Emergency Medicine University of Texas Southwestern Medical Center Dallas TXUSA
- the Clinical Informatics Center University of Texas Southwestern Medical Center Dallas TXUSA
| | - Richard J. Medford
- the Clinical Informatics Center University of Texas Southwestern Medical Center Dallas TXUSA
- the Department of Internal Medicine/Infectious Disease University of Texas Southwestern Medical Center Dallas TXUSA
| | - Mujeeb A. Basit
- the Clinical Informatics Center University of Texas Southwestern Medical Center Dallas TXUSA
- and the Department of Internal Medicine/Cardiology University of Texas Southwestern Medical Center Dallas TXUSA
| | - Deborah B. Diercks
- From the Department of Emergency Medicine University of Texas Southwestern Medical Center Dallas TXUSA
| | - D. Mark Courtney
- From the Department of Emergency Medicine University of Texas Southwestern Medical Center Dallas TXUSA
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23
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McDonald SA, Godleski JJ. Platy Talc, Asbestos, and Talc Fibers in the Female Genital Tract in Patients with Ovarian Cancer. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.047] [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: 11/15/2022] Open
Abstract
Abstract
Introduction/Objective
Recent analyses on human tissue help inform the discussion regarding talc and ovarian cancer, by showing that, in some patients, considerable talc can migrate to multiple organ sites in the pelvic region from perineal application. Recently, we showed that birefringent particles were seen by polarized light microscopy and shown to be talc by scanning electron microscopy/energy dispersive X-ray analysis (SEM/EDS) and/or Raman spectroscopy in surgically resected tissues from patients with ovarian carcinoma and perineal talc exposure. These sites included ovary, cervix, fallopian tube, uterine serosa, and regional lymph nodes. Fibrous talc, with greater carcinogenic potential as determined by the International Agency for Research on Cancer, may be observed in pelvic tissues. Besides ascension through the reproductive tract, particles and fibers may gain entry to pelvic organs by accessing small submucosal lymphatics in the lower part of the tract. Both platy and fibrous talc have an Mg-Si elemental signature, weight % Mg/Si ratio within 5% of the theoretical value of 0.649, and thus are distinguishable from other exogenous substances including the various subtypes of asbestos.
Methods
Tissue-based analytic methods (including in situ SEM, where a paraffin block is examined directly under variable pressure) are critical in the detection of talc and asbestos, particularly since they preserve architecture, and demonstrate talc and/or fibrous particles within their histologic environment; this may help inform exposure origin and pathophysiologic significance.
Results
We reviewed the analytic outcomes of our consultative experience to date. This showed that 180 of 196 patients with a history of perineal talc exposure had birefringent particles seen by light microscopy in surgically resected pelvic tissues, and 82 of 91 had talc confirmed by SEM/EDS. Carcinogenic fibers were found in 28/82 (34%) of these patients, with talc fibers only (19/82 patients, 23%), asbestos (7/82, 9%) or both (2/82, 2%) confirmed by SEM/EDS.
Conclusion
Our study confirms that talc and toxic fibers may be found in human pelvic tissues of talc-exposed patients. Because the SEM/EDS method samples only a small amount of tissue relative to what is in the paraffin block, the finding of exogenous particles by this method typically translates to a high overall particle burden, when scaled mathematically to bulk tissue.
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Affiliation(s)
- S A McDonald
- Pathology, John J. Godleski MD PLLC, Milton, Massachusetts, UNITED STATES
| | - J J Godleski
- Pathology, John J. Godleski MD PLLC, Milton, Massachusetts, UNITED STATES
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24
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McDonald SA, Coban SB, Sottos NR, Withers PJ. Tracking capsule activation and crack healing in a microcapsule-based self-healing polymer. Sci Rep 2019; 9:17773. [PMID: 31780720 PMCID: PMC6883056 DOI: 10.1038/s41598-019-54242-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022] Open
Abstract
Structural polymeric materials incorporating a microencapsulated liquid healing agent demonstrate the ability to autonomously heal cracks. Understanding how an advancing crack interacts with the microcapsules is critical to optimizing performance through tailoring the size, distribution and density of these capsules. For the first time, time-lapse synchrotron X-ray phase contrast computed tomography (CT) has been used to observe in three-dimensions (3D) the dynamic process of crack growth, microcapsule rupture and progressive release of solvent into a crack as it propagates and widens, providing unique insights into the activation and repair process. In this epoxy self-healing material, 150 µm diameter microcapsules within 400 µm of the crack plane are found to rupture and contribute to the healing process, their discharge quantified as a function of crack propagation and distance from the crack plane. Significantly, continued release of solvent takes place to repair the crack as it grows and progressively widens.
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Affiliation(s)
- S A McDonald
- Henry Royce Institute for Advanced Materials, Department of Materials, University of Manchester, Manchester, M13 9PL, UK.
| | - S B Coban
- Centrum Wiskunde & Informatica, Computational Imaging Group, Science Park 123, 1098XG, Amsterdam, The Netherlands
| | - N R Sottos
- Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - P J Withers
- Henry Royce Institute for Advanced Materials, Department of Materials, University of Manchester, Manchester, M13 9PL, UK
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25
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McDonald SA, Holzner C, Lauridsen EM, Reischig P, Merkle AP, Withers PJ. Microstructural evolution during sintering of copper particles studied by laboratory diffraction contrast tomography (LabDCT). Sci Rep 2017; 7:5251. [PMID: 28701768 PMCID: PMC5507940 DOI: 10.1038/s41598-017-04742-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022] Open
Abstract
Pressureless sintering of loose or compacted granular bodies at elevated temperature occurs by a combination of particle rearrangement, rotation, local deformation and diffusion, and grain growth. Understanding of how each of these processes contributes to the densification of a powder body is still immature. Here we report a fundamental study coupling the crystallographic imaging capability of laboratory diffraction contrast tomography (LabDCT) with conventional computed tomography (CT) in a time-lapse study. We are able to follow and differentiate these processes non-destructively and in three-dimensions during the sintering of a simple copper powder sample at 1050 °C. LabDCT quantifies particle rotation (to <0.05° accuracy) and grain growth while absorption CT simultaneously records the diffusion and deformation-related morphological changes of the sintering particles. We find that the rate of particle rotation is lowest for the more highly coordinated particles and decreases during sintering. Consequently, rotations are greater for surface breaking particles than for more highly coordinated interior ones. Both rolling (cooperative) and sliding particle rotations are observed. By tracking individual grains the grain growth/shrinkage kinetics during sintering are quantified grain by grain for the first time. Rapid, abnormal grain growth is observed for one grain while others either grow or are consumed more gradually.
