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White AT, Vaughn V, Petty LA, Gandhi TN, Horowitz JK, Flanders SA, Bernstein SJ, Hofer T, Ratz D, McLaughlin ES, Nielsen D, Czilok T, Minock J, Gupta A. Development of patient safety measures to identify inappropriate diagnosis of common infections. Clin Infect Dis 2024:ciae044. [PMID: 38298158 DOI: 10.1093/cid/ciae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/28/2023] [Accepted: 01/26/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Inappropriate diagnosis of infections results in antibiotic overuse and may delay diagnosis of underlying conditions. Here, we describe the development and characteristics of two safety measures of inappropriate diagnosis of urinary tract infection (UTI) and community-acquired pneumonia (CAP), the most common inpatient infections on general medicine services. METHODS Measures were developed from guidelines and literature and adapted based on data from patients hospitalized with UTI and CAP in 49 Michigan hospitals and feedback from end-users, a technical expert panel (TEP), and a patient focus group. Each measure was assessed for reliability, validity, feasibility, and usability. RESULTS Two measures, now endorsed by the National Quality Forum (NQF), were developed. Measure reliability (derived from 24,483 patients) was excellent (0.90 for UTI; 0.91 for CAP). Both measures had strong validity demonstrated through a) face validity by hospital users, the TEPs, and patient focus group, b) implicit case review (ĸ 0.72 for UTI; ĸ 0.72 for CAP), and c) rare case misclassification (4% for UTI; 0% for CAP) due to data errors (<2% for UTI; 6.3% for CAP). Measure implementation through hospital peer comparison in Michigan hospitals (2017 to 2020) demonstrated significant decreases in inappropriate diagnosis of UTI and CAP (37% and 32%, respectively, p < 0.001), supporting usability. CONCLUSIONS We developed highly reliable, valid, and usable measures of inappropriate diagnosis of UTI and CAP for hospitalized patients. Hospitals seeking to improve diagnostic safety, antibiotic use, and patient care should consider using these measures to reduce inappropriate diagnosis of CAP and UTI.
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Affiliation(s)
- Andrea T White
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Valerie Vaughn
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Health System Innovation & Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lindsay A Petty
- Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tejal N Gandhi
- Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer K Horowitz
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott A Flanders
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Steven J Bernstein
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Health System, Ann Arbor, Michigan, USA
| | - Elizabeth S McLaughlin
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Daniel Nielsen
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tawny Czilok
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Minock
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Saulnier KG, Panaite V, Ganoczy D, Kim HM, Zivin K, Hofer T, Piette JD, Pfeiffer PN. Depression symptom outcomes and re-engagement among VA patients who discontinue care while symptomatic. Gen Hosp Psychiatry 2023; 85:87-94. [PMID: 37862961 DOI: 10.1016/j.genhosppsych.2023.10.008] [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: 03/02/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Evaluate outcomes of Veterans who discontinued treatment with at least moderate ongoing depressive symptoms. METHOD Veterans with elevated depression symptoms from 29 Department of Veterans Affairs facilities completed baseline surveys and follow-up assessments for one year. Analyses examined rates and predictors of treatment discontinuation, treatment re-engagement, and subsequent symptoms among patients who remained out of care. RESULTS A total of 242 (17.8%; n = 1359) participants discontinued treatment while symptomatic, with Black participants, participants with less severe depression, and participants receiving only psychotherapy (versus combined psychotherapy and antidepressant medications) discontinuing at higher rates. Among all participants who discontinued treatment (n = 445), 45.8% re-engaged within the following six months with participants receiving combined treatment re-engaging at higher rates. Of participants who discontinued while symptomatic within the first 6 months of the study and did not return to care (n = 112), 68.8% remained symptomatic at 12 months. Lower baseline treatment expectancy and greater depression symptom severity were associated with remaining symptomatic while untreated. CONCLUSIONS Black race, lower symptom severity, and treatment modality may help identify patients at higher risk for discontinuing care while symptomatic, whereas patients with lower treatment expectations may be at greater risk for remaining out of care despite continuing symptoms.
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Affiliation(s)
- K G Saulnier
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI, USA; VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA.
| | - V Panaite
- James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - D Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - H M Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Consulting for Statistics, Computing, and Analytics Research, Ann Arbor, MI, USA
| | - K Zivin
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - T Hofer
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - J D Piette
- University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - P N Pfeiffer
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Rego RT, Kenney B, Ngugi AK, Espira L, Orwa J, Siwo GH, Sefa C, Shah J, Weinheimer-Haus E, Sophie Delius AJ, Pape UJ, Irfan FB, Abubakar A, Shah R, Wagner A, Kolars J, Boulton ML, Hofer T, Waljee AK. COVID-19 vaccination refusal trends in Kenya over 2021. Vaccine 2023; 41:1161-1168. [PMID: 36624011 PMCID: PMC9808414 DOI: 10.1016/j.vaccine.2022.12.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/23/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vaccination refusal exacerbates global COVID-19 vaccination inequities. No studies in East Africa have examined temporal trends in vaccination refusal, precluding addressing refusal. We assessed vaccine refusal over time in Kenya, and characterized factors associated with changes in vaccination refusal. METHODS We analyzed data from the Kenya Rapid Response Phone Survey (RRPS), a household cohort survey representative of the Kenyan population including refugees. Vaccination refusal (defined as the respondent stating they would not receive the vaccine if offered to them at no cost) was measured in February and October 2021. Proportions of vaccination refusal were plotted over time. We analyzed factors in vaccination refusal using a weighted multivariable logistic regression including interactions for time. FINDINGS Among 11,569 households, vaccination refusal in Kenya decreased from 24 % in February 2021 to 9 % in October 2021. Vaccination refusal was associated with having education beyond the primary level (-4.1[-0.7,-8.9] percentage point difference (ppd)); living with somebody who had symptoms of COVID-19 in the past 14 days (-13.72[-8.9,-18.6]ppd); having symptoms of COVID-19 in the past 14 days (11.0[5.1,16.9]ppd); and distrusting the government in responding to COVID-19 (14.7[7.1,22.4]ppd). There were significant interactions with time and: refugee status and geography, living with somebody with symptoms of COVID-19, having symptoms of COVID-19, and believing in misinformation. INTERPRETATION The temporal reduction in vaccination refusal in Kenya likely represents substantial strides by the Kenyan vaccination program and possible learnt lessons which require examination. Going forward, there are still several groups which need specific targeting to decrease vaccination refusal and improve vaccination equity, including those with lower levels of education, those with recent COVID-19 symptoms, those who do not practice personal COVID-19 mitigation measures, refugees in urban settings, and those who do not trust the government. Policy and program should focus on decreasing vaccination refusal in these populations, and research focus on understanding barriers and motivators for vaccination.
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Affiliation(s)
- Ryan T. Rego
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Corresponding author
| | - Brooke Kenney
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Anthony K. Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Leon Espira
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
| | - James Orwa
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Geoffrey H. Siwo
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Christabel Sefa
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA
| | - Jasmit Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya,Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Eileen Weinheimer-Haus
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Utz Johann Pape
- World Bank Group, Washington, DC, USA,University of Goettingen, Goettingen, Germany
| | - Furqan B. Irfan
- Institute of Global Health, Michigan State University, Lansing, MI, USA
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Abram Wagner
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joseph Kolars
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Timothy Hofer
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Akbar K. Waljee
- Center for Global Health Equity, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA,Michigan Integrated Center for Health Analytics and Medical Prediction (MiCHAMP), Ann Arbor, MI, USA
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4
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Hawley ST, Kidwell K, Zahrieh D, McCarthy A, Wills R, Rankin A, Hofer T, Chow S, Jagsi R, Neuman H. Improving patient-centered communication in breast cancer: a study protocol for a multilevel intervention of a shared treatment deliberation system (SharES) within the NCI community oncology research program (NCORP) (Alliance A231901CD). Trials 2023; 24:16. [PMID: 36609349 PMCID: PMC9817354 DOI: 10.1186/s13063-022-07048-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Advances in precision medicine have given oncologists new evaluative tools to better individualize treatments for patients with curable breast cancer. These innovations have revealed a need to improve patient understanding of novel, often complex information related to breast cancer treatment decisions. Ensuring patients have the emotional support to face consequential treatment decisions, as well as the opportunity to engage and discuss with their clinicians, is key to improving patient-centered communication and patient understanding. METHODS/DESIGN This study will implement a multilevel intervention with patient and clinician components as a NCORP Cancer Care Delivery Research (CCDR) trial within the Alliance for Clinical Trials in Oncology Research Base (Alliance). The two interventions in this study, the Shared Decision Engagement System (SharES), include (1) two versions of an evidence-based patient-facing breast cancer treatment decision tool (iCanDecide +/- an emotional support module) and (2) a clinician-facing dashboard (Clinician Dashboard) that is reviewed by surgeons/clinicians and summarizes ongoing patient needs. The design is a near minimax, hybrid stepped wedge trial of SharES where both interventions are being evaluated in a crossed design over six 12-week time periods. The primary outcome (knowledge) and key secondary outcomes (i.e., self-efficacy and cancer worry) are assessed via patient report at 5 weeks after surgery. Secondary outcomes are also assessed at 5 weeks after surgery, as well as in a second survey 9 months after registration. We anticipate recruiting a total of 700 breast cancer patients (600 evaluable after attrition) from 25 surgical practices affiliated with Alliance. DISCUSSION Upon study completion, we will have better understanding of the impact of a multilevel intervention on patient-centered communication in breast cancer with a specific focus on whether the intervention components improve knowledge and self-efficacy and reduce cancer worry. TRIAL REGISTRATION ClinicalTrials.gov NCT04549571 . Registered on 16 September 2020.
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Affiliation(s)
- Sarah T Hawley
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
| | - Kelley Kidwell
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - David Zahrieh
- Department of Quantitative Health Sciences and Alliance Statistics and Data Management Center (SMDC), Mayo Clinic, Rochester, MN, USA
- Ultragenyx Pharmaceutical, Novato, CA, USA
| | | | - Rachel Wills
- Alliance Protocol Operations Office, Chicago, IL, USA
| | - Aaron Rankin
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Timothy Hofer
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Selina Chow
- Alliance Protocol Operations Office, Chicago, IL, USA
| | - Reshma Jagsi
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Heather Neuman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Pfeiffer PN, Zivin K, Hosanagar A, Panaite V, Ganoczy D, Kim HM, Hofer T, Piette JD. Assessment of Outcome-Based Measures of Depression Care Quality in Veterans Health Administration Facilities. J Behav Health Serv Res 2023; 50:49-67. [PMID: 36207569 PMCID: PMC9542458 DOI: 10.1007/s11414-022-09813-4] [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] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
To inform the potential use of patient-reported depression symptom outcomes as measures of care quality, this study collected and analyzed longitudinal Patient Health Questionnaire (PHQ9) scores among 1,638 patients who screened positive for major depression according to a PHQ9 ≥ 10 across 29 Department of Veterans Affairs facilities. The study found baseline PHQ9, prior mental health visits, physical functioning, and treatment expectancy were consistently associated with subsequent PHQ9 outcomes. No facilities outperformed any others on PHQ9 scores at the 6-month primary endpoint, and the corresponding intra-class coefficient was ≤ .01 for the entire sample (n = 1,214) and 0.03 for the subgroup of patients with new depression episodes (n = 629). Measures of antidepressant receipt, psychotherapy, or treatment intensification were not associated with 6-month PHQ9 scores. PHQ9 outcomes are therefore unlikely to be useful as quality indicators for VA healthcare facilities due to low inter-facility variation, and new care process measures are needed to inform care for patients with chronic depression prevalent in this sample.
