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Lynch C, Sakamuru S, Ooka M, Huang R, Klumpp-Thomas C, Shinn P, Gerhold D, Rossoshek A, Michael S, Casey W, Santillo MF, Fitzpatrick S, Thomas RS, Simeonov A, Xia M. High-Throughput Screening to Advance In Vitro Toxicology: Accomplishments, Challenges, and Future Directions. Annu Rev Pharmacol Toxicol 2024; 64:191-209. [PMID: 37506331 PMCID: PMC10822017 DOI: 10.1146/annurev-pharmtox-112122-104310] [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] [Indexed: 07/30/2023]
Abstract
Traditionally, chemical toxicity is determined by in vivo animal studies, which are low throughput, expensive, and sometimes fail to predict compound toxicity in humans. Due to the increasing number of chemicals in use and the high rate of drug candidate failure due to toxicity, it is imperative to develop in vitro, high-throughput screening methods to determine toxicity. The Tox21 program, a unique research consortium of federal public health agencies, was established to address and identify toxicity concerns in a high-throughput, concentration-responsive manner using a battery of in vitro assays. In this article, we review the advancements in high-throughput robotic screening methodology and informatics processes to enable the generation of toxicological data, and their impact on the field; further, we discuss the future of assessing environmental toxicity utilizing efficient and scalable methods that better represent the corresponding biological and toxicodynamic processes in humans.
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Affiliation(s)
- Caitlin Lynch
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Srilatha Sakamuru
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Masato Ooka
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Ruili Huang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Carleen Klumpp-Thomas
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Paul Shinn
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - David Gerhold
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Anna Rossoshek
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Sam Michael
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Warren Casey
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Michael F Santillo
- Division of Toxicology, Office of Applied Research and Safety Assessment, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Laurel, Maryland, USA
| | - Suzanne Fitzpatrick
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, Maryland, USA
| | - Russell S Thomas
- Center for Computational Toxicology and Exposure, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Anton Simeonov
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
| | - Menghang Xia
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland, USA; ,
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Schaefer HR, Flannery BM, Crosby LM, Pouillot R, Farakos SMS, Van Doren JM, Dennis S, Fitzpatrick S, Middleton K. Reassessment of the cadmium toxicological reference value for use in human health assessments of foods. Regul Toxicol Pharmacol 2023; 144:105487. [PMID: 37640100 DOI: 10.1016/j.yrtph.2023.105487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/12/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023]
Abstract
The U.S. Food and Drug Administration (FDA) developed an oral toxicological reference value (TRV) for characterizing potential health concerns from dietary exposure to cadmium (Cd). The development of the TRV leveraged the FDA's previously published research including (1) a systematic review for adverse health effects associated with oral Cd exposure and (2) a human physiological based pharmacokinetic (PBPK) model adapted from Kjellstrom and Nordberg (1978) for use in reverse dosimetry applied to the U.S. population. Adverse effects of Cd on the bone and kidney are associated with similar points of departure (PODs) of approximately 0.50 μg Cd/g creatinine for females aged 50-60 based on available epidemiologic data. We also used the upper bound estimate of the renal cortical concentration (50 μg/g Cd) occurring in the U.S. population at 50 years of age as a POD. Based on the output from our reverse dosimetry PBPK Model, a range of 0.21-0.36 μg/kg bw/day was developed for the TRV. The animal data used for the animal TRV derivation (0.63-1.8 μg/kg bw/day) confirms biological plausibility for both the bone and kidney endpoints.
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Affiliation(s)
- Heather R Schaefer
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA.
| | - Brenna M Flannery
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Lynn M Crosby
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | | | | | - Jane M Van Doren
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Sherri Dennis
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Suzanne Fitzpatrick
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Karlyn Middleton
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
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Ruglass LM, Shevorykin A, Zhao Y, Killeen TK, Bauer AG, Morgan-López AA, Back SE, Fitzpatrick S, López-Castro T, Norman SB, Saavedra LM, Hien DA. Self-report and urine drug screen concordance among women with co-occurring PTSD and substance use disorders participating in a clinical trial: Impact of drug type and participant characteristics. Drug Alcohol Depend 2023; 244:109769. [PMID: 36696843 PMCID: PMC9987239 DOI: 10.1016/j.drugalcdep.2023.109769] [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: 08/15/2022] [Revised: 12/17/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Self-report measures are important in substance use assessment, yet they are susceptible to reporting errors. Urine drug screens (UDS) are often considered a more valid alternative. However, collecting in-person UDS may not always be feasible, contributing to the need to understand factors that influence the validity of self-reported substance use. METHODS In this secondary analysis of data from 295 women with co-occurring PTSD and substance use disorders (SUD) who participated in a clinical trial testing behavioral interventions, we examined concordance and discordance between self-reported drug use and associated UDS results. Generalized linear mixed models were used to examine the impact of treatment type and participant characteristics on the associations between self-reported drug use and UDS results. RESULTS Findings revealed higher disagreement between self-report and UDS for opioids and sedatives (ranging from.77 to.90) and lower disagreement rates for cannabis and cocaine (ranging from.26 to.33). Treatment type was not a significant moderator of the associations between self-report and UDS across all drugs. Among those with a positive opioid UDS, those who reported employment in the past three years were more likely to self-report no opioid use compared to their counterparts without employment in the past three years. CONCLUSIONS Findings add to the literature that supports the validity of self-reported cannabis and cocaine use. The greater discrepancies between self-report and UDS test results of opioids and sedatives suggest adjunctive UDS may be required, although a variety of factors other than inaccurate self-report may be associated with this discrepancy.
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Affiliation(s)
- L M Ruglass
- Department of Psychology, The City College of New York, CUNY, USA; Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, USA.
| | - A Shevorykin
- Department of Health Behavior, Roswell Comprehensive Cancer Center, USA
| | - Y Zhao
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, USA; School of Nursing, Columbia University, USA; Department of Psychiatry, Yale University School of Medicine, USA
| | - T K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | - A G Bauer
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, USA
| | | | - S E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | | | - T López-Castro
- Department of Psychology, The City College of New York, CUNY, USA
| | - S B Norman
- National Center for PTSD, White River Junction, VT, USA; Department of Psychiatry, University of California, San Diego, USA
| | | | - D A Hien
- Center of Alcohol and Substance Use Studies, Rutgers University-New Brunswick, USA
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Singh S, Fitzpatrick S, Lakshminarayanan M, Saran A, Wood J, Yang T, White H. PROTOCOL: An evidence and gap map of studies of implementation issues for interventions for those affected by and at risk of homelessness in high-income countries. Campbell Syst Rev 2023; 19:e1305. [PMID: 36911861 PMCID: PMC9942265 DOI: 10.1002/cl2.1305] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows. The proposed evidence and gap map will present relevant process evaluations and other studies of barriers and facilitators, both qualitative and quantitative, for eligible homelessness interventions to highlight the issues arising in the implementation of these interventions. Specifically, the objectives of the map are to: (i) develop a clear taxonomy of interventions and implementation issues (e.g., barriers and facilitators-factors which works as barriers to hinder successful implementation of policies and programmes and factors which facilitate the intervention and therefore support its implementation) related to homelessness in high-income countries; (ii) map available systematic reviews and primary studies of the implementation issues of interventions for those experiencing homelessness and those at risk of homelessness, with an overview provided in a summary report; (iii) provide a searchable database of included studies accessible to research users via CHI website.
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Affiliation(s)
- Sabina Singh
- Campbell South AsiaGlobal Development NetworkNew DelhiIndia
| | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing and Equalities Research (I‐SPHERE)Heriott‐Watt UniversityEdinburghUK
| | | | - Ashrita Saran
- Campbell South AsiaGlobal Development NetworkNew DelhiIndia
| | - Jenny Wood
- Institute for Social Policy, Housing and Equalities Research (I‐SPHERE)Heriott‐Watt UniversityEdinburghUK
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Fitzgeraldson E, Triandafilidis Z, Franklin Y, Palazzi K, Kay-Lambkin F, Fitzpatrick S. Feasibility and Acceptability of a Novel Online Program for Mental Health Carers. Int J Psychol Res (Medellin) 2023; 16:41-55. [PMID: 37547866 PMCID: PMC10402641 DOI: 10.21500/20112084.5733] [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: 12/15/2021] [Revised: 07/11/2022] [Accepted: 09/21/2022] [Indexed: 08/08/2023] Open
Abstract
Objective To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms. Methods Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups. Results Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control. Conclusions The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program's efficacy in a full-scale RCT.
