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Sanghera C, McClurg DP, Jones CM. Systematic Review of Hypofractionated Radiation Therapy for the Treatment of Oesophageal Squamous Cell Carcinoma and Oesophageal Adenocarcinoma. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00115-8. [PMID: 38631975 DOI: 10.1016/j.clon.2024.03.020] [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: 10/02/2023] [Revised: 01/15/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND AIM There has been limited progress made in improving the suboptimal outcomes delivered by conventionally fractionated radiotherapy (RT) for oesophageal adenocarcinoma (OAC) and squamous cell carcinoma (OSCC). A greater biological effect may be achieved using hypofractionated RT (HFRT), though the toxicity, tolerability and efficacy of this approach in OAC and OSCC is uncertain. METHODS A systematic literature review was carried out in accordance with Preferred Reporting Items for Systematic Reviews guidance. Medline, EMBASE, PubMed, Cochrane, CINAHL, Scopus and Web of Science databases were searched for terms relating to HFRT (>2.4Gy per fraction) for OAC or OSCC. All relevant clinical studies published between January 2000 and April 2023 were included. Study quality was assessed using predefined criteria. RESULTS Ninety-six studies were screened and 20 subsequently included, together incorporating 1208 patients. Fourteen studies focussed on neoadjuvant or definitive treatment. These were predominantly retrospective (n = 10, 71%) though two (n = 2, 14%) early phase trials were identified. Most focussed on OSCC (n = 7, 47%) or mixed OSCC/OAC (n = 6, 43%) populations. Four (28.6%) included a conventionally fractionated chemoradiotherapy (CRT) comparator, against which median overall (mOS) and progression free survival outcomes from HFRT did not differ. Reported mOS for HFRT ranged between 29-36 months at 2.5-3.125Gy per fraction (total dose 50-60Gy) for OAC and OSCC combined. Toxicity and tolerability with HFRT was comparable with conventionally fractionated CRT up to, but not exceeding, 5Gy. Three (50%) of the six palliative-intent studies were early phase trials and most (n = 4, 67%) focussed on OAC and OSCC. Response rates with HFRT in the palliative setting were 63.6-88.0%. CONCLUSION These data provide evidence in OAC/OSCC for promising efficacy and an acceptable toxicity profile for moderately HFRT, alone or with concurrent chemotherapy. These data should prompt prospective, randomised comparisons of HFRT and conventionally fractionated CRT and single-modality RT schedules. REGISTRATION DETAILS PROSPERO; CRD42023457791.
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Affiliation(s)
- C Sanghera
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D P McClurg
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C M Jones
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, University of Cambridge, Cambridge, UK.
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Buchlak QD, Tang CHM, Seah JCY, Johnson A, Holt X, Bottrell GM, Wardman JB, Samarasinghe G, Dos Santos Pinheiro L, Xia H, Ahmad HK, Pham H, Chiang JI, Ektas N, Milne MR, Chiu CHY, Hachey B, Ryan MK, Johnston BP, Esmaili N, Bennett C, Goldschlager T, Hall J, Vo DT, Oakden-Rayner L, Leveque JC, Farrokhi F, Abramson RG, Jones CM, Edelstein S, Brotchie P. Effects of a comprehensive brain computed tomography deep learning model on radiologist detection accuracy. Eur Radiol 2024; 34:810-822. [PMID: 37606663 PMCID: PMC10853361 DOI: 10.1007/s00330-023-10074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES Non-contrast computed tomography of the brain (NCCTB) is commonly used to detect intracranial pathology but is subject to interpretation errors. Machine learning can augment clinical decision-making and improve NCCTB scan interpretation. This retrospective detection accuracy study assessed the performance of radiologists assisted by a deep learning model and compared the standalone performance of the model with that of unassisted radiologists. METHODS A deep learning model was trained on 212,484 NCCTB scans drawn from a private radiology group in Australia. Scans from inpatient, outpatient, and emergency settings were included. Scan inclusion criteria were age ≥ 18 years and series slice thickness ≤ 1.5 mm. Thirty-two radiologists reviewed 2848 scans with and without the assistance of the deep learning system and rated their confidence in the presence of each finding using a 7-point scale. Differences in AUC and Matthews correlation coefficient (MCC) were calculated using a ground-truth gold standard. RESULTS The model demonstrated an average area under the receiver operating characteristic curve (AUC) of 0.93 across 144 NCCTB findings and significantly improved radiologist interpretation performance. Assisted and unassisted radiologists demonstrated an average AUC of 0.79 and 0.73 across 22 grouped parent findings and 0.72 and 0.68 across 189 child findings, respectively. When assisted by the model, radiologist AUC was significantly improved for 91 findings (158 findings were non-inferior), and reading time was significantly reduced. CONCLUSIONS The assistance of a comprehensive deep learning model significantly improved radiologist detection accuracy across a wide range of clinical findings and demonstrated the potential to improve NCCTB interpretation. CLINICAL RELEVANCE STATEMENT This study evaluated a comprehensive CT brain deep learning model, which performed strongly, improved the performance of radiologists, and reduced interpretation time. The model may reduce errors, improve efficiency, facilitate triage, and better enable the delivery of timely patient care. KEY POINTS • This study demonstrated that the use of a comprehensive deep learning system assisted radiologists in the detection of a wide range of abnormalities on non-contrast brain computed tomography scans. • The deep learning model demonstrated an average area under the receiver operating characteristic curve of 0.93 across 144 findings and significantly improved radiologist interpretation performance. • The assistance of the comprehensive deep learning model significantly reduced the time required for radiologists to interpret computed tomography scans of the brain.
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Affiliation(s)
- Quinlan D Buchlak
- Annalise.ai, Sydney, NSW, Australia.
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia.
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia.
| | | | - Jarrel C Y Seah
- Annalise.ai, Sydney, NSW, Australia
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | | | | | | | | | | | | | | | | | - Hung Pham
- Annalise.ai, Sydney, NSW, Australia
- Department of Radiology, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Jason I Chiang
- Annalise.ai, Sydney, NSW, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | - Nazanin Esmaili
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia
| | - Christine Bennett
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia
- Department of Surgery, Monash University, Clayton, VIC, Australia
| | - Jonathan Hall
- Annalise.ai, Sydney, NSW, Australia
- Department of Radiology, St Vincent's Health Australia, Melbourne, VIC, Australia
- Department of Radiology, Austin Hospital, Melbourne, VIC, Australia
| | - Duc Tan Vo
- Department of Radiology, University Medical Center, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lauren Oakden-Rayner
- Australian Institute for Machine Learning, The University of Adelaide, Adelaide, SA, Australia
| | | | - Farrokh Farrokhi
- Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, WA, USA
| | | | - Catherine M Jones
- Annalise.ai, Sydney, NSW, Australia
- I-MED Radiology Network, Brisbane, QLD, Australia
- School of Public and Preventive Health, Monash University, Clayton, VIC, Australia
- Department of Clinical Imaging Science, University of Sydney, Sydney, NSW, Australia
| | - Simon Edelstein
- Annalise.ai, Sydney, NSW, Australia
- I-MED Radiology Network, Brisbane, QLD, Australia
- Department of Radiology, Monash Health, Clayton, VIC, Australia
| | - Peter Brotchie
- Annalise.ai, Sydney, NSW, Australia
- Department of Radiology, St Vincent's Health Australia, Melbourne, VIC, Australia
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Khoury EG, Lynch-Kelly K, Fulton-Ward T, Heritage S, Devasar A, Jones CM. Online Oncology Careers Events to Attract the Future Oncology Medical Workforce: An Exemplar Event and Review of the Literature. Clin Oncol (R Coll Radiol) 2024; 36:e51-e60. [PMID: 37932187 DOI: 10.1016/j.clon.2023.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/18/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
AIMS There are too few oncologists to meet the increasing burden imposed by the rising incidence of cancer. This results from issues with the retention of established oncologists and longstanding challenges to the recruitment of adequate numbers of trainees. To counter this, the British Oncology Network for Undergraduate Societies (BONUS) devised an online oncology careers event for medical students and junior doctors who are yet to select a specialty. MATERIALS AND METHODS An online careers event was devised with a focus on oncology practice and related subspecialties, as well as research. Event attendees were asked to respond to piloted pre- and post-event surveys. Knowledge and attitudes towards a career in oncology were evaluated using Likert scale and multiple-choice questions. A systematic literature search was carried out to contextualise these data. RESULTS Of the 73 attendees, 44 (60%) participants completed both the pre- and post-event surveys; 79.5% of attendees believed that information on a career in oncology is lacking in medical training. This viewpoint was supported by the systematic review, which highlighted a need for relevant focussed interventions targeted at medical students and fledgling doctors. The education event led to an increase in the median reported understanding of the oncology career pathway from 6.0 to 8.0 (P < 0.05 and P < 0.001), as well as the likelihood of pursuing a career in oncology (8.0-9.0; P < 0.05). It was also associated with a proportional increase in medical and surgical oncology interest, albeit with a fall in interest in clinical and interventional oncology as well as academia. CONCLUSION A targeted online careers event increases knowledge of and interest in a career in oncology, albeit predominantly for medical and surgical subspecialties. Broader initiatives based on our model should be developed and careers in academia as well as clinical and interventional oncology emphasised.