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Affiliation(s)
- S A McDonald
- Henry Moseley X-ray Imaging Facility, School of Materials, University of Manchester, Manchester, M13 9PL, UK.
| | - C Holzner
- Carl Zeiss X-ray Microscopy, Inc., 4385 Hopyard Road, Suite 100, Pleasanton, CA, 94588, USA
| | - E M Lauridsen
- Xnovo Technology ApS, Galoche Alle 15, 4600, Køge, Denmark
| | - P Reischig
- Xnovo Technology ApS, Galoche Alle 15, 4600, Køge, Denmark
| | - A P Merkle
- Carl Zeiss X-ray Microscopy, Inc., 4385 Hopyard Road, Suite 100, Pleasanton, CA, 94588, USA
| | - P J Withers
- Henry Moseley X-ray Imaging Facility, School of Materials, University of Manchester, Manchester, M13 9PL, UK
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26
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Mustansar Z, McDonald SA, Sellers WI, Manning PL, Lowe T, Withers PJ, Margetts L. A study of the progression of damage in an axially loaded Branta leucopsis femur using X-ray computed tomography and digital image correlation. PeerJ 2017; 5:e3416. [PMID: 28652932 PMCID: PMC5483328 DOI: 10.7717/peerj.3416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/15/2017] [Indexed: 11/20/2022] Open
Abstract
This paper uses X-ray computed tomography to track the mechanical response of a vertebrate (Barnacle goose) long bone subjected to an axial compressive load, which is increased gradually until failure. A loading rig was mounted in an X-ray computed tomography system so that a time-lapse sequence of three-dimensional (3D) images of the bone’s internal (cancellous or trabecular) structure could be recorded during loading. Five distinct types of deformation mechanism were observed in the cancellous part of the bone. These were (i) cracking, (ii) thinning (iii) tearing of cell walls and struts, (iv) notch formation, (v) necking and (vi) buckling. The results highlight that bone experiences brittle (notch formation and cracking), ductile (thinning, tearing and necking) and elastic (buckling) modes of deformation. Progressive deformation, leading to cracking was studied in detail using digital image correlation. The resulting strain maps were consistent with mechanisms occurring at a finer-length scale. This paper is the first to capture time-lapse 3D images of a whole long bone subject to loading until failure. The results serve as a unique reference for researchers interested in how bone responds to loading. For those using computer modelling, the study not only provides qualitative information for verification and validation of their simulations but also highlights that constitutive models for bone need to take into account a number of different deformation mechanisms.
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Affiliation(s)
- Zartasha Mustansar
- Research Centre for Modelling and Simulation, National University of Science and Technology, Islamabad, Pakistan.,School of Earth and Environmental Science, University of Manchester, Manchester, UK
| | | | | | - Phillip Lars Manning
- School of Earth and Environmental Science, University of Manchester, Manchester, UK.,Department of Geology and Environmental Geosciences, College of Charleston, Charleston, SC, USA
| | - Tristan Lowe
- School of Materials, University of Manchester, Manchester, UK
| | | | - Lee Margetts
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
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27
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McDonald SA, Innes HA, Aspinall E, Hayes PC, Alavi M, Valerio H, Goldberg DJ, Hutchinson SJ. Prognosis of 1169 hepatitis C chronically infected patients with decompensated cirrhosis in the predirect-acting antiviral era. J Viral Hepat 2017; 24:295-303. [PMID: 27885753 DOI: 10.1111/jvh.12646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 10/05/2016] [Indexed: 12/19/2022]
Abstract
At a population level, little is known regarding the risk of liver- and nonliver-related mortality and hospitalization and the development of hepatocellular carcinoma (HCC) in hepatitis C virus (HCV)-infected patients with decompensated cirrhosis (DC). This large-scale national record-linkage study estimates these outcomes following first hospital admission for DC. Record-linkages between national HCV diagnosis and clinical databases and the national inpatient hospital episode database and mortality register were conducted to follow-up the disease course of all identified HCV-diagnosed and chronically infected persons. The study population consisted of 1169 HCV chronically infected persons who had a first hospital admission for DC within the period 1994-2013. We observed an overall average annual percentage change of 12.6% in new DC patients (from 63 in 1994-1999 to 541 in 2009-2013), with no evidence for any improvement in the relative risks of liver-related or all-cause death over time. Between 1 January 1994 and 31 May 2014, 722 and 95 DC patients had died of a liver- and a nonliver-related cause, respectively, and 106 patients had a subsequent first admission for HCC. The 5-year cumulative incidence of liver-related mortality, nonliver-related mortality and first subsequent HCC admission was 61.3%, 8.2% and 8.8%, respectively. The health burden in HCV-infected patients associated with development of decompensated cirrhosis has increased dramatically over the last 20 years. Our findings establish the baseline mortality and HCC progression rates in DC patients against which the impact of new antiviral therapies can be measured.
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Affiliation(s)
- S A McDonald
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - H A Innes
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - E Aspinall
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - P C Hayes
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Alavi
- Health Protection Scotland, Glasgow, UK
| | - H Valerio
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - D J Goldberg
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
| | - S J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Health Protection Scotland, Glasgow, UK
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28
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Bourne NK, Garcea SC, Eastwood DS, Parry S, Rau C, Withers PJ, McDonald SA, Brown EN. On compression and damage evolution in two thermoplastics. Proc Math Phys Eng Sci 2017; 473:20160495. [PMID: 28265185 PMCID: PMC5312121 DOI: 10.1098/rspa.2016.0495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The well-known Taylor cylinder impact test, which follows the impact of a flat-ended cylindrical rod onto a rigid stationary anvil, is conducted over a range of impact speeds for two polymers, polytetrafluoroethylene (PTFE) and polyetheretherketone (PEEK). In previous work, experiments and a model were developed to capture the deformation behaviour of the cylinder after impact. These works showed a region in which spatial and temporal variation of both longitudinal and radial deformation provided evidence of changes in phase within the material. In this further series of experiments, this region is imaged in a range of impacted targets at the Diamond synchrotron. Further techniques were fielded to resolve compressed regions within the recovered polymer cylinders that showed a fracture zone in the impact region. The combination of macroscopic high-speed photography and three-dimensional X-ray imaging has identified the development of failure with these polymers and shown that there is no abrupt transition in behaviours but rather a continuous range of responses to competing operating mechanisms. The behaviours noted in PEEK in these polymers show critical gaps in understanding of polymer high strain-rate response.