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Affiliation(s)
- E Fitzgeraldson
- Everymind, Newcastle, Australia. University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
| | - Z Triandafilidis
- School of Medicine and Public, University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
| | - Y Franklin
- Everymind, Newcastle, Australia. Australia
| | - K Palazzi
- Everymind, Newcastle, Australia. Australia
| | - F Kay-Lambkin
- Hunter Medical Research Institute, New Lambton Heights, Australia. Hunter Medical Research InstituteAustralia
| | - S Fitzpatrick
- University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
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Arthur A, Montanez-Wiscovich M, Fitzpatrick S, Cuervo-Pardo L. A CASE OF MUCOUS MEMBRANE PEMPHIGOID PRESENTING TO ALLERGY CLINIC AS AN ADVERSE FOOD REACTION. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.860] [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: 11/11/2022]
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Liu J, Guo W, Dong F, Aungst J, Fitzpatrick S, Patterson TA, Hong H. Machine learning models for rat multigeneration reproductive toxicity prediction. Front Pharmacol 2022; 13:1018226. [PMID: 36238576 PMCID: PMC9552001 DOI: 10.3389/fphar.2022.1018226] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Reproductive toxicity is one of the prominent endpoints in the risk assessment of environmental and industrial chemicals. Due to the complexity of the reproductive system, traditional reproductive toxicity testing in animals, especially guideline multigeneration reproductive toxicity studies, take a long time and are expensive. Therefore, machine learning, as a promising alternative approach, should be considered when evaluating the reproductive toxicity of chemicals. We curated rat multigeneration reproductive toxicity testing data of 275 chemicals from ToxRefDB (Toxicity Reference Database) and developed predictive models using seven machine learning algorithms (decision tree, decision forest, random forest, k-nearest neighbors, support vector machine, linear discriminant analysis, and logistic regression). A consensus model was built based on the seven individual models. An external validation set was curated from the COSMOS database and the literature. The performances of individual and consensus models were evaluated using 500 iterations of 5-fold cross-validations and the external validation data set. The balanced accuracy of the models ranged from 58% to 65% in the 5-fold cross-validations and 45%–61% in the external validations. Prediction confidence analysis was conducted to provide additional information for more appropriate applications of the developed models. The impact of our findings is in increasing confidence in machine learning models. We demonstrate the importance of using consensus models for harnessing the benefits of multiple machine learning models (i.e., using redundant systems to check validity of outcomes). While we continue to build upon the models to better characterize weak toxicants, there is current utility in saving resources by being able to screen out strong reproductive toxicants before investing in vivo testing. The modeling approach (machine learning models) is offered for assessing the rat multigeneration reproductive toxicity of chemicals. Our results suggest that machine learning may be a promising alternative approach to evaluate the potential reproductive toxicity of chemicals.
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Affiliation(s)
- Jie Liu
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Wenjing Guo
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Fan Dong
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Jason Aungst
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Suzanne Fitzpatrick
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Tucker A. Patterson
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
| | - Huixiao Hong
- National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR, United States
- *Correspondence: Huixiao Hong,
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Spira A, Spigel D, Camidge R, de Langen A, Kim T, Goto K, Elamin Y, Shum E, Reckamp K, Rotow J, Goldberg S, Gadgeel S, Leal T, Albayya F, Fitzpatrick S, Louie-Gao M, Parepally J, Zalutskaya A, Yu H. EP08.02-019 Phase 1/2 Study of BLU-701, a Highly Selective EGFR Inhibitor, in Patients With EGFR-Mutant Non-Small Cell Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.701] [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: 10/14/2022]
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Anklam E, Bahl MI, Ball R, Beger RD, Cohen J, Fitzpatrick S, Girard P, Halamoda-Kenzaoui B, Hinton D, Hirose A, Hoeveler A, Honma M, Hugas M, Ishida S, Kass GEN, Kojima H, Krefting I, Liachenko S, Liu Y, Masters S, Marx U, McCarthy T, Mercer T, Patri A, Pelaez C, Pirmohamed M, Platz S, Ribeiro AJS, Rodricks JV, Rusyn I, Salek RM, Schoonjans R, Silva P, Svendsen CN, Sumner S, Sung K, Tagle D, Tong L, Tong W, van den Eijnden-van-Raaij J, Vary N, Wang T, Waterton J, Wang M, Wen H, Wishart D, Yuan Y, Slikker Jr. W. Emerging technologies and their impact on regulatory science. Exp Biol Med (Maywood) 2022; 247:1-75. [PMID: 34783606 PMCID: PMC8749227 DOI: 10.1177/15353702211052280] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There is an evolution and increasing need for the utilization of emerging cellular, molecular and in silico technologies and novel approaches for safety assessment of food, drugs, and personal care products. Convergence of these emerging technologies is also enabling rapid advances and approaches that may impact regulatory decisions and approvals. Although the development of emerging technologies may allow rapid advances in regulatory decision making, there is concern that these new technologies have not been thoroughly evaluated to determine if they are ready for regulatory application, singularly or in combinations. The magnitude of these combined technical advances may outpace the ability to assess fit for purpose and to allow routine application of these new methods for regulatory purposes. There is a need to develop strategies to evaluate the new technologies to determine which ones are ready for regulatory use. The opportunity to apply these potentially faster, more accurate, and cost-effective approaches remains an important goal to facilitate their incorporation into regulatory use. However, without a clear strategy to evaluate emerging technologies rapidly and appropriately, the value of these efforts may go unrecognized or may take longer. It is important for the regulatory science field to keep up with the research in these technically advanced areas and to understand the science behind these new approaches. The regulatory field must understand the critical quality attributes of these novel approaches and learn from each other's experience so that workforces can be trained to prepare for emerging global regulatory challenges. Moreover, it is essential that the regulatory community must work with the technology developers to harness collective capabilities towards developing a strategy for evaluation of these new and novel assessment tools.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Reza M Salek
- International Agency for Research on Cancer, France
| | | | | | | | | | | | | | - Li Tong
- Universities of Georgia Tech and Emory, USA
| | | | | | - Neil Vary
- Canadian Food Inspection Agency, Canada
| | - Tao Wang
- National Medical Products Administration, China
| | | | - May Wang
- Universities of Georgia Tech and Emory, USA
| | - Hairuo Wen
- National Institutes for Food and Drug Control, China
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Flanigan TJ, Ferguson SA, Law CD, Rosas-Hernandez H, Cuevas-Martinez E, Fitzpatrick S, Shen AN. Neurobehavioral and neurochemical effects of perinatal arsenite exposure in Sprague-Dawley rats. Neurotoxicol Teratol 2021; 90:107059. [PMID: 34979254 DOI: 10.1016/j.ntt.2021.107059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022]
Abstract
Exposure to relatively high levels of inorganic arsenic (iAs) is associated with detrimental effects on human health, including cancer and diabetes. The effects of lower-level exposures are less clear, and gaps in the literature exist as to the effects of iAs exposure on neurodevelopment. The current study assessed the effects of perinatal iAs exposure on rodent neurodevelopment and behavior. Pregnant Sprague-Dawley (SD) rats were exposed to arsenite (AsIII) via oral gavage on gestational days (GD) 6 through 21, and pups were directly dosed via gavage on postnatal days (PND) 1 through 21. Dams and offspring received the same doses: 0.00, 0.10, 1.50, or 3.75 mg/kg/day. Male and female offspring underwent a battery of behavioral assessments from weaning until PND 180. Brain arsenic levels increased in a dose-dependent manner at both PND 1 and 21. Results from the behavioral tests show that pre- and postnatal AsIII exposure did not adversely affect offspring weight gain, adolescent motor and cognitive functions, or adult motor and cognitive functions in the SD rat. There were no differences in concentration of several brain proteins associated with blood-brain barrier permeability, dopamine functions, and inflammation.
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Affiliation(s)
- Timothy J Flanigan
- Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, AR 72079, United States of America
| | - Sherry A Ferguson
- Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, AR 72079, United States of America
| | - Charles D Law
- Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, AR 72079, United States of America
| | - Hector Rosas-Hernandez
- Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, AR 72079, United States of America
| | - Elvis Cuevas-Martinez
- Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, AR 72079, United States of America
| | - Suzanne Fitzpatrick
- Office of the Center Director, Center for Food Safety and Applied Nutrition/FDA, , United States of America
| | - Andrew N Shen
- Division of Neurotoxicology, National Center for Toxicological Research/FDA, Jefferson, AR 72079, United States of America.
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Wang H, Brown PC, Chow EC, Ewart L, Ferguson SS, Fitzpatrick S, Freedman BS, Guo GL, Hedrich W, Heyward S, Hickman J, Isoherranen N, Li AP, Liu Q, Mumenthaler SM, Polli J, Proctor WR, Ribeiro A, Wang J, Wange RL, Huang S. 3D cell culture models: Drug pharmacokinetics, safety assessment, and regulatory consideration. Clin Transl Sci 2021; 14:1659-1680. [PMID: 33982436 PMCID: PMC8504835 DOI: 10.1111/cts.13066] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022] Open
Abstract
Nonclinical testing has served as a foundation for evaluating potential risks and effectiveness of investigational new drugs in humans. However, the current two-dimensional (2D) in vitro cell culture systems cannot accurately depict and simulate the rich environment and complex processes observed in vivo, whereas animal studies present significant drawbacks with inherited species-specific differences and low throughput for increased demands. To improve the nonclinical prediction of drug safety and efficacy, researchers continue to develop novel models to evaluate and promote the use of improved cell- and organ-based assays for more accurate representation of human susceptibility to drug response. Among others, the three-dimensional (3D) cell culture models present physiologically relevant cellular microenvironment and offer great promise for assessing drug disposition and pharmacokinetics (PKs) that influence drug safety and efficacy from an early stage of drug development. Currently, there are numerous different types of 3D culture systems, from simple spheroids to more complicated organoids and organs-on-chips, and from single-cell type static 3D models to cell co-culture 3D models equipped with microfluidic flow control as well as hybrid 3D systems that combine 2D culture with biomedical microelectromechanical systems. This article reviews the current application and challenges of 3D culture systems in drug PKs, safety, and efficacy assessment, and provides a focused discussion and regulatory perspectives on the liver-, intestine-, kidney-, and neuron-based 3D cellular models.