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Affiliation(s)
- Paul N. Pfeiffer
- grid.413800.e0000 0004 0419 7525VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI USA ,grid.413800.e0000 0004 0419 7525Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, Ann Arbor, MI USA
| | - Kara Zivin
- grid.413800.e0000 0004 0419 7525VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, Ann Arbor, MI USA ,grid.214458.e0000000086837370School of Public Health, University of Michigan, Ann Arbor, MI USA
| | - Avinash Hosanagar
- grid.413800.e0000 0004 0419 7525Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, Ann Arbor, MI USA
| | - Vanessa Panaite
- grid.281075.90000 0001 0624 9286James A. Haley Veterans’ Hospital, Tampa, FL USA
| | - Dara Ganoczy
- grid.413800.e0000 0004 0419 7525VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI USA
| | - H. Myra Kim
- grid.413800.e0000 0004 0419 7525VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Consulting for Statistics, Computing, and Analytics Research, Ann Arbor, MI USA
| | - Timothy Hofer
- grid.413800.e0000 0004 0419 7525VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, Ann Arbor, MI USA
| | - John D. Piette
- grid.413800.e0000 0004 0419 7525VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan Medical School, Ann Arbor, MI USA ,grid.214458.e0000000086837370School of Public Health, University of Michigan, Ann Arbor, MI USA
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Kurian AW, Abrahamse P, Caswell-Jin JL, Hamilton AS, Hofer T, Ward KC, Katz S. Association of germline genetic testing results with chemotherapy regimens received by women with early-stage breast cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10518 Background: Germline genetic testing is widespread after breast cancer diagnosis and increasingly informs treatment decisions; however, guidelines do not advise selecting chemotherapy regimens based on genetic testing results. It is unknown whether women with pathogenic variants (PVs) in BRCA1, BRCA2 ( BRCA1/2) or other cancer risk genes receive different chemotherapy regimens than women with negative genetic testing results. Methods: We linked Surveillance, Epidemiology and End Results (SEER) registry records from Georgia and California to clinical germline genetic testing results from four participating laboratories (Ambry, Bioreference/GeneDx, Invitae, and Myriad). For this analysis, we included patients who: 1) were diagnosed with stages I-III breast cancer, either hormone receptor-positive and HER2-negative (HR+HER2-) or triple-negative, in Georgia or California from 2013-2017; 2) received chemotherapy based on SEER records; and 3) linked to a genetic testing result. We further selected cases by genetic testing results: 50% PVs in BRCA1/2 or another cancer risk gene, 25% variant of uncertain significance (VUS) only and 25% negative. We extracted details of chemotherapy regimens from SEER text fields completed by registrars. We categorized regimens by drug classes reported (anthracycline, taxane, platinum, nitrogen mustard, other). We used multivariable models that controlled for age, race/ethnicity, stage, grade, surgical procedure, radiotherapy receipt and geographic site to test whether PV carriers received a more intensive chemotherapy regimen. For HR+HER2-, a more intensive regimen was defined as at least three drugs including an anthracycline and for triple-negative, as at least four drugs including an anthracycline and a platinum (versus fewer drugs). Results: 2,293 women were included, 1,451 with HR+HER2- and 842 with triple-negative disease. On multivariable analysis, receipt of a more intensive chemotherapy regimen was associated with having a BRCA1/2 PV among women with HR+HER2- disease (odds ratio 1.22, p = 0.036), but not among women with triple-negative disease. Moreover, platinum use was elevated in BRCA1/2 PV carriers with HR+HER2- disease (from an adjusted model: BRCA1/2 PV 10.9%, other PV 3.6%, VUS 5.6%, negative 5.7%), while in BRCA1/2 PV carriers with triple-negative disease, platinum use did not vary significantly by genetic results ( BRCA1/2 27.7%, other PV 27.7%, VUS 20.9%, negative 20.7%; p = 0.025 for interaction between genetic result and subtype). Conclusions: Compared to women with negative genetic testing results, women with BRCA1/2 PVs more often received a platinum and/or an anthracycline in chemotherapy regimens for early-stage, HR+HER2- breast cancer. This suggests potential over-treatment. No differences in chemotherapy regimen by genetic testing result were observed in triple-negative disease.
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Affiliation(s)
| | | | | | | | - Timothy Hofer
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Steven Katz
- University of Michigan School of Medicine, Ann Arbor, MI
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Watson SI, Rego RTT, Hofer T, Lilford RJ. Evaluations of water, sanitation and hygiene interventions should not use diarrhoea as (primary) outcome. BMJ Glob Health 2022; 7:bmjgh-2022-008521. [PMID: 35550338 PMCID: PMC9109038 DOI: 10.1136/bmjgh-2022-008521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/19/2022] [Indexed: 11/09/2022] Open
Abstract
Water, sanitation and hygiene interventions have been the subject of cluster trials of unprecedented size, scale and cost in recent years. However, the question 'what works in water, sanitation, hygiene (WASH)?' remains poorly understood. Evaluations of community interventions to prevent infectious disease typically use lab-confirmed infection as a primary outcome; however, WASH trials mostly use reported diarrhoea. While diarrhoea is a significant source of morbidity, it is subjected to significant misclassification error with respect to enteric infection due to the existence of non-infectious diarrhoea and asymptomatic infection. We show how this may lead to bias of estimated effects of interventions from WASH trials towards no effect. The problem is further compounded by other biases in the measurement process. Alongside testing for infection of the gut, an examination of the causal assumptions underlying WASH interventions present several other reliable alternative and complementary measurements and outcomes. Contemporary guidance on the evaluation of complex interventions requires researchers to take a broad view of the causal effects of an intervention across a system. Reported diarrhoea can fail to even be a reliable measure of changes to gastrointestinal health and so should not be used as a primary outcome if we are to progress our knowledge of what works in WASH.
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Affiliation(s)
- Samuel I Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ryan T T Rego
- Center for Global Health Equity, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard J Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Rego RT, Ngugi AK, Sophie Delius AJ, Luchters S, Kolars JC, Irfan FB, Weinheimer-Haus E, Abubakar A, Shah R, Zhu J, Boulton ML, Hofer T, Waljee AK. COVID-19 vaccine hesitancy among non-refugees and refugees in Kenya. PLOS Glob Public Health 2022; 2:e0000917. [PMID: 36962839 PMCID: PMC10021684 DOI: 10.1371/journal.pgph.0000917] [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] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 07/23/2022] [Indexed: 11/19/2022]
Abstract
Factors associated with COVID-19 vaccine hesitancy (which we define as refusal to be vaccinated when asked, resulting in delayed or non- vaccination) are poorly studied in sub-Saharan Africa and among refugees, particularly in Kenya. Using survey data from wave five (March to June 2021) of the Kenya Rapid Response Phone Survey (RRPS), a household survey representative of the population of Kenya, we estimated the self-reported rates and factors associated with vaccine hesitancy among non-refugees and refugees in Kenya. Non-refugee households were recruited through sampling of the 2015/16 Kenya Household Budget Survey and random digit dialing. Refugee households were recruited through random sampling of registered refugees. Binary response questions on misinformation and information were transformed into a scale. We performed a weighted (to be representative of the overall population of Kenya) multivariable logistic regression including interactions for refugee status, with the main outcome being if the respondent self-reported that they would not take the COVID-19 vaccine if available at no cost. We calculated the marginal effects of the various factors in the model. The weighted univariate analysis estimated that 18.0% of non-refugees and 7.0% of refugees surveyed in Kenya would not take the COVID-19 vaccine if offered at no cost. Adjusted, refugee status was associated with a -13.1[95%CI:-17.5,-8.7] percentage point difference (ppd) in vaccine hesitancy. For the both refugees and non-refugees, having education beyond the primary level, having symptoms of COVID-19, avoiding handshakes, and washing hands more often were also associated with a reduction in vaccine hesitancy. Also for both, having used the internet in the past three months was associated with a 8.1[1.4,14.7] ppd increase in vaccine hesitancy; and disagreeing that the government could be trusted in responding to COVID-19 was associated with a 25.9[14.2,37.5]ppd increase in vaccine hesitancy. There were significant interactions between refugee status and some variables (geography, food security, trust in the Kenyan government's response to COVID-19, knowing somebody with COVID-19, internet use, and TV ownership). These relationships between refugee status and certain variables suggest that programming between refugees and non-refugees be differentiated and specific to the contextual needs of each group.
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Affiliation(s)
- Ryan T Rego
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Anthony K Ngugi
- Dept. of Population Health, Aga Khan University, Nairobi, Kenya
| | | | | | - Joseph C Kolars
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Furqan B Irfan
- Institute of Global Health, Michigan State University, Lansing, Michigan, United States of America
| | - Eileen Weinheimer-Haus
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Reena Shah
- Dept. of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Ji Zhu
- Dept. of Statistics, University of Michigan, LSA, Ann Arbor, Michigan, United States of America
| | - Matthew L Boulton
- Dept. of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Timothy Hofer
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Akbar K Waljee
- Center for Global Health Equity, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
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9
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Rego R, Watson S, Alam MAU, Abdullah SA, Yunus M, Alam IT, Chowdhury AK, Haider S, Faruque ASG, Khan AI, Hofer T, Gill P, Islam MS, Lilford R. A comparison of traditional diarrhoea measurement methods with microbiological and biochemical indicators: A cross-sectional observational study in the Cox's Bazar displaced persons camp. EClinicalMedicine 2021; 42:101205. [PMID: 34849477 PMCID: PMC8608865 DOI: 10.1016/j.eclinm.2021.101205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Water, Sanitation, and Hygiene (WASH) systems aim to reduce the spread of enteric pathogens, particularly amongst children under five years old. The most common primary outcome of WASH trials is carer-reported diarrhoea. We evaluate different diarrhoea survey instruments as proxy markers of enteric pathogen presence in stool. METHODS We recruited 800 community-based participants from the Cox's Bazar Displaced Person's Camp in Bangladesh, split evenly between the rainy (July/August 2020) and dry (November/December 2020) periods. Participants were randomized evenly into either a standard survey asking carers if their child under five years old has had diarrhoea in the past fortnight, or a pictorial survey asking carers to pick from a pictorial chart which stools their child under five years old has had in the past fortnight. We collected stools from a random sub-sample of 120. Stools were examined visually, and tested for proteins associated with enteric infection and 16 enteric pathogens. We calculated sensitivities and specificities for each survey type, visual examination, and proteins with respect to enteric pathogen presence. FINDINGS The sensitivity of the standard survey for enteric pathogen presence was 0.49[95%CI:0.32,0.66] and the specificity was 0.65[0.41,0.85]. Similar sensitivities and specificities were observed for pictorial survey, visual inspection, and proteins. INTERPRETATION While diarrhoea is an important sign in clinical practice it appears that it is a poor proxy for enteric pathogen presence in stool in epidemiological surveys. When enteric infection is of interest, this should be measured directly. FUNDING The project was funded by the National Institutes for Health Research Global Health Research Unit on Improving Health in Slums (16/136/87) and by the University of Warwick.
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Affiliation(s)
- Ryan Rego
- Center for Global Health Equity, University of Michigan at Ann Arbor, USA
- Center for Global Health, University of Warwick, UK
- Institute for Applied Health Research, University of Birmingham, UK
| | - Samuel Watson
- Center for Global Health, University of Warwick, UK
- Institute for Applied Health Research, University of Birmingham, UK
| | | | | | - Mohammad Yunus
- International Center for Diarrhoeal Disease Research, Bangladesh
| | - Imam Taskin Alam
- International Center for Diarrhoeal Disease Research, Bangladesh
| | | | | | - ASG Faruque
- International Center for Diarrhoeal Disease Research, Bangladesh
| | | | - Timothy Hofer
- Center for Global Health Equity, University of Michigan at Ann Arbor, USA
| | - Paramjit Gill
- Center for Global Health, University of Warwick, UK
- Institute for Applied Health Research, University of Birmingham, UK
| | | | - Richard Lilford
- Center for Global Health, University of Warwick, UK
- Institute for Applied Health Research, University of Birmingham, UK
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10
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Käsmann L, Cabeza-Boeddinghaus N, Taugner J, Eze C, Flörsch B, Hofer T, Pelikan C, Belka C, Noessner E, Staab-Weijnitz C, Manapov F. PO-1159 Prognostic role of pro-inflammatory cytokines in multimodal treatment of inoperable stage III NSCLC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07610-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Bion J, Aldridge C, Beet C, Boyal A, Chen YF, Clancy M, Girling A, Hofer T, Lord J, Mannion R, Rees P, Roseveare C, Rowan L, Rudge G, Sun J, Sutton E, Tarrant C, Temple M, Watson S, Willars J, Lilford R. Increasing specialist intensity at weekends to improve outcomes for patients undergoing emergency hospital admission: the HiSLAC two-phase mixed-methods study. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background
NHS England’s 7-day services policy comprised 10 standards to improve access to quality health care across all days of the week. Six standards targeted hospital specialists on the assumption that their absence caused the higher mortality associated with weekend hospital admission: the ‘weekend effect’. The High-intensity Specialist-Led Acute Care (HiSLAC) collaboration investigated this using the implementation of 7-day services as a ‘natural experiment’.
Objectives
The objectives were to determine whether or not increasing specialist intensity at weekends improves outcomes for patients undergoing emergency hospital admission, and to explore mechanisms and cost-effectiveness.
Design
This was a two-phase mixed-methods observational study. Year 1 focused on developing the methodology. Years 2–5 included longitudinal research using quantitative and qualitative methods, and health economics.
Methods
A Bayesian systematic literature review from 2000 to 2017 quantified the weekend effect. Specialist intensity measured over 5 years used self-reported annual point prevalence surveys of all specialists in English acute hospital trusts, expressed as the weekend-to-weekday ratio of specialist hours per 10 emergency admissions. Hospital Episode Statistics from 2007 to 2018 provided trends in weekend-to-weekday mortality ratios. Mechanisms for the weekend effect were explored qualitatively through focus groups and on-site observations by qualitative researchers, and a two-epoch case record review across 20 trusts. Case-mix differences were examined in a single trust. Health economics modelling estimated costs and outcomes associated with increased specialist provision.