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Affiliation(s)
- N K Bourne
- School of Materials , University of Manchester , Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0FA , UK
| | - S C Garcea
- School of Materials , University of Manchester , Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0FA , UK
| | - D S Eastwood
- School of Materials , University of Manchester , Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0FA , UK
| | - S Parry
- School of Materials, University of Manchester, Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0FA, UK; Defence Science and Technology Organisation, Adelaide, Australia
| | - C Rau
- Diamond Light Source Ltd , Harwell Science and Innovation Campus , Didcot, Oxfordshire OX11 0DE , UK
| | - P J Withers
- School of Materials , University of Manchester , Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0FA , UK
| | - S A McDonald
- School of Materials , University of Manchester , Rutherford Appleton Laboratory, Didcot, Oxfordshire OX11 0FA , UK
| | - E N Brown
- Explosive Science and Shock Physics Division , Los Alamos National Laboratory , Los Alamos, NM , USA
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McDonald SA, Reischig P, Holzner C, Lauridsen EM, Withers PJ, Merkle AP, Feser M. Non-destructive mapping of grain orientations in 3D by laboratory X-ray microscopy. Sci Rep 2015; 5:14665. [PMID: 26494523 PMCID: PMC4615976 DOI: 10.1038/srep14665] [Citation(s) in RCA: 22] [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] [Received: 06/30/2015] [Accepted: 08/21/2015] [Indexed: 11/13/2022] Open
Abstract
The ability to characterise crystallographic microstructure, non-destructively and in three-dimensions, is a powerful tool for understanding many aspects related to damage and deformation mechanisms in polycrystalline materials. To this end, the technique of X-ray diffraction contrast tomography (DCT) using monochromatic synchrotron and polychromatic laboratory X-ray sources has been shown to be capable of mapping crystal grains and their orientations non-destructively in 3D. Here we describe a novel laboratory-based X-ray DCT modality (LabDCT), enabling the wider accessibility of the DCT technique for routine use and in-depth studies of, for example, temporal changes in crystallographic grain structure non-destructively over time through ‘4D’ in situ time-lapse studies. The capability of the technique is demonstrated by studying a titanium alloy (Ti-β21S) sample. In the current implementation the smallest grains that can be reliably detected are around 40 μm. The individual grain locations and orientations are reconstructed using the LabDCT method and the results are validated against independent measurements from phase contrast tomography and electron backscatter diffraction respectively. Application of the technique promises to provide important insights related to the roles of recrystallization and grain growth on materials properties as well as supporting 3D polycrystalline modelling of materials performance.
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Affiliation(s)
- S A McDonald
- Manchester X-ray Imaging Facility, School of Materials, University of Manchester, Manchester, M13 9PL, UK
| | - P Reischig
- Xnovo Technology ApS, Galoche Alle 15, 4600 Køge, Denmark
| | - C Holzner
- Carl Zeiss X-ray Microscopy, Inc., 4385 Hopyard Road, Suite 100, Pleasanton, CA 94588, USA
| | - E M Lauridsen
- Xnovo Technology ApS, Galoche Alle 15, 4600 Køge, Denmark
| | - P J Withers
- Manchester X-ray Imaging Facility, School of Materials, University of Manchester, Manchester, M13 9PL, UK
| | - A P Merkle
- Carl Zeiss X-ray Microscopy, Inc., 4385 Hopyard Road, Suite 100, Pleasanton, CA 94588, USA
| | - M Feser
- Carl Zeiss X-ray Microscopy, Inc., 4385 Hopyard Road, Suite 100, Pleasanton, CA 94588, USA
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Kazantsev D, Van Eyndhoven G, Lionheart WRB, Withers PJ, Dobson KJ, McDonald SA, Atwood R, Lee PD. Employing temporal self-similarity across the entire time domain in computed tomography reconstruction. Philos Trans A Math Phys Eng Sci 2015; 373:rsta.2014.0389. [PMID: 25939621 PMCID: PMC4424485 DOI: 10.1098/rsta.2014.0389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 05/19/2023]
Abstract
There are many cases where one needs to limit the X-ray dose, or the number of projections, or both, for high frame rate (fast) imaging. Normally, it improves temporal resolution but reduces the spatial resolution of the reconstructed data. Fortunately, the redundancy of information in the temporal domain can be employed to improve spatial resolution. In this paper, we propose a novel regularizer for iterative reconstruction of time-lapse computed tomography. The non-local penalty term is driven by the available prior information and employs all available temporal data to improve the spatial resolution of each individual time frame. A high-resolution prior image from the same or a different imaging modality is used to enhance edges which remain stationary throughout the acquisition time while dynamic features tend to be regularized spatially. Effective computational performance together with robust improvement in spatial and temporal resolution makes the proposed method a competitive tool to state-of-the-art techniques.