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Affiliation(s)
- Hongbing Wang
- Department of Pharmaceutical SciencesUniversity of Maryland School of PharmacyBaltimoreMarylandUSA
| | - Paul C. Brown
- Center for Drug Evaluation and ResearchUS Food and Drug Administration (FDA)Silver SpringMarylandUSA
| | - Edwin C.Y. Chow
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchUS Food and Drug Administration (FDA)Silver SpringMarylandUSA
| | | | - Stephen S. Ferguson
- Division of the National Toxicology ProgramNational Institute of Environmental Health SciencesResearch Triangle ParkNorth CarolinaUSA
| | - Suzanne Fitzpatrick
- Office of the Center DirectorCenter for Food Safety and Applied NutritionUS Food and Drug Administration (FDA)Silver SpringMarylandUSA
| | - Benjamin S. Freedman
- Division of NephrologyDepartment of PathologyKidney Research Institute, and Institute for Stem Cell and Regenerative MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Grace L. Guo
- Department of Pharmacology and ToxicologyErnest Mario School of PharmacyRutgers UniversityPiscatawayNew JerseyUSA
| | - William Hedrich
- Pharmaceutical Candidate Optimization, Metabolism and PharmacokineticsBristol‐Myers Squibb CompanyPrincetonNew JerseyUSA
| | | | - James Hickman
- NanoScience Technology CenterUniversity of Central FloridaOrlandoFloridaUSA
| | - Nina Isoherranen
- Department of PharmaceuticsSchool of PharmacyUniversity of WashingtonSeattleWashingtonUSA
| | - Albert P. Li
- In Vitro ADMET LaboratoriesColumbiaMarylandUSA
- In Vitro ADMET LaboratoriesMaldenMassachusettsUSA
| | - Qi Liu
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchUS Food and Drug Administration (FDA)Silver SpringMarylandUSA
| | - Shannon M. Mumenthaler
- Lawrence J. Ellison Institute for Transformative MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - James Polli
- Department of Pharmaceutical SciencesUniversity of Maryland School of PharmacyBaltimoreMarylandUSA
| | - William R. Proctor
- Predictive Toxicology, Safety AssessmentGenentech, IncSouth San FranciscoCaliforniaUSA
| | - Alexandre Ribeiro
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchUS Food and Drug Administration (FDA)Silver SpringMarylandUSA
| | - Jian‐Ying Wang
- Department of SurgeryCell Biology GroupUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Ronald L. Wange
- Center for Drug Evaluation and ResearchUS Food and Drug Administration (FDA)Silver SpringMarylandUSA
| | - Shiew‐Mei Huang
- Office of Clinical PharmacologyOffice of Translational SciencesCenter for Drug Evaluation and ResearchUS Food and Drug Administration (FDA)Silver SpringMarylandUSA
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Dent MP, Vaillancourt E, Thomas RS, Carmichael PL, Ouedraogo G, Kojima H, Barroso J, Ansell J, Barton-Maclaren TS, Bennekou SH, Boekelheide K, Ezendam J, Field J, Fitzpatrick S, Hatao M, Kreiling R, Lorencini M, Mahony C, Montemayor B, Mazaro-Costa R, Oliveira J, Rogiers V, Smegal D, Taalman R, Tokura Y, Verma R, Willett C, Yang C. Paving the way for application of next generation risk assessment to safety decision-making for cosmetic ingredients. Regul Toxicol Pharmacol 2021; 125:105026. [PMID: 34389358 PMCID: PMC8547713 DOI: 10.1016/j.yrtph.2021.105026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/22/2021] [Accepted: 08/06/2021] [Indexed: 11/30/2022]
Abstract
Next generation risk assessment (NGRA) is an exposure-led, hypothesis-driven approach that has the potential to support animal-free safety decision-making. However, significant effort is needed to develop and test the in vitro and in silico (computational) approaches that underpin NGRA to enable confident application in a regulatory context. A workshop was held in Montreal in 2019 to discuss where effort needs to be focussed and to agree on the steps needed to ensure safety decisions made on cosmetic ingredients are robust and protective. Workshop participants explored whether NGRA for cosmetic ingredients can be protective of human health, and reviewed examples of NGRA for cosmetic ingredients. From the limited examples available, it is clear that NGRA is still in its infancy, and further case studies are needed to determine whether safety decisions are sufficiently protective and not overly conservative. Seven areas were identified to help progress application of NGRA, including further investments in case studies that elaborate on scenarios frequently encountered by industry and regulators, including those where a ‘high risk’ conclusion would be expected. These will provide confidence that the tools and approaches can reliably discern differing levels of risk. Furthermore, frameworks to guide performance and reporting should be developed.
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Affiliation(s)
- M P Dent
- Unilever Safety and Environmental Assurance Centre, Sharnbrook, Bedfordshire, MK44 1LQ, UK.
| | - E Vaillancourt
- Health Canada, Healthy Environments and Consumer Safety Branch, 269 Laurier Ave. W., Ottawa, ON K1A 0K9, Canada.
| | - R S Thomas
- Center for Computational Toxicology and Exposure, U.S. Environmental Protection Agency, Research, Triangle Park, NC, 27711, USA.
| | - P L Carmichael
- Unilever Safety and Environmental Assurance Centre, Sharnbrook, Bedfordshire, MK44 1LQ, UK.
| | - G Ouedraogo
- l'Oréal, Research and Development, Paris, France.
| | - H Kojima
- National Institute of Health Sciences, 1-18-1 Kamiyoga, Setagaya-ku, 158-8501, Tokyo, Japan.
| | - J Barroso
- European Commission, Joint Research Centre (JRC), Ispra, VA, Italy.
| | - J Ansell
- US Personal Care Products Council (PCPC), 1620 L St. NW, Suite 1200, Washington, D.C, 20036, USA.
| | - T S Barton-Maclaren
- Health Canada, Healthy Environments and Consumer Safety Branch, 269 Laurier Ave. W., Ottawa, ON K1A 0K9, Canada.
| | - S H Bennekou
- National Food Institute, Technical University of Denmark (DTU), Copenhagen, Denmark.
| | - K Boekelheide
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA.
| | - J Ezendam
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - J Field
- Health Canada, Healthy Environments and Consumer Safety Branch, 269 Laurier Ave. W., Ottawa, ON K1A 0K9, Canada.
| | - S Fitzpatrick
- US Food and Drug Administration (US FDA), Center for Food Safety and Applied Nutrition (CFSAN), 5001 Campus Drive, College Park, MD, 20740, USA.
| | - M Hatao
- Japan Cosmetic Industry Association (JCIA), Metro City Kamiyacho 6F, 5-1-5, Toranomon, Minato-ku, Tokyo, 105-0001 Japan.
| | - R Kreiling
- Clariant Produkte (Deutschland) GmbH, Am Unisyspark 1, 65843, Sulzbach, Germany.
| | - M Lorencini
- Grupo Boticário, Research & Development, São José dos Pinhais, Brazil.
| | - C Mahony
- Procter & Gamble Technical Centres Ltd, Reading, RG2 0RX, UK.
| | - B Montemayor
- Cosmetics Alliance Canada, 420 Britannia Road East Suite 102, Mississauga, ON L4Z 3L5, Canada.
| | - R Mazaro-Costa
- Departament of Pharmacology, Universidade Federal de Goiás, Goiânia, GO, 74.690-900, Brazil.
| | - J Oliveira
- Brazilian Health Regulatory Agency (ANVISA), Gerência de Produtos de Higiene, Perfumes, Cosméticos e Saneantes, Setor de Indústria e Abastecimento (SIA), Trecho 5, Área Especial 57, CEP 71205-050, Brasília, DF, Brazil.
| | - V Rogiers
- Vrije Universiteit Brussel, Brussels, Belgium.
| | - D Smegal
- US Food and Drug Administration (US FDA), Center for Food Safety and Applied Nutrition (CFSAN), 5001 Campus Drive, College Park, MD, 20740, USA.
| | - R Taalman
- Cosmetics Europe, Avenue Herrmann-Debroux 40, 1160 Auderghem, Belgium.
| | - Y Tokura
- Allergic Disease Research Center, Chutoen General Medical Center, Kakegawa, Japan.
| | - R Verma
- US Food and Drug Administration (US FDA), Center for Food Safety and Applied Nutrition (CFSAN), 5001 Campus Drive, College Park, MD, 20740, USA.
| | - C Willett
- Humane Society International, Washington, DC, USA.
| | - C Yang
- Taiwan Cosmetic Industry Association (TWCIA), 8F No. 136, Bo'ai Rd., Zhongzheng Dist., Taipei City, 100, Taiwan, ROC.