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Affiliation(s)
- E G Khoury
- Cancer Academic Sciences Unit, University Hospital Southampton, Southampton, UK
| | | | - T Fulton-Ward
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - S Heritage
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Devasar
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - C M Jones
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, University of Cambridge, Cambridge, UK.
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Tang CHM, Seah JCY, Ahmad HK, Milne MR, Wardman JB, Buchlak QD, Esmaili N, Lambert JF, Jones CM. Analysis of Line and Tube Detection Performance of a Chest X-ray Deep Learning Model to Evaluate Hidden Stratification. Diagnostics (Basel) 2023; 13:2317. [PMID: 37510062 PMCID: PMC10378683 DOI: 10.3390/diagnostics13142317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
This retrospective case-control study evaluated the diagnostic performance of a commercially available chest radiography deep convolutional neural network (DCNN) in identifying the presence and position of central venous catheters, enteric tubes, and endotracheal tubes, in addition to a subgroup analysis of different types of lines/tubes. A held-out test dataset of 2568 studies was sourced from community radiology clinics and hospitals in Australia and the USA, and was then ground-truth labelled for the presence, position, and type of line or tube from the consensus of a thoracic specialist radiologist and an intensive care clinician. DCNN model performance for identifying and assessing the positioning of central venous catheters, enteric tubes, and endotracheal tubes over the entire dataset, as well as within each subgroup, was evaluated. The area under the receiver operating characteristic curve (AUC) was assessed. The DCNN algorithm displayed high performance in detecting the presence of lines and tubes in the test dataset with AUCs > 0.99, and good position classification performance over a subpopulation of ground truth positive cases with AUCs of 0.86-0.91. The subgroup analysis showed that model performance was robust across the various subtypes of lines or tubes, although position classification performance of peripherally inserted central catheters was relatively lower. Our findings indicated that the DCNN algorithm performed well in the detection and position classification of lines and tubes, supporting its use as an assistant for clinicians. Further work is required to evaluate performance in rarer scenarios, as well as in less common subgroups.
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Affiliation(s)
- Cyril H M Tang
- Annalise.ai, Sydney, NSW 2000, Australia
- Intensive Care Unit, Gosford Hospital, Sydney, NSW 2250, Australia
| | - Jarrel C Y Seah
- Annalise.ai, Sydney, NSW 2000, Australia
- Department of Radiology, Alfred Health, Melbourne, VIC 3004, Australia
| | | | | | | | - Quinlan D Buchlak
- Annalise.ai, Sydney, NSW 2000, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW 2007, Australia
- Department of Neurosurgery, Monash Health, Melbourne, VIC 3168, Australia
| | - Nazanin Esmaili
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW 2007, Australia
- Faculty of Engineering and Information Technology, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | | | - Catherine M Jones
- Annalise.ai, Sydney, NSW 2000, Australia
- I-MED Radiology Network, Brisbane, QLD 4006, Australia
- School of Public and Preventive Health, Monash University, Clayton, VIC 3800, Australia
- Department of Clinical Imaging Science, University of Sydney, Sydney, NSW 2006, Australia
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Booth ME, Jones CM, Helbrow J, Mansoor W, Peters CJ, Petty RD, Underwood TJ, Smyth EC, Crosby T. The UK National Oesophagogastric Multidisciplinary Team Meeting: An Initiative From the UK & Ireland Oesophagogastric Group. Clin Oncol (R Coll Radiol) 2023; 35:417-420. [PMID: 37069000 DOI: 10.1016/j.clon.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Affiliation(s)
- M E Booth
- Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - C M Jones
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - J Helbrow
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea, UK
| | - W Mansoor
- The Christie Hospital, The Christie Hospitals NHS Foundation Trust, Manchester, UK
| | - C J Peters
- Faculty of Medicine, Imperial College London, London, UK
| | - R D Petty
- The University of Dundee, Dundee, UK
| | - T J Underwood
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - E C Smyth
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre NHS Foundation Trust, Cardiff, UK.
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Kilmarx PH, Maitin T, Adam T, Aslanyan G, Cheetham M, Cruz J, Eigbike M, Gaye O, Jones CM, Kupfer L, Lindo J, Mijumbi R, Nachega JB, Nishi JB, Pantelidou I, Sarker M, Swaminathan S. Increasing Effectiveness and Equity in Strengthening Health Research Capacity Using Data and Metrics: Recent Advances of the ESSENCE Mechanism. Ann Glob Health 2023; 89:38. [PMID: 37273490 PMCID: PMC10237244 DOI: 10.5334/aogh.3948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/09/2023] [Indexed: 06/06/2023] Open
Abstract
Background The ESSENCE on Health Research initiative established a Working Group on Review of Investments in 2018 to improve coordination and collaboration among funders of health research capacity strengthening. The Working Group comprises more than a dozen ESSENCE members, including diverse representation by geography, country income level, the public sector, and philanthropy. Objective The overall goal of the Working Group is increased research on national health priorities as well as improved pandemic preparedness, and, ultimately, fewer countries with very limited research capacity. Methods We developed a basic set of metrics for national health research capacity, assessed different models of coordination and collaboration, took a deeper dive into eight countries to characterize their national research capacity, and began to identify opportunities to better coordinate our investments. In this article, we summarize the presentations, discussions, and outcomes of our second annual (virtual) meeting, which had more than 100 participants representing funders, researchers, and other stakeholders from higher- and lower-income countries worldwide. Findings and conclusions Presentations on the first day included the keynote speaker, Dr. Soumya Swaminathan, chief scientist of the World Health Organization (WHO), and updates on data and metrics for research capacity, which are critical to establish targets, road maps, and budgets. The second day focused on improving collaboration and coordination among funders and other stakeholders, the potential return on investment for health research, ongoing work to increase coordination at the country level, and examples of research capacity strengthening efforts in diverse health research areas from around the world. We concluded that an intentional data- and metric-driven approach to health research capacity strengthening, emphasizing coordination among funders, local leadership, and equitable partnerships and allocation of resources, will enhance the health systems of resource-poor countries as well as the world's pandemic preparedness.
