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Abbasi R, Ackermann M, Adams J, Agarwalla SK, Aguilar JA, Ahlers M, Alameddine JM, Amin NM, Andeen K, Anton G, Argüelles C, Ashida Y, Athanasiadou S, Axani SN, Bai X, Balagopal VA, Baricevic M, Barwick SW, Basu V, Bay R, Beatty JJ, Becker Tjus J, Beise J, Bellenghi C, Benning C, BenZvi S, Berley D, Bernardini E, Besson DZ, Blaufuss E, Blot S, Bontempo F, Book JY, Boscolo Meneguolo C, Böser S, Botner O, Böttcher J, Bourbeau E, Braun J, Brinson B, Brostean-Kaiser J, Burley RT, Busse RS, Butterfield D, Campana MA, Carloni K, Carnie-Bronca EG, Chattopadhyay S, Chau N, Chen C, Chen Z, Chirkin D, Choi S, Clark BA, Classen L, Coleman A, Collin GH, Connolly A, Conrad JM, Coppin P, Correa P, Cowen DF, Dave P, De Clercq C, DeLaunay JJ, Delgado D, Deng S, Deoskar K, Desai A, Desiati P, de Vries KD, de Wasseige G, DeYoung T, Diaz A, Díaz-Vélez JC, Dittmer M, Domi A, Dujmovic H, DuVernois MA, Ehrhardt T, Eller P, Ellinger E, El Mentawi S, Elsässer D, Engel R, Erpenbeck H, Evans J, Evenson PA, Fan KL, Fang K, Farrag K, Fazely AR, Feigl N, Fiedlschuster S, Fienberg AT, Finley C, Fischer L, Fox D, Franckowiak A, Fritz A, Fürst P, Gallagher J, Ganster E, Garcia A, Gerhardt L, Ghadimi A, Glaser C, Glauch T, Glüsenkamp T, Goehlke N, Gonzalez JG, Goswami S, Grant D, Gray SJ, Gries O, Griffin S, Griswold S, Groth KM, Günther C, Gutjahr P, Haack C, Hallgren A, Halliday R, Halve L, Halzen F, Hamdaoui H, Ha Minh M, Hanson K, Hardin J, Harnisch AA, Hatch P, Haungs A, Helbing K, Hellrung J, Henningsen F, Heuermann L, Heyer N, Hickford S, Hidvegi A, Hill C, Hill GC, Hoffman KD, Hori S, Hoshina K, Hou W, Huber T, Hultqvist K, Hünnefeld M, Hussain R, Hymon K, In S, Ishihara A, Jacquart M, Janik O, Jansson M, Japaridze GS, Jeong M, Jin M, Jones BJP, Kang D, Kang W, Kang X, Kappes A, Kappesser D, Kardum L, Karg T, Karl M, Karle A, Katz U, Kauer M, Kelley JL, Khatee Zathul A, Kheirandish A, Kiryluk J, Klein SR, Kochocki A, Koirala R, Kolanoski H, Kontrimas T, Köpke L, Kopper C, Koskinen DJ, Koundal P, Kovacevich M, Kowalski M, Kozynets T, Krishnamoorthi J, Kruiswijk K, Krupczak E, Kumar A, Kun E, Kurahashi N, Lad N, Lagunas Gualda C, Lamoureux M, Larson MJ, Latseva S, Lauber F, Lazar JP, Lee JW, Leonard DeHolton K, Leszczyńska A, Lincetto M, Liu QR, Liubarska M, Lohfink E, Love C, Lozano Mariscal CJ, Lucarelli F, Luszczak W, Lyu Y, Madsen J, Mahn KBM, Makino Y, Manao E, Mancina S, Marie Sainte W, Mariş IC, Marka S, Marka Z, Marsee M, Martinez-Soler I, Maruyama R, Mayhew F, McElroy T, McNally F, Mead JV, Meagher K, Mechbal S, Medina A, Meier M, Merckx Y, Merten L, Micallef J, Mitchell J, Montaruli T, Moore RW, Morii Y, Morse R, Moulai M, Mukherjee T, Naab R, Nagai R, Nakos M, Naumann U, Necker J, Negi A, Neumann M, Niederhausen H, Nisa MU, Noell A, Novikov A, Nowicki SC, Obertacke Pollmann A, O'Dell V, Oehler M, Oeyen B, Olivas A, Orsoe R, Osborn J, O'Sullivan E, Pandya H, Pankova DV, Park N, Parker GK, Paudel EN, Paul L, Pérez de Los Heros C, Peterson J, Philippen S, Pizzuto A, Plum M, Pontén A, Popovych Y, Prado Rodriguez M, Pries B, Procter-Murphy R, Przybylski GT, Raab C, Rack-Helleis J, Rawlins K, Rechav Z, Rehman A, Reichherzer P, Renzi G, Resconi E, Reusch S, Rhode W, Riedel B, Rifaie A, Roberts EJ, Robertson S, Rodan S, Roellinghoff G, Rongen M, Rott C, Ruhe T, Ruohan L, Ryckbosch D, Safa I, Saffer J, Salazar-Gallegos D, Sampathkumar P, Sanchez Herrera SE, Sandrock A, Santander M, Sarkar S, Sarkar S, Savelberg J, Savina P, Schaufel M, Schieler H, Schindler S, Schlickmann L, Schlüter B, Schlüter F, Schmeisser N, Schmidt T, Schneider J, Schröder FG, Schumacher L, Schwefer G, Sclafani S, Seckel D, Seikh M, Seunarine S, Shah R, Sharma A, Shefali S, Shimizu N, Silva M, Skrzypek B, Smithers B, Snihur R, Soedingrekso J, Søgaard A, Soldin D, Soldin P, Sommani G, Spannfellner C, Spiczak GM, Stamatikos M, Stanev T, Stezelberger T, Stürwald T, Stuttard T, Sullivan GW, Taboada I, Ter-Antonyan S, Thiesmeyer M, Thompson WG, Thwaites J, Tilav S, Tollefson K, Tönnis C, Toscano S, Tosi D, Trettin A, Tung CF, Turcotte R, Twagirayezu JP, Ty B, Unland Elorrieta MA, Upadhyay AK, Upshaw K, Valtonen-Mattila N, Vandenbroucke J, van Eijndhoven N, Vannerom D, van Santen J, Vara J, Veitch-Michaelis J, Venugopal M, Vereecken M, Verpoest S, Veske D, Vijai A, Walck C, Weaver C, Weigel P, Weindl A, Weldert J, Wen AY, Wendt C, Werthebach J, Weyrauch M, Whitehorn N, Wiebusch CH, Willey N, Williams DR, Witthaus L, Wolf A, Wolf M, Wrede G, Xu XW, Yanez JP, Yildizci E, Yoshida S, Young R, Yu F, Yu S, Zhang Z, Zhelnin P, Zilberman P, Zimmerman M. Observation of Seven Astrophysical Tau Neutrino Candidates with IceCube. Phys Rev Lett 2024; 132:151001. [PMID: 38682982 DOI: 10.1103/physrevlett.132.151001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 02/15/2024] [Accepted: 02/29/2024] [Indexed: 05/01/2024]
Abstract
We report on a measurement of astrophysical tau neutrinos with 9.7 yr of IceCube data. Using convolutional neural networks trained on images derived from simulated events, seven candidate ν_{τ} events were found with visible energies ranging from roughly 20 TeV to 1 PeV and a median expected parent ν_{τ} energy of about 200 TeV. Considering backgrounds from astrophysical and atmospheric neutrinos, and muons from π^{±}/K^{±} decays in atmospheric air showers, we obtain a total estimated background of about 0.5 events, dominated by non-ν_{τ} astrophysical neutrinos. Thus, we rule out the absence of astrophysical ν_{τ} at the 5σ level. The measured astrophysical ν_{τ} flux is consistent with expectations based on previously published IceCube astrophysical neutrino flux measurements and neutrino oscillations.
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Affiliation(s)
- R Abbasi
- Department of Physics, Loyola University Chicago, Chicago, Illinois 60660, USA
| | - M Ackermann
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - J Adams
- Department of Physics and Astronomy, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
| | - S K Agarwalla
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J A Aguilar
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - M Ahlers
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - J M Alameddine
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - N M Amin
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - K Andeen
- Department of Physics, Marquette University, Milwaukee, Wisconsin 53201, USA
| | - G Anton
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - C Argüelles
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - Y Ashida
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84112, USA
| | - S Athanasiadou
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - S N Axani
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - X Bai
- Physics Department, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - V A Balagopal
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Baricevic
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S W Barwick
- Department of Physics and Astronomy, University of California, Irvine, California 92697, USA
| | - V Basu
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - R Bay
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - J J Beatty
- Department of Astronomy, Ohio State University, Columbus, Ohio 43210, USA
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - J Becker Tjus
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - J Beise
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - C Bellenghi
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - C Benning
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - S BenZvi
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - D Berley
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - E Bernardini
- Dipartimento di Fisica e Astronomia Galileo Galilei, Università Degli Studi di Padova, 35122 Padova PD, Italy
| | - D Z Besson
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - E Blaufuss
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S Blot
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - F Bontempo
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - J Y Book
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C Boscolo Meneguolo
- Dipartimento di Fisica e Astronomia Galileo Galilei, Università Degli Studi di Padova, 35122 Padova PD, Italy
| | - S Böser
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - O Botner
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - J Böttcher
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - E Bourbeau
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - J Braun
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B Brinson
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - J Brostean-Kaiser
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - R T Burley
- Department of Physics, University of Adelaide, Adelaide, 5005, Australia
| | - R S Busse
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - D Butterfield
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M A Campana
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - K Carloni
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - E G Carnie-Bronca
- Department of Physics, University of Adelaide, Adelaide, 5005, Australia
| | - S Chattopadhyay
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - N Chau
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - C Chen
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - Z Chen
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, New York 11794-3800, USA
| | - D Chirkin
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Choi
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - B A Clark
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - L Classen
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - A Coleman
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - G H Collin
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Connolly
- Department of Astronomy, Ohio State University, Columbus, Ohio 43210, USA
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - J M Conrad
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - P Coppin
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - P Correa
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - D F Cowen
- Department of Astronomy and Astrophysics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - P Dave
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - C De Clercq
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - J J DeLaunay
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - D Delgado
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - S Deng
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - K Deoskar
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - A Desai
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - P Desiati
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K D de Vries
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - G de Wasseige
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - T DeYoung
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Diaz
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J C Díaz-Vélez
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Dittmer
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - A Domi
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - H Dujmovic
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M A DuVernois
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - T Ehrhardt
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - P Eller
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - E Ellinger
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - S El Mentawi
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - D Elsässer
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - R Engel
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - H Erpenbeck
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Evans
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - P A Evenson
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - K L Fan
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - K Fang
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Farrag
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - A R Fazely
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - N Feigl
- Institut für Physik, Humboldt-Universität zu Berlin, D-12489 Berlin, Germany
| | - S Fiedlschuster
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - A T Fienberg
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - C Finley
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - L Fischer
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - D Fox
- Department of Astronomy and Astrophysics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - A Franckowiak
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - A Fritz
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - P Fürst
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - J Gallagher
- Department of Astronomy, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - E Ganster
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - A Garcia
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - L Gerhardt
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - A Ghadimi
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - C Glaser
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - T Glauch
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - T Glüsenkamp
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - N Goehlke
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - J G Gonzalez
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - S Goswami
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - D Grant
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - S J Gray
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - O Gries
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - S Griffin
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Griswold
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - K M Groth
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - C Günther
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - P Gutjahr
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - C Haack
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - A Hallgren
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - R Halliday
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - L Halve
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - F Halzen
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - H Hamdaoui
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, New York 11794-3800, USA
| | - M Ha Minh
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - K Hanson
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Hardin
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A A Harnisch
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - P Hatch
- Department of Physics, Engineering Physics, and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - A Haungs
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - K Helbing
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - J Hellrung
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - F Henningsen
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - L Heuermann
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - N Heyer
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - S Hickford
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - A Hidvegi
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - C Hill
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - G C Hill
- Department of Physics, University of Adelaide, Adelaide, 5005, Australia
| | - K D Hoffman
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S Hori
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Hoshina
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - W Hou
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - T Huber
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - K Hultqvist
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - M Hünnefeld
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - R Hussain
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Hymon
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - S In
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - A Ishihara
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - M Jacquart
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - O Janik
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - M Jansson
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - G S Japaridze
- CTSPS, Clark-Atlanta University, Atlanta, Georgia 30314, USA
| | - M Jeong
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - M Jin
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - B J P Jones
- Department of Physics, University of Texas at Arlington, 502 Yates St., Science Hall Rm 108, Box 19059, Arlington, Texas 76019, USA
| | - D Kang
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - W Kang
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - X Kang
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - A Kappes
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - D Kappesser
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - L Kardum
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - T Karg
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - M Karl
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - A Karle
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - U Katz
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - M Kauer
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J L Kelley
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Khatee Zathul
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Kheirandish
- Department of Physics & Astronomy, University of Nevada, Las Vegas, Nevada, 89154, USA
- Nevada Center for Astrophysics, University of Nevada, Las Vegas, Nevada 89154, USA
| | - J Kiryluk
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, New York 11794-3800, USA
| | - S R Klein
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - A Kochocki
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - R Koirala
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - H Kolanoski
- Institut für Physik, Humboldt-Universität zu Berlin, D-12489 Berlin, Germany
| | - T Kontrimas
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - L Köpke
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - C Kopper
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - D J Koskinen
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - P Koundal
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - M Kovacevich
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - M Kowalski
- Institut für Physik, Humboldt-Universität zu Berlin, D-12489 Berlin, Germany
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - T Kozynets
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - J Krishnamoorthi
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Kruiswijk
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - E Krupczak
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Kumar
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - E Kun
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - N Kurahashi
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - N Lad
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - C Lagunas Gualda
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - M Lamoureux
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - M J Larson
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S Latseva
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - F Lauber
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - J P Lazar
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J W Lee
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - K Leonard DeHolton
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - A Leszczyńska
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - M Lincetto
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - Q R Liu
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Liubarska
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - E Lohfink
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - C Love