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Keenan C, Miller S, Hanratty J, Pigott T, Hamilton J, Coughlan C, Mackie P, Fitzpatrick S, Cowman J. Accommodation-based interventions for individuals experiencing, or at risk of experiencing, homelessness. Campbell Syst Rev 2021; 17:e1165. [PMID: 37131929 PMCID: PMC8356295 DOI: 10.1002/cl2.1165] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Globally, almost 1.6 billion individuals lack adequate housing. Many accommodation-based approaches have evolved across the globe to incorporate additional support and services beyond delivery of housing. Objectives This review examines the effectiveness of accommodation-based approaches on outcomes including housing stability, health, employment, crime, wellbeing, and cost for individuals experiencing or at risk of experiencing homelessness. Search Methods The systematic review is based on evidence already identified in two existing EGMs commissioned by the Centre for Homelessness Impact (CHI) and built by White et al. The maps were constructed using a comprehensive three stage search and mapping process. Stage one mapped included studies in an existing systematic review on homelessness, stage two was an extensive search of 17 academic databases, three EGM databases, and eight systematic review databases. Finally stage three included web searches for grey literature, scanning reference lists of included studies and consultation with experts to identify additional literature. We identified 223 unique studies across 551 articles from the effectiveness map on 12th April 2019. Selection Criteria We include research on all individuals currently experiencing, or at risk of experiencing homelessness irrespective of age or gender, in high-income countries. The Network Meta-Analysis (NMA) contains all study designs where a comparison group was used. This includes randomised controlled trials (RCTs), quasi-experimental designs, matched comparisons and other study designs that attempt to isolate the impact of the intervention on homelessness. The NMA primarily addresses how interventions can reduce homelessness and increase housing stability for those individuals experiencing, or at risk of experiencing, homelessness. Additional outcomes are examined and narratively described. These include: access to mainstream healthcare; crime and justice; employment and income; capabilities and wellbeing; and cost of intervention. These outcomes reflect the domains used in the EGM, with the addition of cost. Data Collection and Analysis Due to the diverse nature of the literature on accommodation-based approaches, the way in which the approaches are implemented in practice, and the disordered descriptions of the categories, the review team created a novel typology to allow meaningful categorisations for functional and useful comparison between the various intervention types. Once these eligible categories were identified, we undertook dual data extraction, where two authors completed data extraction and risk of bias (ROB) assessments independently for each study. NMA was conducted across outcomes related to housing stability and health.Qualitative data from process evaluations is included using a "Best Fit" Framework synthesis. The purpose of this synthesis is to complement the quantitative evidence and provide a better understanding of what factors influenced programme effectiveness. All included Qualitative data followed the initial framework provided by the five main analytical categories of factors of influence (reflected in the EGM), namely: contextual factors, policy makers/funders, programme administrators/managers/implementing agencies, staff/case workers and recipients of the programme. Main Results There was a total of 13,128 people included in the review, across 51 reports of 28 studies. Most of the included studies were carried out in the United States of America (25/28), with other locations including Canada and the UK. Sixteen studies were RCTs (57%) and 12 were nonrandomised (quasi-experimental) designs (43%). Assessment of methodological quality and potential for bias was conducted using the second version of the Cochrane Risk of Bias tool for Randomised controlled trials. Nonrandomised studies were coded using the ROBINS- I tool. Out of the 28 studies, three had sufficiently low ROB (11%), 11 (39%) had moderate ROB, and five (18%) presented serious problems with ROB, and nine (32%) demonstrated high, critical problems with their methodology. A NMA on housing stability outcomes demonstrates that interventions offering the highest levels of support alongside unconditional accommodation (High/Unconditional) were more effective in improving housing stability compared to basic support alongside unconditional housing (Basic/Unconditional) (ES=1.10, 95% confidence interval [CI] [0.39, 1.82]), and in comparison to a no-intervention control group (ES=0.62, 95% CI [0.19, 1.06]). A second NMA on health outcomes demonstrates that interventions categorised as offering Moderate/Conditional (ES= 0.36, 95% CI [0.03, 0.69]) and High/Unconditional (ES = 0.22, 95% CI [0.01, 0.43]) support were effective in improving health outcomes compared to no intervention. These effects were smaller than those observed for housing stability. The quality of the evidence was relatively low but varied across the 28 included studies. Depending on the context, finding accommodation for those who need it can be hindered by supply and affordability in the market. The social welfare approach in each jurisdiction can impact heavily on support available and can influence some of the prejudice and stigma surrounding homelessness. The evaluations emphasised the need for collaboration and a shared commitment between policymakers, funders and practitioners which creates community and buy in across sectors and agencies. However, co-ordinating this is difficult and requires sustainability to work. For those implementing programmes, it was important to invest time in developing a culture together to build trust and solid relationships. Additionally, identifying sufficient resources and appropriate referral routes allows for better implementation planning. Involving staff and case workers in creating processes helps drive enthusiasm and energy for the service. Time should be allocated for staff to develop key skills and communicate engage effectively with service users. Finally, staff need time to develop trust and relationships with service users; this goes hand in hand with providing information that is up to date and useful as well making themselves accessible in terms of location and time. Authors' Conclusions The network meta-analysis suggests that all types of accommodation which provided support are more effective than no intervention or Basic/Unconditional accommodation in terms of housing stability and health. The qualitative evidence synthesis raised a primary issue in relation to context: which was the lack of stable, affordable accommodation and the variability in the rental market, such that actually sourcing accommodation to provide for individuals who are homeless is extremely challenging. Collaboration between stakeholders and practitioners can be fruitful but difficult to coordinate across different agencies and organisations.
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Affiliation(s)
- Ciara Keenan
- Campbell UK & Ireland, Centre for Evidence and Social InnovationQueen's UniversityBelfastUK
| | - Sarah Miller
- Campbell UK & Ireland, Centre for Evidence and Social InnovationQueen's UniversityBelfastUK
| | - Jennifer Hanratty
- Campbell UK & Ireland, Centre for Evidence and Social InnovationQueen's UniversityBelfastUK
| | - Terri Pigott
- School of Public HealthGeorgia State UniversityAtlantaGeorgiaUSA
| | - Jayne Hamilton
- Campbell UK & Ireland, Centre for Evidence and Social InnovationQueen's UniversityBelfastUK
| | - Christopher Coughlan
- Campbell UK & Ireland, Centre for Evidence and Social InnovationQueen's UniversityBelfastUK
| | | | | | - John Cowman
- Department of Social WorkHealth Service ExecutiveDublinIreland
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Bawazir M, Islam MN, Cohen DM, Fitzpatrick S, Bhattacharyya I. Gingival Fibroma: An Emerging Distinct Gingival Lesion with Well-Defined Histopathology. Head Neck Pathol 2021; 15:917-922. [PMID: 33686583 PMCID: PMC8384971 DOI: 10.1007/s12105-021-01315-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
Gingival growths, barring a few are mostly reactive and seldom exhibit significant true neoplastic potential. The common etiology is local irritation from dental plaque/calculus, trauma as well as medication-related overgrowth. Such lesions are easily distinguishable and categorized into diagnoses such as pyogenic granuloma, peripheral ossifying fibroma, etc. We present a previously undescribed, but commonly encountered, reactive gingival growth with unique histologic features and suggest the diagnostic term "gingival fibroma." An IRB approved retrospective review of the University of Florida Oral Pathology Biopsy Service encompassing years 2010-2019, was performed to select cases. Demographics, clinical data, and microscopic diagnoses were recorded and analyzed. Four board-certified oral and maxillofacial pathologists agreed upon and established the diagnostic criteria. These are: a prominent fibromyxoid stroma, variable cellularity, a whorled or storiform pattern of arrangement of the cellular elements, lack of significant inflammation or vascularity, and complete absence of calcification, and/or odontogenic islands. A total of 60 cases met all criteria and were included in the study. Age range in years was 14-87 with the mean at 45.11 years. A striking female predilection (90%) was noted. Approximately 62% of cases were reported on the maxillary gingiva, followed by 38.3% in the mandibular gingiva. Majority, 66.7% were in the anterior incisor region followed by 11.7% in the canine/first premolar areas. All lesions were submitted as excisional biopsy, and 4 cases recurred within 2-3 years of excision. In all cases, lesional tissue appeared to extend to the surgical base of the specimen. We present 60 cases of a histologically unique entity occurring exclusively on the gingiva and introduce the diagnostic term "Gingival Fibroma" for these lesions. Further studies with adequate clinical follow-up may help understand the exact clinical behavior of these lesions.