Results
Of 141 acute trusts, 115 submitted data to the survey, and 20 contributed 4000 case records for review and participated in qualitative research (involving interviews, and observations using elements of an ethnographic approach). Emergency department attendances and admissions have increased every year, outstripping the increase in specialist numbers; numbers of beds and lengths of stay have decreased. The reduction in mortality has plateaued; the proportion of patients dying after discharge from hospital has increased. Specialist hours increased between 2012/13 and 2017/18. Weekend specialist intensity is half that of weekdays, but there is no relationship with admission mortality. Patients admitted on weekends are sicker (they have more comorbid disease and more of them require palliative care); adjustment for severity of acute illness annuls the weekend effect. In-hospital care processes are slightly more efficient at weekends; care quality (errors, adverse events, global quality) is as good at weekends as on weekdays and has improved with time. Qualitative researcher assessments of hospital weekend quality concurred with case record reviewers at trust level. General practitioner referrals at weekends are one-third of those during weekdays and have declined further with time.
Limitations
Observational research, variable survey response rates and subjective assessments of care quality were compensated for by using a difference-in-difference analysis over time.
Conclusions
Hospital care is improving. The weekend effect is associated with factors in the community that precede hospital admission. Post-discharge mortality is increasing. Policy-makers should focus their efforts on improving acute and emergency care on a ‘whole-system’ 7-day approach that integrates social, community and secondary health care.
Future work
Future work should evaluate the role of doctors in hospital and community emergency care and investigate pathways to emergency admission and quality of care following hospital discharge.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julian Bion
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Cassie Aldridge
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Chris Beet
- Intensive Care Medicine, Royal Derby Hospital NHS Trust, Derby, UK
| | - Amunpreet Boyal
- Research & Development, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Yen-Fu Chen
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Michael Clancy
- Emergency Medicine, University of Southampton, Southampton, UK
| | - Alan Girling
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Hofer
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Peter Rees
- Patient & Lay Committee, Academy of Medical Royal Colleges, London, UK
| | - Chris Roseveare
- General Internal Medicine, Southern Health NHS Foundation Trust, Southampton, UK
| | - Louise Rowan
- University Department of Anaesthesia & Critical Care, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jianxia Sun
- Informatics, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | | | - Mark Temple
- Nephrology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sam Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Janet Willars
- Health Sciences, University of Leicester, Leicester, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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12
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Manojlovich M, Harrod M, Hofer T, Lafferty M, McBratnie M, Krein SL. Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual Saf 2020; 30:747-754. [PMID: 33168635 PMCID: PMC8140397 DOI: 10.1136/bmjqs-2020-011441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units. METHODS Using a qualitative design, we collected data through observation, shadowing, interviews and focus groups of bedside registered nurses and physicians who worked in four hospitals in the Midwest USA. We analysed the data using inductive content analysis. RESULTS A total of 155 physicians and nurses participated. Eighty-six nurses and 32 physicians participated in focus groups or individual interviews; we shadowed 37 physicians and nurses across all sites. Two major inter-related themes emerged, message and non-message related factors. Message-related factors included the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response. Non-message related factors included trust and interpersonal relationships, and different perspectives between nurses and physicians on the same clinical issue that affected perceptions of urgency, and contributed to delays in responsiveness. CONCLUSIONS Physician responsiveness to communications from bedside nurses depends on a complex combination of factors related to the message itself and non-message related factors. How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups.
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Affiliation(s)
| | - Molly Harrod
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Megan Lafferty
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sarah L Krein
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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13
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Bion J, Aldridge C, Girling AJ, Rudge G, Sun J, Tarrant C, Sutton E, Willars J, Beet C, Boyal A, Rees P, Roseveare C, Temple M, Watson SI, Chen YF, Clancy M, Rowan L, Lord J, Mannion R, Hofer T, Lilford R. Changes in weekend and weekday care quality of emergency medical admissions to 20 hospitals in England during implementation of the 7-day services national health policy. BMJ Qual Saf 2020; 30:536-546. [PMID: 33115851 PMCID: PMC8237174 DOI: 10.1136/bmjqs-2020-011165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 10/06/2020] [Accepted: 10/11/2020] [Indexed: 12/23/2022]
Abstract
Background In 2013, the English National Health Service launched the policy of 7-day services to improve care quality and outcomes for weekend emergency admissions. Aims To determine whether the quality of care of emergency medical admissions is worse at weekends, and whether this has changed during implementation of 7-day services. Methods Using data from 20 acute hospital Trusts in England, we performed randomly selected structured case record reviews of patients admitted to hospital as emergencies at weekends and on weekdays between financial years 2012–2013 and 2016–2017. Senior doctor (‘specialist’) involvement was determined from annual point prevalence surveys. The primary outcome was the rate of clinical errors. Secondary outcomes included error-related adverse event rates, global quality of care and four indicators of good practice. Results Seventy-nine clinical reviewers reviewed 4000 admissions, 800 in duplicate. Errors, adverse events and care quality were not significantly different between weekend and weekday admissions, but all improved significantly between epochs, particularly errors most likely influenced by doctors (clinical assessment, diagnosis, treatment, prescribing and communication): error rate OR 0.78; 95% CI 0.70 to 0.87; adverse event OR 0.48, 95% CI 0.33 to 0.69; care quality OR 0.78, 95% CI 0.70 to 0.87; all adjusted for age, sex and ethnicity. Postadmission in-hospital care processes improved between epochs and were better for weekend admissions (vital signs with National Early Warning Score and timely specialist review). Preadmission processes in the community were suboptimal at weekends and deteriorated between epochs (fewer family doctor referrals, more patients with chronic disease or palliative care designation). Conclusions and implications Hospital care quality of emergency medical admissions is not worse at weekends and has improved during implementation of the 7-day services policy. Causal pathways for the weekend effect may extend into the prehospital setting.
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Affiliation(s)
- Julian Bion
- Department of Intensive Care Medicine, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
| | - Cassie Aldridge
- Department of Intensive Care Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Alan J Girling
- Department of Intensive Care Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Gavin Rudge
- Department of Intensive Care Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jianxia Sun
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Elizabeth Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Chris Beet
- Department of Intensive Care, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Amunpreet Boyal
- Department of Research & Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Rees
- Academy of Medical Royal Colleges, London, UK
| | - Chris Roseveare
- Department of Gastroenterology, Southern Health NHS Foundation Trust, Southampton, UK
| | - Mark Temple
- Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Samuel Ian Watson
- Division of Health Sciences, Medical School, University of Warwick, Coventry, Warwickshire, UK
| | - Yen-Fu Chen
- Division of Health Sciences, Medical School, University of Warwick, Coventry, Warwickshire, UK
| | - Mike Clancy
- Emergency Medicine, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Louise Rowan
- Department of Intensive Care Medicine, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Joanne Lord
- University of Southampton, Southampton, Hampshire, UK
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Timothy Hofer
- Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Richard Lilford
- Department of Public Health, Epidemiology & Biostatistics, University of Birmingham, Birmingham, UK
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14
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Chapman CH, Caram MEV, Radhakrishnan A, Tsodikov A, Deville C, Burns J, Zaslavsky A, Chang M, Leppert JT, Hofer T, Sales AE, Hawley ST, Hollenbeck BK, Skolarus TA. Association between PSA values and surveillance quality after prostate cancer surgery. Cancer Med 2019; 8:7903-7912. [PMID: 31691526 PMCID: PMC6912050 DOI: 10.1002/cam4.2663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Although prostate-specific antigen (PSA) testing is used for prostate cancer detection and posttreatment surveillance, thresholds in these settings differ. The screening cutoff of 4.0 ng/mL may be inappropriately used during postsurgery surveillance, where 0.2 ng/mL is typically used, creating missed opportunities for effective salvage radiation treatment. We performed a study to determine whether guideline concordance with annual postoperative PSA surveillance increases when PSA values exceed 4 ng/mL, which represents a screening threshold that is not relevant after surgery. METHODS We used US Veterans Health Administration data to perform a retrospective longitudinal cohort study of men diagnosed with nonmetastatic prostate cancer from 2005 to 2008 who underwent radical prostatectomy. We used logistic regression to examine the association between postoperative PSA levels and receipt of an annual PSA test. RESULTS Among 10 400 men and 38 901 person-years of follow-up, annual guideline concordance decreased from 95% in year 1 to 79% in year 7. After adjustment, guideline concordance was lower for the youngest and oldest men, Black, and unmarried men. Guideline concordance significantly increased as PSA exceeded 4 ng/mL (adjusted odds ratio 2.20 PSA > 4-6 ng/mL vs PSA > 1-4 ng/mL, 95% confidence interval 1.20-4.03; P = .01). CONCLUSIONS Guideline concordance with prostate cancer surveillance increased when PSA values exceeded 4 ng/mL, suggesting a screening threshold not relevant after prostate cancer surgery, where 0.2 ng/mL is considered treatment failure, is impacting cancer surveillance quality. Clarification of PSA thresholds for early detection vs cancer surveillance, as well as emphasizing adherence for younger and Black men, appears warranted.
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Affiliation(s)
- Christina Hunter Chapman
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Megan E V Caram
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Alexander Tsodikov
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Burns
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Michael Chang
- Hunter Holmes McGuire Veterans Affairs Healthcare System, Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - John T Leppert
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System and the Department of Urology, Stanford University, Stanford, CA, USA
| | - Timothy Hofer
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anne E Sales
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Sarah T Hawley
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Ted A Skolarus
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Urology, University of Michigan, Ann Arbor, MI, USA
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15
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Lilford R, Kyobutungi C, Ndugwa R, Sartori J, Watson SI, Sliuzas R, Kuffer M, Hofer T, Porto de Albuquerque J, Ezeh A. Because space matters: conceptual framework to help distinguish slum from non-slum urban areas. BMJ Glob Health 2019; 4:e001267. [PMID: 31139443 PMCID: PMC6509608 DOI: 10.1136/bmjgh-2018-001267] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 10/30/2018] [Revised: 12/10/2018] [Accepted: 12/24/2018] [Indexed: 11/04/2022] Open
Abstract
Despite an estimated one billion people around the world living in slums, most surveys of health and well-being do not distinguish between slum and non-slum urban residents. Identifying people who live in slums is important for research purposes and also to enable policymakers, programme managers, donors and non-governmental organisations to better target investments and services to areas of greatest deprivation. However, there is no consensus on what a slum is let alone how slums can be distinguished from non-slum urban precincts. Nor has attention been given to a more fine-grained classification of urban spaces that might go beyond a simple slum/non-slum dichotomy. The purpose of this paper is to provide a conceptual framework to help tackle the related issues of slum definition and classification of the urban landscape. We discuss:The concept of space as an epidemiological variable that results in 'neighbourhood effects'.The problems of slum area definition when there is no 'gold standard'.A long-list of variables from which a selection must be made in defining or classifying urban slum spaces.Methods to combine any set of identified variables in an operational slum area definition.Two basic approaches to spatial slum area definitions-top-down (starting with a predefined area which is then classified according to features present in that area) and bottom-up (defining the areal unit based on its features).Different requirements of a slum area definition according to its intended use.Implications for research and future development.
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Affiliation(s)
- Richard Lilford
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | | | - Robert Ndugwa
- Global Urban Observatory Unit, United Nations Human Settlements Programme, Nairobi, Kenya
| | - Jo Sartori
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Samuel I Watson
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Richard Sliuzas
- Faculty of Geo-Information Science and Earth Observation, Universiteit Twente, Enschede, The Netherlands
| | - Monika Kuffer
- Faculty of Geo-Information Science and Earth Observation, Universiteit Twente, Enschede, The Netherlands
| | - Timothy Hofer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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16
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Radhakrishnan A, Henry J, Zhu K, Hawley ST, Hollenbeck BK, Hofer T, Wittmann DA, Sales AE, Skolarus TA. Determinants of quality prostate cancer survivorship care across the primary and specialty care interface: Lessons from the Veterans Health Administration. Cancer Med 2019; 8:2686-2702. [PMID: 30950216 PMCID: PMC6536973 DOI: 10.1002/cam4.2106] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/20/2022] Open
Abstract
Background With over 3 million US prostate cancer survivors, ensuring high‐quality, coordinated cancer survivorship care is important. However, implementation of recommended team‐based cancer care has lagged, and determinants of quality care across primary and specialty care remain unclear. Guided by the theoretical domains framework (TDF), we explored multidisciplinary determinants of quality survivorship care in an integrated delivery system. Methods We conducted semistructured interviews with primary (4) and specialty (7) care providers across 6 Veterans Health Administration clinic sites. Using template analysis, we coded interview transcripts into the TDF, mapping statements to specific constructs within each domain. We assessed whether each construct was perceived a barrier or facilitator, examining results for both primary care providers (PCPs) and prostate cancer specialists. Results Cancer specialists and PCPs identified 2 primary TDF domains impacting their prostate cancer survivorship care: Knowledge and Environmental context and resources. Both groups noted knowledge (about survivorship care) and procedural knowledge (about how to deliver survivorship care) as positive determinants or facilitators, whereas resources/material resources (to deliver survivorship care) was noted as a negative determinant or barrier to care. Additional domains more commonly referenced by cancer specialists included Social/professional role and identity and Goals, while PCPs reported the domain Beliefs about capabilities as relevant. Conclusions We used the TDF to identify several behavioral domains acting as determinants of high‐quality, team‐based prostate cancer survivorship care. These results can inform prostate cancer survivorship care plan content, and may guide tailored, multidisciplinary implementation strategies to improve survivorship care across the primary and specialty care interface.