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Affiliation(s)
- D Kazantsev
- Manchester X-ray Imaging Facility, School of Materials, University of Manchester, Manchester M13 9PL, UK Research Complex at Harwell, Didcot, Oxfordshire OX11 0FA, UK
| | - G Van Eyndhoven
- iMinds-Vision Lab, University of Antwerp, 2610 Wilrijk, Belgium
| | - W R B Lionheart
- School of Mathematics, University of Manchester, Alan Turing Building, Manchester M13 9PL, UK
| | - P J Withers
- Manchester X-ray Imaging Facility, School of Materials, University of Manchester, Manchester M13 9PL, UK Research Complex at Harwell, Didcot, Oxfordshire OX11 0FA, UK
| | - K J Dobson
- Department of Earth and Environmental Sciences, Ludwig Maximilian University, Munich, Germany
| | - S A McDonald
- Manchester X-ray Imaging Facility, School of Materials, University of Manchester, Manchester M13 9PL, UK
| | - R Atwood
- Diamond Light Source, Harwell Science and Innovation Campus, Didcot OX11 0DE, UK
| | - P D Lee
- Manchester X-ray Imaging Facility, School of Materials, University of Manchester, Manchester M13 9PL, UK Research Complex at Harwell, Didcot, Oxfordshire OX11 0FA, UK
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McDonald SA, Hutchinson SJ, Innes HA, Allen S, Bramley P, Bhattacharyya D, Carman W, Dillon JF, Fox R, Fraser A, Goldberg DJ, Kennedy N, Mills PR, Morris J, Stanley AJ, Wilks D, Hayes PC. Attendance at specialist hepatitis clinics and initiation of antiviral treatment among persons chronically infected with hepatitis C: examining the early impact of Scotland's Hepatitis C Action Plan. J Viral Hepat 2014; 21:366-76. [PMID: 24716639 DOI: 10.1111/jvh.12153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 06/27/2013] [Indexed: 01/08/2023]
Abstract
Primary goals of the Hepatitis C Action Plan for Scotland Phase II (May 2008-March 2011) were to increase, among persons chronically infected with the hepatitis C (HCV) virus, attendance at specialist outpatient clinics and initiation on antiviral therapy. We evaluated progress towards these goals by comparing the odds, across time, of (a) first clinic attendance within 12 months of HCV diagnosis (n = 9747) and (b) initiation on antiviral treatment within 12 months of first attendance (n = 5736). Record linkage between the national HCV diagnosis (1996-2009) and HCV clinical (1996-2010) databases and logistic regression analyses were conducted for both outcomes. For outcome (a), 32% and 45% in the respective pre-Phase II (before 1 May 2008) and Phase II periods attended a specialist clinic within 12 months of diagnosis; the odds of attendance within 12 months increased over time (OR = 1.05 per year, 95% CI: 1.04-1.07), but was not significantly greater for persons diagnosed with HCV in the Phase II era, compared with the pre-Phase II era (OR = 1.1, 95% CI: 0.9-1.3), after adjustment for temporal trend. For outcome (b), 13% and 28% were initiated on treatment within 12 months of their first clinic attendance in the pre-Phase II and Phase II periods, respectively. Higher odds of treatment initiation were associated with first clinic attendance in the Phase II (OR = 1.9, 95% CI: 1.5-2.4), compared with the pre-Phase II era. Results were consistent with a positive impact of the Hepatitis C Action Plan on the treatment of chronically infected individuals, but further monitoring is required to confirm a sustained effect.
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Affiliation(s)
- S A McDonald
- Health Protection Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Colzani E, McDonald SA, Carrillo-Santisteve P, Busana MC, Lopalco P, Cassini A. Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006-2011. Vaccine 2014; 32:1814-9. [PMID: 24530930 DOI: 10.1016/j.vaccine.2014.01.094] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 01/24/2014] [Accepted: 01/30/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Challenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS. METHODS Country-specific data on measles national vaccination coverage 2006-2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage. RESULTS The reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: -0.047 to -0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007. CONCLUSIONS This study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles.
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Affiliation(s)
- E Colzani
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - S A McDonald
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - M C Busana
- London School of Hygiene and Preventive Medicine, London, United Kingdom
| | - P Lopalco
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - A Cassini
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Abstract
Alcoholic liver disease including cirrhosis is a major health burden with huge cost to the National Health Service due to frequent hospital admissions of patients with alcoholic liver disease. The highest morbidity and mortality from alcoholic liver disease in Western Europe is in the West of Scotland. This study analyses the mortality and re-admission rates of patients admitted with alcoholic liver disease to a Glasgow hospital and compares the outcome with a Scotland wide historic control. Mortality in the study of 124 patients admitted to the hospital with alcoholic liver disease was 18% during index admission, and was 40% when including follow-up of one year after discharge. Re-admissions were high in this population. Seventy-five per cent of patients had at least one re-admission within one year, and patients spent an average of over one month in hospital during the study period. Survival rates in the Glasgow hospital were comparable to survival in the Scottish cohort. However, re-admission rates were significantly higher in the Glasgow hospital. In conclusion, patients with alcoholic liver disease requiring hospitalisation have very high mortality and frequent re-admissions.
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Mazick A, Gergonne B, Nielsen J, Wuillaume F, Virtanen MJ, Fouillet A, Uphoff H, Sideroglou T, Paldy A, Oza A, Nunes B, Flores-Segovia VM, Junker C, McDonald SA, Green HK, Pebody R, Mølbak K. Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveill 2012. [DOI: 10.2807/ese.17.14.20138-en] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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
In February and March 2012, excess deaths among the elderly have been observed in 12 European countries that carry out weekly monitoring of all-cause mortality. These preliminary data indicate that the impact of influenza in Europe differs from the recent pandemic and post-pandemic seasons. The current excess mortality among the elderly may be related to the return of influenza A(H3N2) virus, potentially with added effects of a cold snap.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark
| | - B Gergonne
- The National Board of Health and Welfare, Stockholm, Sweden
| | - J Nielsen
- Statens Serum Institut, Copenhagen, Denmark
| | - F Wuillaume
- Scientific Institute of Public Health, Brussels, Belgium
| | - M J Virtanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - A Fouillet
- French Institute for Public Health Surveillance (Institut de Veille Sanitaire, InVS), Saint-Maurice, France
| | - H Uphoff
- Hesse State Health Office, Dillenburg, Germany
| | - T Sideroglou
- Hellenic Centre for Disease Control and Prevention, Athens, Greece
| | - A Paldy
- Hungary National Institute of Environmental Health, Budapest, Hungary
| | - A Oza
- Health Protection Surveillance Centre, Dublin, Ireland
| | - B Nunes
- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - C Junker
- Federal Statistical Office, Neuchâtel, Switzerland
| | - S A McDonald
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - H K Green
- Health Protection Agency, Colindale, United Kingdom
| | - R Pebody
- Health Protection Agency, Colindale, United Kingdom
| | - K Mølbak
- Statens Serum Institut, Copenhagen, Denmark
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Mazick A, Gergonne B, Nielsen J, Wuillaume F, Virtanen MJ, Fouillet A, Uphoff H, Sideroglou T, Paldy A, Oza A, Nunes B, Flores-Segovia VM, Junker C, McDonald SA, Green HK, Pebody R, Mølbak K. Excess mortality among the elderly in 12 European countries, February and March 2012. Euro Surveill 2012; 17:20138. [PMID: 22516003] [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: 05/31/2023] Open
Abstract
In February and March 2012, excess deaths among the elderly have been observed in 12 European countries that carry out weekly monitoring of all-cause mortality. These preliminary data indicate that the impact of influenza in Europe differs from the recent pandemic and post-pandemic seasons. The current excess mortality among the elderly may be related to the return of influenza A(H3N2) virus, potentially with added effects of a cold snap.