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Affiliation(s)
- M. Bawazir
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA ,Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, Gainesville, USA
| | - M. N. Islam
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA
| | - D. M. Cohen
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA
| | - S. Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA
| | - I. Bhattacharyya
- Department of Oral and Maxillofacial Diagnostic Services, University of Florida College of Dentistry, 1395 Center Dr, Gainesville, FL 32610-0414 USA
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Miller S, Keenan C, Hanratty J, Hamilton J, Coughlan C, Mackie P, Fitzpatrick S, Maddock A. PROTOCOL: Improving access to health and social services for individuals experiencing, or at risk of experiencing, homelessness. Campbell Syst Rev 2020; 16:e1118. [PMID: 37016614 PMCID: PMC8356276 DOI: 10.1002/cl2.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Sarah Miller
- Centre for Evidence and Social Innovation, Campbell UK & IrelandQueen's University BelfastBelfastUK
| | - Ciara Keenan
- School of Geography and PlanningCardiff UniversityCardiffUK
| | - Jennifer Hanratty
- Institute for Social Policy, Housing, Environment and Real Estate (I‐SPHERE)Heriot‐Watt UniversityEdinburghUK
| | - Jayne Hamilton
- Centre for Evidence and Social Innovation, Campbell UK & IrelandQueen's University BelfastBelfastUK
| | - Christopher Coughlan
- Centre for Evidence and Social Innovation, Campbell UK & IrelandQueen's University BelfastBelfastUK
| | - Peter Mackie
- School of Geography and PlanningCardiff UniversityCardiffUK
| | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing, Environment and Real Estate (I‐SPHERE)Heriot‐Watt UniversityEdinburghUK
| | - Alan Maddock
- School of Social Sciences, Education and Social WorkQueen's University BelfastBelfastUK
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16
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Lewer D, King E, Bramley G, Fitzpatrick S, Treanor MC, Maguire N, Bullock M, Hayward A, Story A. The ACE Index: mapping childhood adversity in England. J Public Health (Oxf) 2020; 42:e487-e495. [PMID: 31883007 PMCID: PMC7685852 DOI: 10.1093/pubmed/fdz158] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Studies of adults show that adverse childhood experiences (ACEs) are associated with health and social problems and are more common among people living in deprived areas. However, there is limited information about the geographical pattern of contemporary ACEs. Methods We used data from the police, social services, schools and vital statistics in England to calculate population rates of events that represent childhood adversity. We constructed an ‘ACE Index’ that summarizes the relative frequency of ACEs at local authority level, informed by the methods of the Index of Multiple Deprivation. We explored associations between the ACE Index and local characteristics in cross-sectional ecological analysis. Results The ACE Index was strongly associated with the proportion of children that live in income-deprived households (child poverty). In addition, the ACE Index was independently associated with higher population density and was higher in certain regions, particularly the north-east. Conclusions The association between ACEs and child poverty provides evidence of a process in which deprivation increases the risk of adverse experiences in childhood. The ACE Index can inform allocation of resources for prevention and mitigation of ACEs.
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Affiliation(s)
- Dan Lewer
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Emma King
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Glen Bramley
- Institute for Social Policy, Housing, Equalities Research; Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing, Equalities Research; Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - Morag C Treanor
- Institute for Social Policy, Housing, Equalities Research; Heriot-Watt University, Edinburgh, EH14 4AS, UK
| | - Nick Maguire
- Psychology, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Miriam Bullock
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Al Story
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology and Health Care UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.,Find&Treat, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK
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Lewer D, King E, Bramley G, Fitzpatrick S, Treanor M, Maguire N, Bullock M, Hayward A, Story A. Erratum: The ACE Index: mapping childhood adversity in the UK. J Public Health (Oxf) 2020; 42:873. [PMID: 32086508 PMCID: PMC7685782 DOI: 10.1093/pubmed/fdaa026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Keenan C, Miller S, Hanratty J, Pigott TD, Mackie P, Cowman J, Coughlan C, Hamilton J, Fitzpatrick S. PROTOCOL: Accommodation-based interventions for individuals experiencing, or at risk of experiencing, homelessness. Campbell Syst Rev 2020; 16:e1103. [PMID: 37133280 PMCID: PMC8356315 DOI: 10.1002/cl2.1103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Ciara Keenan
- Campbell UK and Ireland, Centre for Evidence and Social InnovationQueen's University BelfastBelfastUK
| | - Sarah Miller
- Campbell UK and Ireland, Centre for Evidence and Social InnovationQueen's University BelfastBelfastUK
| | - Jennifer Hanratty
- Campbell UK and Ireland, Centre for Evidence and Social InnovationQueen's University BelfastBelfastUK
| | - Therese D. Pigott
- College of Education and Human DevelopmentGeorgia State UniversityUSA
| | - Peter Mackie
- School of Geography and PlanningCardiff UniversityUK
| | - John Cowman
- Department of Social WorkHealth Service ExecutiveDublinIreland
| | - Christopher Coughlan
- Campbell UK and Ireland, Centre for Evidence and Social InnovationQueen's University BelfastBelfastUK
| | - Jayne Hamilton
- Campbell UK and Ireland, Centre for Evidence and Social InnovationQueen's University BelfastBelfastUK
| | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing, Environment and Real Estate (I‐SPHERE)Heriott Watt UniversityUK
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19
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Calvo F, Fitzpatrick S, Fàbregas C, Carbonell X, Turró-Garriga O. Individuals experiencing chronic homelessness: A 10-year follow-up of a cohort in Spain. Health Soc Care Community 2020; 28:1787-1794. [PMID: 32378262 DOI: 10.1111/hsc.13005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
With the start of the great economic recession in 2007, homelessness increased fivefold in some regions of southern Europe. Larger numbers of people experiencing homelessness, compounded by a lowered capacity for social and health services to respond to their needs, precipitated an increase in so-called 'chronic homelessness'. The aim of this study was to establish the presence of chronic homelessness in a defined geographical area of Spain, and to determine the prevalence of diagnosed mental disorders within both the chronic and non-chronic homeless population. A prospective and descriptive study was designed to monitor a cohort of 826 individuals experiencing homelessness who constituted the entire identified homeless population in the relevant territory in 2006. This sample was followed until 2016 and sociodemographic as well as clinical information was collected, including the time spent homeless. The results obtained indicated that one in 10 participants met the criteria for chronic homelessness, a rate that is lower than in the US, where the definition of chronicity that was applied originates from. Alcohol use disorder was the most common mental health disorder that contributed to the chronicity associated with homelessness. Being born in the country (Spain) where the study was conducted and being older were the main other variables associated with chronicity. People defined as chronically homeless in Spain were on average younger than in the US, but women were present in the chronic subgroup at a similar rate. We also reflect on the limitations of the study and in particular the appropriateness of the concept of chronicity as applied to homelessness.
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Affiliation(s)
- Fran Calvo
- Departament de Pedagogia, Institut de Recerca sobre Qualitat de Vida, Universitat de Girona, Girona, Spain
- Grupo de Investigación en Salud Mental y Adicciones, Instituto de Investigación Biomédica de Girona [IdIBGi], Institut d'Assistència Sanitària (IAS), Girona, Spain
| | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing, Equalities Research [I-SPHERE], Heriot-Watt university, Edinburgh, Scotland
| | - Carles Fàbregas
- Centre d'Acolliment i Serveis Socials "la Sopa", Girona, Spain
| | | | - Oriol Turró-Garriga
- Grupo de Investigación en Envejecimiento, Discapacidad y Salud, Instituto de Investigación Biomédica de Girona [IdIBGi], Girona, Spain
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20
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Rovida C, Barton-Maclaren T, Benfenati E, Caloni F, Chandrasekera PC, Chesné C, Cronin MTD, De Knecht J, Dietrich DR, Escher SE, Fitzpatrick S, Flannery B, Herzler M, Hougaard Bennekou S, Hubesch B, Kamp H, Kisitu J, Kleinstreuer N, Kovarich S, Leist M, Maertens A, Nugent K, Pallocca G, Pastor M, Patlewicz G, Pavan M, Presgrave O, Smirnova L, Schwarz M, Yamada T, Hartung T. Internationalization of read-across as a validated new approach method (NAM) for regulatory toxicology. ALTEX 2020; 37:579-606. [PMID: 32369604 PMCID: PMC9201788 DOI: 10.14573/altex.1912181] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/28/2020] [Indexed: 11/23/2022]
Abstract
Read-across (RAx) translates available information from well-characterized chemicals to a substance for which there is a toxicological data gap. The OECD is working on case studies to probe general applicability of RAx, and several regulations (e.g., EU-REACH) already allow this procedure to be used to waive new in vivo tests. The decision to prepare a review on the state of the art of RAx as a tool for risk assessment for regulatory purposes was taken during a workshop with international experts in Ranco, Italy in July 2018. Three major issues were identified that need optimization to allow a higher regulatory acceptance rate of the RAx procedure: (i) the definition of similarity of source and target, (ii) the translation of biological/toxicological activity of source to target in the RAx procedure, and (iii) how to deal with issues of ADME that may differ between source and target. The use of new approach methodologies (NAM) was discussed as one of the most important innovations to improve the acceptability of RAx. At present, NAM data may be used to confirm chemical and toxicological similarity. In the future, the use of NAM may be broadened to fully characterize the hazard and toxicokinetic properties of RAx compounds. Concerning available guidance, documents on Good Read-Across Practice (GRAP) and on best practices to perform and evaluate the RAx process were identified. Here, in particular, the RAx guidance, being worked out by the European Commission’s H2020 project EU-ToxRisk together with many external partners with regulatory experience, is given.