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Affiliation(s)
| | - Jennifer Henry
- VA Health Service Research & Development Center for Clinical Management Research, Ann Arbor, Michigan
| | - Kevin Zhu
- VA Health Service Research & Development Center for Clinical Management Research, Ann Arbor, Michigan
| | - Sarah T Hawley
- Division of General Medicine, University of Michigan, Ann Arbor, Michigan.,VA Health Service Research & Development Center for Clinical Management Research, Ann Arbor, Michigan.,Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Timothy Hofer
- Division of General Medicine, University of Michigan, Ann Arbor, Michigan.,VA Health Service Research & Development Center for Clinical Management Research, Ann Arbor, Michigan
| | - Daniela A Wittmann
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.,School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Anne E Sales
- VA Health Service Research & Development Center for Clinical Management Research, Ann Arbor, Michigan.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Ted A Skolarus
- VA Health Service Research & Development Center for Clinical Management Research, Ann Arbor, Michigan.,Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan.,Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
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17
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Manojlovich M, Frankel RM, Harrod M, Heshmati A, Hofer T, Umberfield E, Krein S. Formative evaluation of the video reflexive ethnography method, as applied to the physician-nurse dyad. BMJ Qual Saf 2018; 28:160-166. [PMID: 30007915 DOI: 10.1136/bmjqs-2017-007728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/15/2017] [Revised: 05/30/2018] [Accepted: 06/24/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Despite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety. The lack of progress suggests that it is time to consider alternative approaches with greater potential to identify and improve communication than those used to date. We conducted a formative evaluation to assess the feasibility, acceptability and utility of using video reflexive ethnography (VRE) to examine, and potentially improve, communication between nurses and physicians. METHODS We begin with a brief description of the institutional review boardapproval process and recruitment activities, then explain how we conducted the formative evaluation by describing (1) the VRE process itself; (2) our assessment of the exposure to the VRE process; and (3) challenges encountered and lessons learnt as a result of the process, along with suggestions for change. RESULTS Our formative evaluation demonstrates that it is feasible and acceptable to video-record communication between physicians and nurses during patient care rounds across many units at a large, academic medical centre. The lessons that we learnt helped to identify procedural changes for future projects. We also discuss the broader application of this methodology as a possible strategy for improving other important quality and safety practices in healthcare settings. CONCLUSIONS The VRE process did generate increased reflection in both nurse and physician participants. Moreover, VRE has utility in assessing communication and, based on the comments of our participants, can serve as an intervention to possibly improve communication, with implications for patient safety.
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Affiliation(s)
| | - Richard M Frankel
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Molly Harrod
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | | | - Timothy Hofer
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Sarah Krein
- Center for Clinical Management Research, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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18
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Abstract
Zusammenfassung
Ziel: Welche klinische Bedeutung hat das echte Magnakrossenrezidiv (MKR) im Kontext mit der natürlichen Progression der Varizenkrankheit in einem Kollektiv von Voroperierten (KVO)? Methode: Bei 221 Patienten mit erneuter Varizenbildung bei Zustand nach früher erfolgten Krossektomien mit oder ohne Stripping epifaszialer Varizen werden die MKR und die von ihnen ausgehenden Rezidivvarizen auf ihre klinische und hämodynamische Relevanz hin untersucht und den im Rahmen der Progression der Varikosis neu aufgetretenen Magnakrosseninsuffizienzen (nMKI) gegenübergestellt. Ergebnisse: Neben 112 nMKI bestehen 118 MKR, 46 von ihnen stehen in Verbindung mit einem noch in situ gelegenen Magnastamm (oder kalibermäßig vergleichbarem Gefäß). In 50% lässt sich in diesen Fällen photoplethysmographisch ein pathologischer T0-Wert <19 s nachweisen. 54 MKR, in Verbindung stehend mit unsystematischen Seitenastvarizen oder einer Vena saphena magna accessoria zeigen nur in 24% T0-Werte <19 s (p = 0,014). 39% der MKR erfordern eine erneute operative Revision. Dies entspricht 20% der duplexsonographisch nachgewiesenen MKR und nMKI im KVO. Schlussfolgerung: Die klinische Relevanz der MKR bleibt bescheiden im direkten Vergleich mit der Progression der Varizenkrankheit.
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19
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Amorim CEG, Hofer T, Ray N, Foll M, Ruiz-Linares A, Excoffier L. Long-distance dispersal suppresses introgression of local alleles during range expansions. Heredity (Edinb) 2017; 118:135-142. [PMID: 27577693 PMCID: PMC5234476 DOI: 10.1038/hdy.2016.68] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 07/15/2016] [Accepted: 07/18/2016] [Indexed: 12/24/2022] Open
Abstract
During range expansions, even low levels of interbreeding can lead to massive introgression of local alleles into an invader's genome. Nonetheless, this pattern is not always observed in human populations. For instance, European Americans in North America are barely introgressed by Amerindian genes in spite of known contact and admixture. With coalescent spatially explicit simulations, we examined the impact of long-distance dispersal (LDD) events on introgression of local alleles into the invading population using a set of different demographic scenarios applicable to a diverse range of natural populations and species. More specifically, we consider two distinct LDD models: one where LDD events originate in the range core and targets only the expansion front and a second one where LDD events can occur from any area to any other. We find that LDD generally prevents introgression, but that LDD events specifically targeting the expansion front are most efficient in suppressing introgression. This is likely due to the fact that LDD allows for the presence of a larger number of invader alleles at the wave front, where effective population size is thus increased and local introgressed alleles are rapidly outnumbered. We postulate that the documented settlement of pioneers directly on the wave front in North America has contributed to low levels of Amerindian admixture observed in European Americans and that this phenomenon may well explain the lack of introgression after a range expansion in natural populations without the need to evoke other mechanisms such as natural selection.
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Affiliation(s)
- C E G Amorim
- Department of Biological Sciences,
Columbia University, New York, NY,
USA
- CAPES Foundation, Ministry of
Education of Brazil, Brasília, Distrito
Federal, Brazil
| | - T Hofer
- Computational and Molecular
Population Genetics Lab, Institute of Ecology and Evolution, University of
Bern, Bern, Switzerland
- Swiss Institute of
Bioinformatics, Lausanne, Switzerland
| | - N Ray
- EnviroSPACE Laboratory, Institute for
Environmental Sciences, University of Geneva, Geneva,
Switzerland
| | - M Foll
- Genetic Cancer Susceptibility Group,
International Agency for Research on Cancer, Lyon,
France
| | - A Ruiz-Linares
- Department of Genetics, Evolution and
Environment, University College London, London,
UK
| | - L Excoffier
- Computational and Molecular
Population Genetics Lab, Institute of Ecology and Evolution, University of
Bern, Bern, Switzerland
- Swiss Institute of
Bioinformatics, Lausanne, Switzerland
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20
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Friese CR, Li Y, Bondarenko I, Hofer T, Ward KC, Hamilton AS, Deapen D, Kurian AW, Katz SJ. Chemotherapy decisions and patient experience with the recurrence score assay for early-stage breast cancer. Cancer 2017; 123:43-51. [PMID: 27775837 PMCID: PMC5161570 DOI: 10.1002/cncr.30324] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/08/2016] [Accepted: 08/16/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The 21-gene recurrence score (RS) assay stratifies early-stage, estrogen receptor-positive breast cancer by recurrence risk. Few studies have examined the ways in which physicians use the RS to recommend adjuvant systemic chemotherapy or patients' experiences with testing and decision making. METHODS This study surveyed 3880 women treated for breast cancer in 2013-2014; they were identified from the Los Angeles County and Georgia Surveillance, Epidemiology, and End Results registries (response rate, 71%). Women reported chemotherapy recommendations, the receipt of chemotherapy, testing experiences, and decision satisfaction. Registries linked the tumor data, RS, and surveys. Regression models examined factors associated with chemotherapy recommendations and receipt by the RS and subgroups. RESULTS There were 1527 patients with stage I/II, estrogen receptor/progesterone receptor-positive, human epidermal growth factor 2-negative disease: 778 received an RS (62.6% of patients with node-negative, favorable disease, 24.3% of patients with node-negative, unfavorable disease, and 13.0% of patients with node-positive disease; P < .001). Overall, 47.2% of the patients received a recommendation against chemotherapy, and 40.5% received a recommendation for it. RS results correlated with recommendations: nearly all patients with high scores (31-100) received a chemotherapy recommendation (86.9%-96.5% across clinical subgroups), whereas the majority of the patients with low-risk results (0-18) received a recommendation against it (65.9%-78.2% across subgroups). Most patients with high RSs received chemotherapy (87.0%, 91.1%, and 100% across subgroups), whereas few patients with low scores received it (2.9%, 9.5%, and 26.6% across subgroups). There were no substantial racial/ethnic differences in testing or treatment. Women were largely satisfied with the RS and chemotherapy decisions. CONCLUSIONS Oncologists use the RS to personalize treatment, even for those with node-positive disease. High satisfaction and an absence of disparities in testing and treatment suggest that precision-medicine advances have improved systemic breast cancer treatment. Cancer 2017;43-51. © 2016 American Cancer Society.
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Affiliation(s)
- Christopher R. Friese
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan
| | - Yun Li
- Department of Biostatistics, School of Public Health, University of Michigan
| | - Irina Bondarenko
- Department of Biostatistics, School of Public Health, University of Michigan
| | - Timothy Hofer
- Division of General Medicine, Department of Internal Medicine, University of Michigan, HSR&D Center of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI
| | - Kevin C. Ward
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
| | - Ann S. Hamilton
- Keck School of Medicine, University of Southern California, Department of Preventive Medicine, Los Angeles, CA
| | - Dennis Deapen
- Keck School of Medicine, University of Southern California, Department of Preventive Medicine, Los Angeles, CA
| | - Allison W. Kurian
- Departments of Medicine and Health Research and Policy, Stanford University Medical Center
| | - Steven J. Katz
- Departments of Internal Medicine and Health Management and Policy, Schools of Medicine and Public Health, University of Michigan
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Gutzkow KB, Duale N, Danielsen T, von Stedingk H, Shahzadi S, Instanes C, Olsen AK, Steffensen IL, Hofer T, Törnqvist M, Brunborg G, Lindeman B. Enhanced susceptibility of obese mice to glycidamide-induced sperm chromatin damage without increased oxidative stress. Andrology 2016; 4:1102-1114. [DOI: 10.1111/andr.12233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/26/2016] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- K. B. Gutzkow
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
| | - N. Duale
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
| | - T. Danielsen
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
| | - H. von Stedingk
- Department of Environmental Science and Analytical Chemistry; Stockholm University; Stockholm Sweden
| | - S. Shahzadi
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
| | - C. Instanes
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
| | - A.-K. Olsen
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
| | - I.-L. Steffensen
- Division of Environmental Medicine; Department of Food, Water and Cosmetics; Norwegian Institute of Public Health; Oslo Norway
| | - T. Hofer
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
| | - M. Törnqvist
- Department of Environmental Science and Analytical Chemistry; Stockholm University; Stockholm Sweden
| | - G. Brunborg
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
| | - B. Lindeman
- Division of Environmental Medicine; Department of Chemicals and Radiation; Norwegian Institute of Public Health; Oslo Norway
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22
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Scherr KA, Fagerlin A, Hofer T, Scherer LD, Holmes-Rovner M, Williamson LD, Kahn VC, Montgomery JS, Greene KL, Zhang B, Ubel PA. Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions. Med Decis Making 2016; 37:56-69. [PMID: 27510740 DOI: 10.1177/0272989x16662841] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/13/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer. METHODS We enrolled 257 men with clinically localized prostate cancer (prostate-specific antigen <20; Gleason score 6 or 7) seen by urologists (primarily residents and fellows) in 4 Veterans Affairs medical centers. We measured patients' baseline preferences prior to their urology appointments, including initial treatment preference, cancer-related anxiety, and interest in sex. In longitudinal follow-up, we determined which treatment patients received. We used hierarchical logistic regression to determine the factors that predicted treatment received (active treatment v. active surveillance) and urologist recommendations. We also conducted a directed content analysis of recorded clinical encounters to determine if urologists discussed patients' interest in sex. RESULTS Patients' initial treatment preferences did not predict receipt of active treatment versus surveillance, Δχ2(4) = 3.67, P = 0.45. Instead, receipt of active treatment was predicted primarily by urologists' recommendations, Δχ2(2) = 32.81, P < 0.001. Urologists' recommendations, in turn, were influenced heavily by medical factors (age and Gleason score) but were unrelated to patient preferences, Δχ2(6) = 0, P = 1. Urologists rarely discussed patients' interest in sex (<15% of appointments). CONCLUSIONS Patients' treatment decisions were based largely on urologists' recommendations, which, in turn, were based on medical factors (age and Gleason score) and not on patients' personal views of the relative pros and cons of treatment alternatives.