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - C J Lozano Mariscal
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - F Lucarelli
- Département de physique nucléaire et corpusculaire, Université de Genève, CH-1211 Genève, Switzerland
| | - W Luszczak
- Department of Astronomy, Ohio State University, Columbus, Ohio 43210, USA
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - Y Lyu
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J Madsen
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K B M Mahn
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - Y Makino
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - E Manao
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - S Mancina
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
- Dipartimento di Fisica e Astronomia Galileo Galilei, Università Degli Studi di Padova, 35122 Padova PD, Italy
| | - W Marie Sainte
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - I C Mariş
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - S Marka
- Columbia Astrophysics and Nevis Laboratories, Columbia University, New York, New York 10027, USA
| | - Z Marka
- Columbia Astrophysics and Nevis Laboratories, Columbia University, New York, New York 10027, USA
| | - M Marsee
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - I Martinez-Soler
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - R Maruyama
- Department of Physics, Yale University, New Haven, Connecticut 06520, USA
| | - F Mayhew
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - T McElroy
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - F McNally
- Department of Physics, Mercer University, Macon, Georgia 31207-0001, USA
| | - J V Mead
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - K Meagher
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Mechbal
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - A Medina
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - M Meier
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - Y Merckx
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - L Merten
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - J Micallef
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - J Mitchell
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - T Montaruli
- Département de physique nucléaire et corpusculaire, Université de Genève, CH-1211 Genève, Switzerland
| | - R W Moore
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - Y Morii
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - R Morse
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Moulai
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - T Mukherjee
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - R Naab
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - R Nagai
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - M Nakos
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - U Naumann
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - J Necker
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - A Negi
- Department of Physics, University of Texas at Arlington, 502 Yates St., Science Hall Rm 108, Box 19059, Arlington, Texas 76019, USA
| | - M Neumann
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - H Niederhausen
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - M U Nisa
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Noell
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - A Novikov
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - S C Nowicki
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Obertacke Pollmann
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - V O'Dell
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Oehler
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - B Oeyen
- Department of Physics and Astronomy, University of Gent, B-9000 Gent, Belgium
| | - A Olivas
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - R Orsoe
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - J Osborn
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - E O'Sullivan
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - H Pandya
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - D V Pankova
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - N Park
- Department of Physics, Engineering Physics, and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - G K Parker
- Department of Physics, University of Texas at Arlington, 502 Yates St., Science Hall Rm 108, Box 19059, Arlington, Texas 76019, USA
| | - E N Paudel
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - L Paul
- Department of Physics, Marquette University, Milwaukee, Wisconsin 53201, USA
- Physics Department, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - C Pérez de Los Heros
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - J Peterson
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Philippen
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - A Pizzuto
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Plum
- Physics Department, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - A Pontén
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - Y Popovych
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - M Prado Rodriguez
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B Pries
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - R Procter-Murphy
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - G T Przybylski
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C Raab
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - J Rack-Helleis
- Institute of Physics, University of Mainz, Staudinger Weg 7, D-55099 Mainz, Germany
| | - K Rawlins
- Department of Physics and Astronomy, University of Alaska Anchorage, 3211 Providence Dr., Anchorage, Alaska 99508, USA
| | - Z Rechav
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Rehman
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - P Reichherzer
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - G Renzi
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - E Resconi
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - S Reusch
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - W Rhode
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - B Riedel
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Rifaie
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - E J Roberts
- Department of Physics, University of Adelaide, Adelaide, 5005, Australia
| | - S Robertson
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - S Rodan
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - G Roellinghoff
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - M Rongen
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - C Rott
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84112, USA
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - T Ruhe
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - L Ruohan
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - D Ryckbosch
- Department of Physics and Astronomy, University of Gent, B-9000 Gent, Belgium
| | - I Safa
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Saffer
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - D Salazar-Gallegos
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - P Sampathkumar
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - S E Sanchez Herrera
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - A Sandrock
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - M Santander
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - S Sarkar
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - S Sarkar
- Department of Physics, University of Oxford, Parks Road, Oxford OX1 3PU, United Kingdom
| | - J Savelberg
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - P Savina
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Schaufel
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - H Schieler
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - S Schindler
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - L Schlickmann
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - B Schlüter
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - F Schlüter
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - N Schmeisser
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - T Schmidt
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - J Schneider
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - F G Schröder
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - L Schumacher
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - G Schwefer
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - S Sclafani
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - D Seckel
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - M Seikh
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - S Seunarine
- Department of Physics, University of Wisconsin, River Falls, Wisconsin 54022, USA
| | - R Shah
- Department of Physics, Drexel University, 3141 Chestnut Street, Philadelphia, Pennsylvania 19104, USA
| | - A Sharma
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - S Shefali
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - N Shimizu
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - M Silva
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B Skrzypek
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - B Smithers
- Department of Physics, University of Texas at Arlington, 502 Yates St., Science Hall Rm 108, Box 19059, Arlington, Texas 76019, USA
| | - R Snihur
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Soedingrekso
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - A Søgaard
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - D Soldin
- Karlsruhe Institute of Technology, Institute of Experimental Particle Physics, D-76021 Karlsruhe, Germany
| | - P Soldin
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - G Sommani
- Fakultät für Physik & Astronomie, Ruhr-Universität Bochum, D-44780 Bochum, Germany
| | - C Spannfellner
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - G M Spiczak
- Department of Physics, University of Wisconsin, River Falls, Wisconsin 54022, USA
| | - M Stamatikos
- Department of Physics and Center for Cosmology and Astro-Particle Physics, Ohio State University, Columbus, Ohio 43210, USA
| | - T Stanev
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - T Stezelberger
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - T Stürwald
- Department of Physics, University of Wuppertal, D-42119 Wuppertal, Germany
| | - T Stuttard
- Niels Bohr Institute, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - G W Sullivan
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - I Taboada
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - S Ter-Antonyan
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - M Thiesmeyer
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - W G Thompson
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J Thwaites
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Tilav
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - K Tollefson
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - C Tönnis
- Department of Physics, Sungkyunkwan University, Suwon 16419, Korea
| | - S Toscano
- Université Libre de Bruxelles, Science Faculty CP230, B-1050 Brussels, Belgium
| | - D Tosi
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - A Trettin
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - C F Tung
- School of Physics and Center for Relativistic Astrophysics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - R Turcotte
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - J P Twagirayezu
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - B Ty
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M A Unland Elorrieta
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - A K Upadhyay
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - K Upshaw
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - N Valtonen-Mattila
- Department of Physics and Astronomy, Uppsala University, Box 516, S-75120 Uppsala, Sweden
| | - J Vandenbroucke
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - N van Eijndhoven
- Vrije Universiteit Brussel (VUB), Dienst ELEM, B-1050 Brussels, Belgium
| | - D Vannerom
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J van Santen
- Deutsches Elektronen-Synchrotron DESY, Platanenallee 6, 15738 Zeuthen, Germany
| | - J Vara
- Institut für Kernphysik, Westfälische Wilhelms-Universität Münster, D-48149 Münster, Germany
| | - J Veitch-Michaelis
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Venugopal
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - M Vereecken
- Centre for Cosmology, Particle Physics and Phenomenology-CP3, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - S Verpoest
- Bartol Research Institute and Department of Physics and Astronomy, University of Delaware, Newark, Delaware 19716, USA
| | - D Veske
- Columbia Astrophysics and Nevis Laboratories, Columbia University, New York, New York 10027, USA
| | - A Vijai
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - C Walck
- Oskar Klein Centre and Department of Physics, Stockholm University, SE-10691 Stockholm, Sweden
| | - C Weaver
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - P Weigel
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Weindl
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - J Weldert
- Department of Physics, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - A Y Wen
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C Wendt
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - J Werthebach
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - M Weyrauch
- Karlsruhe Institute of Technology, Institute for Astroparticle Physics, D-76021 Karlsruhe, Germany
| | - N Whitehorn
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - C H Wiebusch
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - N Willey
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - D R Williams
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487, USA
| | - L Witthaus
- Department of Physics, TU Dortmund University, D-44221 Dortmund, Germany
| | - A Wolf
- III. Physikalisches Institut, RWTH Aachen University, D-52056 Aachen, Germany
| | - M Wolf
- Physik-department, Technische Universität München, D-85748 Garching, Germany
| | - G Wrede
- Erlangen Centre for Astroparticle Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, D-91058 Erlangen, Germany
| | - X W Xu
- Department of Physics, Southern University, Baton Rouge, Louisiana 70813, USA
| | - J P Yanez
- Department of Physics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1
| | - E Yildizci
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - S Yoshida
- Department of Physics and The International Center for Hadron Astrophysics, Chiba University, Chiba 263-8522, Japan
| | - R Young
- Department of Physics and Astronomy, University of Kansas, Lawrence, Kansas 66045, USA
| | - F Yu
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - S Yu
- Department of Physics and Astronomy, Michigan State University, East Lansing, Michigan 48824, USA
| | - Z Zhang
- Department of Physics and Astronomy, Stony Brook University, Stony Brook, New York 11794-3800, USA
| | - P Zhelnin
- Department of Physics and Laboratory for Particle Physics and Cosmology, Harvard University, Cambridge, Massachusetts 02138, USA
| | - P Zilberman
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - M Zimmerman
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
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Shah V, Geller G, Xu D, Taylor L, Griffin S, Usher-Smith JA. Evaluating the potential impact of lifestyle-based behavior change interventions delivered at the time of colorectal cancer screening. Cancer Causes Control 2024; 35:561-574. [PMID: 37925646 PMCID: PMC10838843 DOI: 10.1007/s10552-023-01773-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/01/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To analyze interventions implemented at the time of colorectal cancer (CRC) screening, or among individuals who have previously undergone investigation for CRC, focused on reducing CRC risk through promotion of lifestyle behavior change. Additionally, this review evaluated to what extent such interventions apply behavior change techniques (BCTs) to achieve their objectives. METHODS Five databases were systematically searched to identify randomized control trials seeking to reduce CRC risk through behavior change. Outcomes were changes in health-related lifestyle behaviors associated with CRC risk, including changes in dietary habits, body mass index, smoking behaviors, alcohol consumption, and physical activity. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using random effects models. BCT's were coded from a published taxonomy of 93 techniques. RESULTS Ten RCT's met the inclusion criteria. Greater increase in fruit/vegetable consumption in the intervention group were observed with respect to the control (SMD 0.13, 95% CI 0.08 to 0.18; p < 0.001). Across fiber, alcohol, fat, red meat, and multivitamin consumption, and smoking behaviors, similar positive outcomes were observed (SMD 0.09-0.57 for all, p < 0.01). However, among physical activity and body mass index, no difference between the intervention groups compared with controls were observed. A median of 7.5 BCTs were applied across included interventions. CONCLUSION While magnitude of the observed effect sizes varied, they correspond to potentially important changes in lifestyle behaviors when considered on a population scale. Future interventions should identify avenues to maximize long-term engagement to promote sustained lifestyle behavior change.
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Affiliation(s)
- Veeraj Shah
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
| | - Greta Geller
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Diane Xu
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 0SP, UK
| | - Lily Taylor
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Simon Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK
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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Kim Y, Jang H, Wang M, Shi Q, Strain T, Sharp SJ, Yeung SLA, Luo S, Griffin S, Wareham NJ, Wijndaele K, Brage S. Replacing device-measured sedentary time with physical activity is associated with lower risk of coronary heart disease regardless of genetic risk. J Intern Med 2024; 295:38-50. [PMID: 37614046 PMCID: PMC10953003 DOI: 10.1111/joim.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Excess sedentary time (ST) is recognized as an important modifiable risk factor for coronary heart disease (CHD). However, whether the associations of genetic susceptibility with CHD incidence can be modified by replacing wearable-device-measured ST with physical activity (PA) is unknown. OBJECTIVES To examine the associations of wearable-device-measured ST replaced by PA with incident CHD across strata of genetic susceptibility. METHODS This study included 77,500 White British (57% female) with valid wrist-worn accelerometry and without prevalent CHD/stroke from UK Biobank. Genetic susceptibility to CHD was quantified through weighted polygenic risk scores for CHD based on 300 single-nucleotide polymorphisms. Wrist-worn accelerometer data were used to derive ST, light PA, and moderate-to-vigorous PA (MVPA). RESULTS Reallocation of 60 min/day of ST into the same amount of MVPA was associated with approximately 9% lower relative risk of CHD for all participants and across strata of genetic risk: replacement of 1 min/day of ST associated with <1% lower relative risk of CHD. No evidence of interaction (p: 0.784) was found between genetic risk and ST for CHD risk. Reallocating 60 min/day of ST into the same MVPA time was associated with greater absolute CHD risk reductions at high genetic risk (0.27%) versus low genetic risk (0.15%). CONCLUSIONS Replacing any amount of ST with an equal amount of MVPA time is associated with a lower relative risk of CHD, irrespective of genetic susceptibility to CHD. Reductions in CHD absolute risk for replacing ST with MVPA are greater at high genetic risk versus low genetic risk.