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Affiliation(s)
- Costanza Rovida
- Center for Alternatives to Animal Testing, CAAT-Europe, University of Konstanz, Konstanz, Germany
| | | | - Emilio Benfenati
- Laboratory of Environmental Chemistry and Toxicology, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Francesca Caloni
- Università degli Studi di Milano, Department of Veterinary Medicine (DIMEVET) Milan, Italy
| | | | | | - Mark T D Cronin
- Liverpool John Moores University, School of Pharmacy and Biomolecular Sciences, Liverpool, UK
| | - Joop De Knecht
- Centre for Safety of Substances and Products, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Daniel R Dietrich
- Human and Environmental Toxicology, University of Konstanz, Konstanz, Germany
| | - Sylvia E Escher
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Suzanne Fitzpatrick
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, MD, USA
| | - Brenna Flannery
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, MD, USA
| | - Matthias Herzler
- German Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Susanne Hougaard Bennekou
- Danish Environmental Protection Agency, Copenhagen, Denmark / Danish Technical University, FOOD, Lyngby, Denmark
| | - Bruno Hubesch
- European Chemical Industry Council (Cefic), Brussels, Belgium
| | - Hennicke Kamp
- Experimental Toxicology and Ecology, BASF SE, Ludwigshafen, Germany
| | - Jaffar Kisitu
- In vitro Toxicology and Biomedicine, Dept inaugurated by the Doerenkamp-Zbinden Foundation, University of Konstanz, Konstanz, Germany
| | - Nicole Kleinstreuer
- NTP Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM), National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States
| | | | - Marcel Leist
- Center for Alternatives to Animal Testing, CAAT-Europe, University of Konstanz, Konstanz, Germany.,In vitro Toxicology and Biomedicine, Dept inaugurated by the Doerenkamp-Zbinden Foundation, University of Konstanz, Konstanz, Germany
| | - Alexandra Maertens
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins University, Baltimore, MD, USA
| | - Kerry Nugent
- Australian Government Department of Health, Canberra, Australia
| | - Giorgia Pallocca
- Center for Alternatives to Animal Testing, CAAT-Europe, University of Konstanz, Konstanz, Germany
| | - Manuel Pastor
- Research Programme on Biomedical Informatics (GRIB), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dept. of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Grace Patlewicz
- Center for Computational Toxicology & Exposure (CCTE), U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | | | - Octavio Presgrave
- Departamento de Farmacologia e Toxicologia, Instituto Nacional de Controle da Qualidade em Saúde, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Lena Smirnova
- Center for Alternatives to Animal Testing (CAAT), Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Thomas Hartung
- Center for Alternatives to Animal Testing, CAAT-Europe, University of Konstanz, Konstanz, Germany.,Center for Alternatives to Animal Testing (CAAT), Johns Hopkins University, Baltimore, MD, USA
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Parish ST, Aschner M, Casey W, Corvaro M, Embry MR, Fitzpatrick S, Kidd D, Kleinstreuer NC, Lima BS, Settivari RS, Wolf DC, Yamazaki D, Boobis A. An evaluation framework for new approach methodologies (NAMs) for human health safety assessment. Regul Toxicol Pharmacol 2020; 112:104592. [DOI: 10.1016/j.yrtph.2020.104592] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/15/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
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White H, Saran A, Fowler B, Portes A, Fitzpatrick S, Teixeira L. PROTOCOL: Studies of the effectiveness of interventions to improve the welfare of those affected by, and at risk of, homelessness in high-income countries: An evidence and gap map. Campbell Syst Rev 2020; 16:e1069. [PMID: 37131983 PMCID: PMC8356271 DOI: 10.1002/cl2.1069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Homelessness - people living on the street, in temporary accommodation, or at risk of losing their homes - is a persistent problem across the developed world. Policies and programmes to tackle homelessness should be informed by evidence of effectiveness. This is the protocol for an evidence and gap map for studies of the effectiveness of interventions to improve the welfare of those experiencing homelessness or at risk of homelessness. We proposed a comprehensive search for studies, with systematic screening, coding and reporting. The available studies will be presented in an online interactive map together with a supporting report.
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Affiliation(s)
- Howard White
- Campbell CollaborationGlobal Development NetworkNew DelhiIndia
| | - Ashrita Saran
- Campbell CollaborationGlobal Development NetworkNew DelhiIndia
| | - Ben Fowler
- Centre for Homelessness ImpactCRISISLondonUK
| | - Audrey Portes
- Campbell CollaborationFolkehelseinstituttetOsloNorway
| | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing, Environment and Real EstateHerriot Watt UniversityEdinburghUK
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Karmaus AL, Bialk H, Fitzpatrick S, Krishan M. State of the science on alternatives to animal testing and integration of testing strategies for food safety assessments: Workshop proceedings. Regul Toxicol Pharmacol 2020; 110:104515. [DOI: 10.1016/j.yrtph.2019.104515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/24/2019] [Accepted: 11/03/2019] [Indexed: 12/31/2022]
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Flannery BM, Dolan LC, Hoffman-Pennesi D, Gavelek A, Jones OE, Kanwal R, Wolpert B, Gensheimer K, Dennis S, Fitzpatrick S. U.S. Food and Drug Administration's interim reference levels for dietary lead exposure in children and women of childbearing age. Regul Toxicol Pharmacol 2020; 110:104516. [DOI: 10.1016/j.yrtph.2019.104516] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 12/16/2022]
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Schaefer HR, Dennis S, Fitzpatrick S. Cadmium: Mitigation strategies to reduce dietary exposure. J Food Sci 2020; 85:260-267. [PMID: 31957884 PMCID: PMC7027482 DOI: 10.1111/1750-3841.14997] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 06/26/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 12/20/2022]
Abstract
Abstract Cadmium has long been recognized as an environmental contaminant that poses risks to human health. Cadmium is of concern since nearly everyone in the general population is exposed to the metal through the food supply and the ability of the element to accumulate in the body over a lifetime. In support of the United States Food and Drug Administration's (FDA) Toxic Element Working Group's efforts to reduce the risks associated with elements in food, this review sought to identify current or new mitigation efforts that have the potential to reduce exposures of cadmium throughout the food supply chain. Cadmium contamination of foods can occur at various stages, including agronomic production, processing, and consumer preparation for consumption. The presence of cadmium in food is variable and dependent on the geographical location, the bioavailability of cadmium from the soil, crop genetics, agronomic practices used, and postharvest operations. Although there are multiple points in the food supply system for foods to be contaminated and mitigations to be applied, a key step to reducing cadmium in the diet is to reduce or prevent initial uptake by plants consumed as food or feed crops. Due to complex interactions of soil chemistry, plant genetics, and agronomic practices, additional research is needed. Support for field‐based experimentation and testing is needed to inform risk modeling and to develop practical farm‐specific management strategies. This study can also assist the FDA in determining where to focus resources so that research and regulatory efforts can have the greatest impact on reducing cadmium exposures from the food supply. Practical Application The presence of cadmium in food is highly variable and highly dependent on the geographical location, the bioavailability of cadmium from the soil, crop genetics, and agronomic practices used. This study can assist the FDA in determining where to focus resources so that research and regulatory efforts can have the greatest impact on reducing cadmium exposures from the food supply.
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Affiliation(s)
- Heather R Schaefer
- Center for Food Safety and Applied Nutrition (CFSAN), US Food and Drug Administration (FDA), 5001 Campus Drive, College Park, MD, 20740, U.S.A
| | - Sherri Dennis
- Center for Food Safety and Applied Nutrition (CFSAN), US Food and Drug Administration (FDA), 5001 Campus Drive, College Park, MD, 20740, U.S.A
| | - Suzanne Fitzpatrick
- Center for Food Safety and Applied Nutrition (CFSAN), US Food and Drug Administration (FDA), 5001 Campus Drive, College Park, MD, 20740, U.S.A
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Dolan LC, Flannery BM, Hoffman-Pennesi D, Gavelek A, Jones OE, Kanwal R, Wolpert B, Gensheimer K, Dennis S, Fitzpatrick S. A review of the evidence to support interim reference level for dietary lead exposure in adults. Regul Toxicol Pharmacol 2020; 111:104579. [PMID: 31945454 DOI: 10.1016/j.yrtph.2020.104579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/13/2022]
Abstract
FDA developed the interim reference level (IRL) for lead of 3 μg/day in children and 12.5 μg/day in women of childbearing age (WOCBA) to better protect the fetus from lead toxicity. These IRLs correspond to a blood lead level (BLL) of 0.5 μg/dL in both populations. The current investigation was performed to determine if the IRL for WOCBA should apply to the general population of adults. A literature review of epidemiological studies was conducted to determine whether a BLL of 0.5 μg/dL is associated with adverse effects in adults. Some studies reported adverse effects over a wide range of BLLs that included 0.5 μg/dL adding uncertainty to conclusions about effects at 0.5 μg/dL; however, no studies clearly identified this BLL as an adverse effect level. Results also showed that the previously developed PTTDI for adults of 75 μg/day lead may not be health protective, supporting use of a lower reference value for lead toxicity in this population group. Use of the 12.5 μg/day IRL as a benchmark for dietary lead intake is one way FDA will ensure that dietary lead intake in adults is reduced.