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Affiliation(s)
- Karen A Scherr
- Fuqua School of Business and School of Medicine, Duke University, Durham, NC, USA (KAS)
| | - Angela Fagerlin
- Departments of Internal Medicine and Psychology, Center for Bioethics and Sciences in Medicine, University of Michigan Ann Arbor, The Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA (AF)
| | - Timothy Hofer
- Division of Internal Medicine, University of Michigan Ann Arbor, The Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA (TH)
| | - Laura D Scherer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA (LDS)
| | - Margaret Holmes-Rovner
- Department of Medicine and Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI, USA (MH-R)
| | | | - Valerie C Kahn
- Division of General Medicine, Department of Internal Medicine, Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA (VCK)
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan Ann Arbor, Department of Surgery, Ann Arbor VA, Ann Arbor, MI, USA (JSM)
| | - Kirsten L Greene
- Department of Urology, University of California San Francisco, Department of Urology, San Francisco VA, San Francisco, CA, USA (KLG)
| | | | - Peter A Ubel
- Fuqua School of Business, School of Medicine and Sanford School of Public Policy, Duke University, Durham, NC, USA (PAU)
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23
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Agnese R, Anderson AJ, Aramaki T, Asai M, Baker W, Balakishiyeva D, Barker D, Basu Thakur R, Bauer DA, Billard J, Borgland A, Bowles MA, Brink PL, Bunker R, Cabrera B, Caldwell DO, Calkins R, Cerdeno DG, Chagani H, Chen Y, Cooley J, Cornell B, Cushman P, Daal M, Di Stefano PCF, Doughty T, Esteban L, Fallows S, Figueroa-Feliciano E, Ghaith M, Godfrey GL, Golwala SR, Hall J, Harris HR, Hofer T, Holmgren D, Hsu L, Huber ME, Jardin D, Jastram A, Kamaev O, Kara B, Kelsey MH, Kennedy A, Leder A, Loer B, Lopez Asamar E, Lukens P, Mahapatra R, Mandic V, Mast N, Mirabolfathi N, Moffatt RA, Morales Mendoza JD, Oser SM, Page K, Page WA, Partridge R, Pepin M, Phipps A, Prasad K, Pyle M, Qiu H, Rau W, Redl P, Reisetter A, Ricci Y, Roberts A, Rogers HE, Saab T, Sadoulet B, Sander J, Schneck K, Schnee RW, Scorza S, Serfass B, Shank B, Speller D, Toback D, Underwood R, Upadhyayula S, Villano AN, Welliver B, Wilson JS, Wright DH, Yellin S, Yen JJ, Young BA, Zhang J. New Results from the Search for Low-Mass Weakly Interacting Massive Particles with the CDMS Low Ionization Threshold Experiment. Phys Rev Lett 2016; 116:071301. [PMID: 26943526 DOI: 10.1103/physrevlett.116.071301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Indexed: 06/05/2023]
Abstract
The CDMS low ionization threshold experiment (CDMSlite) uses cryogenic germanium detectors operated at a relatively high bias voltage to amplify the phonon signal in the search for weakly interacting massive particles (WIMPs). Results are presented from the second CDMSlite run with an exposure of 70 kg day, which reached an energy threshold for electron recoils as low as 56 eV. A fiducialization cut reduces backgrounds below those previously reported by CDMSlite. New parameter space for the WIMP-nucleon spin-independent cross section is excluded for WIMP masses between 1.6 and 5.5 GeV/c^{2}.
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Affiliation(s)
- R Agnese
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - A J Anderson
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - T Aramaki
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M Asai
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - W Baker
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - D Balakishiyeva
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - D Barker
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - R Basu Thakur
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - D A Bauer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J Billard
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Borgland
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M A Bowles
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - P L Brink
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R Bunker
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - B Cabrera
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D O Caldwell
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - R Calkins
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - D G Cerdeno
- Institute for Particle Physics Phenomenology, Department of Physics, Durham University, Durham DH1 3LE, United Kingdom
| | - H Chagani
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Y Chen
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - J Cooley
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Cornell
- Division of Physics, Mathematics and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - P Cushman
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Daal
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - P C F Di Stefano
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - T Doughty
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - L Esteban
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - S Fallows
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E Figueroa-Feliciano
- Department of Physics & Astronomy, Northwestern University, Evanston, Illinois 60208-3112, USA
| | - M Ghaith
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - G L Godfrey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S R Golwala
- Division of Physics, Mathematics and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - J Hall
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - H R Harris
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - T Hofer
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - D Holmgren
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Hsu
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M E Huber
- Department of Physics, University of Colorado Denver, Denver, Colorado 80217, USA
| | - D Jardin
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - A Jastram
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - O Kamaev
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - B Kara
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - M H Kelsey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - A Kennedy
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Leder
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Loer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - E Lopez Asamar
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - P Lukens
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - R Mahapatra
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - V Mandic
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - N Mast
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - N Mirabolfathi
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - R A Moffatt
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J D Morales Mendoza
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - S M Oser
- Department of Physics & Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - K Page
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - W A Page
- Department of Physics & Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - R Partridge
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M Pepin
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Phipps
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - K Prasad
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - M Pyle
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - H Qiu
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - W Rau
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - P Redl
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - A Reisetter
- Department of Physics, University of Evansville, Evansville, Indiana 47722, USA
| | - Y Ricci
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - A Roberts
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - H E Rogers
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - T Saab
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - B Sadoulet
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - J Sander
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - K Schneck
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R W Schnee
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - S Scorza
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Serfass
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - B Shank
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D Speller
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - D Toback
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - R Underwood
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - S Upadhyayula
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - A N Villano
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Welliver
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - J S Wilson
- Department of Physics and Astronomy, and the Mitchell Institute for Fundamental Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - D H Wright
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S Yellin
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J J Yen
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - B A Young
- Department of Physics, Santa Clara University, Santa Clara, California 95053, USA
| | - J Zhang
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Sussman JB, Wiitala W, Hofer T, Zawitowski M, Vijan S, Hayward R. Abstract 166: Developing the Veterans Affairs Cardiac Risk Score. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
The risk-based approach employed in the 2013 ACC/AHA lipid guidelines is based on extensive research showing that cardiovascular (CV) risk, not individual risk factors like LDL levels, are more efficient and effective guides for CV prevention pharmacotherapy. The primary limitations of the guideline are ease of use and specific risk scores’ poor calibration between different populations. We hypothesized that we could create a risk tool that solves these problems for 6 million Americans with a relatively small investment by creating an automated risk prediction tool that only uses the VA electronic health record. We hypothesize that this tool will perform as well or better than existing risk tools.
Methods:
Our population consisted of US Veterans ages 45-80 who used VA ambulatory care services in 2001. Participants could have no history of myocardial infarction (MI), stroke, coronary artery bypass grafting, percutaneous coronary intervention, congestive heart failure, or furosemide use. We divided our population into derivation and validation cohorts. We predicted events using traditional risk factors and other established risk factors. Our outcome variable was new-onset MI, stroke, or cardiovascular mortality. We obtained outcome data from VA sources, Medicare, and the National Death Index. We predicted events with logistic regression. We compared the effect of using our risk score in our population with using the “ASCVD” score and the Framingham Score. We then assessed the implication on statin use of guiding care with the ASCVD score vs. our new VARS score.
Results:
Our population had 1.7 million patients. 96% were men. The AUROC was 0.68 for both the VARS score and the ASCVD score in our population. However, the ASCVD score substantially
underpredicted
events, by well over 20% . The VARS score was well-calibrated in the validation analysis. In our sample, almost all US Veterans age 45 and older had a cardiac risk that would recommend statin use.
Conclusion:
We demonstrated that an EHR in a specific population could risk-stratify patients as well those from as organized cohort studies and greatly improve calibration. Further, our finding that the ASCVD score greatly underpredicted in our population, while previous work have reported the ASCVD over-predictind in other cohorts, suggests that rather than arguing about which risk tool is best, our patients may be better served by us focusing on calibrating CV risk tools for our specific patient population using their EHR data.
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Affiliation(s)
- Jeremy B Sussman
- VA Ann Arbor Healthcare System and Univ of Michigan, Ann Arbor, MI
| | | | - Timothy Hofer
- VA Ann Arbor Healthcare System and Univ of Michigan, Ann Arbor, MI
| | | | - Sandeep Vijan
- VA Ann Arbor Healthcare System and Univ of Michigan, Ann Arbor, MI
| | - Rodney Hayward
- VA Ann Arbor Healthcare System and Univ of Michigan, Ann Arbor, MI
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25
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Agnese R, Anderson AJ, Balakishiyeva D, Basu Thakur R, Bauer DA, Billard J, Borgland A, Bowles MA, Brandt D, Brink PL, Bunker R, Cabrera B, Caldwell DO, Cerdeno DG, Chagani H, Chen Y, Cooley J, Cornell B, Crewdson CH, Cushman P, Daal M, Di Stefano PCF, Doughty T, Esteban L, Fallows S, Figueroa-Feliciano E, Godfrey GL, Golwala SR, Hall J, Harris HR, Hertel SA, Hofer T, Holmgren D, Hsu L, Huber ME, Jastram A, Kamaev O, Kara B, Kelsey MH, Kennedy A, Kiveni M, Koch K, Leder A, Loer B, Lopez Asamar E, Mahapatra R, Mandic V, Martinez C, McCarthy KA, Mirabolfathi N, Moffatt RA, Moore DC, Nelson H, Nelson RH, Ogburn RW, Page K, Page WA, Partridge R, Pepin M, Phipps A, Prasad K, Pyle M, Qiu H, Rau W, Redl P, Reisetter A, Ricci Y, Rogers HE, Saab T, Sadoulet B, Sander J, Schneck K, Schnee RW, Scorza S, Serfass B, Shank B, Speller D, Upadhyayula S, Villano AN, Welliver B, Wright DH, Yellin S, Yen JJ, Young BA, Zhang J. First direct limits on lightly ionizing particles with electric charge less than e/6. Phys Rev Lett 2015; 114:111302. [PMID: 25839256 DOI: 10.1103/physrevlett.114.111302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Indexed: 06/04/2023]
Abstract
While the standard model of particle physics does not include free particles with fractional charge, experimental searches have not ruled out their existence. We report results from the Cryogenic Dark Matter Search (CDMS II) experiment that give the first direct-detection limits for cosmogenically produced relativistic particles with electric charge lower than e/6. A search for tracks in the six stacked detectors of each of two of the CDMS II towers finds no candidates, thereby excluding new parameter space for particles with electric charges between e/6 and e/200.
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Affiliation(s)
- R Agnese
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - A J Anderson
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - D Balakishiyeva
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - R Basu Thakur
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - D A Bauer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J Billard
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Borgland
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M A Bowles
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - D Brandt
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - P L Brink
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R Bunker
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - B Cabrera
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D O Caldwell
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - D G Cerdeno
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- IPPP, Department of Physics, Durham University, Durham DH1 3LE, United Kingdom
| | - H Chagani
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Y Chen
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - J Cooley
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Cornell
- Division of Physics, Mathematics, & Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - C H Crewdson
- Department of Physics, Queen's University, Kingston, ON, Canada K7L 3N6
| | - P Cushman
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Daal
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - P C F Di Stefano
- Department of Physics, Queen's University, Kingston, ON, Canada K7L 3N6
| | - T Doughty
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - L Esteban
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - S Fallows
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E Figueroa-Feliciano
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G L Godfrey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S R Golwala
- Division of Physics, Mathematics, & Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - J Hall
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - H R Harris
- Department of Physics & Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - S A Hertel
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - T Hofer
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - D Holmgren
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Hsu
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M E Huber
- Department of Physics, University of Colorado Denver, Denver, Colorado 80217, USA
| | - A Jastram
- Department of Physics & Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - O Kamaev
- Department of Physics, Queen's University, Kingston, ON, Canada K7L 3N6
| | - B Kara
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - M H Kelsey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - A Kennedy
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Kiveni
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - K Koch
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Leder
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Loer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - E Lopez Asamar
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - R Mahapatra
- Department of Physics & Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - V Mandic
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C Martinez
- Department of Physics, Queen's University, Kingston, ON, Canada K7L 3N6
| | - K A McCarthy
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - N Mirabolfathi
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - R A Moffatt
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D C Moore
- Division of Physics, Mathematics, & Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - H Nelson
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - R H Nelson
- Division of Physics, Mathematics, & Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - R W Ogburn
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - K Page
- Department of Physics, Queen's University, Kingston, ON, Canada K7L 3N6
| | - W A Page
- Department of Physics & Astronomy, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - R Partridge
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M Pepin
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Phipps
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - K Prasad
- Department of Physics & Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - M Pyle
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - H Qiu
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - W Rau
- Department of Physics, Queen's University, Kingston, ON, Canada K7L 3N6
| | - P Redl
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - A Reisetter
- Department of Physics, University of Evansville, Evansville, Indiana 47722, USA
| | - Y Ricci
- Department of Physics, Queen's University, Kingston, ON, Canada K7L 3N6
| | - H E Rogers
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - T Saab
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - B Sadoulet
- Department of Physics, University of California, Berkeley, California 94720, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J Sander
- Department of Physics & Astronomy, Texas A&M University, College Station, Texas 77843, USA
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - K Schneck
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R W Schnee
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
- Department of Physics, South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - S Scorza
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
- Karlsruhe Institute of Technology, Institut für Experimentelle Kernphysik, 76128 Karlsruhe, Germany
| | - B Serfass
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - B Shank
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D Speller
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - S Upadhyayula
- Department of Physics & Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - A N Villano
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Welliver
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - D H Wright
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S Yellin
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J J Yen
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - B A Young
- Department of Physics, Santa Clara University, Santa Clara, California 95053, USA
| | - J Zhang
- School of Physics & Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
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26
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Agnese R, Anderson AJ, Asai M, Balakishiyeva D, Basu Thakur R, Bauer DA, Beaty J, Billard J, Borgland A, Bowles MA, Brandt D, Brink PL, Bunker R, Cabrera B, Caldwell DO, Cerdeno DG, Chagani H, Chen Y, Cherry M, Cooley J, Cornell B, Crewdson CH, Cushman P, Daal M, DeVaney D, Di Stefano PCF, Silva EDCE, Doughty T, Esteban L, Fallows S, Figueroa-Feliciano E, Godfrey GL, Golwala SR, Hall J, Hansen S, Harris HR, Hertel SA, Hines BA, Hofer T, Holmgren D, Hsu L, Huber ME, Jastram A, Kamaev O, Kara B, Kelsey MH, Kenany S, Kennedy A, Kiveni M, Koch K, Leder A, Loer B, Lopez Asamar E, Mahapatra R, Mandic V, Martinez C, McCarthy KA, Mirabolfathi N, Moffatt RA, Nelson RH, Novak L, Page K, Partridge R, Pepin M, Phipps A, Platt M, Prasad K, Pyle M, Qiu H, Rau W, Redl P, Reisetter A, Resch RW, Ricci Y, Ruschman M, Saab T, Sadoulet B, Sander J, Schmitt RL, Schneck K, Schnee RW, Scorza S, Seitz DN, Serfass B, Shank B, Speller D, Tomada A, Upadhyayula S, Villano AN, Welliver B, Wright DH, Yellin S, Yen JJ, Young BA, Zhang J. Search for low-mass weakly interacting massive particles with SuperCDMS. Phys Rev Lett 2014; 112:241302. [PMID: 24996080 DOI: 10.1103/physrevlett.112.241302] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Indexed: 06/03/2023]
Abstract
We report a first search for weakly interacting massive particles (WIMPs) using the background rejection capabilities of SuperCDMS. An exposure of 577 kg days was analyzed for WIMPs with mass <30 GeV/c(2), with the signal region blinded. Eleven events were observed after unblinding. We set an upper limit on the spin-independent WIMP-nucleon cross section of 1.2×10(-42) cm(2) at 8 GeV/c(2). This result is in tension with WIMP interpretations of recent experiments and probes new parameter space for WIMP-nucleon scattering for WIMP masses <6 GeV/c(2).