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Affiliation(s)
- A Mazick
- Statens Serum Institut, Copenhagen, Denmark.
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McDonald SA, Hutchinson SJ, Cameron S, Bird SM, Mills PR, McLeod A, Goldberg DJ. Uptake of hepatitis C antibody testing in patients with end-stage liver disease in Glasgow, 1993-2007. J Viral Hepat 2011; 18:e61-5. [PMID: 21029257 DOI: 10.1111/j.1365-2893.2010.01377.x] [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: 12/09/2022]
Abstract
Individuals infected with hepatitis C virus (HCV) need to be diagnosed well before developing end-stage liver disease to benefit from treatment. We aimed to ascertain what proportion of cases had been tested for HCV to inform on the effectiveness of current guidelines. Record linkage between national databases of HCV tests, hospital discharges and deaths identified 10,645 persons who were hospitalized or had died with mention of end-stage liver disease in Glasgow, Scotland, between 1993 and 2007. We estimated HCV test uptake and prevalence of HCV infection within the study population. The associations between both HCV test uptake and HCV-antibody status and sex, age group and deprivation quintile were estimated using logistic regression. We found that 43% of those hospitalized (n = 9153) and 23% of those who otherwise died (n = 1492) with first-time mention of end-stage liver disease had been tested for HCV during this period. Test uptake in those hospitalized increased from 13 (95% CI: 12-14%) in 1993-1997 to 58% (56-59%) in 2003-2007. The adjusted odds of being tested for HCV were significantly higher for men (OR=1.3, 95% CI: 1.2-1.5), for ages 25-54 (25-34 years: 2.7, 95% CI: 2.1-3.4; 35-44 years: 2.3, 95% CI: 2.0-2.6; 45-54 years: 1.5, 95% CI: 1.4-1.7) compared with 55+ years, and for those residing in the two most deprived quintiles (1.1, 95% CI: 1.0-1.2). Twenty-eight per cent of the HCV testees aged 25-44 years were HCV infected. These results highlight the continuing need for raising awareness among medical professionals for comprehensive HCV testing in patients with liver disease.
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Affiliation(s)
- S A McDonald
- Health Protection Scotland, Clifton House, Glasgow, Scotland, UK.
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McDonald SA, Hutchinson SJ, Mills PR, Bird SM, Cameron S, Dillon JF, Goldberg DJ. The influence of hepatitis C and alcohol on liver-related morbidity and mortality in Glasgow's injecting drug user population. J Viral Hepat 2011; 18:e126-33. [PMID: 20964793 DOI: 10.1111/j.1365-2893.2010.01380.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infection with the hepatitis C virus (HCV) is associated with the development of severe liver disease, but cofactors--namely alcohol abuse--in Scotland's HCV-positive population complicate estimation of the unique contribution of HCV. We compared the risk of hospital admission/death for a liver-related cause in a large cohort of Glasgow's injecting drug users (IDUs) testing HCV-positive with IDUs testing HCV negative. Data for 6566 current/former IDUs who had been tested for anti-HCV and/or HCV RNA by polymerase chain reaction in Greater Glasgow health board between 1993 and 2007 were linked to the national hospitalization database and deaths registry to identify all admissions and deaths from a liver-related condition. Relative risks were estimated using Cox proportional hazards regression for recurrent events. Time at risk was censored at 2 years following an HCV test to address bias owing to unobserved seroconversion. The risk of hospitalization/death from a liver-related or an alcoholic liver-related condition following HCV testing was greater for those IDUs with no prior alcohol-related hospitalization who tested positive [adjusted hazard ratio (HR) = 3.2, 95% CI: 1.5-6.7; 4.9, 95% CI: 1.8-13.1, respectively], compared with those who tested anti-HCV negative, but not for those IDUs with a prior alcohol admission (HR = 0.8, 95% CI: 0.4-1.5; 0.8, 95% CI: 0.4-1.6). There was little evidence for an increased risk of hospitalization/death for an exclusively nonalcoholic liver condition for those testing positive (HR = 1.5, 95% CI: 0.8-2.7), after adjustment for previous alcohol-related admission. Within Glasgow's IDU population, HCV positivity is associated with an increased risk of a liver-related outcome, but this is not observed for those IDUs whose problem alcohol use already increases their risk.
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Affiliation(s)
- S A McDonald
- Health Protection Scotland, Glasgow, Scotland, UK.
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McDonald SA, Hutchinson SJ, Bird SM, Robertson C, Mills PR, Graham L, Dillon JF, Goldberg DJ. The growing contribution of hepatitis C virus infection to liver-related mortality in Scotland. Euro Surveill 2010. [DOI: 10.2807/ese.15.18.19562-en] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The large number of individuals in Scotland who became infected with the hepatitis C virus (HCV) in the 1970s and 1980s leads us to expect liver-related morbidity and mortality to increase in the coming years. We investigated the contribution of HCV to liver-related mortality in the period January 1991 to June 2006. The study population consisted of 26,861 individuals whose death record mentioned a liver-related cause (underlying or contributing). Record-linkage to the national HCV Diagnosis database supplied HCV-diagnosed status for the study population. The proportion diagnosed with HCV among people dying from a liver-related cause rose from 2.8% (1995-1997) to 4.4% (2004-June 2006); the largest increase occurred in those aged 35-44 years at death (7% to 17%). Among all deaths from a liver-related cause, an HCV-positive diagnosis was more likely in those who died in 2001 or later than those who died in 1995-1997 (2001-2003: odds ratio=1.4, 95% confidence interval: 1.1-1.7; 2004-June 2006: 1.6, 1.3-2.0), and in those who died at under 55 compared with at least 55 years of age. HCV infection represents a significant, growing, public health burden in Scotland in terms of early deaths from liver disease.