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Affiliation(s)
- Youngwon Kim
- School of Public HealthThe University of Hong Kong Li Ka Shing Faculty of MedicinePokfulamHong Kong
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
| | - Haeyoon Jang
- School of Public HealthThe University of Hong Kong Li Ka Shing Faculty of MedicinePokfulamHong Kong
| | - Mengyao Wang
- School of Public HealthThe University of Hong Kong Li Ka Shing Faculty of MedicinePokfulamHong Kong
| | - Qiaoxin Shi
- School of Public HealthThe University of Hong Kong Li Ka Shing Faculty of MedicinePokfulamHong Kong
| | - Tessa Strain
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
| | - Stephen J Sharp
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
| | - Shiu Lun Au Yeung
- School of Public HealthThe University of Hong Kong Li Ka Shing Faculty of MedicinePokfulamHong Kong
| | - Shan Luo
- School of Public HealthThe University of Hong Kong Li Ka Shing Faculty of MedicinePokfulamHong Kong
| | - Simon Griffin
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
| | - Nicholas J. Wareham
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
| | - Katrien Wijndaele
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
| | - Soren Brage
- MRC Epidemiology UnitUniversity of Cambridge School of Clinical MedicineCambridgeUnited Kingdom
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Chen S, Marshall T, Jackson C, Cooper J, Crowe F, Nirantharakumar K, Saunders CL, Kirk P, Richardson S, Edwards D, Griffin S, Yau C, Barrett JK. Sociodemographic characteristics and longitudinal progression of multimorbidity: A multistate modelling analysis of a large primary care records dataset in England. PLoS Med 2023; 20:e1004310. [PMID: 37922316 PMCID: PMC10655992 DOI: 10.1371/journal.pmed.1004310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/17/2023] [Accepted: 10/09/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Multimorbidity, characterised by the coexistence of multiple chronic conditions in an individual, is a rising public health concern. While much of the existing research has focused on cross-sectional patterns of multimorbidity, there remains a need to better understand the longitudinal accumulation of diseases. This includes examining the associations between important sociodemographic characteristics and the rate of progression of chronic conditions. METHODS AND FINDINGS We utilised electronic primary care records from 13.48 million participants in England, drawn from the Clinical Practice Research Datalink (CPRD Aurum), spanning from 2005 to 2020 with a median follow-up of 4.71 years (IQR: 1.78, 11.28). The study focused on 5 important chronic conditions: cardiovascular disease (CVD), type 2 diabetes (T2D), chronic kidney disease (CKD), heart failure (HF), and mental health (MH) conditions. Key sociodemographic characteristics considered include ethnicity, social and material deprivation, gender, and age. We employed a flexible spline-based parametric multistate model to investigate the associations between these sociodemographic characteristics and the rate of different disease transitions throughout multimorbidity development. Our findings reveal distinct association patterns across different disease transition types. Deprivation, gender, and age generally demonstrated stronger associations with disease diagnosis compared to ethnic group differences. Notably, the impact of these factors tended to attenuate with an increase in the number of preexisting conditions, especially for deprivation, gender, and age. For example, the hazard ratio (HR) (95% CI; p-value) for the association of deprivation with T2D diagnosis (comparing the most deprived quintile to the least deprived) is 1.76 ([1.74, 1.78]; p < 0.001) for those with no preexisting conditions and decreases to 0.95 ([0.75, 1.21]; p = 0.69) with 4 preexisting conditions. Furthermore, the impact of deprivation, gender, and age was typically more pronounced when transitioning from an MH condition. For instance, the HR (95% CI; p-value) for the association of deprivation with T2D diagnosis when transitioning from MH is 2.03 ([1.95, 2.12], p < 0.001), compared to transitions from CVD 1.50 ([1.43, 1.58], p < 0.001), CKD 1.37 ([1.30, 1.44], p < 0.001), and HF 1.55 ([1.34, 1.79], p < 0.001). A primary limitation of our study is that potential diagnostic inaccuracies in primary care records, such as underdiagnosis, overdiagnosis, or ascertainment bias of chronic conditions, could influence our results. CONCLUSIONS Our results indicate that early phases of multimorbidity development could warrant increased attention. The potential importance of earlier detection and intervention of chronic conditions is underscored, particularly for MH conditions and higher-risk populations. These insights may have important implications for the management of multimorbidity.
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Affiliation(s)
- Sida Chen
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Jennifer Cooper
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Francesca Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Krish Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Catherine L. Saunders
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Paul Kirk
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sylvia Richardson
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Duncan Edwards
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Christopher Yau
- Nuffield Department for Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Health Data Research, Oxford, United Kingdom
| | - Jessica K. Barrett
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Morris A, Bright C, Cocks M, Gibson N, Goff L, Greaves C, Griffin S, Jane B, Kinnafick F, Robb P, Roberts M, Salman D, Saxton J, Taylor A, West D, Yates T, Andrews RC, Gill JMR. Recommendations from Diabetes UK's 2022 diabetes and physical activity workshop. Diabet Med 2023; 40:e15169. [PMID: 37381170 DOI: 10.1111/dme.15169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
AIMS To describe the process and outputs of a workshop convened to identify key priorities for future research in the area of diabetes and physical activity and provide recommendations to researchers and research funders on how best to address them. METHODS A 1-day research workshop was conducted, bringing together researchers, people living with diabetes, healthcare professionals, and members of staff from Diabetes UK to identify and prioritise recommendations for future research into physical activity and diabetes. RESULTS Workshop attendees prioritised four key themes for further research: (i) better understanding of the physiology of exercise in all groups of people: in particular, what patient metabolic characteristics influence or predict the physiological response to physical activity, and the potential role of physical activity in beta cell preservation; (ii) designing physical activity interventions for maximum impact; (iii) promoting sustained physical activity across the life course; (iv) designing physical activity studies for groups with multiple long-term conditions. CONCLUSIONS This paper outlines recommendations to address the current gaps in knowledge related to diabetes and physical activity and calls on the research community to develop applications in these areas and funders to consider how to stimulate research in these areas.
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Affiliation(s)
| | | | - Matthew Cocks
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Louise Goff
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ben Jane
- School of Health and Wellbeing, Plymouth Marjon University, Plymouth, UK
| | - Florence Kinnafick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough, UK
| | | | | | - David Salman
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - John Saxton
- Department of Sport, Health & Exercise Science, University of Hull, Hull, UK
| | - Adrian Taylor
- Schools of Dentistry & Medicine, University of Plymouth, Plymouth, UK
| | - Daniel West
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rob C Andrews
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jason M R Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Dambha-Miller H, Hounkpatin HO, Stuart B, Farmer A, Griffin S. Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study. PLoS One 2023; 18:e0290791. [PMID: 37643199 PMCID: PMC10464964 DOI: 10.1371/journal.pone.0290791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Biochemical remission of type 2 diabetes is achievable through dietary changes, physical activity and subsequent weight loss. We aim to identify distinct diabetes remission trajectories in a large population-based cohort over seven-years follow-up and to examine associations between remission trajectories and diabetes complications. Group-based trajectory modelling examined longitudinal patterns of HbA1c level (adjusting for remission status) over time. Multivariable Cox models quantified the association between each remission trajectory and microvascular complications, macrovascular complications, cardiovascular (CVD) events and all-cause mortality. Four groups were assigned. Group 1 (8,112 [13.5%]; achieving HbA1c <48 mmol/mol (6.5%) followed by increasing HbA1c levels); Group 2 (6,369 [10.6%]; decreasing HbA1c levels >48 mmol/mol (6.5%)); Group 3 (36,557 [60.6%]; stable high HbA1c levels); Group 4 (9,249 [15.3%]; stable low HbA1c levels (<48mmol/mol or <6.5%)). Compared to Group 3, Groups 1 and 4 had lower risk of microvascular complications (aHRs (95% CI): 0.65 (0.61-0.70), p-value <0.001;0.59 (0.55-0.64) p-value<0.001, respectively)), macrovascular complications (aHRs (95% CI): 0.83 (0.75-0.92), p-value<0.001; 0.66 (0.61-0.71), p-value<0.001) and CVD events (aHRs (95% CI): 0.74(0.67-0.83), p-value<0.001; 0.67(0.61-0.73), p-vlaue<0.001). Risk of CVD outcomes were similar for Groups 2 and 3. Compared to Group 3, Group 1 (aHR: 0.82(95% CI: 0.76-0.89)) had lower risk of mortality, but Group 4 had higher risk of mortality (aHR: 1.11(95% CI: 1.03-1.19)). Risk of CVD outcomes vary by pattern of remission over time, with lowest risk for those in remission longer. People who achieve remission, even for shorter periods of time, continue to benefit from this lower exposure to hyperglycaemia, which may, in turn, lower the risk of CVD outcomes including mortality.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, England
| | - Hilda O. Hounkpatin
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, England
| | - Beth Stuart
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, England
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
| | - Simon Griffin
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, England
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, England
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Yerrakalva D, Hajna S, Suhrcke M, Wijndaele K, Westgate K, Khaw KT, Wareham N, Brage S, Griffin S. Associations between change in physical activity and sedentary time and health-related quality of life in older english adults: the EPIC-Norfolk cohort study. Health Qual Life Outcomes 2023; 21:60. [PMID: 37349799 PMCID: PMC10288723 DOI: 10.1186/s12955-023-02137-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND No previous studies have examined the associations between changes in objectively-measured physical behaviours with follow-up QoL in older adults. Based on cross-sectional evidence, it is biologically plausible that such associations exist. If so, this bolsters the case for the commissioning of activity interventions and for including QoL as an outcome in trials of such interventions. METHODS We assessed physical behaviours (total physical activity, moderate-to-vigorous physical activity (MVPA), light physical activity, total sedentary time and prolonged sedentary bout time) for 7 days using hip-worn accelerometers at baseline (2006-2011) and follow-up (2012-2016) and health-related quality-of-life (QoL) using EQ-5D questionnaires at follow-up in 1433 participants (≥ 60 years) of the EPIC (European Prospective Investigation into Cancer)-Norfolk study. The EQ-5D summary score was used, with 0 as the worst to 1 as best perceived quality-of-life. We evaluated the prospective associations of baseline physical behaviours with follow-up QoL, and of changes in behaviours with follow-up QoL using multi-level regression. RESULTS On average, MVPA decreased by 4.0 min/day/year (SD 8.3) for men and 4.0 min/day/year for women (SD 12.0) between baseline and follow-up. Total sedentary time increased by an average 5.5 min/day/yr (SD 16.0) for men and 6.4 min/day/yr (SD 15.0) for women between baseline and follow-up. Mean (SD) follow-up time was 5.8 (1.8) years. We found that higher baseline MVPA and lower sedentary time was associated with higher subsequent QoL (e.g. 1 h/day greater baseline MVPA was associated with 0.02 higher EQ-5D score, 95% CI 0.06, 0.36). More pronounced declines in activity were associated with worse Hr-QoL (0.005 (95% CI 0.003, 0.008) lower EQ-5D per min/day/yr decrease in MVPA). Increases in sedentary behaviours were also associated with poorer QoL (0.002 lower EQ-5D, 95% CI -0.003, -0.0007 per hour/day/yr increase in total sedentary time). CONCLUSIONS Promotion of physical activity and limiting sedentary time among older adults may improve quality-of-life, and therefore this relationship ought to be included in future cost effectiveness analyses so that greater commissioning of activity interventions can be considered.
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Affiliation(s)
- Dharani Yerrakalva
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Samantha Hajna
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | | | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
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11
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Gonzales TI, Jeon JY, Lindsay T, Westgate K, Perez-Pozuelo I, Hollidge S, Wijndaele K, Rennie K, Forouhi N, Griffin S, Wareham N, Brage S. Resting heart rate is a population-level biomarker of cardiorespiratory fitness: The Fenland Study. PLoS One 2023; 18:e0285272. [PMID: 37167327 PMCID: PMC10174582 DOI: 10.1371/journal.pone.0285272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Few large studies have evaluated the relationship between resting heart rate (RHR) and cardiorespiratory fitness. Here we examine cross-sectional and longitudinal relationships between RHR and fitness, explore factors that influence these relationships, and demonstrate the utility of RHR for remote population monitoring. METHODS In cross-sectional analyses (The UK Fenland Study: 5,722 women, 5,143 men, aged 29-65y), we measured RHR (beats per min, bpm) while seated, supine, and during sleep. Fitness was estimated as maximal oxygen consumption (ml⋅min-1⋅kg-1) from an exercise test. Associations between RHR and fitness were evaluated while adjusting for age, sex, adiposity, and physical activity. In longitudinal analyses (6,589 participant subsample), we re-assessed RHR and fitness after a median of 6 years and evaluated the association between within-person change in RHR and fitness. During the coronavirus disease-2019 pandemic, we used a smartphone application to remotely and serially measure RHR (1,914 participant subsample, August 2020 to April 2021) and examined differences in RHR dynamics by pre-pandemic fitness level. RESULTS Mean RHR while seated, supine, and during sleep was 67, 64, and 57 bpm. Age-adjusted associations (beta coefficients) between RHR and fitness were -0.26, -0.29, and -0.21 ml⋅kg-1⋅beat-1 in women and -0.27, -0.31, and -0.19 ml⋅kg-1⋅beat-1 in men. Adjustment for adiposity and physical activity attenuated the RHR-to-fitness relationship by 10% and 50%, respectively. Longitudinally, a 1-bpm increase in supine RHR was associated with a 0.23 ml⋅min-1⋅kg-1 decrease in fitness. During the pandemic, RHR increased in those with low pre-pandemic fitness but was stable in others. CONCLUSIONS RHR is a valid population-level biomarker of cardiorespiratory fitness. Physical activity and adiposity attenuate the relationship between RHR and fitness.