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Affiliation(s)
- R Agnese
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - A J Anderson
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - M Asai
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - D Balakishiyeva
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - R Basu Thakur
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA and Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - D A Bauer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J Beaty
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Billard
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Borgland
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M A Bowles
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - D Brandt
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - P L Brink
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R Bunker
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - B Cabrera
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D O Caldwell
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - D G Cerdeno
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - H Chagani
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Y Chen
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - M Cherry
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - J Cooley
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Cornell
- Division of Physics, Mathematics, & Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - C H Crewdson
- Department of Physics, Queen's University, Kingston, Ontario K7 L 3N6, Canada
| | - P Cushman
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Daal
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - D DeVaney
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - P C F Di Stefano
- Department of Physics, Queen's University, Kingston, Ontario K7 L 3N6, Canada
| | - E Do Couto E Silva
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - T Doughty
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - L Esteban
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - S Fallows
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E Figueroa-Feliciano
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G L Godfrey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S R Golwala
- Division of Physics, Mathematics, & Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - J Hall
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - S Hansen
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - H R Harris
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - S A Hertel
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B A Hines
- Department of Physics, University of Colorado Denver, Denver, Colorado 80217, USA
| | - T Hofer
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - D Holmgren
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Hsu
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M E Huber
- Department of Physics, University of Colorado Denver, Denver, Colorado 80217, USA
| | - A Jastram
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - O Kamaev
- Department of Physics, Queen's University, Kingston, Ontario K7 L 3N6, Canada
| | - B Kara
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - M H Kelsey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S Kenany
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - A Kennedy
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Kiveni
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - K Koch
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Leder
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Loer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - E Lopez Asamar
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - R Mahapatra
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - V Mandic
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C Martinez
- Department of Physics, Queen's University, Kingston, Ontario K7 L 3N6, Canada
| | - K A McCarthy
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - N Mirabolfathi
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - R A Moffatt
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - R H Nelson
- Division of Physics, Mathematics, & Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - L Novak
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K Page
- Department of Physics, Queen's University, Kingston, Ontario K7 L 3N6, Canada
| | - R Partridge
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M Pepin
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Phipps
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - M Platt
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - K Prasad
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - M Pyle
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - H Qiu
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - W Rau
- Department of Physics, Queen's University, Kingston, Ontario K7 L 3N6, Canada
| | - P Redl
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - A Reisetter
- Department of Physics, University of Evansville, Evansville, Indiana 47722, USA
| | - R W Resch
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - Y Ricci
- Department of Physics, Queen's University, Kingston, Ontario K7 L 3N6, Canada
| | - M Ruschman
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - T Saab
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - B Sadoulet
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA and Department of Physics, University of California, Berkeley, California 94720, USA
| | - J Sander
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - R L Schmitt
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - K Schneck
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R W Schnee
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - S Scorza
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - D N Seitz
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - B Serfass
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - B Shank
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D Speller
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - A Tomada
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S Upadhyayula
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - A N Villano
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Welliver
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - D H Wright
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S Yellin
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J J Yen
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - B A Young
- Department of Physics, Santa Clara University, Santa Clara, California 95053, USA
| | - J Zhang
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Manojlovich M, Harrod M, Holtz B, Hofer T, Kuhn L, Krein SL. The use of multiple qualitative methods to characterize communication events between physicians and nurses. Health Commun 2014; 30:61-69. [PMID: 24483246 DOI: 10.1080/10410236.2013.835894] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite the importance of communication to patient safety in hospital settings, we know surprisingly little about communication patterns between physicians and nurses, particularly on general medical-surgical units. Poor communication is the leading cause of preventable adverse events in hospitals, as well as a major root cause of sentinel events. The literature provides little guidance on what qualitative methods are best for capturing different types of communication events and patterns. The purpose of this study was to develop a methodology for identifying and characterizing communication events between physicians and nurses to better understand communication patterns on general medical-surgical units. We used a sequential qualitative mixed method design beginning with general observation, progressing to shadowing and focus groups of physicians and nurses who worked on two medical-surgical units at one academically affiliated U.S. Department of Veterans Affairs (VA) hospital. Each data collection method (observation, shadowing, and focus groups) had its own advantages and disadvantages for capturing communication events and patterns. Through observation we were able to see the "what": communication activities. Shadowing was most useful for understanding "how" physicians and nurses communicated. Focus groups helped answer "why" certain patterns emerged and allowed us to further explore communication events within a group setting. By using all three methods we were able to more thoroughly characterize communication events than by using a single method alone, providing a more holistic picture of how communication occurs on an inpatient medical-surgical unit.
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Agnese R, Anderson AJ, Asai M, Balakishiyeva D, Basu Thakur R, Bauer DA, Billard J, Borgland A, Bowles MA, Brandt D, Brink PL, Bunker R, Cabrera B, Caldwell DO, Cerdeno DG, Chagani H, Cooley J, Cornell B, Crewdson CH, Cushman P, Daal M, Di Stefano PCF, Doughty T, Esteban L, Fallows S, Figueroa-Feliciano E, Godfrey GL, Golwala SR, Hall J, Harris HR, Hertel SA, Hofer T, Holmgren D, Hsu L, Huber ME, Jastram A, Kamaev O, Kara B, Kelsey MH, Kennedy A, Kiveni M, Koch K, Loer B, Lopez Asamar E, Mahapatra R, Mandic V, Martinez C, McCarthy KA, Mirabolfathi N, Moffatt RA, Moore DC, Nadeau P, Nelson RH, Page K, Partridge R, Pepin M, Phipps A, Prasad K, Pyle M, Qiu H, Rau W, Redl P, Reisetter A, Ricci Y, Saab T, Sadoulet B, Sander J, Schneck K, Schnee RW, Scorza S, Serfass B, Shank B, Speller D, Villano AN, Welliver B, Wright DH, Yellin S, Yen JJ, Young BA, Zhang J. Search for low-mass weakly interacting massive particles using voltage-assisted calorimetric ionization detection in the SuperCDMS experiment. Phys Rev Lett 2014; 112:041302. [PMID: 24580434 DOI: 10.1103/physrevlett.112.041302] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Indexed: 06/03/2023]
Abstract
SuperCDMS is an experiment designed to directly detect weakly interacting massive particles (WIMPs), a favored candidate for dark matter ubiquitous in the Universe. In this Letter, we present WIMP-search results using a calorimetric technique we call CDMSlite, which relies on voltage-assisted Luke-Neganov amplification of the ionization energy deposited by particle interactions. The data were collected with a single 0.6 kg germanium detector running for ten live days at the Soudan Underground Laboratory. A low energy threshold of 170 eVee (electron equivalent) was obtained, which allows us to constrain new WIMP-nucleon spin-independent parameter space for WIMP masses below 6 GeV/c2.
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Affiliation(s)
- R Agnese
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - A J Anderson
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - M Asai
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - D Balakishiyeva
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - R Basu Thakur
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA and Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - D A Bauer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J Billard
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Borgland
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M A Bowles
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - D Brandt
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - P L Brink
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R Bunker
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - B Cabrera
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D O Caldwell
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - D G Cerdeno
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - H Chagani
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Cooley
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Cornell
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - C H Crewdson
- Department of Physics, Queen's University, Kingston Ontario, Canada K7L 3N6
| | - P Cushman
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Daal
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - P C F Di Stefano
- Department of Physics, Queen's University, Kingston Ontario, Canada K7L 3N6
| | - T Doughty
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - L Esteban
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - S Fallows
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E Figueroa-Feliciano
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G L Godfrey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S R Golwala
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - J Hall
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - H R Harris
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - S A Hertel
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - T Hofer
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - D Holmgren
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Hsu
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M E Huber
- Department of Physics, University of Colorado Denver, Denver, Colorado 80217, USA
| | - A Jastram
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - O Kamaev
- Department of Physics, Queen's University, Kingston Ontario, Canada K7L 3N6
| | - B Kara
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - M H Kelsey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - A Kennedy
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Kiveni
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - K Koch
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Loer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - E Lopez Asamar
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - R Mahapatra
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - V Mandic
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C Martinez
- Department of Physics, Queen's University, Kingston Ontario, Canada K7L 3N6
| | - K A McCarthy
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - N Mirabolfathi
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - R A Moffatt
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D C Moore
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - P Nadeau
- Department of Physics, Queen's University, Kingston Ontario, Canada K7L 3N6
| | - R H Nelson
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - K Page
- Department of Physics, Queen's University, Kingston Ontario, Canada K7L 3N6
| | - R Partridge
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - M Pepin
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Phipps
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - K Prasad
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - M Pyle
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - H Qiu
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - W Rau
- Department of Physics, Queen's University, Kingston Ontario, Canada K7L 3N6
| | - P Redl
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - A Reisetter
- Department of Physics, University of Evansville, Evansville, Indiana 47722, USA
| | - Y Ricci
- Department of Physics, Queen's University, Kingston Ontario, Canada K7L 3N6
| | - T Saab
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - B Sadoulet
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA and Department of Physics, University of California, Berkeley, California 94720, USA
| | - J Sander
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - K Schneck
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - R W Schnee
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - S Scorza
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Serfass
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - B Shank
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D Speller
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - A N Villano
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Welliver
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - D H Wright
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, 2575 Sand Hill Road, Menlo Park, California 94025, USA
| | - S Yellin
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J J Yen
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - B A Young
- Department of Physics, Santa Clara University, Santa Clara, California 95053, USA
| | - J Zhang
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
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29
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Agnese R, Ahmed Z, Anderson AJ, Arrenberg S, Balakishiyeva D, Basu Thakur R, Bauer DA, Billard J, Borgland A, Brandt D, Brink PL, Bruch T, Bunker R, Cabrera B, Caldwell DO, Cerdeno DG, Chagani H, Cooley J, Cornell B, Crewdson CH, Cushman P, Daal M, Dejongh F, do Couto e Silva E, Doughty T, Esteban L, Fallows S, Figueroa-Feliciano E, Filippini J, Fox J, Fritts M, Godfrey GL, Golwala SR, Hall J, Harris RH, Hertel SA, Hofer T, Holmgren D, Hsu L, Huber ME, Jastram A, Kamaev O, Kara B, Kelsey MH, Kennedy A, Kim P, Kiveni M, Koch K, Kos M, Leman SW, Loer B, Lopez Asamar E, Mahapatra R, Mandic V, Martinez C, McCarthy KA, Mirabolfathi N, Moffatt RA, Moore DC, Nadeau P, Nelson RH, Page K, Partridge R, Pepin M, Phipps A, Prasad K, Pyle M, Qiu H, Rau W, Redl P, Reisetter A, Ricci Y, Saab T, Sadoulet B, Sander J, Schneck K, Schnee RW, Scorza S, Serfass B, Shank B, Speller D, Sundqvist KM, Villano AN, Welliver B, Wright DH, Yellin S, Yen JJ, Yoo J, Young BA, Zhang J. Silicon detector dark matter results from the final exposure of CDMS II. Phys Rev Lett 2013; 111:251301. [PMID: 24483735 DOI: 10.1103/physrevlett.111.251301] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 07/27/2013] [Indexed: 06/03/2023]
Abstract
We report results of a search for weakly interacting massive particles (WIMPS) with the silicon detectors of the CDMS II experiment. This blind analysis of 140.2 kg day of data taken between July 2007 and September 2008 revealed three WIMP-candidate events with a surface-event background estimate of 0.41(-0.08)(+0.20)(stat)(-0.24)(+0.28)(syst). Other known backgrounds from neutrons and 206Pb are limited to <0.13 and <0.08 events at the 90% confidence level, respectively. The exposure of this analysis is equivalent to 23.4 kg day for a recoil energy range of 7-100 keV for a WIMP of mass 10 GeV/c2. The probability that the known backgrounds would produce three or more events in the signal region is 5.4%. A profile likelihood ratio test of the three events that includes the measured recoil energies gives a 0.19% probability for the known-background-only hypothesis when tested against the alternative WIMP+background hypothesis. The highest likelihood occurs for a WIMP mass of 8.6 GeV/c2 and WIMP-nucleon cross section of 1.9×10(-41) cm2.