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Affiliation(s)
- Peter H. Kilmarx
- Fogarty International Center, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | - Thabi Maitin
- South African Medical Research Council, Parow Valley, Cape Town, Western Cape, South Africa
| | - Taghreed Adam
- Research for Health Department, World Health Organization, Geneva, Switzerland
| | - Garry Aslanyan
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Michael Cheetham
- Office of Portfolio Analysis, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | - Janelle Cruz
- Fogarty International Center, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | | | - Oumar Gaye
- Cheikh Anta Diop University, Dakar, Senegal
| | - Catherine M. Jones
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Linda Kupfer
- Fogarty International Center, U.S. National Institutes of Health, Bethesda, Maryland, USA
| | - John Lindo
- University of the West Indies, Kingston, Jamaica
| | - Rhona Mijumbi
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Jean B. Nachega
- Department of Epidemiology School of Public Health and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Malabika Sarker
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Fulton-Ward T, Khoury E, Rowe M, Baxter MA, Jones CM. NOTCH and BONUS as Vehicles for Early and Sustained Leadership Training. Clin Oncol (R Coll Radiol) 2023; 35:e301-e302. [PMID: 36710154 DOI: 10.1016/j.clon.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023]
Affiliation(s)
- T Fulton-Ward
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - E Khoury
- Cancer Sciences Academic Unit, University Hospital Southampton, Southampton, UK
| | - M Rowe
- Plymouth Oncology Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M A Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK; Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Tayside, UK
| | - C M Jones
- Department of Oncology, University of Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Jones CM, Sobngwi-Tambekou J, Mijumbi RM, Hedquist A, Wenham C, Parkhurst J. The Roles of Regional Organisations in Strengthening Health Research Systems in Africa: Activities, Gaps, and Future Perspectives. Int J Health Policy Manag 2022; 11:2672-2685. [PMID: 35279037 PMCID: PMC9818106 DOI: 10.34172/ijhpm.2022.6426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/07/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Regional cooperation on health in Africa is not new. The institutional landscape of regional cooperation for health and health research, however, has seen important changes. Recent health emergencies have focussed regional bodies' attention on supporting aspects of national health preparedness and response. The state of national health research systems is a key element of capacity to plan and respond to health needs - raising questions about the roles African regional bodies can or should play in strengthening health research systems. METHODS We mapped regional organisations involved in health research across Africa and conducted 18 interviews with informants from 15 regional organisations. We investigated the roles, challenges, and opportunities of these bodies in strengthening health research. We deductively coded interview data using themes from established pillars of health research systems - governance, creating resources, research production and use, and financing. We analysed organisations' relevant activities in these areas, how they do this work, and where they perceive impact. RESULTS Regional organisations with technical foci on health or higher education (versus economic or political remits) were involved in all four areas. Most organisations reported activities in governance and research use. Involvement in governance centred mainly around agenda-setting and policy harmonisation. For organisations involved in creating resources, activities focused on strengthening human resources, but few reported developing research institutions, networks, or infrastructure. Organisations reported more involvement in disseminating than producing research. Generally, few have directly contributed to financing health research. Informants reported gaps in research coordination, infrastructure, and advocacy at regional level. Finally, we found regional bodies' mandates, authority, and collaborations influence their activities in supporting national health research systems. CONCLUSION Continued strengthening of health research on the African continent requires strategic thinking about the roles, comparative advantages, and capability of regional organisations to facilitate capacity and growth of health research systems.
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Affiliation(s)
- Catherine M. Jones
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Rhona M. Mijumbi
- The Centre for Rapid Evidence Synthesis, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Aaron Hedquist
- LSE Health, London School of Economics and Political Science, London, UK
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Hillis JM, Bizzo BC, Mercaldo S, Chin JK, Newbury-Chaet I, Digumarthy SR, Gilman MD, Muse VV, Bottrell G, Seah JC, Jones CM, Kalra MK, Dreyer KJ. Evaluation of an Artificial Intelligence Model for Detection of Pneumothorax and Tension Pneumothorax in Chest Radiographs. JAMA Netw Open 2022; 5:e2247172. [PMID: 36520432 PMCID: PMC9856508 DOI: 10.1001/jamanetworkopen.2022.47172] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Early detection of pneumothorax, most often via chest radiography, can help determine need for emergent clinical intervention. The ability to accurately detect and rapidly triage pneumothorax with an artificial intelligence (AI) model could assist with earlier identification and improve care. OBJECTIVE To compare the accuracy of an AI model vs consensus thoracic radiologist interpretations in detecting any pneumothorax (incorporating both nontension and tension pneumothorax) and tension pneumothorax. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study was a retrospective standalone performance assessment using a data set of 1000 chest radiographs captured between June 1, 2015, and May 31, 2021. The radiographs were obtained from patients aged at least 18 years at 4 hospitals in the Mass General Brigham hospital network in the United States. Included radiographs were selected using 2 strategies from all chest radiography performed at the hospitals, including inpatient and outpatient. The first strategy identified consecutive radiographs with pneumothorax through a manual review of radiology reports, and the second strategy identified consecutive radiographs with tension pneumothorax using natural language processing. For both strategies, negative radiographs were selected by taking the next negative radiograph acquired from the same radiography machine as each positive radiograph. The final data set was an amalgamation of these processes. Each radiograph was interpreted independently by up to 3 radiologists to establish consensus ground-truth interpretations. Each radiograph was then interpreted by the AI model for the presence of pneumothorax and tension pneumothorax. This study was conducted between July and October 2021, with the primary analysis performed between October and November 2021. MAIN OUTCOMES AND MEASURES The primary end points were the areas under the receiver operating characteristic curves (AUCs) for the detection of pneumothorax and tension pneumothorax. The secondary end points were the sensitivities and specificities for the detection of pneumothorax and tension pneumothorax. RESULTS The final analysis included radiographs from 985 patients (mean [SD] age, 60.8 [19.0] years; 436 [44.3%] female patients), including 307 patients with nontension pneumothorax, 128 patients with tension pneumothorax, and 550 patients without pneumothorax. The AI model detected any pneumothorax with an AUC of 0.979 (95% CI, 0.970-0.987), sensitivity of 94.3% (95% CI, 92.0%-96.3%), and specificity of 92.0% (95% CI, 89.6%-94.2%) and tension pneumothorax with an AUC of 0.987 (95% CI, 0.980-0.992), sensitivity of 94.5% (95% CI, 90.6%-97.7%), and specificity of 95.3% (95% CI, 93.9%-96.6%). CONCLUSIONS AND RELEVANCE These findings suggest that the assessed AI model accurately detected pneumothorax and tension pneumothorax in this chest radiograph data set. The model's use in the clinical workflow could lead to earlier identification and improved care for patients with pneumothorax.
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Affiliation(s)
- James M. Hillis
- Data Science Office, Mass General Brigham, Boston, Massachusetts
- Department of Neurology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Bernardo C. Bizzo
- Data Science Office, Mass General Brigham, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Sarah Mercaldo
- Data Science Office, Mass General Brigham, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Boston
| | - John K. Chin
- Data Science Office, Mass General Brigham, Boston, Massachusetts
| | | | - Subba R. Digumarthy
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Matthew D. Gilman
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Victorine V. Muse
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Boston
| | | | | | - Catherine M. Jones
- Annalise-AI, Sydney, Australia
- I-MED Radiology Network, Brisbane, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mannudeep K. Kalra
- Data Science Office, Mass General Brigham, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Keith J. Dreyer
- Data Science Office, Mass General Brigham, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Massachusetts General Hospital, Boston
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Jones CM, Walls G, Spencer K. Growing Evidence for a Need for a Greater Emphasis on Oncology Teaching in Medical School Curricula. Clin Oncol (R Coll Radiol) 2022; 34:e446. [PMID: 35780006 DOI: 10.1016/j.clon.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- C M Jones
- Department of Oncology, University of Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - G Walls
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK; Cancer Centre, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - K Spencer
- Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Foley KG, Franklin J, Jones CM, Coles B, Roberts SA, Underwood TJ, Crosby T. The impact of endoscopic ultrasound on the management and outcome of patients with oesophageal cancer: an update of a systematic review. Clin Radiol 2022; 77:e346-e355. [PMID: 35289292 DOI: 10.1016/j.crad.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
AIM To provide an updated systematic review concerning the impact of endoscopic ultrasound (EUS) in the modern era of oesophageal cancer staging. MATERIALS AND METHODS To update the previous systematic review, databases including MEDLINE and EMBASE were searched and studies published from 2005 onwards were selected. Studies reporting primary data in patients with oesophageal or gastro-oesophageal junction cancer who underwent radiological staging and treatment, regardless of intent, were included. The primary outcome was the reported change in management after EUS. Secondary outcomes were recurrence rate and overall survival. Two reviewers extracted data from included articles. This study was registered with PROSPERO (CRD42021231852). RESULTS Eighteen studies with 11,836 patients were included comprising 2,805 patients (23.7%) who underwent EUS compared to 9,031 (76.3%) without EUS examination. Reported change of management varied widely from 0% to 56%. When used, EUS fine-needle aspiration precluded curative treatment in 37.5%-71.4%. Overall survival improvements ranged between 121 and 639 days following EUS intervention compared to patients without EUS. Smaller effect sizes were observed in a randomised controlled trial, compared to larger differences reported in observational studies. CONCLUSION Current evidence for the effectiveness of EUS in oesophageal cancer pathways is conflicting and of limited quality. In particular, the extent to which EUS adds value to contemporary cross-sectional imaging techniques is unclear and requires formal re-evaluation.