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Affiliation(s)
- Laurie C Dolan
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Brenna M Flannery
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA.
| | - Dana Hoffman-Pennesi
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Alexandra Gavelek
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Olivia E Jones
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Richard Kanwal
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Beverly Wolpert
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Kathleen Gensheimer
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Sherri Dennis
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Suzanne Fitzpatrick
- US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
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Gavelek A, Spungen J, Hoffman-Pennesi D, Flannery B, Dolan L, Dennis S, Fitzpatrick S. Lead exposures in older children (males and females 7-17 years), women of childbearing age (females 16-49 years) and adults (males and females 18+ years): FDA total diet study 2014-16. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2019; 37:104-109. [PMID: 31647750 DOI: 10.1080/19440049.2019.1681595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Dietary exposures to lead were estimated for older children, females of childbearing age and adults based on lead concentration data from the FDA's Total Diet Study and on food consumption data from What We Eat In America (WWEIA), the food survey portion of the National Health and Nutrition Examination Survey (NHANES). Estimated mean exposures varied based on the population and on the three different substitution scenarios for lead values below the limit of detection (non-detects = 0; non-detects = limit of detection; hybrid approach). Estimated mean lead exposures range from 1.4 to 4.0 µg/day for older children (males and females 7-17 years), 1.6 to 4.6 µg/day for women of childbearing age (females 16-49 years) and 1.7 to 5.3 µg/day for adults (males and females 18 years and older). Estimated 90th percentile lead exposures range from 2.3 to 5.8 µg/day for older children, 2.8 to 6.7 µg/day for women of childbearing age and 3.2 to 7.8 µg/day for adults. Exposure estimates suggest some older children may be exposed to dietary lead above the FDA interim reference level for lead in children of 3 µg/day. The results of this study can be used by the FDA to prioritise research and regulatory efforts in the area of dietary lead exposure.
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Affiliation(s)
- Alexandra Gavelek
- US Food and Drug Administration (FDA), Center for Food Safety and Applied, Nutrition (CFSAN), College Park, MD, USA
| | - Judith Spungen
- US Food and Drug Administration (FDA), Center for Food Safety and Applied, Nutrition (CFSAN), College Park, MD, USA
| | - Dana Hoffman-Pennesi
- US Food and Drug Administration (FDA), Center for Food Safety and Applied, Nutrition (CFSAN), College Park, MD, USA
| | - Brenna Flannery
- US Food and Drug Administration (FDA), Center for Food Safety and Applied, Nutrition (CFSAN), College Park, MD, USA
| | - Laurie Dolan
- US Food and Drug Administration (FDA), Center for Food Safety and Applied, Nutrition (CFSAN), College Park, MD, USA
| | - Sherri Dennis
- US Food and Drug Administration (FDA), Center for Food Safety and Applied, Nutrition (CFSAN), College Park, MD, USA
| | - Suzanne Fitzpatrick
- US Food and Drug Administration (FDA), Center for Food Safety and Applied, Nutrition (CFSAN), College Park, MD, USA
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Abstract
The management of head trauma in children from suspected abuse is multidisciplinary. The primary role of neurosurgeons is to manage the acute clinical situation. They also have a secondary role in assisting others to determine the cause of the injury and prevent recurrences. This article aims to guide the trainee neurosurgeon on management of this patient group according to current literature.
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Affiliation(s)
- S Fitzpatrick
- a College of Medicine, University of Cardiff , Wales , UK
| | - P Leach
- b Department of Paediatric Neurosurgery , University Hospital of Wales , Cardiff , UK
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Fitzpatrick S, Sprando R. Advancing Regulatory Science Through Innovation: In Vitro Microphysiological Systems. Cell Mol Gastroenterol Hepatol 2018; 7:239-240. [PMID: 30585159 PMCID: PMC6305840 DOI: 10.1016/j.jcmgh.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/09/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Suzanne Fitzpatrick
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration, College Park, Maryland.
| | - Robert Sprando
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration, College Park, Maryland
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Luchenski SA, Fitzpatrick S, Hewett N, Aldridge RW, Hayward AC. Can deinstitutionalisation contribute to exclusion? - Authors' reply. Lancet 2018; 391:2210-2211. [PMID: 29893220 DOI: 10.1016/s0140-6736(18)30755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/19/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Serena April Luchenski
- The Farr Institute of Health Informatics Research, University College London, London NW1 2DA, UK.
| | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing and Equalities Research, Heriot-Watt University, Edinburgh, UK
| | | | - Robert W Aldridge
- The Farr Institute of Health Informatics Research, University College London, London NW1 2DA, UK; Centre for Public Health Data Science, Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Andrew C Hayward
- The Farr Institute of Health Informatics Research, University College London, London NW1 2DA, UK; Centre for Public Health Data Science, Institute of Health Informatics, University College London, London NW1 2DA, UK; Institute of Epidemiology and Health Care, University College London, London NW1 2DA, UK
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Fitzpatrick S, Kerr D, Fitzpatrick B. P424Exploring the relationship between pacemaker dependency, cardiac symptoms and perceived quality of life in patients with implanted dual chamber pacemakers. Europace 2018. [DOI: 10.1093/europace/euy015.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Fitzpatrick
- Altnagelvin Area Hospital, Cardiac Investigations Unit, Londonderry, United Kingdom
| | - D Kerr
- Ulster University, Institute of Nursing and Health Research, Jordanstown, United Kingdom
| | - B Fitzpatrick
- Ulster University, Sport and Exercise Sciences Research Institute, Derry, United Kingdom
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Luchenski S, Maguire N, Aldridge RW, Hayward A, Story A, Perri P, Withers J, Clint S, Fitzpatrick S, Hewett N. What works in inclusion health: overview of effective interventions for marginalised and excluded populations. Lancet 2018; 391:266-280. [PMID: 29137868 DOI: 10.1016/s0140-6736(17)31959-1] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 12/28/2022]
Abstract
Inclusion health is a service, research, and policy agenda that aims to prevent and redress health and social inequities among the most vulnerable and excluded populations. We did an evidence synthesis of health and social interventions for inclusion health target populations, including people with experiences of homelessness, drug use, imprisonment, and sex work. These populations often have multiple overlapping risk factors and extreme levels of morbidity and mortality. We identified numerous interventions to improve physical and mental health, and substance use; however, evidence is scarce for structural interventions, including housing, employment, and legal support that can prevent exclusion and promote recovery. Dedicated resources and better collaboration with the affected populations are needed to realise the benefits of existing interventions. Research must inform the benefits of early intervention and implementation of policies to address the upstream causes of exclusion, such as adverse childhood experiences and poverty.
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Affiliation(s)
- Serena Luchenski
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK.
| | - Nick Maguire
- Department of Psychology, University of Southampton, Southampton, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Andrew Hayward
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alistair Story
- Find and Treat Service, University College London Hospitals, London, UK
| | - Patrick Perri
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, PA, USA; Street Medicine Institute, Ingomar, PA, USA
| | | | | | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing and Equalities Research, Heriot-Watt University, Edinburgh, UK
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Woods T, Fitzpatrick S, Cohen D, Islam M, Bhattacharyya I. Clear cell changes in salivary gland neoplasms: A 20-year retrospective study. Med Oral Patol Oral Cir Bucal 2017; 22:e276-e281. [PMID: 28390124 PMCID: PMC5432075 DOI: 10.4317/medoral.21570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/01/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Clear cells are observed histopathologically in both benign and malignant neoplasms but their presence in salivary gland tumors has not been extensively documented. MATERIAL AND METHODS With IRB approval, the archive of the University of Florida College of Dentistry oral pathology biopsy service was retrospectively searched from 1994-2014 for all benign and malignant salivary tumors. Epidemiological data, tumor location and duration, and type of tumor were recorded. A four reviewer panel examined the original slides. Reviewers scaled each case as 0 (no clear cells present), 1 (few to focal clear cells), 2 (less than 50% clear cells), and 3 (greater than 50% clear cells). RESULTS A total of 535 cases were included of which 48% of tumors displayed 0 clear cells (257/535), 31.4% (168/535) scored 1, 13.6% (73/535) scored 2, and 7% (37/535) scored 3. Of the 251 (47%) malignant neoplasms, 64% (160/251) demonstrated 0-1 clear cell change, while 36% (91/251) showed a score of 2-3. For the total 284 (53%) benign tumors, 93% (265/535) scored 0-1 and 7% (19/535) scored a 2-3 range. No statistical difference was noted for gender, age, or duration of time present in regards to presence or absence of clear cells. Statistically significant differences in clear cell presence were found between location groups, between benign and malignant diagnosis, and between specific diagnostic groups. CONCLUSIONS This study demonstrates the frequent presence of increased numbers of clear cells in oral salivary malignancies and highlights salivary gland differential diagnoses when presented with clear cell changes.