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Affiliation(s)
- R Agnese
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - Z Ahmed
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - A J Anderson
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S Arrenberg
- Physics Institute, University of Zürich, Winterthurerstrasse 190, CH-8057, Switzerland
| | - D Balakishiyeva
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - R Basu Thakur
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - D A Bauer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - J Billard
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Borgland
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - D Brandt
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - P L Brink
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - T Bruch
- Physics Institute, University of Zürich, Winterthurerstrasse 190, CH-8057, Switzerland
| | - R Bunker
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - B Cabrera
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D O Caldwell
- Department of Physics, University of California, Santa Barbara, California 93106, USA
| | - D G Cerdeno
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - H Chagani
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Cooley
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Cornell
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - C H Crewdson
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - P Cushman
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Daal
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - F Dejongh
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - E do Couto e Silva
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - T Doughty
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - L Esteban
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - S Fallows
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E Figueroa-Feliciano
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Filippini
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - J Fox
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - M Fritts
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - G L Godfrey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - S R Golwala
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - J Hall
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - R H Harris
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - S A Hertel
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - T Hofer
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - D Holmgren
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - L Hsu
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - M E Huber
- Department of Physics, University of Colorado, Denver, Colorado 80217, USA
| | - A Jastram
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - O Kamaev
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - B Kara
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - M H Kelsey
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - A Kennedy
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - P Kim
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - M Kiveni
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - K Koch
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Kos
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - S W Leman
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Loer
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - E Lopez Asamar
- Departamento de Física Teórica and Instituto de Física Teórica UAM/CSIC, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - R Mahapatra
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - V Mandic
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C Martinez
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - K A McCarthy
- Department of Physics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - N Mirabolfathi
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - R A Moffatt
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D C Moore
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - P Nadeau
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - R H Nelson
- Division of Physics, Mathematics, and Astronomy, California Institute of Technology, Pasadena, California 91125, USA
| | - K Page
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - R Partridge
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - M Pepin
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Phipps
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - K Prasad
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - M Pyle
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - H Qiu
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - W Rau
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - P Redl
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - A Reisetter
- Department of Physics, University of Evansville, Evansville, Indiana 47722, USA
| | - Y Ricci
- Department of Physics, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - T Saab
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - B Sadoulet
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA and Department of Physics, University of California, Berkeley, California 94720, USA
| | - J Sander
- Department of Physics, Texas A&M University, College Station, Texas 77843, USA
| | - K Schneck
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - R W Schnee
- Department of Physics, Syracuse University, Syracuse, New York 13244, USA
| | - S Scorza
- Department of Physics, Southern Methodist University, Dallas, Texas 75275, USA
| | - B Serfass
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - B Shank
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D Speller
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - K M Sundqvist
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - A N Villano
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Welliver
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - D H Wright
- SLAC National Accelerator Laboratory/Kavli Institute for Particle Astrophysics and Cosmology, Menlo Park, California 94025, USA
| | - S Yellin
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J J Yen
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J Yoo
- Fermi National Accelerator Laboratory, Batavia, Illinois 60510, USA
| | - B A Young
- Department of Physics, Santa Clara University, Santa Clara, California 95053, USA
| | - J Zhang
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
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30
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Sargurupremraj M, Pukelsheim K, Hofer T, Wjst M. Intermediary quantitative traits--an alternative in the identification of disease genes in asthma? Genes Immun 2013; 15:1-7. [PMID: 24131956 DOI: 10.1038/gene.2013.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/23/2013] [Accepted: 09/09/2013] [Indexed: 01/14/2023]
Abstract
Intermediary quantitative traits are a possible alternative for the identification of disease genes. This may be particularly relevant when diagnostic criteria are not very well defined as described for asthma. We analyzed serum samples from 944 individuals of 218 asthma families for 17 cytokines (eotaxin, GM-CSF, IFNγ, IL1B, IL1RA, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12(p40), IL-13, IL-17, IL-23, IL-33, TSLP and TNF-α) and determined the heritability. Linked chromosomal regions were identified by a genome-wide analysis using 334 autosomal microsatellite marker and association tested by further 550 SNP marker at genes implicated earlier with immune response. Heritability varied with TNF-α and IL-8 levels having the highest and TSLP having the lowest heritability. Linkage was significantly increased only for IL-12(p40) at D17S949. There were multiple significant single-nucleotide polymorphisms (SNP) associations (P<0.05) as found in the transmission disequilibrium test, whereas only a few replicated in parents or children only. These include SNPs in IL1RN that were associated with IL-33 and TSLP levels, and a SNP in NR3C2 that was associated with eotaxin, IL-13 and IFN-γ levels. Circulating level of serum cytokines exhibits genetic associations with asthma traits that are otherwise not detected using clinical diagnosis or when the clinical details are ambiguous.
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Affiliation(s)
- M Sargurupremraj
- Institute of Lung Biology and Health (iLBD), Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - K Pukelsheim
- Institute of Lung Biology and Health (iLBD), Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - T Hofer
- Institute of Lung Biology and Health (iLBD), Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Munich-Neuherberg, Germany
| | - M Wjst
- Institute of Lung Biology and Health (iLBD), Comprehensive Pneumology Center (CPC), Helmholtz Zentrum München, Munich-Neuherberg, Germany
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31
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Laetsch B, Hofer T, Lombriser N, Lautenschlager S. Irradiation-induced morphea: x-rays as triggers of autoimmunity. Dermatology 2011; 223:9-12. [PMID: 21865672 DOI: 10.1159/000330324] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 05/19/2011] [Indexed: 11/19/2022] Open
Abstract
We report on 3 females with breast cancer who developed morphea at the site of post-surgery radiotherapy. One was suffering from other autoimmune skin diseases before the diagnosis and treatment of breast cancer. Postirradiation morphea is a potential complication after radiotherapy, particularly radiotherapy for cancer. This troublesome skin disease can occur months to years after treatment, and is associated with remarkable morbidity and pain, and also cosmetic aspects. Therefore, it is crucial to be aware of this condition, and to try to identify patients who might be at an increased risk of developing morphea.
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Affiliation(s)
- B Laetsch
- Department of Dermatology, Triemli Hospital, Zurich, Switzerland
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Hafner J, Mayer D, Amann B, French LE, Läuchli S, Hofer T, Ramelet AA, Jeanneret C. [Chronic venous insufficiency in postthrombotic syndrome and varicose veins]. Praxis (Bern 1994) 2010; 99:1195-1202. [PMID: 20931495 DOI: 10.1024/1661-8157/a000262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Venous disorders have a high prevalence and require approximately 1% of health budgets of industrialized countries. The postthrombotic syndrome (PTS) is defined by subjective symptoms and morphologic trophical skin changes following deep venous thrombosis. Prevention of venous thromboembolism in risk situations, easy availability of diagnostic tools (D-dimers, colour-coded duplex sonography) and early detection of deep venous thrombosis, as well as immediate therapeutic anticoagulation along with leg compression during the acute phase and over a two year period of time significantly reduce the incidence of PTS. Chronic venous insufficiency (CVI) includes trophical skin and soft tissue pathologies of the lower leg due to venous hypertension in the distal venous system of the lower extremity. Roughly, two main causes can be distinguished. (A) Deep venous insufficiency (A1 in postthrombotic syndrome; A2 in primary deep venous insufficiency) and (B) superficial venous reflux, usually varicose veins. Compression therapy, surgical ablation of superficial venous reflux, and tangential ablation with split skin graft (shave treatment) of refractory venous ulcers are the mainstays in the treatment of CVI.
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Affiliation(s)
- Jürg Hafner
- Dermatologische Klinik, Universitätsspital Zürich, Zürich.
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Stittrich AB, Haftmann C, Hegazy A, Floessdorf M, Dong J, Fuhrmann F, Heinz G, Li N, Fang Z, Jahn A, Baumgrass R, Grun J, Chen W, Hofer T, Lohning M, Chang HD, Rajewsky N, Radbruch A, Mashreghi MF. MicroRNA-182 promotes clonal expansion of activated T helper cells. Ann Rheum Dis 2010. [DOI: 10.1136/ard.2010.129668a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Patterns of genetic diversity between populations are often used to detect loci under selection in genome scans. Indeed, loci involved in local adaptations should show high F(ST) values, whereas loci under balancing selection should rather show low F(ST) values. Most tests of selection based on F(ST) use a null distribution generated under a simple island model of population differentiation. Although this model has been shown to be robust, many species have a more complex genetic structure, with some populations sharing a recent ancestry or due to the presence of barriers to gene flow between different parts of a species range. In this paper, we propose the use of a hierarchical island model, in which demes exchange more migrants within groups than between groups, to generate the joint distribution of genetic diversity within and between populations. We show that tests not accounting for a hierarchical structure, when it exists, do generate a large excess of false positive loci, whereas the hierarchical island model is robust to uncertainties about the exact number of groups and demes per group in the system. Our approach also explicitly takes into account the mutational process, and does not just rely on allele frequencies, which is important for short tandem repeat (STR) data. An application to human and stickleback STR data sets reveals a much lower number of significant loci than previously obtained under a non-hierarchical model. The elimination of false positive loci from genome scans should allow us to better determine on which specific class of genes selection is operating.
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Affiliation(s)
- L Excoffier
- Computational and Molecular Population Genetics Lab, Institute of Ecology and Evolution, University of Bern, Bern, Switzerland.
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Hofer T, Ray N, Wegmann D, Excoffier L. Large Allele Frequency Differences between Human Continental Groups are more Likely to have Occurred by Drift During range Expansions than by Selection. Ann Hum Genet 2009; 73:95-108. [PMID: 19040659 DOI: 10.1111/j.1469-1809.2008.00489.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Hofer
- Computational and Molecular Population Genetics Lab, Institute of Ecology and Evolution, University of Bern, 3012 Bern, Switzerland
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Hofer T. A rare cause for discomfort of the legs. Phlebologie 2009. [DOI: 10.1055/s-0037-1622282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThis paper presents two women who visited the phlebology surgery in the opinion that varices would be responsible for their symptoms. Patient 1 complained of nocturnal pain that radiated from the posterior surface of the left thigh to the anterior and lateral surfaces of the knee and lateral aspect of the calf. This pain occurred whenever she changed position. Patient 2 felt numbness in her right foot and an annoying burning sensation in her right heel. She was known to have lumbar discopathy and stenosis of the spinal canal which however, according to neurological diagnosis, could not explain the symptoms. On clinical examination neither had visible nor palpable varices, nor any recognisable dermal signs of venous hypertension. However, it was conspicuous that the left foot of patient 1 barely reached the floor when she was sitting down. In patient 2 the circumference of the right calf was increased by 2 cm.In both cases a coarse, circumscribed thickening was palpable deep in the posterior surface of the thigh (patient 1) and the proximal calf (patient 2). This was responsible for the asymmetrical posture in sitting of patient 1. Doppler/duplex sonography did not reveal any pathological findings in either patient. Thanks to MRI scans the cause in both cases was found to be a subfascial tumour that was displacing the musculature, thus compressing nervous structures; once in the thigh (patient 1: 600 g), once in the calf (patient 2: 200 g). In both women the symptoms disappeared after surgical extirpation of the clinically and histologically verified lipomas.