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Affiliation(s)
- K G Foley
- Department of Clinical Radiology, Royal Glamorgan Hospital, Llantrisant, UK; Department of Clinical Radiology, Velindre Cancer Centre, Cardiff, UK.
| | - J Franklin
- Institute of Medical Imaging and Visualisation, Bournemouth University, UK
| | - C M Jones
- Department of Clinical Oncology, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Coles
- Velindre University NHS Trust Library & Knowledge Service, Cardiff University, UK
| | - S A Roberts
- Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - T J Underwood
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| | - T Crosby
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
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Hedquist A, Jones CM, Mijumbi RM, Sobngwi-Tambekou J, Parkhurst J, Wenham C. Mapping regional cooperation of state actors for health research systems in Africa: A social network analysis. PLOS Glob Public Health 2022; 2:e0001142. [PMID: 36962649 PMCID: PMC10022136 DOI: 10.1371/journal.pgph.0001142] [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: 07/15/2021] [Accepted: 09/12/2022] [Indexed: 03/26/2023]
Abstract
Regional bodies can potentially play an important role in improving health research in Africa. This study analyses the network of African state-based regional organisations for health research and assesses their potential relationship with national health research performance metrics. After cataloguing organisations and their membership, we conducted a social network analysis to determine key network attributes of national governments' connections via regional organisations supporting functions of health research systems. This data was used to test the hypothesis that state actors with more connections to other actors via regional organisations would have higher levels of health research performance across indicators. With 21 unique regional organisations, the African continent is densely networked around health research systems issues. In general, the regional network for health research is inclusive. No single actor serves as a nexus. However, when statistics are grouped by African Union regions, influential poles emerge, with the most predominate spheres of influence in Eastern and Western Africa. Further, when connectivity data was analysed against national health research performance, there were no statistically significant relationships between increased connectivity and higher performance of key health research metrics. The inclusive and dense network dynamics of African regional organisations for health research strengthening present key opportunities for knowledge diffusion and cooperation to improve research capacity on the continent. Further reflection is needed on appropriate and meaningful ways to assess the role of regionalism and evaluate the influence of regional organisations in strengthening health research systems in Africa.
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Affiliation(s)
- Aaron Hedquist
- LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Catherine M Jones
- LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Rhona M Mijumbi
- The Centre for Rapid Evidence Synthesis, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Jones CM, Danaher L, Milne MR, Tang C, Seah J, Oakden-Rayner L, Johnson A, Buchlak QD, Esmaili N. Assessment of the effect of a comprehensive chest radiograph deep learning model on radiologist reports and patient outcomes: a real-world observational study. BMJ Open 2021; 11:e052902. [PMID: 34930738 PMCID: PMC8689166 DOI: 10.1136/bmjopen-2021-052902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Artificial intelligence (AI) algorithms have been developed to detect imaging features on chest X-ray (CXR) with a comprehensive AI model capable of detecting 124 CXR findings being recently developed. The aim of this study was to evaluate the real-world usefulness of the model as a diagnostic assistance device for radiologists. DESIGN This prospective real-world multicentre study involved a group of radiologists using the model in their daily reporting workflow to report consecutive CXRs and recording their feedback on level of agreement with the model findings and whether this significantly affected their reporting. SETTING The study took place at radiology clinics and hospitals within a large radiology network in Australia between November and December 2020. PARTICIPANTS Eleven consultant diagnostic radiologists of varying levels of experience participated in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of CXR cases where use of the AI model led to significant material changes to the radiologist report, to patient management, or to imaging recommendations. Additionally, level of agreement between radiologists and the model findings, and radiologist attitudes towards the model were assessed. RESULTS Of 2972 cases reviewed with the model, 92 cases (3.1%) had significant report changes, 43 cases (1.4%) had changed patient management and 29 cases (1.0%) had further imaging recommendations. In terms of agreement with the model, 2569 cases showed complete agreement (86.5%). 390 (13%) cases had one or more findings rejected by the radiologist. There were 16 findings across 13 cases (0.5%) deemed to be missed by the model. Nine out of 10 radiologists felt their accuracy was improved with the model and were more positive towards AI poststudy. CONCLUSIONS Use of an AI model in a real-world reporting environment significantly improved radiologist reporting and showed good agreement with radiologists, highlighting the potential for AI diagnostic support to improve clinical practice.
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Affiliation(s)
- Catherine M Jones
- Annalise-AI, Sydney, New South Wales, Australia
- I-Med Radiology Network, Sydney, New South Wales, Australia
| | - Luke Danaher
- I-Med Radiology Network, Sydney, New South Wales, Australia
| | - Michael R Milne
- Annalise-AI, Sydney, New South Wales, Australia
- I-Med Radiology Network, Sydney, New South Wales, Australia
| | - Cyril Tang
- Annalise-AI, Sydney, New South Wales, Australia
| | - Jarrel Seah
- Annalise-AI, Sydney, New South Wales, Australia
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Luke Oakden-Rayner
- Australian Institute for Machine Learning, The University of Adelaide, Adelaide, South Australia, Australia
| | | | - Quinlan D Buchlak
- Annalise-AI, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame Australia School of Medicine Sydney Campus, Darlinghurst, New South Wales, Australia
| | - Nazanin Esmaili
- School of Medicine, The University of Notre Dame Australia School of Medicine Sydney Campus, Darlinghurst, New South Wales, Australia
- Faculty of Engineering and IT, University of Technology Sydney, Sydney, New South Wales, Australia
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Seah J, Tang C, Buchlak QD, Milne MR, Holt X, Ahmad H, Lambert J, Esmaili N, Oakden-Rayner L, Brotchie P, Jones CM. Do comprehensive deep learning algorithms suffer from hidden stratification? A retrospective study on pneumothorax detection in chest radiography. BMJ Open 2021; 11:e053024. [PMID: 34876430 PMCID: PMC8655590 DOI: 10.1136/bmjopen-2021-053024] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the ability of a commercially available comprehensive chest radiography deep convolutional neural network (DCNN) to detect simple and tension pneumothorax, as stratified by the following subgroups: the presence of an intercostal drain; rib, clavicular, scapular or humeral fractures or rib resections; subcutaneous emphysema and erect versus non-erect positioning. The hypothesis was that performance would not differ significantly in each of these subgroups when compared with the overall test dataset. DESIGN A retrospective case-control study was undertaken. SETTING Community radiology clinics and hospitals in Australia and the USA. PARTICIPANTS A test dataset of 2557 chest radiography studies was ground-truthed by three subspecialty thoracic radiologists for the presence of simple or tension pneumothorax as well as each subgroup other than positioning. Radiograph positioning was derived from radiographer annotations on the images. OUTCOME MEASURES DCNN performance for detecting simple and tension pneumothorax was evaluated over the entire test set, as well as within each subgroup, using the area under the receiver operating characteristic curve (AUC). A difference in AUC of more than 0.05 was considered clinically significant. RESULTS When compared with the overall test set, performance of the DCNN for detecting simple and tension pneumothorax was statistically non-inferior in all subgroups. The DCNN had an AUC of 0.981 (0.976-0.986) for detecting simple pneumothorax and 0.997 (0.995-0.999) for detecting tension pneumothorax. CONCLUSIONS Hidden stratification has significant implications for potential failures of deep learning when applied in clinical practice. This study demonstrated that a comprehensively trained DCNN can be resilient to hidden stratification in several clinically meaningful subgroups in detecting pneumothorax.