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Affiliation(s)
- T Woods
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, 1385 Center Road, Gainesville Florida 32610,
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Smith M, Reith J, Fitzpatrick S, Cohen D, Islam M, Bhattacharyya I. MYOFIBROMA OF THE ORAL CAVITY: AN ANALYSIS OF A LARGE SERIES OF 24 NEW CASES AND REVIEW OF THE LITERATURE. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.066] [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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Mintline M, Fitzpatrick S, Bhattacharyya I, Cohen D, Sibille K, Islam M. INSIGHTS AND PITFALLS OF A SELECTIVE P16INK4A IMMUNOHISTOCHEMICAL TESTING STRATEGY FOR ORAL SQUAMOUS CELL CARCINOMA AND EPITHELIAL DYSPLASIA: A STUDY OF CLINICAL AND HISTOLOGIC FEATURES ASSOCIATED WITH P16INK4A OVEREXPRESSION. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.032] [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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Alkassimi F, Islam M, Fitzpatrick S, Cohen D, Bhattacharyya I. GINGIVAL PRESENTATION OF ODONTOGENIC KERATOCYST (KERATOCYSTIC ODONTOGENIC TUMOR): A CASE SERIES. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.081] [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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Hakeem A, Fitzpatrick S, Bhattacharyya I, Islam M, Cohen D. SYSTEMIC MEDICATION USE IN A COHORT OF PATIENTS WITH BURNING MOUTH SYNDROME. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Upadhyaya J, Fitzpatrick S, Islam M, . Bhattacharyya I, Cohen D. ODONTOGENIC CYSTS WITH BOTRYOID FEATURES: A RETROSPECTIVE CLINICOPATHOLOGICAL REVIEW OF 10 CASES. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.074] [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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Davidova L, Fitzpatrick S, Bhattacharyya I, Cohen D, Islam M. THE SPECTRUM OF CLINICAL AND HISTOPATHOLOGIC FEATURES OF FIBROUS DYSPLASIA: ANALYSIS OF A SERIES OF 40 CASES. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.038] [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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40
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Stephens ML, Betts K, Beck NB, Cogliano V, Dickersin K, Fitzpatrick S, Freeman J, Gray G, Hartung T, McPartland J, Rooney AA, Scherer RW, Verloo D, Hoffmann S. The Emergence of Systematic Review in Toxicology. Toxicol Sci 2016; 152:10-6. [PMID: 27208075 PMCID: PMC4922539 DOI: 10.1093/toxsci/kfw059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The Evidence-based Toxicology Collaboration hosted a workshop on "The Emergence of Systematic Review and Related Evidence-based Approaches in Toxicology," on November 21, 2014 in Baltimore, Maryland. The workshop featured speakers from agencies and organizations applying systematic review approaches to questions in toxicology, speakers with experience in conducting systematic reviews in medicine and healthcare, and stakeholders in industry, government, academia, and non-governmental organizations. Based on the workshop presentations and discussion, here we address the state of systematic review methods in toxicology, historical antecedents in both medicine and toxicology, challenges to the translation of systematic review from medicine to toxicology, and thoughts on the way forward. We conclude with a recommendation that as various agencies and organizations adapt systematic review methods, they continue to work together to ensure that there is a harmonized process for how the basic elements of systematic review methods are applied in toxicology.
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Affiliation(s)
- Martin L Stephens
- Johns Hopkins Center for Alternatives to Animal Testing, Baltimore, Maryland
| | - Kellyn Betts
- Freelance Science and Technology Writer, Takoma Park, Maryland
| | - Nancy B Beck
- American Chemistry Council, Washington, District of Columbia
| | | | - Kay Dickersin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Suzanne Fitzpatrick
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland
| | - James Freeman
- ExxonMobil Biomedical Sciences, Annandale, New Jersey
| | - George Gray
- George Washington University Milken Institute School of Public Health, Washington, DC
| | - Thomas Hartung
- Johns Hopkins Center for Alternatives to Animal Testing, Baltimore, Maryland University of Konstanz, CAAT-Europe, Germany
| | | | - Andrew A Rooney
- Office of Health Assessment and Translation, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Roberta W Scherer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Andersen ME, Betts K, Dragan Y, Fitzpatrick S, Goodman JL, Hartung T, Himmelfarb J, Ingber DE, Jacobs A, Kavlock R, Kolaja K, Stevens JL, Tagle D, Lansing Taylor D, Throckmorton D. Developing microphysiological systems for use as regulatory tools--challenges and opportunities. ALTEX 2015; 31:364-7. [PMID: 25061900 DOI: 10.14573/altex.1405151] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Melvin E Andersen
- Hamner Institutes for Health Sciences, Research Triangle Park, NC, USA
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Hakeem A, Cohen D, Bhattacharyya I, Fitzpatrick S, Islam M. A report of a rare case of oral melanoacanthoma in white male and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2014. [DOI: 10.1016/j.oooo.2014.05.066] [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: 10/24/2022]
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Rodrigue JR, Fleishman A, Vishnevsky T, Fitzpatrick S, Boger M. Organ donation video messaging: differential appeal, emotional valence, and behavioral intention. Clin Transplant 2014; 28:1184-92. [DOI: 10.1111/ctr.12449] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- J. R. Rodrigue
- Center for Transplant Outcomes and Quality Improvement; The Transplant Institute; Beth Israel Deaconess Medical Center; Boston MA USA
- Harvard Medical School; Boston MA USA
| | - A. Fleishman
- Center for Transplant Outcomes and Quality Improvement; The Transplant Institute; Beth Israel Deaconess Medical Center; Boston MA USA
| | - T. Vishnevsky
- Center for Transplant Outcomes and Quality Improvement; The Transplant Institute; Beth Israel Deaconess Medical Center; Boston MA USA
| | | | - M. Boger
- New England Organ Bank; Waltham MA USA
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Avalle P, Pollitt M, Bradley K, Cooper B, Pearce G, Djemai A, Fitzpatrick S. Development of Process Analytical Technology (PAT) methods for controlled release pellet coating. Eur J Pharm Biopharm 2014; 87:244-51. [DOI: 10.1016/j.ejpb.2014.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/09/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
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Fitzpatrick S, Honda K, Sattar A, Hirsch S. Histologic Lichenoid Features in Oral Dysplasia and Squamous Cell Carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2013. [DOI: 10.1016/j.oooo.2013.09.021] [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: 11/28/2022]
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Kleensang A, Maertens A, Rosenberg M, Fitzpatrick S, Lamb J, Auerbach S, Brennan R, Crofton KM, Gordon B, Fornace AJ, Gaido K, Gerhold D, Haw R, Henney A, Ma'ayan A, McBride M, Monti S, Ochs MF, Pandey A, Sharan R, Stierum R, Tugendreich S, Willett C, Wittwehr C, Xia J, Patton GW, Arvidson K, Bouhifd M, Hogberg HT, Luechtefeld T, Smirnova L, Zhao L, Adeleye Y, Kanehisa M, Carmichael P, Andersen ME, Hartung T. Pathways of Toxicity. ALTEX 2013; 31:53-61. [PMID: 24127042 DOI: 10.14573/altex.1309261] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 01/01/2023]
Abstract
Despite wide-spread consensus on the need to transform toxicology and risk assessment in order to keep pace with technological and computational changes that have revolutionized the life sciences, there remains much work to be done to achieve the vision of toxicology based on a mechanistic foundation. To this end, a workshop was organized to explore one key aspect of this transformation - the development of Pathways of Toxicity as a key tool for hazard identification based on systems biology. Several issues were discussed in depth in the workshop: The first was the challenge of formally defining the concept of a Pathway of Toxicity (PoT), as distinct from, but complementary to, other toxicological pathway concepts such as mode of action (MoA). The workshop came up with a preliminary definition of PoT as "A molecular definition of cellular processes shown to mediate adverse outcomes of toxicants". It is further recognized that normal physiological pathways exist that maintain homeostasis and these, sufficiently perturbed, can become PoT. Second, the workshop sought to define the adequate public and commercial resources for PoT information, including data, visualization, analyses, tools, and use-cases, as well as the kinds of efforts that will be necessary to enable the creation of such a resource. Third, the workshop explored ways in which systems biology approaches could inform pathway annotation, and which resources are needed and available that can provide relevant PoT information to the diverse user communities.
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Affiliation(s)
- Andre Kleensang
- Johns Hopkins University, Bloomberg School of Public Health, Center for Alternatives to Animal Testing, Baltimore, MD, USA
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Stephens ML, Andersen M, Becker RA, Betts K, Boekelheide K, Carney E, Chapin R, Devlin D, Fitzpatrick S, Fowle JR, Harlow P, Hartung T, Hoffmann S, Holsapple M, Jacobs A, Judson R, Naidenko O, Pastoor T, Patlewicz G, Rowan A, Scherer R, Shaikh R, Simon T, Wolf D, Zurlo J. Evidence-based toxicology for the 21st century: opportunities and challenges. ALTEX 2013; 30:74-103. [PMID: 23338808 DOI: 10.14573/altex.2013.1.074] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Evidence-based Toxicology Collaboration (EBTC) was established recently to translate evidence-based approaches from medicine and health care to toxicology in an organized and sustained effort. The EBTC held a workshop on "Evidence-based Toxicology for the 21st Century: Opportunities and Challenges" in Research Triangle Park, North Carolina, USA on January 24-25, 2012. The presentations largely reflected two EBTC priorities: to apply evidence-based methods to assessing the performance of emerging pathway-based testing methods consistent with the 2007 National Research Council report on "Toxicity Testing in the 21st Century" as well as to adopt a governance structure and work processes to move that effort forward. The workshop served to clarify evidence-based approaches and to provide food for thought on substantive and administrative activities for the EBTC. Priority activities include conducting pilot studies to demonstrate the value of evidence-based approaches to toxicology, as well as conducting educational outreach on these approaches.
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Affiliation(s)
| | - Julie Christian
- b School of Psychology , University of Birmingham , Birmingham , UK
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Stavropoulos M, Fitzpatrick S, Bowers L, Neuman A, Hinkson D, Green J, Bhattacharyya I, Cohen D. Development of bisphosphonate-related osteonecrosis of the jaws in patients treated with annual zoledronic acid infusion (Reclast®) with history of oral bisphosphonate use: a case series. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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