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Affiliation(s)
- Tomas I. Gonzales
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Justin Y. Jeon
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Department of Sport Industry Studies, Exercise Medicine Center for Diabetes and Cancer Patients (ICONS), Yonsei University, Seoul, Korea
| | - Timothy Lindsay
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | | | - Stefanie Hollidge
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Kirsten Rennie
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Nita Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Simon Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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12
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Mc Mahon A, Griffin S, Gorman E, Lennon A, Kielthy S, Flannery A, Cherian BS, Josy M, Marsh B. Patient-Centred Outcomes Following Tracheostomy in Critical Care. J Intensive Care Med 2023:8850666231160669. [PMID: 36883211 PMCID: PMC10374991 DOI: 10.1177/08850666231160669] [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: 03/09/2023]
Abstract
INTRODUCTION Around 20% of intensive care unit (ICU) patients undergo tracheostomy insertion and expect high-quality care concentrating on patient-centered outcomes including communication, oral intake, and mobilization. The majority of data has focused on timing, mortality, and resource utilization, with a paucity of information on quality of life following tracheostomy. METHODS Single center retrospective study including all patients requiring tracheostomy from 2017 to 2019. Information collected on demographics, severity of illness, ICU and hospital length of stay (LOS), ICU and hospital mortality, discharge disposition, sedation, time to vocalization, swallow and mobilization. Outcomes were compared for early versus late tracheostomy (early = <day 10) and age category (≤ 65 vs ≥ 66 years). RESULTS In total, 304 patients were included and 71% male, median age 59, APACHE II score 17. Median ICU and hospital LOS 16 and 56 days, respectively. ICU and hospital mortality 9.9% and 22.4%. Median time to tracheostomy 8 days, 8.55% open. Following tracheostomy, median days of sedation was 0, time to noninvasive ventilation (NIV) 1 day (94% of patients achieving this), ventilator-free breathing (VFB) 5 days (72%), speaking valve 7 days (60%), dynamic sitting 5 days (64%), and swallow assessment 16 days (73%). Early tracheostomy was associated with shorter ICU LOS (13 vs 26 days, P < .0001), reduced sedation (6 vs 12 days, P < .0001), faster transition to level 2 care (6 vs 10 days, P < .003), NIV (1 vs 2 days, P < .003), and VFB (4 vs 7 days, P < .005). Older patients received less sedation, had higher APACHE II scores and mortality (36.1%) and 18.5% were discharged home. Median time to VFB was 6 days (63.9%), speaking valve 7 days (64.7%), swallow assessment 20.5 days (66.7%), and dynamic sitting 5 days (62.2%). CONCLUSION Patient-centered outcomes are a worthy goal to consider when selecting patients for tracheostomy in addition to mortality or timing alone, including in older patients.
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Affiliation(s)
- A Mc Mahon
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Griffin
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | - Emma Gorman
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | - Aoife Lennon
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephen Kielthy
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | - Andrea Flannery
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | - Bindu Sam Cherian
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | - Minu Josy
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
| | - B Marsh
- Department of Critical Care Medicine, 8881Mater Misericordiae University Hospital, Dublin, Ireland
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Massella V, Griffin S, Pietropaolo A, Ripa F, Sinha M, Somani B. Is paediatric ‘Dusting and Pop-dusting’ with high power laser a new standard of care for treatment of ureteroscopy and lasertripsy (URSL): Prospective outcomes from a university teaching hospital. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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14
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Tanidir Y, Sekerci C, Castellani D, Ferretti S, Gatti C, Campobasso D, Bujons A, Quiroz Y, Teoh J, Pietropaolo A, Ragoori D, Bhatia T, Vaddi C, Shrestha A, Lim E, Fong K, Sinha M, Griffin S, Sarica K, Somani B, Traxer O, Gauhar V. The utility and safety of ureteral access sheath during retrograde intrarenal surgery in children. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00632-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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15
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Quaife M, Medley GF, Jit M, Drake T, Asaria M, van Baal P, Baltussen R, Bollinger L, Bozzani F, Brady O, Broekhuizen H, Chalkidou K, Chi YL, Dowdy DW, Griffin S, Haghparast-Bidgoli H, Hallett T, Hauck K, Hollingsworth TD, McQuaid CF, Menzies NA, Merritt MW, Mirelman A, Morton A, Ruiz FJ, Siapka M, Skordis J, Tediosi F, Walker P, White RG, Winskill P, Vassall A, Gomez GB. Considering equity in priority setting using transmission models: Recommendations and data needs. Epidemics 2022; 41:100648. [PMID: 36343495 PMCID: PMC9623400 DOI: 10.1016/j.epidem.2022.100648] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. METHODS We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. RESULTS We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. CONCLUSIONS Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.
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Affiliation(s)
- M. Quaife
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - GF Medley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - M. Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - T. Drake
- Center for Global Development in Europe (CGD Europe), UK
| | - M. Asaria
- LSE Health, London School of Economics, UK
| | - P. van Baal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
| | - R. Baltussen
- Nijmegen International Center for Health Systems Research and Education, Radboudmc, the Netherlands
| | | | - F. Bozzani
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
| | - O. Brady
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - H. Broekhuizen
- Centre for Space, Place, and Society, Wageningen University and Research, Netherlands
| | - K. Chalkidou
- International Decision Support Initiative, Imperial College London, UK
| | - Y.-L. Chi
- International Decision Support Initiative, Imperial College London, UK
| | - DW Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - S. Griffin
- Centre for Health Economics, University of York, UK
| | - H. Haghparast-Bidgoli
- Institute for Global Health, Centre for Global Health Economics, University College London, UK
| | - T. Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - K. Hauck
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - TD Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
| | - CF McQuaid
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - NA Menzies
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
| | - MW Merritt
- Johns Hopkins Berman Institute of Bioethics and Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - A. Mirelman
- Centre for Health Economics, University of York, UK
| | - A. Morton
- Department of Management Science, University of Strathclyde, UK
| | - FJ Ruiz
- International Decision Support Initiative, Imperial College London, UK
| | - M. Siapka
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Impact Elipsis, Greece
| | - J. Skordis
- Institute for Global Health, Centre for Global Health Economics, University College London, UK
| | - F. Tediosi
- Swiss Tropical and Public Health Institute and Universität Basel, Switzerland
| | - P. Walker
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - RG White
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | - P. Winskill
- Department of Infectious Disease Epidemiology, Imperial College London, UK
| | - A. Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK,Correspondence to: London School of Hygiene and Tropical Medicine, 15 – 17 Tavistock Place, London WC1H 9SH, UK
| | - GB Gomez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
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Nichols L, Taverner T, Crowe F, Richardson S, Yau C, Kiddle S, Kirk P, Barrett J, Nirantharakumar K, Griffin S, Edwards D, Marshall T. In simulated data and health records, latent class analysis was the optimum multimorbidity clustering algorithm. J Clin Epidemiol 2022; 152:164-175. [PMID: 36228971 PMCID: PMC7613854 DOI: 10.1016/j.jclinepi.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the reproducibility and validity of latent class analysis (LCA) and hierarchical cluster analysis (HCA), multiple correspondence analysis followed by k-means (MCA-kmeans) and k-means (kmeans) for multimorbidity clustering. METHODS We first investigated clustering algorithms in simulated datasets with 26 diseases of varying prevalence in predetermined clusters, comparing the derived clusters to known clusters using the adjusted Rand Index (aRI). We then them investigated the medical records of male patients, aged 65 to 84 years from 50 UK general practices, with 49 long-term health conditions. We compared within cluster morbidity profiles using the Pearson correlation coefficient and assessed cluster stability using in 400 bootstrap samples. RESULTS In the simulated datasets, the closest agreement (largest aRI) to known clusters was with LCA and then MCA-kmeans algorithms. In the medical records dataset, all four algorithms identified one cluster of 20-25% of the dataset with about 82% of the same patients across all four algorithms. LCA and MCA-kmeans both found a second cluster of 7% of the dataset. Other clusters were found by only one algorithm. LCA and MCA-kmeans clustering gave the most similar partitioning (aRI 0.54). CONCLUSION LCA achieved higher aRI than other clustering algorithms.
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Affiliation(s)
- Linda Nichols
- Research Fellow, Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK
| | - Tom Taverner
- Research Fellow, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Francesca Crowe
- Lecturer in Epidemiology and Health Informatics, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Sylvia Richardson
- Emeritus Director, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Christopher Yau
- Professor of Artificial Intelligence, Nuffield Department of Women's & Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Steven Kiddle
- Director, Health Data Science, AstraZeneca, 1 Francis Crick Avenue, Cambridge, Biomedical Campus, Cambridge, CB2 0AA, UK
| | - Paul Kirk
- MRC Investigator, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Jessica Barrett
- MRC Investigator, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | - Krishnarajah Nirantharakumar
- Professor of Public Health and Health Informatics, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK
| | - Simon Griffin
- Professor of General Practice, Primary Care Unit, Strangeways Research Laboratory Worts Causeway Cambridge CB1 8RN, UK
| | - Duncan Edwards
- Senior Clinical Research Associate, Primary Care Unit, Primary Care Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Tom Marshall
- Professor of Public Health and Primary Care, Institute of Applied Health Research, University of Birmingham, B15 2TT, UK.
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Abstract
Rapid advances in technology and data science have the potential to improve the precision of preventive and therapeutic interventions, and enable the right treatment to be recommended, at the right time, to the right person. There are well-described examples of successful precision medicine approaches for monogenic conditions such as specific diets for phenylketonuria, and sulfonylurea treatments for certain types of MODY. However, the majority of chronic diseases are polygenic, and it is unlikely that the research strategies used for monogenic diseases will deliver similar changes to practice for polygenic traits. Type 2 diabetes, for example, is a multifactorial, heterogeneous, polygenic palette of metabolic disorders. In this non-systematic review I highlight limitations of the evidence, and the challenges that need to be overcome prior to implementation of precision medicine in the prevention and management of type 2 diabetes. Most precision medicine approaches are spuriously precise, overly complex and too narrowly focused on predicting blood glucose levels with a limited set of characteristics of individuals rather than the whole person and their context. Overall, the evidence to date is insufficient to justify widespread implementation of precision medicine approaches into routine clinical practice for type 2 diabetes. We need to retain a degree of humility and healthy scepticism when evaluating novel strategies, and to demand that existing evidence thresholds are exceeded prior to implementation.
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Affiliation(s)
- Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
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18
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Essery R, Pollet S, Bradbury K, Western MJ, Grey E, Denison-Day J, Smith KA, Hayter V, Kelly J, Somerville J, Stuart B, Becque T, Zhang J, Slodkowska-Barabasz J, Mowbray F, Ferrey A, Yao G, Zhu S, Kendrick T, Griffin S, Mutrie N, Robinson S, Brooker H, Griffiths G, Robinson L, Rossor M, Ballard C, Gallacher J, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Parallel randomized controlled feasibility trials of the "Active Brains" digital intervention to protect cognitive health in adults aged 60-85. Front Public Health 2022; 10:962873. [PMID: 36203694 PMCID: PMC9530972 DOI: 10.3389/fpubh.2022.962873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/30/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Multidomain interventions to address modifiable risk factors for dementia are promising, but require more cost-effective, scalable delivery. This study investigated the feasibility of the "Active Brains" digital behavior change intervention and its trial procedures. Materials and methods Active Brains aims to reduce cognitive decline by promoting physical activity, healthy eating, and online cognitive training. We conducted 12-month parallel-design randomized controlled feasibility trials of "Active Brains" amongst "lower cognitive scoring" (n = 180) and "higher cognitive scoring" (n = 180) adults aged 60-85. Results We collected 67.2 and 76.1% of our 12-month primary outcome (Baddeley verbal reasoning task) data for the "lower cognitive score" and "higher cognitive score" groups, respectively. Usage of "Active Brains" indicated overall feasibility and satisfactory engagement with the physical activity intervention content (which did not require sustained online engagement), but engagement with online cognitive training was limited. Uptake of the additional brief telephone support appeared to be higher in the "lower cognitive score" trial. Preliminary descriptive trends in the primary outcome data might indicate a protective effect of Active Brains against cognitive decline, but further investigation in fully-powered trials is required to answer this definitively. Discussion Whilst initial uptake and engagement with the online intervention was modest, it was in line with typical usage of other digital behavior change interventions, and early indications from the descriptive analysis of the primary outcome and behavioral data suggest that further exploration of the potential protective benefits of Active Brains are warranted. The study also identified minor modifications to procedures, particularly to improve online primary-outcome completion. Further investigation of Active Brains will now seek to determine its efficacy in protecting cognitive performance amongst adults aged 60-85 with varied levels of existing cognitive performance.
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Affiliation(s)
- Rosie Essery
- University of Southampton, Southampton, United Kingdom,*Correspondence: Rosie Essery
| | | | - Katherine Bradbury
- University of Southampton, Southampton, United Kingdom,NIHR ARC Wessex, Southampton, United Kingdom
| | | | | | | | | | | | - Joanne Kelly
- University of Southampton, Southampton, United Kingdom
| | | | - Beth Stuart
- University of Southampton, Southampton, United Kingdom,Queen Mary University of London, London, United Kingdom
| | - Taeko Becque
- University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- University of Southampton, Southampton, United Kingdom
| | | | | | - Anne Ferrey
- University of Oxford, Oxford, United Kingdom
| | - Guiqing Yao
- University of Leicester, Leicester, United Kingdom
| | - Shihua Zhu
- University of Southampton, Southampton, United Kingdom
| | - Tony Kendrick
- University of Southampton, Southampton, United Kingdom
| | | | | | | | | | - Gareth Griffiths
- NIHR Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | | | | | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Patient and Public Involvement Contributor, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- University of Southampton, Southampton, United Kingdom,University of Bristol, Bristol, United Kingdom
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19
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Dambha-Miller H, Hinton W, Wilcox CR, Lemanska A, Joy M, Feher M, Stuart B, de Lusignan S, Hippisley-Cox J, Griffin S. Mortality from angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers in people infected with COVID-19: a cohort study of 3.7 million people. Fam Pract 2022; 40:330-337. [PMID: 36003039 PMCID: PMC9452130 DOI: 10.1093/fampra/cmac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association between ACE-I/ARB treatment and risk of death amongst people with COVID-19 in the first 6 months of the pandemic. METHODS We identified a cohort of adults diagnosed with either confirmed or probable COVID-19 (from 1 January to 21 June 2020) using computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. This comprised 465 general practices in England, United Kingdom with a nationally representative population of 3.7 million people. We constructed mixed-effects logistic regression models to quantify the association between ACE-I/ARBs and all-cause mortality among people with COVID-19, adjusted for sociodemographic factors, comorbidities, concurrent medication, smoking status, practice clustering, and household number. RESULTS There were 9,586 COVID-19 cases in the sample and 1,463 (15.3%) died during the study period between 1 January 2020 and 21 June 2020. In adjusted analysis ACE-I and ARBs were not associated with all-cause mortality (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 0.85-1.21 and OR 0.84, 95% CI 0.67-1.07, respectively). CONCLUSION Use of ACE-I/ARB, which are commonly used drugs, did not alter the odds of all-cause mortality amongst people diagnosed with COVID-19. Our findings should inform patient and prescriber decisions concerning continued use of these medications during the pandemic.