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Affiliation(s)
- Jarrel Seah
- Radiology, Alfred Health, Melbourne, Victoria, Australia
- annalise.ai, Sydney, New South Wales, Australia
| | - Cyril Tang
- annalise.ai, Sydney, New South Wales, Australia
| | - Quinlan D Buchlak
- annalise.ai, Sydney, New South Wales, Australia
- University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Michael Robert Milne
- annalise.ai, Sydney, New South Wales, Australia
- annalise.ai, Sydney, New South Wales, Australia
| | - Xavier Holt
- annalise.ai, Sydney, New South Wales, Australia
| | | | | | - Nazanin Esmaili
- University of Notre Dame Australia, Sydney, New South Wales, Australia
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Luke Oakden-Rayner
- Australian Institute for Machine Learning, The University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Brotchie
- annalise.ai, Sydney, New South Wales, Australia
- Radiology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Catherine M Jones
- annalise.ai, Sydney, New South Wales, Australia
- I-MED Radiology, Brisbane, Queensland, Australia
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Juma PA, Jones CM, Mijumbi-Deve R, Wenham C, Masupe T, Sobngwi-Tambekou J, Biemba G, Mtombo N, Parkhurst J. Governance of health research in four eastern and southern African countries. Health Res Policy Syst 2021; 19:132. [PMID: 34645454 PMCID: PMC8513324 DOI: 10.1186/s12961-021-00781-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/21/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Health research governance is an essential function of national health research systems. Yet many African countries have not developed strong health research governance structures and processes. This paper presents a comparative analysis of national health research governance in Botswana, Kenya, Uganda and Zambia, where health sciences research production is well established relative to some others in the region and continues to grow. The paper aims to examine progress made and challenges faced in strengthening health research governance in these countries. METHODS We collected data through document review and key informant interviews with a total of 80 participants including decision-makers, researchers and funders across stakeholder institutions in the four countries. Data on health research governance were thematically coded for policies, legislation, regulation and institutions and analysed comparatively across the four national health research systems. RESULTS All countries were found to be moving from using a research governance framework set by national science, technology and innovation policies to one that is more anchored in health research structures and policies within the health sectors. Kenya and Zambia have adopted health research legislation and policies, while Botswana and Uganda are in the process of developing the same. National-level health research coordination and regulation is hampered by inadequate financial and human resource capacities, which present challenges for building strong health research governance institutions. CONCLUSION Building health research governance as a key pillar of national health research systems involves developing stronger governance institutions, strengthening health research legislation, increasing financing for governance processes and improving human resource capacity in health research governance and management.
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Affiliation(s)
| | - Catherine M. Jones
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Rhona Mijumbi-Deve
- The Centre for Rapid Evidence Synthesis, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Tiny Masupe
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | | | - Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Jones CM, Buchlak QD, Oakden‐Rayner L, Milne M, Seah J, Esmaili N, Hachey B. Chest radiographs and machine learning - Past, present and future. J Med Imaging Radiat Oncol 2021; 65:538-544. [PMID: 34169648 PMCID: PMC8453538 DOI: 10.1111/1754-9485.13274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/08/2021] [Indexed: 01/15/2023]
Abstract
Despite its simple acquisition technique, the chest X-ray remains the most common first-line imaging tool for chest assessment globally. Recent evidence for image analysis using modern machine learning points to possible improvements in both the efficiency and the accuracy of chest X-ray interpretation. While promising, these machine learning algorithms have not provided comprehensive assessment of findings in an image and do not account for clinical history or other relevant clinical information. However, the rapid evolution in technology and evidence base for its use suggests that the next generation of comprehensive, well-tested machine learning algorithms will be a revolution akin to early advances in X-ray technology. Current use cases, strengths, limitations and applications of chest X-ray machine learning systems are discussed.
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Affiliation(s)
- Catherine M Jones
- I‐MED Radiology NetworkBrisbaneQueenslandAustralia
- Annalise.aiSydneyNew South WalesAustralia
| | - Quinlan D Buchlak
- Annalise.aiSydneyNew South WalesAustralia
- School of MedicineThe University of Notre Dame AustraliaSydneyNew South WalesAustralia
- Harrison.aiSydneyNew South WalesAustralia
| | - Luke Oakden‐Rayner
- Australian Institute for Machine LearningThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Michael Milne
- I‐MED Radiology NetworkBrisbaneQueenslandAustralia
- Annalise.aiSydneyNew South WalesAustralia
| | - Jarrel Seah
- Annalise.aiSydneyNew South WalesAustralia
- Harrison.aiSydneyNew South WalesAustralia
- Department of RadiologyAlfred HealthMelbourneVictoriaAustralia
| | - Nazanin Esmaili
- School of MedicineThe University of Notre Dame AustraliaSydneyNew South WalesAustralia
- Faculty of Engineering and Information TechnologyUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Ben Hachey
- Annalise.aiSydneyNew South WalesAustralia
- Harrison.aiSydneyNew South WalesAustralia
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17
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Seah JCY, Tang CHM, Buchlak QD, Holt XG, Wardman JB, Aimoldin A, Esmaili N, Ahmad H, Pham H, Lambert JF, Hachey B, Hogg SJF, Johnston BP, Bennett C, Oakden-Rayner L, Brotchie P, Jones CM. Effect of a comprehensive deep-learning model on the accuracy of chest x-ray interpretation by radiologists: a retrospective, multireader multicase study. Lancet Digit Health 2021; 3:e496-e506. [PMID: 34219054 DOI: 10.1016/s2589-7500(21)00106-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/02/2021] [Accepted: 05/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chest x-rays are widely used in clinical practice; however, interpretation can be hindered by human error and a lack of experienced thoracic radiologists. Deep learning has the potential to improve the accuracy of chest x-ray interpretation. We therefore aimed to assess the accuracy of radiologists with and without the assistance of a deep-learning model. METHODS In this retrospective study, a deep-learning model was trained on 821 681 images (284 649 patients) from five data sets from Australia, Europe, and the USA. 2568 enriched chest x-ray cases from adult patients (≥16 years) who had at least one frontal chest x-ray were included in the test dataset; cases were representative of inpatient, outpatient, and emergency settings. 20 radiologists reviewed cases with and without the assistance of the deep-learning model with a 3-month washout period. We assessed the change in accuracy of chest x-ray interpretation across 127 clinical findings when the deep-learning model was used as a decision support by calculating area under the receiver operating characteristic curve (AUC) for each radiologist with and without the deep-learning model. We also compared AUCs for the model alone with those of unassisted radiologists. If the lower bound of the adjusted 95% CI of the difference in AUC between the model and the unassisted radiologists was more than -0·05, the model was considered to be non-inferior for that finding. If the lower bound exceeded 0, the model was considered to be superior. FINDINGS Unassisted radiologists had a macroaveraged AUC of 0·713 (95% CI 0·645-0·785) across the 127 clinical findings, compared with 0·808 (0·763-0·839) when assisted by the model. The deep-learning model statistically significantly improved the classification accuracy of radiologists for 102 (80%) of 127 clinical findings, was statistically non-inferior for 19 (15%) findings, and no findings showed a decrease in accuracy when radiologists used the deep-learning model. Unassisted radiologists had a macroaveraged mean AUC of 0·713 (0·645-0·785) across all findings, compared with 0·957 (0·954-0·959) for the model alone. Model classification alone was significantly more accurate than unassisted radiologists for 117 (94%) of 124 clinical findings predicted by the model and was non-inferior to unassisted radiologists for all other clinical findings. INTERPRETATION This study shows the potential of a comprehensive deep-learning model to improve chest x-ray interpretation across a large breadth of clinical practice. FUNDING Annalise.ai.