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Brown C, Hofer T, Johal A, Thomson R, Nicholl J, Franklin BD, Lilford RJ. An epistemology of patient safety research: a framework for study design and interpretation. Part 3. End points and measurement. Qual Saf Health Care 2008; 17:170-7. [PMID: 18519622 DOI: 10.1136/qshc.2007.023655] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This article builds on the previous two articles in this series, which focused on an evaluation framework and study designs for patient safety research. The current article focuses on what to measure as evidence of safety and how these measurements can be undertaken. It considers four different end points, highlighting their methodological advantages and disadvantages: patient outcomes, fidelity, intervening variables and clinical error. The choice of end point depends on the nature of the intervention being evaluated and the patient safety problem it has been designed to address. This paper also discusses the different methods of measuring error, reviewing best practice and paying particular attention to case note review. Two key issues with any method of data collection are ensuring construct validity and reliability. Since no end point or method of data collection is infallible, the present authors advocate the use of multiple end points and methods where feasible.
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Affiliation(s)
- C Brown
- Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Brown C, Hofer T, Johal A, Thomson R, Nicholl J, Franklin BD, Lilford RJ. An epistemology of patient safety research: a framework for study design and interpretation. Part 1. Conceptualising and developing interventions. Qual Saf Health Care 2008; 17:158-62. [PMID: 18519620 DOI: 10.1136/qshc.2007.023630] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This is the first of a four-part series of articles examining the epistemology of patient safety research. Parts 2 and 3 will describe different study designs and methods of measuring outcomes in the evaluation of patient safety interventions, before Part 4 suggests that "one size does not fit all". Part 1 sets the scene by defining patient safety research as a challenging form of service delivery and organisational research that has to deal (although not exclusively) with some very rare events. It then considers two inter-related ideas: a causal chain that can be used to identify where in an organisation's structure and/or processes an intervention may impact; and the need for preimplementation evaluation of proposed interventions. Finally, the paper outlines the authors' pragmatist ontological stance to patient safety research, which sets the philosophical basis for the remaining three articles.
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Affiliation(s)
- C Brown
- Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Brown C, Hofer T, Johal A, Thomson R, Nicholl J, Franklin BD, Lilford RJ. An epistemology of patient safety research: a framework for study design and interpretation. Part 2. Study design. Qual Saf Health Care 2008; 17:163-9. [PMID: 18519621 DOI: 10.1136/qshc.2007.023648] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This is the second in a four-part series of articles detailing the epistemology of patient safety research. This article concentrates on issues of study design. It first considers the range of designs that may be used in the evaluation of patient safety interventions, highlighting the circumstances in which each is appropriate. The paper then provides details about an innovative study design, the stepped wedge, which may be particularly appropriate in the context of patient safety interventions, since these are expected to do more good than harm. The unit of allocation in patient safety research is also considered, since many interventions need to be delivered at cluster or service level. The paper also discusses the need to ensure the masking of patients, caregivers, observers and analysts wherever possible to minimise information biases and the Hawthorne effect. The difficulties associated with masking in patient safety research are described and suggestions given on how these can be ameliorated. The paper finally considers the role of study design in increasing confidence in the generalisability of study results over time and place. The extent to which findings can be generalised over time and place should be considered as part of an evaluation, for example by undertaking qualitative or quantitative measures of fidelity, attitudes or subgroup effects.
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Affiliation(s)
- C Brown
- Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Brown C, Hofer T, Johal A, Thomson R, Nicholl J, Franklin BD, Lilford RJ. An epistemology of patient safety research: a framework for study design and interpretation. Part 4. One size does not fit all. Qual Saf Health Care 2008; 17:178-81. [DOI: 10.1136/qshc.2007.023663] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Katz SJ, Hawley ST, Hamilton AS, Hofer T. Patient satisfaction and surgeon experience: Does system quality matter? J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6525] [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: 11/20/2022] Open
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Baskar S, Kwong KY, Hofer T, Levy JM, Kennedy MG, Lee E, Staudt LM, Wilson WH, Wiestner A, Rader C. Unique Cell Surface Expression of Receptor Tyrosine Kinase ROR1 in Human B-Cell Chronic Lymphocytic Leukemia. Clin Cancer Res 2008; 14:396-404. [DOI: 10.1158/1078-0432.ccr-07-1823] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lilford R, Edwards A, Girling A, Hofer T, Di Tanna GL, Petty J, Nicholl J. Inter-rater reliability of case-note audit: a systematic review. J Health Serv Res Policy 2007; 12:173-80. [PMID: 17716421 DOI: 10.1258/135581907781543012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The quality of clinical care is often assessed by retrospective examination of case-notes (charts, medical records). Our objective was to determine the inter-rater reliability of case-note audit. METHODS We conducted a systematic review of the inter-rater reliability of case-note audit. Analysis was restricted to 26 papers reporting comparisons of two or three raters making independent judgements about the quality of care. RESULTS Sixty-six separate comparisons were possible, since some papers reported more than one measurement of reliability. Mean kappa values ranged from 0.32 to 0.70. These may be inflated due to publication bias. Measured reliabilities were found to be higher for case-note reviews based on explicit, as opposed to implicit, criteria and for reviews that focused on outcome (including adverse effects) rather than process errors. We found an association between kappa and the prevalence of errors (poor quality care), suggesting alternatives such as tetrachoric and polychoric correlation coefficients be considered to assess inter-rater reliability. CONCLUSIONS Comparative studies should take into account the relationship between kappa and the prevalence of the events being measured.
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Affiliation(s)
- Richard Lilford
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK.
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Bitterle E, Karg E, Schroeppel A, Kreyling WG, Tippe A, Ferron GA, Schmid O, Heyder J, Maier KL, Hofer T. Dose-controlled exposure of A549 epithelial cells at the air-liquid interface to airborne ultrafine carbonaceous particles. Chemosphere 2006; 65:1784-90. [PMID: 16762398 DOI: 10.1016/j.chemosphere.2006.04.035] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 04/03/2006] [Accepted: 04/11/2006] [Indexed: 05/10/2023]
Abstract
The geometry of commercially available perfusion chambers designed for harbouring three membrane-based cell cultures was modified for reliable and dose-controlled air-liquid interface (ALI) exposures. Confluent A549 epithelial cells grown on membranes were integrated in the chamber system and supplied with medium from the chamber bottom. Cell viability was not impaired by the conditions of ALI exposure without particles. Expression of the inflammatory cytokines interleukin 6 and interleukin 8 by A549 cells during ALI exposure to filtered air for 6h and subsequent stimulation with tumor necrosis factor was not altered compared to submersed controls, indicating that the cells maintained their functional integrity. Ultrafine carbonaceous model particles with a count median mobility diameter of about 95+/-5 nm were produced by spark discharge at a stable concentration of about 2 x 10(6) cm(-3) and continuously monitored for accurate determination of the exposure dose. Delivery to the ALI exposure system yielded a homogeneous particle deposition over the membranes with a deposition efficiency of 2%. Mid dose exposure of A549 cells to this aerosol for 6h yielded a total particle deposition of (2.6+/-0.4) x 10(8) cm(-2) corresponding to (87+/-23) ng cm(-2). The 2.7-fold (p < or = 0.05) increased transcription of heme oxygenase-1 indicated a sensitive antioxidant and stress response, while cell viability did not reveal a toxic mechanism.
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Affiliation(s)
- E Bitterle
- GSF National Research Center for Environment and Health, Institute for Inhalation Biology, Ingolstaedter Landstr. 1, D-85764 Neuherberg/Munich, Germany
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Hawley S, Lantz P, Salem B, Fagerlin A, Janz N, Morrow M, Hofer T, Deapen D, Liu L, Schwartz K, Katz SJ. Patient and surgeon correlates of shared decision making for surgical breast cancer treatment. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6031 Background: The choice of surgical breast cancer treatment represents an opportunity for shared decision making (SDM), since both mastectomy and breast conserving surgery are viable options. Yet women vary in their desire for involvement in this decision. Correlates of SDM and/or the level of involvement in breast cancer surgical treatment decision-making are not known. Methods: Breast cancer patients of Detroit and Los Angeles SEER registries were mailed a questionnaire shortly after diagnosis in 2002 (N = 1,800, RR: 77%). Their responses were merged with a surgeon survey (N = 456, RR: 80%) for a dataset of 1,547 patients of 318 surgeons. Surgical treatment decision making was categorized into: 1) surgeon-based; 2) shared; or 3) patient-based. The concordance between a woman’s self-reported actual and desired decisional involvement was categorized as having more, less, or the right amount of involvement. Decision making and concordance were each analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient clinical, treatment and demographic factors, surgeon demographic and practice-related factors, and a measure of surgeon-patient communication. Results: 37% of women reported the surgery decision was shared, 25% that it was surgeon-based, and 38% that it was patient-based. Two-thirds experienced the right amount of involvement, while 13% had less and 19% had more. Compared to women who reported a shared decision, those with surgeon-based decision were significantly (p < 0.05) more likely to have male surgeons, and those reporting a patient-based decision were more likely to have received mastectomy vs. breast conserving surgery. Women who were less involved in the surgery decision than they wanted were younger and had less education, while those with more involvement (vs. the right amount) more often had male surgeons. Patient-surgeon communication was associated with decisional involvement. Conclusions: Correlates of SDM and decisional involvement relating to surgical breast cancer treatment differ. Determining patients’ desired role in decision making may as important as achieving a shared decision for evaluating perceived quality of care. No significant financial relationships to disclose.
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Affiliation(s)
- S. Hawley
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - P. Lantz
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - B. Salem
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - A. Fagerlin
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - N. Janz
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - M. Morrow
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - T. Hofer
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - D. Deapen
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - L. Liu
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - K. Schwartz
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
| | - S. J. Katz
- University of Michigan, Ann Arbor, MI; Fox Chase Cancer Center, Philadelphia, PA; University of Southern California, Los Angeles, CA; Wayne State University, Detroit, MI
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Kujoth GC, Hiona A, Pugh TD, Someya S, Panzer K, Wohlgemuth SE, Hofer T, Seo AY, Sullivan R, Jobling WA, Morrow JD, Van Remmen H, Sedivy JM, Yamasoba T, Tanokura M, Weindruch R, Leeuwenburgh C, Prolla TA. Mitochondrial DNA mutations, oxidative stress, and apoptosis in mammalian aging. Science 2005; 309:481-4. [PMID: 16020738 DOI: 10.1126/science.1112125] [Citation(s) in RCA: 1522] [Impact Index Per Article: 80.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mutations in mitochondrial DNA (mtDNA) accumulate in tissues of mammalian species and have been hypothesized to contribute to aging. We show that mice expressing a proofreading-deficient version of the mitochondrial DNA polymerase g (POLG) accumulate mtDNA mutations and display features of accelerated aging. Accumulation of mtDNA mutations was not associated with increased markers of oxidative stress or a defect in cellular proliferation, but was correlated with the induction of apoptotic markers, particularly in tissues characterized by rapid cellular turnover. The levels of apoptotic markers were also found to increase during aging in normal mice. Thus, accumulation of mtDNA mutations that promote apoptosis may be a central mechanism driving mammalian aging.
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Affiliation(s)
- G C Kujoth
- Departments of Genetics and Medical Genetics, University of Wisconsin, Madison, WI 53706, USA
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Hawley S, Hofer T, Lakhani I, Katz S. Determinants of surgeon variation in local therapy for breast cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6003] [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: 11/20/2022] Open
Affiliation(s)
- S. Hawley
- Univ of Michigan and Ann Arbor VAMC, Ann Arbor, MI
| | - T. Hofer
- Univ of Michigan and Ann Arbor VAMC, Ann Arbor, MI
| | - I. Lakhani
- Univ of Michigan and Ann Arbor VAMC, Ann Arbor, MI
| | - S. Katz
- Univ of Michigan and Ann Arbor VAMC, Ann Arbor, MI
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Hofer T. Die Perforansvenen bei der Entwicklung der epifaszialen Varikosis. Hautarzt 2004; 55:367-70. [PMID: 15146883 DOI: 10.1007/s00105-004-0707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM Does it make sense to dissect any incompetent perforator which is found with the color duplex sonography during the preoperative mapping of varicose veins? PATIENTS AND METHODS 221 patients with recurrent varicose veins were examined by color duplex sonography for new transfascial insufficiencies. RESULTS Among 371 transfascial insufficiencies there were 61 (16.4%) incompetent perforators. 31 isolated perforators (25 (9.4%) of 266 legs isolated perforators of the thigh,6 (2.3%) isolated perforators of the calf) were exclusively responsible for the recurrence of varicose veins. 13 incompetent perforators of the calf were associated with additional transfascial insufficiencies,as well as superficial and in 3 cases even deep varicose veins, resulting at an advanced clinical stage (CEAP-classification C3-CS). CONCLUSION The dissection of the thigh perforators and the rare isolated perforators of the calf may help to protect from possible and early recurrence.
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Affiliation(s)
- T Hofer
- Dermatologie FMH Phlebologie SGP, Operative Dermatologie VOD, Wettingen, Schweiz.
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Zeisig M, Hofer T, Cadet J, Möller L. 436 32P-HPLC analysis of 8-oxo-2′-deoxyguanosine. Toxicol Lett 2003. [DOI: 10.1016/s0378-4274(03)90435-8] [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: 11/24/2022]
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