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Affiliation(s)
- Hajira Dambha-Miller
- Division of Primary Care and Population Health, University of Southampton, Southampton, United Kingdom
| | - William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Christopher R Wilcox
- Division of Primary Care and Population Health, University of Southampton, Southampton, United Kingdom
| | - Agnieszka Lemanska
- Department of Clinical and Experimental Medicine, School of Health Sciences, University of Surrey, Surrey, United Kingdom
| | - Mark Joy
- Department of Clinical and Experimental Medicine, School of Health Sciences, University of Surrey, Surrey, United Kingdom
| | - Michael Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Beth Stuart
- Division of Primary Care and Population Health, University of Southampton, Southampton, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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20
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Powell A, Hoare S, Modi R, Williams K, Dymond A, Chapman C, Griffin S, Mant J, Burt J. How to embed qualitative research in trials: insights from the feasibility study of the SAFER trial programme. Trials 2022; 23:394. [PMID: 35549744 PMCID: PMC9096750 DOI: 10.1186/s13063-022-06308-7] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Qualitative research can enhance the design, conduct and interpretation of trials. Despite this, few trials incorporate qualitative methods, and those that do may not realise their full potential. In this commentary, we highlight how qualitative research can contribute to the design, conduct and day-to-day running of a trial, outlining the working arrangements and relationships that facilitate these contributions. In doing so, we draw on (i) existing frameworks on the role of qualitative research alongside trials and (ii) our experience of integrated qualitative research conducted as part of the feasibility study of the SAFER trial (Screening for Atrial Fibrillation with ECG to Reduce stroke), a cluster randomised controlled trial of screening people aged 70 and above for atrial fibrillation in primary care in England. The activities and presence of the qualitative team contributed to important changes in the design, conduct and day-to-day running of the SAFER feasibility study, and the subsequent main trial, informing diverse decisions concerning trial documentation, trial delivery, timing and content of measures and the information given to participating patients and practices. These included asking practices to give screening results to all participants and not just to 'screen positive' participants, and greater recognition of the contribution of practice reception staff to trial delivery. These changes were facilitated by a 'one research team' approach that underpinned all formal and informal working processes from the outset and maximised the value of both qualitative and trial coordination expertise. The challenging problems facing health services require a combination of research methods and data types. Our experience and the literature show that the benefits of embedding qualitative research in trials are more likely to be realised if attention is given to both structural factors and relationships from the outset. These include sustained and sufficient funding for qualitative research, embedding qualitative research fully within the trial programme, providing shared infrastructure and resources and committing to relationships based on mutual recognition of and respect for the value of different methods and perspectives. We outline key learning for the planning of future trials.Trial registration: Screening for atrial fibrillation with ECG to reduce stroke ISRCTN16939438 (feasibility study); Screening for atrial fibrillation with ECG to reduce stroke - a randomised controlled trial ISRCTN72104369 .
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Affiliation(s)
- Alison Powell
- The Healthcare Improvement Studies Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK.
| | - Sarah Hoare
- The Healthcare Improvement Studies Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK
| | - Rakesh Modi
- Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Kate Williams
- Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Andrew Dymond
- Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Cheryl Chapman
- Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Simon Griffin
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SL, UK
| | - Jonathan Mant
- Primary Care Unit, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK
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21
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Ripa F, Pietropaolo A, Griffin S, Somani B. Treatment of large paediatric stone with Flexible Ureteroscopy and Laser Lithotripsy (FURSL) and Ureteral Access Sheath (UAS). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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22
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Sinha M, Pietropaolo A, Madarriaga Y, De Knecht E, Bujons Tur A, Griffin S, Somani B. Comparing and evaluating outcomes of ureteroscopy for management of stone disease in early and late childhood: a 15 year analysis of 2 European centers. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00200-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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23
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Sinha M, Pietropaolo A, Madarriaga Y, De Knecht E, Bujons Tur A, Griffin S, Somani B. Results of ureteroscopy and laser fragmentation (URSL) in extremes of age (less than or equal to 10 years and more than or equal to 80 years): Comparative outcomes from 2 European tertiary referral centers. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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24
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Bates SE, Thomas C, Islam N, Ahern AL, Breeze P, Griffin S, Brennan A. Using health economic modelling to inform the design and development of an intervention: estimating the justifiable cost of weight loss maintenance in the UK. BMC Public Health 2022; 22:290. [PMID: 35151300 PMCID: PMC8840781 DOI: 10.1186/s12889-022-12737-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 01/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is a need to develop cost-effective weight loss maintenance interventions to prolong the positive impact of weight loss on health outcomes. Conducting pre-trial health economic modelling is recommended to inform the design and development of behavioural interventions. We aimed to use health economic modelling to estimate the maximum cost per-person (justifiable cost) of a cost-effective behavioural weight loss maintenance intervention, given an estimated intervention effect for individuals with: i) a Body Mass Index (BMI) of 28 kg/m2 or above without diabetes and ii) a diagnosis of type 2 diabetes prescribed a single non-insulin diabetes medication. METHODS The School for Public Health Research Diabetes prevention model was used to estimate the lifetime Quality-adjusted life year (QALY) gains, healthcare costs, and maximum justifiable cost associated with a weight loss maintenance intervention. Based on a meta-analysis, the estimated effect of a weight loss maintenance intervention following a 9 kg weight loss, was a regain of 1.33 kg and 4.38 kg in years one and two respectively compared to greater regain of 2.84 kg and 5.6 kg in the control group. Sensitivity analysis was conducted around the rate of regain, duration of effect and initial weight loss. RESULTS The justifiable cost for a weight loss maintenance intervention at an ICER of £20,000 per QALY was £104.64 for an individual with a BMI of 28 or over and £88.14 for an individual with type 2 diabetes. Within sensitivity analysis, this varied from £36.42 to £203.77 for the former, and between £29.98 and £173.05 for the latter. CONCLUSIONS Researchers developing a weight loss maintenance intervention should consider these maximum justifiable cost estimates and the potential impact of the duration of effect and initial weight loss when designing intervention content and deciding target populations. Future research should consider using the methods demonstrated in this study to use health economic modelling to inform the design and budgetary decisions in the development of a behavioural interventions.
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Affiliation(s)
- Sarah E Bates
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK.
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Nazrul Islam
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amy L Ahern
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Penny Breeze
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Simon Griffin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
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25
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Lim E, Traxer O, Madarriaga Y, Castellani D, Fong K, Chan VS, Tur A, Pietropaolo A, Ragoori D, Shrestha A, Vaddi C, Bhatia T, Mani M, Juliebø-Jones P, Griffin S, Rojo E, Corrales M, Sekerci C, Tanidir Y, Teoh JC, Gauhar V, Somani B. Outcomes from practice of Retrograde Intrarenal Surgery (RIRS) in a paediatric setting of various age groups: A global study across 8 centres. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00857-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Khunti K, Griffin S, Brennan A, Dallosso H, Davies M, Eborall H, Edwardson C, Gray L, Hardeman W, Heathcote L, Henson J, Morton K, Pollard D, Sharp S, Sutton S, Troughton J, Yates T. Behavioural interventions to promote physical activity in a multiethnic population at high risk of diabetes: PROPELS three-arm RCT. Health Technol Assess 2022; 25:1-190. [PMID: 34995176 DOI: 10.3310/hta25770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a leading cause of mortality globally and accounts for significant health resource expenditure. Increased physical activity can reduce the risk of diabetes. However, the longer-term clinical effectiveness and cost-effectiveness of physical activity interventions in those at high risk of type 2 diabetes is unknown. OBJECTIVES To investigate whether or not Walking Away from Diabetes (Walking Away) - a low-resource, 3-hour group-based behavioural intervention designed to promote physical activity through pedometer use in those with prediabetes - leads to sustained increases in physical activity when delivered with and without an integrated mobile health intervention compared with control. DESIGN Three-arm, parallel-group, pragmatic, superiority randomised controlled trial with follow-up conducted at 12 and 48 months. SETTING Primary care and the community. PARTICIPANTS Adults whose primary care record included a prediabetic blood glucose measurement recorded within the past 5 years [HbA1c ≥ 42 mmol/mol (6.0%), < 48 mmol/mol (6.5%) mmol/mol; fasting glucose ≥ 5.5 mmol/l, < 7.0 mmol/l; or 2-hour post-challenge glucose ≥ 7.8 mmol/l, < 11.1 mmol/l] were recruited between December 2013 and February 2015. Data collection was completed in July 2019. INTERVENTIONS Participants were randomised (1 : 1 : 1) using a web-based tool to (1) control (information leaflet), (2) Walking Away with annual group-based support or (3) Walking Away Plus (comprising Walking Away, annual group-based support and a mobile health intervention that provided automated, individually tailored text messages to prompt pedometer use and goal-setting and provide feedback, in addition to biannual telephone calls). Participants and data collectors were not blinded; however, the staff who processed the accelerometer data were blinded to allocation. MAIN OUTCOME MEASURES The primary outcome was accelerometer-measured ambulatory activity (steps per day) at 48 months. Other objective and self-reported measures of physical activity were also assessed. RESULTS A total of 1366 individuals were randomised (median age 61 years, median body mass index 28.4 kg/m2, median ambulatory activity 6638 steps per day, women 49%, black and minority ethnicity 28%). Accelerometer data were available for 1017 (74%) and 993 (73%) individuals at 12 and 48 months, respectively. The primary outcome assessment at 48 months found no differences in ambulatory activity compared with control in either group (Walking Away Plus: 121 steps per day, 97.5% confidence interval -290 to 532 steps per day; Walking Away: 91 steps per day, 97.5% confidence interval -282 to 463). This was consistent across ethnic groups. At the intermediate 12-month assessment, the Walking Away Plus group had increased their ambulatory activity by 547 (97.5% confidence interval 211 to 882) steps per day compared with control and were 1.61 (97.5% confidence interval 1.05 to 2.45) times more likely to achieve 150 minutes per week of objectively assessed unbouted moderate to vigorous physical activity. In the Walking Away group, there were no differences compared with control at 12 months. Secondary anthropometric, biomechanical and mental health outcomes were unaltered in either intervention study arm compared with control at 12 or 48 months, with the exception of small, but sustained, reductions in body weight in the Walking Away study arm (≈ 1 kg) at the 12- and 48-month follow-ups. Lifetime cost-effectiveness modelling suggested that usual care had the highest probability of being cost-effective at a threshold of £20,000 per quality-adjusted life-year. Of 50 serious adverse events, only one (myocardial infarction) was deemed possibly related to the intervention and led to the withdrawal of the participant from the study. LIMITATIONS Loss to follow-up, although the results were unaltered when missing data were replaced using multiple imputation. CONCLUSIONS Combining a physical activity intervention with text messaging and telephone support resulted in modest, but clinically meaningful, changes in physical activity at 12 months, but the changes were not sustained at 48 months. FUTURE WORK Future research is needed to investigate which intervention types, components and features can help to maintain physical activity behaviour change over the longer term. TRIAL REGISTRATION Current Controlled Trials ISRCTN83465245. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 77. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Applied Research Collaboration, East Midlands, UK
| | - Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration, East Midlands, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Helen Eborall
- Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Charlotte Edwardson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Laura Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laura Heathcote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Joseph Henson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katie Morton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Innovia Technology Limited, Cambridge, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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Harrison H, Usher-Smith JA, Li L, Roberts L, Lin Z, Thompson RE, Rossi SH, Stewart GD, Walter FM, Griffin S, Zhou Y. Risk prediction models for symptomatic patients with bladder and kidney cancer: a systematic review. Br J Gen Pract 2022; 72:e11-e18. [PMID: 34844922 PMCID: PMC8714528 DOI: 10.3399/bjgp.2021.0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/25/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Timely diagnosis of bladder and kidney cancer is key to improving clinical outcomes. Given the challenges of early diagnosis, models incorporating clinical symptoms and signs may be helpful to primary care clinicians when triaging at-risk patients. AIM To identify and compare published models that use clinical signs and symptoms to predict the risk of undiagnosed prevalent bladder or kidney cancer. DESIGN AND SETTING Systematic review. METHOD A search identified primary research reporting or validating models predicting the risk of bladder or kidney cancer in MEDLINE and EMBASE. After screening identified studies for inclusion, data were extracted onto a standardised form. The risk models were classified using TRIPOD guidelines and evaluated using the PROBAST assessment tool. RESULTS The search identified 20 661 articles. Twenty studies (29 models) were identified through screening. All the models included haematuria (visible, non-visible, or unspecified), and seven included additional signs and symptoms (such as abdominal pain). The models combined clinical features with other factors (including demographic factors and urinary biomarkers) to predict the risk of undiagnosed prevalent cancer. Several models (n = 13) with good discrimination (area under the receiver operating curve >0.8) were identified; however, only eight had been externally validated. All of the studies had either high or unclear risk of bias. CONCLUSION Models were identified that could be used in primary care to guide referrals, with potential to identify lower-risk patients with visible haematuria and to stratify individuals who present with non-visible haematuria. However, before application in general practice, external validations in appropriate populations are required.