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Affiliation(s)
- Jarrel C Y Seah
- Annalise.ai, Sydney, NSW, Australia; Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | | | | | | | | | | | - Nazanin Esmaili
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia; Faculty of Engineering and IT, University of Technology Sydney, Sydney, NSW, Australia
| | | | | | | | | | | | | | - Christine Bennett
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Luke Oakden-Rayner
- Australian Institute for Machine Learning, The University of Adelaide, Adelaide, SA, Australia
| | - Peter Brotchie
- Annalise.ai, Sydney, NSW, Australia; Department of Radiology, St Vincent's Health Australia, Melbourne, VIC, Australia
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Jones CM, Gautier L, Ridde V. A scoping review of theories and conceptual frameworks used to analyse health financing policy processes in sub-Saharan Africa. Health Policy Plan 2021; 36:1197-1214. [PMID: 34027987 DOI: 10.1093/heapol/czaa173] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 11/15/2022] Open
Abstract
Health financing policies are critical policy instruments to achieve Universal Health Coverage, and they constitute a key area in policy analysis literature for the health policy and systems research (HPSR) field. Previous reviews have shown that analyses of policy change in low- and middle-income countries are under-theorised. This study aims to explore which theories and conceptual frameworks have been used in research on policy processes of health financing policy in sub-Saharan Africa and to identify challenges and lessons learned from their use. We conducted a scoping review of literature published in English and French between 2000 and 2017. We analysed 23 papers selected as studies of health financing policies in sub-Saharan African countries using policy process or health policy-related theory or conceptual framework ex ante. Theories and frameworks used alone were from political science (35%), economics (9%) and HPSR field (17%). Thirty-five per cent of authors adopted a 'do-it-yourself' (bricolage) approach combining theories and frameworks from within political science or between political science and HPSR. Kingdon's multiple streams theory (22%), Grindle and Thomas' arenas of conflict (26%) and Walt and Gilson's policy triangle (30%) were the most used. Authors select theories for their empirical relevance, methodological rational (e.g. comparison), availability of examples in literature, accessibility and consensus. Authors cite few operational and analytical challenges in using theory. The hybridisation, diversification and expansion of mid-range policy theories and conceptual frameworks used deductively in health financing policy reform research are issues for HPSR to consider. We make three recommendations for researchers in the HPSR field. Future research on health financing policy change processes in sub-Saharan Africa should include reflection on learning and challenges for using policy theories and frameworks in the context of HPSR.
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Affiliation(s)
- Catherine M Jones
- London School of Economics and Political Science, LSE Health, Houghton Street, London WC2A 2AE, UK
| | - Lara Gautier
- Département de Gestion, d'Évaluation et de Politique de Santé, École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, 7101 avenue du Parc, Montréal, QC H3N 1X9, Canada
| | - Valéry Ridde
- Institut de Recherche pour le Développement, Centre Population et Développement - CEPED (IRD-Université de Paris), Université de Paris ERL INSERM SAGESUD, 45 rue des Saints-Peres, Paris 75006, France
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Jones CM, Hawkins M, Mukherjee S, Radhakrishna G, Crosby T. Corrigendum to "Considerations for the Treatment of Oesophageal Cancer with Radiotherapy During the COVID-19 Pandemic" [Clin Oncol 32 (2020) 354-357]. Clin Oncol (R Coll Radiol) 2021; 33:e362. [PMID: 33795184 PMCID: PMC8436418 DOI: 10.1016/j.clon.2021.03.010] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C M Jones
- School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Hawkins
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - G Radhakrishna
- Christie Hospital, The Christie NHS Foundation Trust, Manchester, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK.
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Jones CM, Lyles A, Foley KG. A national cross-sectional survey investigating the use of endoscopic ultrasound in the diagnosis and treatment of oesophageal cancer in the UK. Clin Radiol 2021; 76:458-464. [PMID: 33752881 DOI: 10.1016/j.crad.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/17/2021] [Indexed: 01/01/2023]
Abstract
AIM To evaluate variation in the pre-pandemic use of endoscopic ultrasound (EUS) for oesophageal cancer diagnosis and treatment planning up to 2019, and which factors contributed to this. MATERIALS AND METHODS A UK-wide online survey of oesophagogastric multidisciplinary team lead clinicians was undertaken to determine perceptions towards, and the use of, EUS to aid staging and treatment planning in oesophageal cancer. RESULTS Thirty-five responses were received, representing 97 UK National Health Service Trusts/Health Boards. A majority of centres (n=21, 60%) did not have formal written guidance for EUS use. Although all respondents had access to EUS, a perceived lack of utility (n=7) and concerns about delaying treatment start dates (n=8) each restricted EUS use for a fifth of respondents. For most centres (n=24, 68.6%), EUS use is case-specific, whereas for 10 (28.6%) EUS is used for all patients with potentially curable disease. A majority of centres use diagnostic positron-emission tomography for radiotherapy target volume delineation (TVD), whereas 22 (62.9%) use EUS. The factors contributing to decisions to use EUS for staging, TVD and surgical planning varied between centres. The proportion of centre respondents who would request EUS in each of six clinical scenarios varied considerably. CONCLUSION There were substantial differences in the patient and disease characteristics that are perceived to be indications for EUS use for both staging and treatment planning. Research to clarify in which patients with oesophageal cancer EUS affords benefit is required, as is urgent standardisation of its role in the diagnostic pathway.
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Affiliation(s)
- C M Jones
- Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK.
| | - A Lyles
- Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K G Foley
- Department of Clinical Radiology, Velindre Cancer Centre, Cardiff, UK
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Chambers DC, Apte SH, Deller D, Masel PJ, Jones CM, Newbigin K, Matula M, Rapchuk IL. Radiological outcomes of whole lung lavage for artificial stone-associated silicosis. Respirology 2021; 26:501-503. [PMID: 33626187 DOI: 10.1111/resp.14018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Daniel C Chambers
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Qld Lung Transplant Program, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Simon H Apte
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Qld Lung Transplant Program, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - David Deller
- Gold Coast Respiratory and Sleep Clinic, Gold Coast, QLD, Australia
| | - Philip J Masel
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Qld Lung Transplant Program, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Catherine M Jones
- Department of Radiology, Wesley Hospital, Brisbane, QLD, Australia.,Department of Chest Imaging, I-Med Radiology, Brisbane, QLD, Australia
| | - Katrina Newbigin
- Department of Radiology, Wesley Hospital, Brisbane, QLD, Australia.,Department of Chest Imaging, I-Med Radiology, Brisbane, QLD, Australia
| | - Michael Matula
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Ivan L Rapchuk
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Qld Lung Transplant Program, The Prince Charles Hospital, Brisbane, QLD, Australia
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22
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Breeze TD, Bailey AP, Balcombe KG, Brereton T, Comont R, Edwards M, Garratt MP, Harvey M, Hawes C, Isaac N, Jitlal M, Jones CM, Kunin WE, Lee P, Morris RKA, Musgrove A, O'Connor RS, Peyton J, Potts SG, Roberts SPM, Roy DB, Roy HE, Tang CQ, Vanbergen AJ, Carvell C. Pollinator monitoring more than pays for itself. J Appl Ecol 2020. [DOI: 10.1111/1365-2664.13755] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Tom D. Breeze
- School of Agriculture, Policy and Development University of Reading Reading UK
| | - Alison P. Bailey
- Department Land Management and Systems Lincoln University Lincoln New Zealand
| | - Kelvin G. Balcombe
- School of Agriculture, Policy and Development University of Reading Reading UK
| | | | | | - Mike Edwards
- Edwards Ecological and Data Services Ltd Wallingford UK
| | - Michael P. Garratt
- School of Agriculture, Policy and Development University of Reading Reading UK
| | - Martin Harvey
- School of Environment, Earth and Ecosystem Sciences The Open University Milton Keynes UK
| | | | - Nick Isaac
- Centre for Ecology and Hydrology Wallingford UK
| | | | | | | | | | | | | | - Rory S. O'Connor
- School of Agriculture, Policy and Development University of Reading Reading UK
- Department of Biology Leeds University Leeds UK
| | | | - Simon G. Potts
- School of Agriculture, Policy and Development University of Reading Reading UK
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23
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Jones CM, Spencer K. Nurturing a Research-active Clinical Oncology Workforce: A Trainee Perspective. Clin Oncol (R Coll Radiol) 2020; 33:e39-e43. [PMID: 32636144 DOI: 10.1016/j.clon.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- C M Jones
- Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK.