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Affiliation(s)
- S A McDonald
- Health Protection Scotland, Glasgow, United Kingdom
| | - S J Hutchinson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
- Health Protection Scotland, Glasgow, United Kingdom
| | - S M Bird
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, United Kingdom
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - C Robertson
- Health Protection Scotland, Glasgow, United Kingdom
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - P R Mills
- Gartnavel General Hospital, Glasgow, United Kingdom
| | - L Graham
- Information Services Division, National Services Scotland, Edinburgh, United Kingdom
| | - J F Dillon
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - D J Goldberg
- Health Protection Scotland, Glasgow, United Kingdom
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McDonald SA, Hutchinson SJ, Bird SM, Robertson C, Mills PR, Graham L, Dillon JF, Goldberg DJ. The growing contribution of hepatitis C virus infection to liver-related mortality in Scotland. Euro Surveill 2010; 15:19562. [PMID: 20460092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
The large number of individuals in Scotland who became infected with the hepatitis C virus (HCV) in the 1970s and 1980s leads us to expect liver-related morbidity and mortality to increase in the coming years. We investigated the contribution of HCV to liver-related mortality in the period January 1991 to June 2006. The study population consisted of 26,861 individuals whose death record mentioned a liver-related cause (underlying or contributing). Record-linkage to the national HCV Diagnosis database supplied HCV-diagnosed status for the study population. The proportion diagnosed with HCV among people dying from a liver-related cause rose from 2.8% (1995-1997) to 4.4% (2004-June 2006); the largest increase occurred in those aged 35-44 years at death (7% to 17%). Among all deaths from a liver-related cause, an HCV-positive diagnosis was more likely in those who died in 2001 or later than those who died in 1995-1997 (2001-2003: odds ratio (OR)=1.4, 95% confidence interval (CI): 1.1-1.7; 2004-June 2006: 1.6, 1.3-2.0), and in those who died at under 55 compared with at least 55 years of age. HCV infection represents a significant, growing, public health burden in Scotland in terms of early deaths from liver disease.
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Affiliation(s)
- S A McDonald
- Health Protection Scotland, Glasgow, United Kingdom.
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McDonald SA, Marone F, Hintermüller C, Bensadoun JC, Aebischer P, Stampanoni M. High-throughput, high-resolution X-ray phase contrast tomographic microscopy for visualisation of soft tissue. ACTA ACUST UNITED AC 2009. [DOI: 10.1088/1742-6596/186/1/012043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Newman LC, Cady RK, Landy S, O'Carroll P, Kwong WJ, Burch SP, Nelsen AC, McDonald SA. Treatment satisfaction and efficacy of the rapid release formulation of sumatriptan 100 mg tablets utilising an early intervention paradigm in patients previously unsatisfied with sumatriptan. Int J Clin Pract 2008; 62:1889-99. [PMID: 19166436 PMCID: PMC2704938 DOI: 10.1111/j.1742-1241.2008.01935.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS To evaluate treatment satisfaction, efficacy and functional ability of the rapid release formulation of sumatriptan 100 mg tablets (sumatriptan RT 100 mg) in an early intervention paradigm in patients who were dissatisfied with low-dose sumatriptan and not completely satisfied with their current migraine regimen. METHODS Experienced migraineurs who reported a mild migraine pain phase, dissatisfaction with the previous sumatriptan treatment and some dissatisfaction with their current treatment regimen had no experience with sumatriptan at the 100 mg dose were enrolled in an open-label, single group study. Subjects were instructed to treat four migraine attacks within 30 min of the onset of mild pain. Treatment satisfaction was measured with the Patient Perception of Migraine Questionnaire Revised version (PPMQ-R) questionnaire. RESULTS More than half of the subjects were either very satisfied or satisfied with the efficacy of early intervention sumatriptan RT 100 mg after each attack and at the follow-up study visit. The mean total PPMQ-R score was 75.2 out of 100. Between 63% and 73% of subjects were pain-free within 4 h of dosing. Between 79% and 90% of subjects reported an ability to function normally within 4 h of taking the study medication. CONCLUSION Subjects who were previously unsatisfied with lower doses of sumatriptan and less than very satisfied with their current treatment regimen were more likely to be satisfied or very satisfied with sumatriptan RT 100 mg in an early intervention paradigm. Results were consistent across four migraine attacks and at a follow-up visit. The treatment satisfaction results corresponded with positive results on efficacy measures and a functional status measure.
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Affiliation(s)
- L C Newman
- The Headache Institute, Roosevelt Hospital Center, New York, Albert Einstein College of Medicine Bronx, NY 10019, USA.
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McDonald SA, Hutchinson SJ, Bird SM, Robertson C, Mills PR, Dillon JF, Goldberg DJ. A record-linkage study of the development of hepatocellular carcinoma in persons with hepatitis C infection in Scotland. Br J Cancer 2008; 99:805-10. [PMID: 18728670 PMCID: PMC2528155 DOI: 10.1038/sj.bjc.6604563] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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: 02/06/2023] Open
Abstract
We investigated trends in first-time hospital admissions and deaths attributable to hepatocellular carcinoma (HCC) in a large population-based cohort of 22 073 individuals diagnosed with hepatitis C viral (HCV) infection through laboratory testing in Scotland in 1991–2006. We identified new cases of HCC through record-linkage to the national inpatient hospital discharge database and deaths registry. A total of 172 persons diagnosed with HCV were admitted to hospital or died with first-time mention of HCC. Hepatocellular carcinoma incidence increased between 1996 and 2006 (average annual change of 6.1, 95% confidence interval (CI): 0.9–11.6%, P=0.021). The adjusted relative risk of HCC was greater for males (hazard ratio=2.7, 95% CI: 1.7–4.2), for those aged 60 years or older (hazard ratio=2.7, 95% CI: 1.9–4.1) compared with 50–59 years, and for those with a previous alcohol-related hospital admission (hazard ratio=2.5, 95% CI: 1.7–3.7). The risk of individuals diagnosed with HCV developing HCC was greatly increased compared with the general Scottish population (standardised incidence ratio=127, 95% CI: 102–156). Owing to the advancing age of the Scottish HCV-diagnosed population, the annual number of HCC cases is projected to increase, with a consequent increasing burden on the public healthcare system.
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Affiliation(s)
- S A McDonald
- Health Protection Scotland, Clifton House, Clifton Place, Glasgow G3 7LN, UK.