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Affiliation(s)
- Hannah Harrison
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Lanxin Li
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge
| | - Lydia Roberts
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge
| | - Zhiyuan Lin
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge
| | - Rachel E Thompson
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge
| | - Sabrina H Rossi
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, and director, Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Simon Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Yin Zhou
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
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Lindsay T, Wijndaele K, Westgate K, Dempsey P, Strain T, De Lucia Rolfe E, Forouhi NG, Griffin S, Wareham NJ, Brage S. Joint associations between objectively measured physical activity volume and intensity with body fatness: the Fenland study. Int J Obes (Lond) 2022; 46:169-177. [PMID: 34593963 PMCID: PMC8748201 DOI: 10.1038/s41366-021-00970-8] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/16/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND/OBJECTIVES Physical activity energy expenditure (PAEE) represents the total volume of all physical activity. This can be accumulated as different underlying intensity profiles. Although volume and intensity have been studied in isolation, less is known about their joint association with health. We examined this association with body fatness in a population-based sample of middle-aged British adults. METHODS In total, 6148 women and 5320 men from the Fenland study with objectively measured physical activity from individually calibrated combined heart rate and movement sensing and DXA-derived body fat percentage (BF%) were included in the analyses. We used linear and compositional isocaloric substitution analysis to examine associations of PAEE and its intensity composition with body fatness. Sex-stratified models were adjusted for socio-economic and dietary covariates. RESULTS PAEE was inversely associated with body fatness in women (beta = -0.16 (95% CI: -0.17; -0.15) BF% per kJ day-1 kg-1) and men (beta = -0.09 (95% CI: -0.10; -0.08) BF% per kJ day-1 kg-1). Intensity composition was significantly associated with body fatness, beyond that of PAEE; the reallocation of energy to vigorous physical activity (>6 METs) from other intensities was associated with less body fatness, whereas light activity (1.5-3 METs) was positively associated. However, light activity was the main driver of overall PAEE volume, and the relative importance of intensity was marginal compared to that of volume; the difference between PAEE in tertile 1 and 2 in women was associated with 3 percentage-point lower BF%. Higher vigorous physical activity in the same group to the maximum observed value was associated with 1 percentage-point lower BF%. CONCLUSIONS In this large, population-based cohort study with objective measures, PAEE was inversely associated with body fatness. Beyond the PAEE association, greater levels of intense activity were also associated with lower body fatness. This contribution was marginal relative to PAEE. These findings support current guidelines for physical activity which emphasise that any movement is beneficial, rather than specific activity intensity or duration targets.
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Affiliation(s)
- Tim Lindsay
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Paddy Dempsey
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
- Physical Activity and Behavioural Epidemiology Laboratories, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Tessa Strain
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | | | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Simon Griffin
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Nick J Wareham
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, UK.
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Phillips V, Neves J, Pedro B, Linney C, Griffin S. Computed tomography diagnosis of a caval-azygos communication in a dog with cor triatriatum dexter. J Vet Cardiol 2021; 38:59-66. [PMID: 34801805 DOI: 10.1016/j.jvc.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/01/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
An 18-month-old Springer Spaniel was presented for investigation of ascites, exercise intolerance and suspected cor triatriatum dexter. Division of the right atrium into two separate chambers by an anomalous perforated membrane consistent with cor triatriatum dexter was confirmed during echocardiography. However, a routine agitated saline contrast (bubble) study yielded results that could not be explained by the congenital heart defect alone. Computed tomography angiography was performed and revealed a dilated ventral internal vertebral venous plexus and a short, dilated vessel in the midlumbar region redirecting blood flow away from the caudal vena cava and into the azygos vein. Balloon dilatation of the orifice within the cor triatriatum dexter membrane successfully reduced pressure within the caudal chamber of the right atrium and enhanced return via the caudal vena cava with subsequent resolution of clinical signs. This case report highlights the use of cross-sectional imaging in dogs with cor triatriatum dexter and unexpected contrast study results, as a means by which concurrent vascular anomalies may be identified.
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Affiliation(s)
- V Phillips
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, B90 4NH, United Kingdom
| | - J Neves
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, B90 4NH, United Kingdom
| | - B Pedro
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, B90 4NH, United Kingdom
| | - C Linney
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, B90 4NH, United Kingdom
| | - S Griffin
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, B90 4NH, United Kingdom.
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30
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Griffin S, Jongco A, Kessel R. M147 THE ROLE OF AN ALLERGIST/IMMUNOLOGIST IN THE MANAGEMENT OF ACQUIRED IMMUNODEFICIENCY DUE TO CLOVES SYNDROME. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Work M, Allerton F, Griffin S, Kent A. Percutaneous-endoscopic rendezvous cholangiography with biliary stent placement in a dog with extra-hepatic biliary duct obstruction. J Small Anim Pract 2021; 63:416-420. [PMID: 34658028 DOI: 10.1111/jsap.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/07/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
A middle-aged male springer spaniel was presented for investigation of acute vomiting, lethargy and icterus. Marked distension of the gall bladder and common bile duct was evident at ultrasound due to obstruction by mineralised intraluminal material. After 48 hours of hospitalisation with intravenous fluid therapy, analgesia and antimicrobial therapy, intervention was deemed necessary to relieve the obstruction. A percutaneous-endoscopic rendezvous approach was used to achieve placement of a pigtail stent into the distal common bile duct, successfully relieving the obstruction. Serial biochemistry measurements postprocedure confirmed marked improvements in serum bilirubin. The patient remains clinically well 24 months postprocedure, and all hepatic enzyme activities have normalised. Based on the literature search performed, this is the first successful application of this technique in the management of canine extrahepatic biliary duct obstruction.
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Affiliation(s)
- M Work
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - F Allerton
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - S Griffin
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
| | - A Kent
- Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull, B90 4NH, UK
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32
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Essery R, Pollet S, Smith KA, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Bradbury K, Grey E, Western MJ, Milton A, Hunter C, Ferrey AE, Müller AM, Stuart B, Mutrie N, Griffin S, Kendrick T, Brooker H, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Planning and optimising a digital intervention to protect older adults' cognitive health. Pilot Feasibility Stud 2021; 7:158. [PMID: 34407886 PMCID: PMC8371874 DOI: 10.1186/s40814-021-00884-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2050, worldwide dementia prevalence is expected to triple. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the theory-, evidence- and person-based development of 'Active Brains': a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults. METHODS During the initial planning phase, scoping reviews, consultation with PPI contributors and expert co-investigators and behavioural analysis collated and recorded evidence that was triangulated to inform provisional 'guiding principles' and an intervention logic model. The following optimisation phase involved qualitative think aloud and semi-structured interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes and additions to guiding principles, the behavioural analysis and the logic model which, in turn, informed changes to intervention content. RESULTS Scoping reviews and qualitative interviews suggested that the same intervention content may be suitable for individuals with higher and lower cognitive performance. Qualitative findings revealed that maintaining independence and enjoyment motivated engagement in intervention-targeted behaviours, whereas managing ill health was a potential barrier. Social support for engaging in such activities could provide motivation, but was not desirable for all. These findings informed development of intervention content and functionality that appeared highly acceptable amongst a sample of target users. CONCLUSIONS A digitally delivered intervention with minimal support appears acceptable and potentially engaging to older adults with higher and lower levels of cognitive performance. As well as informing our own intervention development, insights obtained through this process may be useful for others working with, and developing interventions for, older adults and/or those with cognitive impairment.
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Affiliation(s)
- Rosie Essery
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
| | - Sebastien Pollet
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Victoria Hayter
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | | | | | - Alexander Milton
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Cheryl Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.,Centre for Sport & Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - John Niven
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK. .,School of Psychological Science, University of Bristol, Bristol, UK.
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Thomas C, Mandrik O, Saunders CL, Thompson D, Whyte S, Griffin S, Usher-Smith JA. The Costs and Benefits of Risk Stratification for Colorectal Cancer Screening Based On Phenotypic and Genetic Risk: A Health Economic Analysis. Cancer Prev Res (Phila) 2021; 14:811-822. [PMID: 34039685 PMCID: PMC7611464 DOI: 10.1158/1940-6207.capr-20-0620] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/15/2021] [Accepted: 05/24/2021] [Indexed: 01/07/2023]
Abstract
Population-based screening for colorectal cancer is an effective and cost-effective way of reducing colorectal cancer incidence and mortality. Many genetic and phenotypic risk factors for colorectal cancer have been identified, leading to development of colorectal cancer risk scores with varying discrimination. However, these are not currently used by population screening programs. We performed an economic analysis to assess the cost-effectiveness, clinical outcomes, and resource impact of using risk-stratification based on phenotypic and genetic risk, taking a UK National Health Service perspective. Biennial fecal immunochemical test (FIT), starting at an age determined through risk-assessment at age 40, was compared with FIT screening starting at a fixed age for all individuals. Compared with inviting everyone from age 60, using a risk score with area under the receiver operating characteristic curve of 0.721 to determine FIT screening start age, produces 418 QALYs, costs £247,000, and results in 218 fewer colorectal cancer cases and 156 fewer colorectal cancer deaths per 100,000 people, with similar FIT screening invites. There is 96% probability that risk-stratification is cost-effective, with net monetary benefit (based on £20,000 per QALY threshold) estimated at £8.1 million per 100,000 people. The maximum that could be spent on risk-assessment and still be cost-effective is £114 per person. Lower benefits are produced with lower discrimination risk scores, lower mean screening start age, or higher FIT thresholds. Risk-stratified screening benefits men more than women. Using risk to determine FIT screening start age could improve the clinical outcomes and cost effectiveness of colorectal cancer screening without using significant additional screening resources. PREVENTION RELEVANCE: Colorectal cancer screening is essential for early detection and prevention of colorectal cancer, but implementation is often limited by resource constraints. This work shows that risk-stratification using genetic and phenotypic risk could improve the effectiveness and cost-effectiveness of screening programs, without using substantially more screening resources than are currently available.
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Affiliation(s)
- Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
| | - Olena Mandrik
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Catherine L Saunders
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Deborah Thompson
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, United Kingdom
| | - Sophie Whyte
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Simon Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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34
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Khunti K, Griffin S, Brennan A, Dallosso H, Davies MJ, Eborall HC, Edwardson CL, Gray LJ, Hardeman W, Heathcote L, Henson J, Pollard D, Sharp SJ, Sutton S, Troughton J, Yates T. Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial. BMC Med 2021; 19:130. [PMID: 34078362 PMCID: PMC8173914 DOI: 10.1186/s12916-021-01997-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Physical activity is associated with a reduced risk of type 2 diabetes and cardiovascular disease but limited evidence exists for the sustained promotion of increased physical activity within diabetes prevention trials. The aim of the study was to investigate the long-term effectiveness of the Walking Away programme, an established group-based behavioural physical activity intervention with pedometer use, when delivered alone or with a supporting mHealth intervention. METHODS Those at risk of diabetes (nondiabetic hyperglycaemia) were recruited from primary care, 2013-2015, and randomised to (1) Control (information leaflet); (2) Walking Away (WA), a structured group education session followed by annual group-based support; or (3) Walking Away Plus (WAP), comprising WA annual group-based support and an mHealth intervention delivering tailored text messages supported by telephone calls. Follow-up was conducted at 12 and 48 months. The primary outcome was accelerometer measured ambulatory activity (steps/day). Change in primary outcome was analysed using analysis of covariance with adjustment for baseline, randomisation and stratification variables. RESULTS One thousand three hundred sixty-six individuals were randomised (median age = 61 years, ambulatory activity = 6638 steps/day, women = 49%, ethnic minorities = 28%). Accelerometer data were available for 1017 (74%) individuals at 12 months and 993 (73%) at 48 months. At 12 months, WAP increased their ambulatory activity by 547 (97.5% CI 211, 882) steps/day compared to control and were 1.61 (97.5% CI 1.05, 2.45) times more likely to achieve 150 min/week of moderate-to-vigorous physical activity. Differences were not maintained at 48 months. WA was no different to control at 12 or 48 months. Secondary anthropometric and health outcomes were largely unaltered in both intervention groups apart from small reductions in body weight in WA (~ 1 kg) at 12- and 48-month follow-up. CONCLUSIONS Combining a pragmatic group-based intervention with text messaging and telephone support resulted in modest changes to physical activity at 12 months, but changes were not maintained at 48 months. TRIAL REGISTRATION ISRCTN 83465245 (registered on 14 June 2012).