| | - K Spencer
- Radiotherapy Research Group, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Health Sciences, Faculty of Medicine & Health, University of Leeds, Leeds, UK
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24
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Lopez AJ, Jones CM, Geiger AJ, Heinrichs AJ. Short communication: Variation in serum immunoglobulin G concentrations from birth to 112 days of age in Holstein calves fed a commercial colostrum replacer or maternal colostrum. J Dairy Sci 2020; 103:7535-7539. [PMID: 32534921 DOI: 10.3168/jds.2020-18400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/15/2020] [Indexed: 11/19/2022]
Abstract
Serum IgG concentrations in dairy calves change throughout their first weeks of life, peaking at 24 h and then steadily decreasing until calves begin to produce endogenous IgG. The objective of this study was to observe serum IgG dynamics from birth until 16 wk of life in calves fed either maternal colostrum (MC) or colostrum replacer (CR). A total of 44 Holstein calves were randomly assigned to 1 of the 4 colostrum treatments and followed throughout the study. Treatments consisted of feeding high-quality MC, low-quality MC supplemented with CR, or 1 of 2 distinct levels of IgG concentration from CR. Overall, the interaction between type of colostrum fed and sampling time was significant. Individual differences for this effect were found at d 1, 7, 14, 21, 28, and 98, while the other time points were not different.
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Affiliation(s)
- A J Lopez
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - C M Jones
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - A J Geiger
- Zinpro Corporation, Eden Prairie, MN 55344
| | - A J Heinrichs
- Department of Animal Science, The Pennsylvania State University, University Park 16802.
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25
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Mitchell LK, Jones CM, Heinrichs AJ. Effect of converting weaned dairy calves from a component-fed diet to a total mixed ration on growth and nutrient digestibility. J Dairy Sci 2020; 103:6190-6199. [PMID: 32331899 DOI: 10.3168/jds.2019-17980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/21/2020] [Indexed: 11/19/2022]
Abstract
The objective was to determine the effects of converting calves from a component-fed ration to a total mixed ration (TMR) at 8, 10, or 12 wk of age on intake, growth, and nutrient digestibility. Holstein calves (n = 40) were randomly assigned to 1 of 4 groups (no TMR, TMR conversion at 8, 10 or 12 wk; T0, T8, T10, and T12, respectively). Calves were weaned at 6 wk of age, housed individually, and studied from 7 to 14 wk of age. Rations, consisting of a 20% crude protein texturized starter and grass hay, were offered ad libitum as separate components or as a TMR with 85% starter and 15% grass hay on a dry matter (DM) basis. Intakes and body weights (BW) were measured weekly. Component intake for TMR was calculated from the proportion of grass hay and starter contained in the TMR. Fecal grab samples were collected every 9 h over 3 d for a total of 8 samples that formed a composite at 9, 11, and 13 wk of age from the same 4 calves per group. Rumen fluid samples were collected via esophageal tube at -1, 0, 3, and 7 d relative to conversion from component to TMR. Feed and feces were evaluated for DM, neutral detergent fiber, acid detergent fiber, and acid detergent lignin (internal flow marker) to estimate digestibility. Average daily gain and final BW tended to be least for T8. Empty BW gain was significantly less for T8 than for T0 but not different from T10 or T12 (T0 = 1.07, T8 = 0.93, T10 = 1.02, T12 = 1.04 kg/d). Hip growth tended to be least for T8 and resulted in lower final hip width (T0 = 25.9, T8 = 25.2, T10 = 25.6, T12 = 25.8 cm). Intake tended to be reduced for calves converted to TMR earlier. Throughout the study, calves fed TMR ate more hay and less starter than component-fed calves. Metabolizable energy intake was less for T8 versus T0 but not different from T10 or T12 (T0 = 8.46, T8 = 7.55, T10 = 8.01, T12 = 8.23 Mcal/d). We observed no differences in feed efficiency for the duration of the study. Differences in DM digestibility were not observed, but fiber digestibility was greater for calves fed TMR at 9, 11, and 13 wk of age. Conversion to TMR increased rumen pH. These results indicate that TMR conversion increased hay consumption and subsequently decreased starter and total DM intake. This led to reduced weight and structural growth; however, calves that were converted to TMR as early as 8 wk still achieved adequate growth. The increase in rumen pH and subsequent increase in fiber digestibility allowed for calves to be converted to a 15% grass hay TMR as early as 8 wk and still achieve desirable growth goals.
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Affiliation(s)
- L K Mitchell
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - C M Jones
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - A J Heinrichs
- Department of Animal Science, The Pennsylvania State University, University Park 16802.
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Abstract
Reflexivity has emerged as a key concept in the field of health promotion
(HP). Yet it remains unclear how diverse forms of reflexivity are
specifically relevant to HP concerns, and how these “reflexivities”
are interconnected. We argue that frameworks are needed to support
more systematic integration of reflexivity in HP training and
practice. In this article, we propose a typology of reflexivity in HP
to facilitate the understanding of reflexivity in professional
training. Drawing from key theories and models of reflexivity, this
typology proposes three reflexive positions (ideal-types) with
specific purposes for HP: reflexivity in, on, and underlying action.
This article illustrates our typology’s ideal-types with vignettes
collected from HP actors working with reflexivity in North America and
Europe. We suggest that our typology constitutes a conceptual device
to organize and discuss a variety of experiences of engaging with
reflexivity for HP. We propose the typology may support integrating
reflexivity as a key feature in training a future cadre of health
promoters and as a means for building a responsible HP practice.
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Affiliation(s)
| | | | | | - Nicole Beaudet
- Montreal Health and Social Services Agency, Montreal, Canada
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27
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Jones CM, Hawkins M, Mukherjee S, Radhakrishna G, Crosby T. Considerations for the Treatment of Oesophageal Cancer With Radiotherapy During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:354-357. [PMID: 32299723 PMCID: PMC7144663 DOI: 10.1016/j.clon.2020.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
- C M Jones
- School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Hawkins
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - G Radhakrishna
- Christie Hospital, The Christie NHS Foundation Trust, Manchester, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK.