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Silberstein SD, Mannix LK, Goldstein J, Couch JR, Byrd SC, Ames MH, McDonald SA, Lener SE, Toso C. Multimechanistic (sumatriptan-naproxen) early intervention for the acute treatment of migraine. Neurology 2008; 71:114-21. [PMID: 18606965 DOI: 10.1212/01.wnl.0000316800.22949.20] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S D Silberstein
- Jefferson Headache Center, 111 South 11th Street, Suite 8130, Philadelphia, PA 19107, USA.
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Spitzyna GA, Wise RJS, McDonald SA, Plant GT, Kidd D, Crewes H, Leff AP. Optokinetic therapy improves text reading in patients with hemianopic alexia: a controlled trial. Neurology 2007; 68:1922-30. [PMID: 17536049 PMCID: PMC2651560 DOI: 10.1212/01.wnl.0000264002.30134.2a] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE An acquired right-sided homonymous hemianopia can result in slowed left-to-right text reading, called hemianopic alexia (HA). Patients with HA lack essential visual information to help guide ensuing reading fixations. We tested two hypotheses: first, that practice with a visual rehabilitation method that induced small-field optokinetic nystagmus (OKN) would improve reading speeds in patients with HA when compared to a sham visual rehabilitation therapy; second, that this therapy would preferentially affect reading saccades into the blind field. METHODS Nineteen patients with HA were entered into a two-armed study with two therapy blocks in each arm: one group practiced reading moving text (MT) that scrolled from right to left daily for two 4-week blocks (Group1), while the other had sham therapy (spot the difference) for the first block and then crossed over to MT for the second. RESULTS Group 1 showed significant improvements in static text reading speed over both therapy blocks (18% improvement), while Group 2 did not significantly improve over the first block (5% improvement) but did when they crossed over to the MT block (23% improvement). MT therapy was associated with a direction-specific effect on saccadic amplitude for rightward but not leftward reading saccades. CONCLUSION Optokinetic nystagmus inducing therapy preferentially affects reading saccades in the direction of the induced (involuntary) saccadic component. This is the first study to demonstrate the effectiveness of a specific eye movement based therapy in patients with hemianopic alexia (HA) in the context of a therapy-controlled trial. A free Web-based version of the therapy used in this study is available online to suitable patients with HA.
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Affiliation(s)
- G A Spitzyna
- Department of Clinical Neurosciences, Royal Free Hospital and University College Medical School, London, UK
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McDonald SA, Mummery PM, Johnson G, Withers PJ. Characterization of the three-dimensional structure of a metallic foam during compressive deformation. J Microsc 2006; 223:150-8. [PMID: 16911075 DOI: 10.1111/j.1365-2818.2006.01607.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
X-ray microtomography has been employed to collect three-dimensional images of aluminium closed-cell foam, enabling the internal structure to be characterized in three dimensions. An experimental technique and image analysis approach has been developed, and is described, in terms of the labelling of cells and the extraction of quantitative data such as the cell volume and cell compression. An in situ compressive deformation experiment has been performed on a single sample in order to illustrate the approach. The effect of the three-dimensional cellular structure on the mechanisms of deformation suggests not only the position of large cell volumes to be very important in the local concentration of stress, but also the distribution of cell volumes of immediate neighbours.
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Affiliation(s)
- S A McDonald
- Materials Science Centre, School of Materials, University of Manchester, Grosvenor Street, Manchester M1 7HS, UK.
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Abstract
In this paper, high-resolution tomographic synchrotron X-ray imaging is applied to study the occurrence and evolution of damage in Ti-6Al-4V/SCS6 SiC fibre composite materials. Three composite morphologies of increasing complexity have been studied, namely single fibre, single-ply and multi-ply composites. The single fibre composite was strained to full fibre fragmentation and the progressive introduction of damage monitored. For the single-ply composite, damage was introduced deliberately by laser drilling to establish the effect of damaged fibres on their neighbours, whereas for the multi-ply composite the morphology of a fibre bridging fatigue crack was studied. In addition to traditional mode I fibre fractures, subsequent fibre wedge cracks were observed presumably nucleating from damage introduced into the fibre surface by the first fracture event. In addition to these crack morphologies, spiral defects were observed for the single ply during failure. Finally, for the multi-ply composite, the matrix crack front showed a number of characteristic features, including advancement in fibre-free regions, crack bifurcation near fibres and different crack plane heights either side of a fibre.
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Affiliation(s)
- S A McDonald
- Manchester Materials Science Centre, University of Manchester and UMIST, Grosvenor Street, Manchester M1 7HS, UK
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McDonald SA, Shillcock RC. Rethinking the word frequency effect: the neglected role of distributional information in lexical processing. Lang Speech 2001; 44:295-323. [PMID: 11814216 DOI: 10.1177/00238309010440030101] [Citation(s) in RCA: 48] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Attempts to quantify lexical variation have produced a large number of theoretical and empirical constructs, such as Word Frequency, Concreteness, and Ambiguity, which have been claimed to predict between-word differences in lexical processing behavior. Models of word recognition that have been developed to account for the effects of these variables have typically lacked adequate semantic representations, and have dealt with words as if they exist in isolation from their environment. We present a new dimension of lexical variation that is addressed to this concern. Contextual Distinctiveness (CD), a corpus-derived summary measure of the frequency distribution of the contexts in which a word occurs, is naturally compatible with contextual theories of semantic representation and meaning. Experiment 1 demonstrates that CD is a significantly better predictor of lexical decision latencies than occurrence frequency, suggesting that CD is the more psychologically relevant variable. We additionally explore the relationship between CD and six subjectively-defined measures: Concreteness, Context Availability, Number of Contexts, Ambiguity, Age of Acquisition and Familiarity and find CD to be reliably related to Ambiguity only. We argue for the priority of immediate context in determining the representation and processing of language.
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Affiliation(s)
- S A McDonald
- Institute for Communicating and Collaborative Systems, Division of Informatics, University of Edinburgh, Scotland, UK.