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK. .,NIHR Applied Research Collaboration - East Midlands, Leicester, UK.
| | - Simon Griffin
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration - East Midlands, Leicester, UK.,Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | | | - Charlotte L Edwardson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Laura J Gray
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Laura Heathcote
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Joe Henson
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jacqui Troughton
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
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35
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Mosquera Seoane L, Brewin A, Pietropaolo A, Quiroz Madarriaga Y, Llorens De Knecht E, Jones P, Bujons Tur A, Griffin S, Somani B. Safety and outcomes of using ureteral access sheaths for treatment of paediatric renal stones: A review of 48 patients across 2 large European endourology centres. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Mosquera Seoane L, Pietropaolo A, Quiroz Madarriaga Y, Llorens De Knecht E, Jones P, Bujons Tur A, Griffin S, Somani B. Is flexible ureteroscopy and laser lithotripsy (FURLS) the new gold standard for paediatric lower pole stones: Outcomes from 2 large European tertiary paediatric endourology centres. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Smith AM, Huynh P, Griffin S, Baughn M, Monka P. Strong, non-specific adhesion using C-lectin heterotrimers in a molluscan defensive secretion. Integr Comp Biol 2021; 61:1440-1449. [PMID: 34048555 DOI: 10.1093/icb/icab100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The defensive mucus produced by the slug Arion subfuscus is tough and remarkably sticky. It spreads rapidly and adheres strongly to a wide range of surfaces. The adhesion is equally strong on wettable (glass) and non-wettable (plastic) surfaces. The adhesion appears to depend on a group of proteins that adsorb equally well to a wide range of different natural and artificial surfaces. Prominent among these proteins were those that distinguish the adhesive secretion from the non-adhesive mucus. The adhesive proteins were not washed off by non-ionic detergent, nor was the adhesion of the glue as a whole affected by this treatment. In contrast, high salt concentrations washed the most abundant adhesive proteins off the surfaces, and correspondingly weakened the glue's attachment. The most abundant of the adhesive proteins were C-lectins, which appear to form heterotrimers. These and other lectin-like proteins in slug glue have a high proportion of aromatic amino acids at conserved locations, and are relatively small and often basic. The aromatic and cationic side chains may provide a powerful combination promoting and maintaining surface adhesion.
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Affiliation(s)
- A M Smith
- Ithaca College, Department of Biology, Ithaca, NY
| | - P Huynh
- Ithaca College, Department of Biology, Ithaca, NY
| | - S Griffin
- Ithaca College, Department of Biology, Ithaca, NY
| | - M Baughn
- Ithaca College, Department of Biology, Ithaca, NY
| | - P Monka
- Ithaca College, Department of Biology, Ithaca, NY
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Kassavou A, Mirzaei V, Shpendi S, Brimicombe J, Chauhan J, Bhattacharya D, Naughton F, Hardeman W, Eborall H, Van Emmenis M, De Simoni A, Takhar A, Gupta P, Patel P, Mascolo C, Prevost AT, Morris S, Griffin S, McManus RJ, Mant J, Sutton S. The feasibility of the PAM intervention to support treatment-adherence in people with hypertension in primary care: a randomised clinical controlled trial. Sci Rep 2021; 11:8897. [PMID: 33903656 PMCID: PMC8076273 DOI: 10.1038/s41598-021-88170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 04/06/2021] [Indexed: 11/22/2022] Open
Abstract
The PAM intervention is a behavioural intervention to support adherence to anti-hypertensive medications and therefore to lower blood pressure. This feasibility trial recruited 101 nonadherent patients (54% male, mean age 65.8 years) with hypertension and high blood pressure from nine general practices in the UK. The trial had 15.5% uptake and 7.9% attrition rate. Patients were randomly allocated to two groups: the intervention group (n = 61) received the PAM intervention as an adjunct to usual care; the control group (n = 40) received usual care only. At 3 months, biochemically validated medication adherence was improved by 20% (95% CI 3–36%) in the intervention than control, and systolic blood pressure was reduced by 9.16 mmHg (95% CI 5.69–12.64) in intervention than control. Improvements in medication adherence and reductions in blood pressure suggested potential intervention effectiveness. For a subsample of patients, improvements in medication adherence and reductions in full lipid profile (cholesterol 1.39 mmol/mol 95% CI 0.64–1.40) and in glycated haemoglobin (3.08 mmol/mol, 95% CI 0.42–5.73) favoured the intervention. A larger trial will obtain rigorous evidence about the potential clinical effectiveness and cost-effectiveness of the intervention. Trial registration Trial date of first registration 28/01/2019. ISRCTN74504989. https://doi.org/10.1186/ISRCTN74504989.
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Affiliation(s)
- Aikaterini Kassavou
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK.
| | - Venus Mirzaei
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Sonia Shpendi
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Jagmohan Chauhan
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK.,School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Helen Eborall
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Miranda Van Emmenis
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Anna De Simoni
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Amrit Takhar
- Cambridgeshire and Peterborough Clinical Commissioning Group, Cambridge, UK
| | - Pankaj Gupta
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Prashanth Patel
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Cecilia Mascolo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Andrew Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, King's College London, London, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
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Mosquera L, Pietropaolo A, Brewin A, Madarriaga YQ, de Knecht EL, Jones P, Bujons A, Griffin S, Somani BK. Safety and Outcomes of using ureteric access sheath (UAS) for treatment of Pediatric renal stones: Outcomes from 2 tertiary endourology centers. Urology 2021; 157:222-226. [PMID: 33891927 DOI: 10.1016/j.urology.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/15/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To look at the safety and outcomes of using ureteral access sheath (UAS) for pediatric renal stones. The use of UAS is variable in urological practice with very little clinical work on their use in pediatric kidney stone disease. PATIENTS AND METHODS Data was retrospectively collected from 2 large European tertiary endourology centers for all pediatric patients (≤16 years) with renal stones who underwent flexible ureteroscopy and lasertripsy (FURSL) via UAS. Data was collected on patient details, stone demographics and clinical outcomes of the FURSL procedure. RESULTS Forty-eight patients with a mean age of 10.7 years were treated with FURSL for a mean single and cumulative stone size of 10.4 mm and 15 mm respectively, with two-third having multiple stones and stones in the lower pole. The initial and final stone free rate (SFR) was 66.7% and 100% respectively with 1.3 procedures/patient. One patient each had intra-operative grade 1 ureteric injury and post-operative UTI, with no other injuries or complications noted. Over a mean follow-up of 17 months, no other complications were noted. CONCLUSION Ureteral access sheath is safe for treatment of pediatric renal stones with excellent outcomes and are especially useful for larger or multiple stones. While there does not seem to be any medium-term sequalae, to avoid risk of ureteral injury, we would suggest using the smallest size sheath possible. We would argue these procedures are best done in specialist high-volume endourology units for optimal results.
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Affiliation(s)
- L Mosquera
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Pietropaolo
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Brewin
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | | | | | - P Jones
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - A Bujons
- Urology Department, Fundació Puigvert, Barcelona, Spain
| | - S Griffin
- Southampton Children's Hospital NHS Trust, Southampton, United Kingdom
| | - B K Somani
- University Hospital Southampton NHS Trust, Southampton, United Kingdom.
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Smith KA, Bradbury K, Essery R, Pollet S, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Kelly J, Somerville J, Zhang J, Grey E, Western M, Ferrey AE, Krusche A, Stuart B, Mutrie N, Robinson S, Yao GL, Griffiths G, Robinson L, Rossor M, Gallacher J, Griffin S, Kendrick T, Rathod S, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. The Active Brains Digital Intervention to Reduce Cognitive Decline in Older Adults: Protocol for a Feasibility Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e18929. [PMID: 33216010 PMCID: PMC7718093 DOI: 10.2196/18929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/04/2020] [Accepted: 08/16/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults. OBJECTIVE In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial. METHODS In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463). RESULTS Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021. CONCLUSIONS The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18929.
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Affiliation(s)
- Kirsten Ailsa Smith
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Katherine Bradbury
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Rosie Essery
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Sebastien Pollet
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Fiona Mowbray
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Joanna Slodkowska-Barabasz
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - James Denison-Day
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Victoria Hayter
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Jo Kelly
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jane Somerville
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Jin Zhang
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Elisabeth Grey
- Department for Health, University of Bath, Bath, United Kingdom
| | - Max Western
- Department for Health, University of Bath, Bath, United Kingdom
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Adele Krusche
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Sian Robinson
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Guiqing Lily Yao
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Louise Robinson
- Institute of Population Health Sciences, University of Newcastle, Newcastle upon Tyne, United Kingdom
| | - Martin Rossor
- Dementia Research Centre, University College London, London, United Kingdom
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - John Niven
- Public and Patient Involvement (PPI) representative, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Centre for Community and Clinical Applications of Health Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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Galle A, Cossa H, Osman N, Roelens K, Griffin S, Degomme O. Pregnancy and childbirth in Mozambique: men as decision makers and women as caretakers? Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.879] [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: 11/13/2022] Open
Abstract
Abstract
Background
Increasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men's involvement in maternal health in southern Mozambique.
Methods
Ten key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in maternal health, followed by 10 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis.
Results
Results show a lack of strategy at policy level to stimulate male involvement in maternal health. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives and women accompanied by a husband are often put in a submissive position. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity.
Conclusions
A clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and health programs should step away from linking male involvement to HIV prevention.
Key messages
Linking the promotion of gender equality to male involvement is the key for success. Step away from linking HIV prevention to male involvement in maternal health.
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Affiliation(s)
- A Galle
- Ghent University, Gent, Belgium
- Eduardo Mondlane University, Maputo, Mozambique
| | - H Cossa
- Eduardo Mondlane University, Maputo, Mozambique
| | - N Osman
- Eduardo Mondlane University, Maputo, Mozambique
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Dambha-Miller H, Albasri A, Hodgson S, Wilcox C, Islam N, Khan S, Little P, Griffin S. Drug treatments affecting ACE2 in COVID-19 infection: a systematic review protocol. BJGP Open 2020; 4:bjgpopen20X101115. [PMID: 32665234 PMCID: PMC7465570 DOI: 10.3399/bjgpopen20x101115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/02/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 virus causing COVID-19 binds human angiotensin-converting enzyme 2 (ACE2) receptors in human tissues. ACE2 expression may be associated with COVID-19 infection and mortality rates. Routinely prescribed drugs that up- or down-regulate ACE2 expression are, therefore, of critical research interest as agents that might promote or reduce risk of COVID-19 infection in a susceptible population. AIM To collate evidence on routinely prescribed drug treatments in the UK that could up- or down-regulate ACE2, and thus potentially affect COVID-19 infection. DESIGN & SETTING Systematic review of studies published in MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), the Cochrane Library, and Web of Science from inception to 1 April 2020. METHOD A systematic review will be conducted in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Inclusion criteria will be: (1) assesses the effect of drug exposure on ACE2 level of expression or activity; (2) the drug is included in the British National Formulary (BNF) and, therefore, available to prescribe in the UK; and (3) a control, placebo, or sham group is included as comparator. Exclusion criteria will be: (1) ACE2 measurement in utero; (2) ACE2 measurement in children aged <18 years; (3) drug not in the BNF; and (4) review article. Quality will be assessed using the Cochrane risk of bias tool for human studies, and the SYstematic Review Center for Laboratory animal Experimentation (SYRCLE) risk of bias tool for animal studies. RESULTS Data will be reported in summary tables and narrative synthesis. CONCLUSION This systematic review will identify drug therapies that may increase or decrease ACE2 expression. This might identify medications increasing risk of COVID-19 transmission, or as targets for intervention in mitigating transmission.
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Affiliation(s)
- Hajira Dambha-Miller
- NIHR Academic Clinical Lecturer and GP, Division of Primary Care and Population Health, University of Southampton, Southampton, UK
| | - Ali Albasri
- Clinical Pharmacist and Research Fellow, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sam Hodgson
- NIHR Academic Clinical Fellow, Division of Primary Care and Population Health, University of Southampton, Southampton, UK
| | - Christopher Wilcox
- NIHR Academic Clinical Fellow, Division of Primary Care and Population Health, University of Southampton, Southampton, UK
| | - Nazrul Islam
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Shareen Khan
- Specialist Pharmacist, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Paul Little
- Professor of Primary Care, Division of Primary Care and Population Health, University of Southampton, Southampton, UK
| | - Simon Griffin
- Professor of General Practice, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Kitchen SA, Von Kuster G, Kuntz KLV, Reich HG, Miller W, Griffin S, Fogarty ND, Baums IB. STAGdb: a 30K SNP genotyping array and Science Gateway for Acropora corals and their dinoflagellate symbionts. Sci Rep 2020; 10:12488. [PMID: 32719467 PMCID: PMC7385180 DOI: 10.1038/s41598-020-69101-z] [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: 02/13/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022] Open
Abstract
Standardized identification of genotypes is necessary in animals that reproduce asexually and form large clonal populations such as coral. We developed a high-resolution hybridization-based genotype array coupled with an analysis workflow and database for the most speciose genus of coral, Acropora, and their symbionts. We designed the array to co-analyze host and symbionts based on bi-allelic single nucleotide polymorphisms (SNP) markers identified from genomic data of the two Caribbean Acropora species as well as their dominant dinoflagellate symbiont, Symbiodinium ‘fitti’. SNPs were selected to resolve multi-locus genotypes of host (called genets) and symbionts (called strains), distinguish host populations and determine ancestry of coral hybrids between Caribbean acroporids. Pacific acroporids can also be genotyped using a subset of the SNP loci and additional markers enable the detection of symbionts belonging to the genera Breviolum, Cladocopium, and Durusdinium. Analytic tools to produce multi-locus genotypes of hosts based on these SNP markers were combined in a workflow called the Standard Tools for Acroporid Genotyping (STAG). The STAG workflow and database are contained within a customized Galaxy environment (https://coralsnp.science.psu.edu/galaxy/), which allows for consistent identification of host genet and symbiont strains and serves as a template for the development of arrays for additional coral genera. STAG data can be used to track temporal and spatial changes of sampled genets necessary for restoration planning and can be applied to downstream genomic analyses. Using STAG, we uncover bi-directional hybridization between and population structure within Caribbean acroporids and detect a cryptic Acroporid species in the Pacific.
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Affiliation(s)
- S A Kitchen
- Department of Biology, The Pennsylvania State University, 208 Mueller Laboratory, University Park, PA, 16802, USA
| | - G Von Kuster
- The Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
| | - K L Vasquez Kuntz
- Department of Biology, The Pennsylvania State University, 208 Mueller Laboratory, University Park, PA, 16802, USA
| | - H G Reich
- Department of Biology, The Pennsylvania State University, 208 Mueller Laboratory, University Park, PA, 16802, USA
| | - W Miller
- Centre for Comparative Genomics and Bioinformatics, The Pennsylvania State University, University Park, PA, 16802, USA
| | - S Griffin
- NOAA Restoration Center, 260 Guard Rd., Aguadilla, PR, 00603, USA
| | - Nicole D Fogarty
- Department of Biology and Marine Biology, Center for Marine Science, University of North Carolina Wilmington, Wilmington, NC, 28403, USA
| | - I B Baums
- Department of Biology, The Pennsylvania State University, 208 Mueller Laboratory, University Park, PA, 16802, USA.
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Abstract
Supported employment services have been utilized with developmentally disabled persons for nearly two decades (Wehman, 1988). This article explores the issues related to the use of supported employment and time-related transitional employment for blind and visually impaired persons, many of whom are unemployed or underemployed. It defines the concepts of supported and time-limited transitional employment, describes the characteristics that distinguish these services from others, and discusses the need for these services from the ecological, philosophical, fiscal, and learning perspectives.
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Affiliation(s)
- C. Hanley-Maxwell
- Cheryl Hanley-Maxwell, Rehabilitation Institute, Southern Illinois University, Carbon-dale, IL 62901–4609
| | - S. Griffin
- RRTC, Virginia Commonwealth University, VCU Box 2011, Richmond, VA 23284-2011
| | - E.M. Szymanski
- Department of Rehabilitation, Psychology, and Special Education, University of Wisconsin, 432 North Murray Street, Madison, WI 53 706
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McKeaveney C, Noble H, Courtney AE, Gill P, Griffin S, Johnston W, Maxwell AP, Teasdale F, Reid J. Understanding the holistic experiences of living with a kidney transplant: an interpretative phenomenological study (protocol). BMC Nephrol 2020; 21:222. [PMID: 32527229 PMCID: PMC7289222 DOI: 10.1186/s12882-020-01860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 11/11/2022] Open
Abstract
Background Currently very little is known about the perceptions and experiences of kidney transplant recipients from a qualitative perspective. As highlighted by the European Kidney Health Alliance recommendations, providing holistic care to kidney patients is important however this is currently an unmet care need in renal disease. It is imperative to understand patient experiences to ensure that they are included in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support impacting on overall health. Method A purposive sampling strategy will recruit individuals currently living with a kidney transplant, 6 months to 5 years post-transplant. A maximum of 30 patients will be recruited between two Regional Nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews will be undertaken with participants living with a kidney transplant across the two sites. Interviews will be digitally-recorded, transcribed verbatim and subjected to interpretative phenomenological analysis. Discussion Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multi-domain experiences that these patients experience will help healthcare professionals to recognize the needs of this group and ensure more responsive care.
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Affiliation(s)
| | - H Noble
- Queen's University Belfast, Belfast, UK
| | | | - P Gill
- Cardiff University, Cardiff, UK
| | - S Griffin
- University Hospital of Wales, Cardiff, UK
| | - W Johnston
- Northern Ireland Kidney Patients Association, Belfast, UK.,Kidney Care UK, Alton, UK
| | - A P Maxwell
- Queen's University Belfast, Belfast, UK.,Belfast Health & Social Care Trust, Belfast, UK
| | | | - J Reid
- Queen's University Belfast, Belfast, UK.
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Kassavou A, Mirzaei V, Brimicombe J, Edwards S, Massou E, Prevost AT, Griffin S, Sutton S. A Highly Tailored Text and Voice Messaging Intervention to Improve Medication Adherence in Patients With Either or Both Hypertension and Type 2 Diabetes in a UK Primary Care Setting: Feasibility Randomized Controlled Trial of Clinical Effectiveness. J Med Internet Res 2020; 22:e16629. [PMID: 32427113 PMCID: PMC7267991 DOI: 10.2196/16629] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/04/2020] [Accepted: 02/01/2020] [Indexed: 12/20/2022] Open
Abstract
Background The efficacy of a highly tailored digital intervention to support medication adherence and feasibility to support clinical effectiveness as an adjunct to the primary care setting has not been evaluated. Objective This trial aimed to assess the behavioral efficacy of a highly tailored digital intervention to support medication adherence and to evaluate the feasibility of its clinical effectiveness, in patients with either or both hypertension and type 2 diabetes. We also examined quality of life and mechanisms of behavior change. Intervention fidelity, engagement, and satisfaction were also explored. Methods This was a multicenter, individually randomized controlled trial of 2 parallel groups: an intervention group that received a highly tailored text message and interactive voice response intervention for 12 weeks, and a control group that received usual care. Medication adherence was measured using self-reports and assessor-blinded practice records of a repeat prescription. Systolic blood pressure and glucose levels were assessed by nurses blinded to group allocation during practice visits at 3 months follow-up. Questionnaires obtained data to assess intervention mechanisms of action and satisfaction and digital log files captured data to evaluate fidelity and engagement. Results A total of 135 nonadherent patients (62/135, 46% female; 122/135, 90.3%; aged above 50 years) were randomly allocated in the intervention (n=79) or in the control group (n=56); of whom 13% (18/135) were lost at follow-up. Medication adherence was significantly improved in the intervention group compared with the control group (t116=2.27; P=.02, 2-tailed). Systolic blood pressure was 0.6 mmHg (95% CI −7.423 to 6.301), and hemoglobin A1c was 4.5 mmol/mol (95% CI −13.099 to 4.710) lower in the intervention group compared with the control group. Changes in intentional nonadherence and nonintentional nonadherence explained the improvements in medication adherence in the intervention group (beta=.074, SE=0.464; P=.04), but not in the control group (beta=.00, SE 1.35; P=.37). The intervention had 100% fidelity, a median of 12 days of engagement, and 76% overall satisfaction. Conclusions Our trial is the first that has been conducted in the United Kingdom and showed that among nonadherent patients with either or both hypertension and type 2 diabetes, a highly tailored digital intervention was effective at improving treatment adherence and feasible to obtain clinically meaningful outcomes. Changes in intentional and nonintentional nonadherence predicted the improvements in medication adherence. The intervention had high fidelity, engagement, and satisfaction. Future research using a rigorous design is needed to evaluate the clinical effectiveness and cost-effectiveness of the intervention in primary care. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 10668149; http://www.controlled-trials.com/ISRCTN10668149.
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Affiliation(s)
| | - Venus Mirzaei
- The University of Cambridge, Cambridge, United Kingdom
| | | | - Simon Edwards
- The University of Cambridge, Cambridge, United Kingdom
| | | | | | - Simon Griffin
- The University of Cambridge, Cambridge, United Kingdom
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Baud K, Griffin S, Martinez-Taboada F, Burton NJ. CT evaluation of elbow congruity in dogs: radial incisure versus apical medial coronoid process fragmentation. J Small Anim Pract 2020; 61:224-229. [PMID: 32017094 DOI: 10.1111/jsap.13110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 12/06/2019] [Accepted: 12/18/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare elbow congruity in two cohorts of Labrador retrievers affected with either radial incisure or apex fragmentation of the medial coronoid process. MATERIALS AND METHODS Dogs were included if they had elbow lameness and a CT diagnosis of a fissure or fragmentation of the medial coronoid process occurring either along the radial incisure or at the coronoid apex. Radioulnar joint space was measured incrementally from the lateral to the medial coronoid process on transverse slice images. Axial radioulnar congruency was also measured at the apex and mid-coronoid in the dorsal plane and at the base of the coronoid in the sagittal plane. RESULTS We studied 99 elbows (in 66 dogs) of which 56 had a fissure or fragmentation along the radial incisure and 43 had an apical fragment. No difference was found between the two groups at the different measuring points - with the exception of a transverse plane radioulnar joint space measurement in the radial incisure group that was smaller adjacent to the lateral coronoid process. CLINICAL SIGNIFICANCE Abnormal ulnar morphology in the radial incisure group could result in a fulcrum effect within the radioulnar joint, overloading the radial incisure and predisposing to osteochondral damage at this site.
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Affiliation(s)
- K Baud
- Wear Referrals, Bradbury, Stockton-on-Tees, TS21 2ES, UK
| | - S Griffin
- Willows Referral Service, Solihull, West Midlands, B90 4NH, UK
| | - F Martinez-Taboada
- University Veterinary Teaching Hospital, School of Veterinary Science, University of Sydney, Sydney, NSW, 2050, Australia
| | - N J Burton
- Wear Referrals, Bradbury, Stockton-on-Tees, TS21 2ES, UK
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Ray F, Cooper W, Scolyer R, Griffin S, Lim P, Strasser S, Kench J, McKenzie C. 19. The many faces of colonic malakoplakia: A case series and review of the literature. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lindsay T, Westgate K, Wijndaele K, Hollidge S, Kerrison N, Forouhi N, Griffin S, Wareham N, Brage S. Descriptive epidemiology of physical activity energy expenditure in UK adults (The Fenland study). Int J Behav Nutr Phys Act 2019; 16:126. [PMID: 31818302 PMCID: PMC6902569 DOI: 10.1186/s12966-019-0882-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/13/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Physical activity (PA) plays a role in the prevention of a range of diseases including obesity and cardiometabolic disorders. Large population-based descriptive studies of PA, incorporating precise measurement, are needed to understand the relative burden of insufficient PA levels and to inform the tailoring of interventions. Combined heart and movement sensing enables the study of physical activity energy expenditure (PAEE) and intensity distribution. We aimed to describe the sociodemographic correlates of PAEE and moderate-to-vigorous physical activity (MVPA) in UK adults. METHODS The Fenland study is a population-based cohort study of 12,435 adults aged 29-64 years-old in Cambridgeshire, UK. Following individual calibration (treadmill), participants wore a combined heart rate and movement sensor continuously for 6 days in free-living, from which we derived PAEE (kJ•day- 1•kg- 1) and time in MVPA (> 3 & > 4 METs) in bouts greater than 1 min and 10 min. Socio-demographic information was self-reported. Stratum-specific summary statistics and multivariable analyses were performed. RESULTS Women accumulated a mean (sd) 50(20) kJ•day- 1•kg- 1 of PAEE, and 83(67) and 33(39) minutes•day- 1 of 1-min bouted and 10-min bouted MVPA respectively. By contrast, men recorded 59(23) kJ•day- 1•kg- 1, 124(84) and 60(58) minutes•day- 1. Age and BMI were also important correlates of PA. Association with age was inverse in both sexes, more strongly so for PAEE than MVPA. Obese individuals accumulated less PA than their normal-weight counterparts, whether considering PAEE or allometrically-scaled PAEE (- 10 kJ•day- 1•kg- 1 or - 15 kJ•day- 1•kg-2/3 in men). Higher income and manual work were associated with higher PA; manual workers recorded 13-16 kJ•kg- 1•day- 1 more PAEE than sedentary counterparts. Overall, 86% of women and 96% of men accumulated a daily average of MVPA (> 3 METs) corresponding to 150 min per week. These values were 49 and 74% if only considering bouts > 10 min (15 and 31% for > 4 METs). CONCLUSIONS PA varied by age, sex and BMI, and was higher in manual workers and those with higher incomes. Light physical activity was the main driver of PAEE; a component of PA that is currently not quantified as a target in UK guidelines.
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Affiliation(s)
- Tim Lindsay
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Stefanie Hollidge
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Nicola Kerrison
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Nita Forouhi
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Simon Griffin
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK.
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Yerrakalva D, Yerrakalva D, Hajna S, Griffin S. Effects of Mobile Health App Interventions on Sedentary Time, Physical Activity, and Fitness in Older Adults: Systematic Review and Meta-Analysis. J Med Internet Res 2019; 21:e14343. [PMID: 31778121 PMCID: PMC6908977 DOI: 10.2196/14343] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/01/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background High sedentary time, low physical activity (PA), and low physical fitness place older adults at increased risk of chronic diseases, functional decline, and premature mortality. Mobile health (mHealth) apps, apps that run on mobile platforms, may help promote active living. Objective We aimed to quantify the effect of mHealth app interventions on sedentary time, PA, and fitness in older adults. Methods We systematically searched five electronic databases for trials investigating the effects of mHealth app interventions on sedentary time, PA, and fitness among community-dwelling older adults aged 55 years and older. We calculated pooled standardized mean differences (SMDs) in these outcomes between the intervention and control groups after the intervention period. We performed a Cochrane risk of bias assessment and Grading of Recommendations, Assessment, Development, and Evaluation certainty assessment. Results Overall, six trials (486 participants, 66.7% [324/486] women; age mean 68 [SD 6] years) were included (five of these trials were included in the meta-analysis). mHealth app interventions may be associated with decreases in sedentary time (SMD=−0.49; 95% CI −1.02 to 0.03), increases in PA (506 steps/day; 95% CI −80 to 1092), and increases in fitness (SMD=0.31; 95% CI −0.09 to 0.70) in trials of 3 months or shorter and with increases in PA (753 steps/day; 95% CI −147 to 1652) in trials of 6 months or longer. Risk of bias was low for all but one study. The quality of evidence was moderate for PA and sedentary time and low for fitness. Conclusions mHealth app interventions have the potential to promote changes in sedentary time and PA over the short term, but the results did not achieve statistical significance, possibly because studies were underpowered by small participant numbers. We highlight a need for larger trials with longer follow-up to clarify if apps deliver sustained clinically important effects.
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Affiliation(s)
- Dharani Yerrakalva
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Dhrupadh Yerrakalva
- Barking, Havering, and Redbridge University Hospitals Trust, London, United Kingdom
| | - Samantha Hajna
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Simon Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
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