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Higgins LM, McDonald SA, Whittle N, Crockett N, Shields JG, MacDonald TT. Regulation of T cell activation in vitro and in vivo by targeting the OX40-OX40 ligand interaction: amelioration of ongoing inflammatory bowel disease with an OX40-IgG fusion protein, but not with an OX40 ligand-IgG fusion protein. J Immunol 1999; 162:486-93. [PMID: 9886424] [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: 02/09/2023]
Abstract
OX40 is a member of the TNFR superfamily, and is found predominantly on activated CD4-positive T cells. In vitro an OX40-IgG fusion protein inhibits mitogen- and Ag-driven proliferation and cytokine release by splenocytes and lymph node T cells. In contrast, an OX40 ligand-IgG fusion protein enhanced proliferative responses. In normal mice, OX40-positive cells are observed only in lymphoid tissues, including Peyer's patches of the gut. In mice with hapten-induced colitis or IL-2 knockout mice with spontaneous colitis, OX40-positive cells are found infiltrating the lamina propria. Administration of the OX40-IgG fusion protein to mice with ongoing colitis (but not the OX40 ligand-IgG) ameliorated disease in both mouse models of inflammatory bowel disease. This was evidenced by a reduction in tissue myeloperoxidase; reduced transcripts for TNF-alpha, IL-1, IL-12, and IFN-gamma; and a reduction in the T cell infiltrate. Targeting OX40 therefore shows considerable promise as a new strategy to inhibit ongoing T cell reactions in the gut.
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MESH Headings
- Animals
- CHO Cells
- Colitis/genetics
- Colitis/immunology
- Colitis/therapy
- Concanavalin A/pharmacology
- Cricetinae
- Cytokines/biosynthesis
- Epitopes, T-Lymphocyte/immunology
- Female
- Humans
- Immunoglobulin G/genetics
- Immunoglobulin G/physiology
- Inflammatory Bowel Diseases/genetics
- Inflammatory Bowel Diseases/immunology
- Inflammatory Bowel Diseases/therapy
- Injections, Intraperitoneal
- Interleukin-2/deficiency
- Interleukin-2/genetics
- Ligands
- Lymphocyte Activation/genetics
- Membrane Glycoproteins
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C3H
- Mice, Knockout
- OX40 Ligand
- Receptors, OX40
- Receptors, Tumor Necrosis Factor/genetics
- Receptors, Tumor Necrosis Factor/physiology
- Recombinant Fusion Proteins/administration & dosage
- Recombinant Fusion Proteins/therapeutic use
- T-Lymphocyte Subsets/immunology
- T-Lymphocyte Subsets/metabolism
- Tumor Necrosis Factor Receptor Superfamily, Member 7/biosynthesis
- Tumor Necrosis Factor Receptor Superfamily, Member 7/genetics
- Tumor Necrosis Factor Receptor Superfamily, Member 7/physiology
- Tumor Necrosis Factors
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Affiliation(s)
- L M Higgins
- Department of Paediatric Gastroenterology, St. Bartholemew's and The Royal London School of Medicine and Dentistry, St. Bartholomew's Hospital, United Kingdom
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McDonald SA, Palmen MJ, Van Rees EP, MacDonald TT. Characterization of the mucosal cell-mediated immune response in IL-2 knockout mice before and after the onset of colitis. Immunol Suppl 1997; 91:73-80. [PMID: 9203968 PMCID: PMC1364037 DOI: 10.1046/j.1365-2567.1997.00217.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [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: 02/04/2023]
Abstract
One of the major advances in the understanding of inflammatory bowel disease has been the observation that mice with immunoregulatory defects, such as interleukin-2 knockout (IL-2 -/-) mice, develop spontaneous gut inflammation. Here we have characterized the immune response in the ileum, caecum and colon of these mice before and after the onset of colitis by examining the cellular infiltrate, the cytokines produced by these cells and the mucosal vascular addressin MAdCAM-1. IL-2 -/- mice developed colitis after 35 days of age and before this the mice were apparently healthy. IL-2 -/- mice aged over 35 days with colitis had large numbers of CD4+, CD8+, alpha beta T-cell receptor (TCR)+ and gamma delta TCR+ T cells, macrophages, dendritic cells and MAdCAM-1+ endothelial cells in the caecum and colon. This was associated with an increase in the number of interferon-gamma (IFN-gamma), IL-1 and tumour necrosis factor-alpha (TNF-alpha) transcripts and a decrease in IL-4 and IL-10 transcripts. Treatment of IL-2 -/- mice with cyclosporin A significantly delayed mortality. Interestingly, IL-2 -/- mice under 35 days, although healthy, did show some subtle immunological signs of preclinical disease. There was a significant increase in the number of macrophages and dendritic cells in the colonic lamina propria and increased mRNA for IL-1 and TNF-alpha. There were also increased numbers of MAdCAM-1+ endothelial cells, but IFN-gamma transcripts were not elevated. These results suggest that T-cell-mediated colitis in IL-2 -/- mice may be secondary to an initial non-specific inflammation.
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Affiliation(s)
- S A McDonald
- Department of Paediatric Gastroenterology, St Bartholomews London, UK
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Abstract
The objective of this study was to investigate the interaction between ethanol and dextroamphetamine with regard to psychomotor performance. Twelve healthy, male, paid volunteers, moderate users of ethanol and amphetamines, participated in this study. Ethanol (0.85 g/kg or placebo) was administered over a 30-min interval. Five minutes before the termination of ethanol or placebo ingestion, dextroamphetamine elixir (0.09 mg/kg, 0.18 mg/kg or placebo) diluted in 50 ml of orange juice was administered. Subjects were tested in a single-blind, latin-square, crossover design with each of the following six conditions: placebo ethanol/placebo dextroamphetamine; placebo ethanol/low-dose dextroamphetamine; placebo ethanol/high-dose dextroamphetamine; ethanol/placebo dextroamphetamine; ethanol/low-dose dextroamphetamine; and ethanol/high-dose dextroamphetamine. The variables measured in this study were: subjective rating of ethanol and dextroamphetamine intoxication, accuracy and latency of response in the Simulator Evaluation of Drug Impairment (SEDI task), blood ethanol concentration by breath analyzer, and plasma concentrations of dextroamphetamine by gas chromatography. Results indicate ethanol induced decrements in performance of the skills necessary to drive an automobile were significantly decreased by dextroamphetamine in a dose-response fashion. The administration of dextroamphetamine did not decrease the subjective ratings of ethanol intoxication.
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Affiliation(s)
- M Perez-Reyes
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill 27599-7175
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