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Lopez AJ, Jones CM, Geiger AJ, Heinrichs AJ. Comparison of immunoglobulin G absorption in calves fed maternal colostrum, a commercial whey-based colostrum replacer, or supplemented maternal colostrum. J Dairy Sci 2020; 103:4838-4845. [PMID: 32197853 DOI: 10.3168/jds.2019-17949] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/04/2020] [Indexed: 11/19/2022]
Abstract
Successful passive transfer of antibodies in neonatal calves can be achieved by feeding an adequate quantity and quality of maternal colostrum (MC) or colostrum replacer (CR). An alternative could be feeding low-quality maternal colostrum (LMC) with added IgG from a CR. The objective of this study was to determine if a commercial whey-based CR product containing low levels of casein (Premolac PLUS Bovine IgG; Zinpro Corporation, Eden Prairie, MN) fed to replace MC or supplement LMC could lead to adequate serum IgG levels and apparent efficiency of absorption (AEA) in neonatal dairy calves. Holstein calves (n = 20 per treatment) were separated from their dam after birth and randomly assigned to be fed 3.79 L of MC (106 g/L of IgG; 401 g of IgG fed), LMC (30 g/L IgG) supplemented with CR (41 g/L IgG; 154 g of IgG total fed; LMC-CR), or 1.3 L of 1 of 2 levels of CR (110 or 150 g of IgG fed; CR-110 or CR-150) within 1.5 h of birth. Colostrum was obtained from the first (MC) or second and third milkings (LMC) of cows from Pennsylvania State University dairy and pooled by source into large batches. Blood samples were taken from calves before colostrum feeding and 24 h after birth and were analyzed for serum total protein, total IgG, hematocrit, and Brix percentage. Calves fed MC had higher 24-h IgG values (means ± SEM) than calves fed LMC-CR (27.04 ± 1.07 vs. 22.33 ± 1.08 mg/mL, respectively). Feeding 150 g of IgG from CR led to higher 24-h serum IgG values than feeding 110 g of IgG (16.90 ± 1.09 vs. 12.79 ± 1.08 mg/mL). Serum IgG levels were different between the CR-fed calves and the calves fed LMC-CR and MC, but all had average values >10 mg/mL IgG. Calves fed LMC-CR had greater AEA than calves fed MC (54.58 ± 2.39 vs. 24.38 ± 2.36%, respectively). Among calves fed CR-110 or CR-150, AEA did not differ. Serum total protein and Brix percentage had strong correlations with actual IgG values across the entire study. We found no differences in average daily gain or health variables measured, and no differences in final hip width, withers height, or body weight for calves fed MC, LMC-CR, CR-150, or CR-110. These results indicate that CR can be fed successfully as an alternative to MC or as a supplement to colostrum with low IgG.
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Affiliation(s)
- A J Lopez
- Department of Animal Science, Pennsylvania State University, University Park 16802
| | - C M Jones
- Department of Animal Science, Pennsylvania State University, University Park 16802
| | - A J Geiger
- Zinpro Corporation, Eden Prairie, MN 55344
| | - A J Heinrichs
- Department of Animal Science, Pennsylvania State University, University Park 16802.
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29
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Jones CM, Pasricha SS, Heinze SB, MacDonald S. Silicosis in artificial stone workers: Spectrum of radiological high‐resolution CT chest findings. J Med Imaging Radiat Oncol 2020; 64:241-249. [PMID: 32157793 DOI: 10.1111/1754-9485.13015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/06/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Stefan B Heinze
- Department of Radiology Royal Melbourne Hospital Melbourne Victoria Australia
| | - Sharyn MacDonald
- Department of Radiology Canterbury and West Coast Hospitals Christchurch New Zealand
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Abstract
National policy on global health (NPGH) arenas are multisectoral governing arrangements for cooperation between health, development, and foreign affairs sectors in government policy for global health governance. To explore the relationship between national and global processes for governing global health, this paper asks: in what forms of interaction between NPGH arenas and global health governance are learning and networking processes present? In a multiple case study of Norwegian and Swiss NPGH arenas, we collected data on intersectoral policy processes from semi-structured interviews with 33 informants in 2014-2015. Adapting Real-Dato's framework, we analyzed each case separately, producing monographs for comparing NPGH arenas. Analyzing both NPGH arenas for relational structures linking external resources to internal policy arena processes, we found five zones of interactions - including institutions, transgovernmental clubs, and connective forms. These interactions circulate ideas and soften arenas' boundaries. We argue that NPGH is characteristic of transnational governance of global health.
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Affiliation(s)
- Catherine M. Jones
- LSE Health, London School of Economics and Political Science, London, UK
| | - Carole Clavier
- Regroupement stratégique Politiques publiques et santé des populations, Réseau de recherche en santé des populations, Montréal, Québec Canada
- Département de science politique de l’Université du Québec à Montréal, Montréal, Québec Canada
| | - Louise Potvin
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec Canada
- Département de Médecine sociale et préventive, École de santé publique de l’Université de Montréal, Montréal, Québec Canada
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Heinrichs AJ, Jones CM, Erickson PS, Chester-Jones H, Anderson JL. Symposium review: Colostrum management and calf nutrition for profitable and sustainable dairy farms. J Dairy Sci 2019; 103:5694-5699. [PMID: 31785867 DOI: 10.3168/jds.2019-17408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/11/2019] [Indexed: 01/31/2023]
Abstract
Multistate dairy management research project NC-2042, which is part of the National Institute of Food and Agriculture, has devoted an ongoing objective to calf and heifer nutrition and management. Within this objective, colostrum research has been a priority due to continued opportunities to improve this area on US dairy farms. Research has focused on heating colostrum to reduce bacterial populations and pathogens while increasing IgG absorption. Research also identified other proteins that are reduced when heating colostrum. Studies indicated an apparent upper limit to IgG absorption from colostrum fed to calves. Additional studies have shed light on absorption of IgG from colostrum replacers and evaluated the use of lactoferrin and sodium bicarbonate in both maternal colostrum and colostrum replacers. Milk replacer formulation, feeding strategies, and the effect of calfhood nutrition on future performance have also been researched. Finally, water quality and its effect on calves and heifers have been studied. This review focuses on research done by multistate research project NC-2042 member states in the area of colostrum and calf nutrition and management.
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Affiliation(s)
- A J Heinrichs
- Department of Animal Science, The Pennsylvania State University, University Park 16802.
| | - C M Jones
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - P S Erickson
- Department of Agriculture, Nutrition, and Food Systems, University of New Hampshire, Durham 03824
| | - H Chester-Jones
- Southern Research and Outreach Center, University of Minnesota, Waseca 56093
| | - J L Anderson
- Dairy and Food Science Department, South Dakota State University, Brookings 57007
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32
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O'Connor RS, Kunin WE, Garratt MPD, Potts SG, Roy HE, Andrews C, Jones CM, Peyton JM, Savage J, Harvey MC, Morris RKA, Roberts SPM, Wright I, Vanbergen AJ, Carvell C. Monitoring insect pollinators and flower visitation: The effectiveness and feasibility of different survey methods. Methods Ecol Evol 2019. [DOI: 10.1111/2041-210x.13292] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Rory S. O'Connor
- Centre for Agri‐Environmental Research School of Agriculture, Policy and Development University of Reading Reading UK
- The Faculty of Biological Sciences University of Leeds Leeds UK
| | | | - Michael P. D. Garratt
- Centre for Agri‐Environmental Research School of Agriculture, Policy and Development University of Reading Reading UK
| | - Simon G. Potts
- Centre for Agri‐Environmental Research School of Agriculture, Policy and Development University of Reading Reading UK
| | | | | | - Catherine M. Jones
- The Faculty of Biological Sciences University of Leeds Leeds UK
- Buglife – The Invertebrate Conservation Trust Peterborough UK
| | | | | | | | | | - Stuart P. M. Roberts
- Centre for Agri‐Environmental Research School of Agriculture, Policy and Development University of Reading Reading UK
| | | | - Adam J. Vanbergen
- Centre for Ecology & Hydrology Penicuik UK
- AgroécologieAgroSup DijonINRAUniv. Bourgogne Franche‐Comté Dijon France
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Mullane KM, Morrison VA, Camacho LH, Arvin A, McNeil SA, Durrand J, Campbell B, Su SC, Chan ISF, Parrino J, Kaplan SS, Popmihajlov Z, Annunziato PW, Cerana S, Dictar MO, Bonvehi P, Tregnaghi JP, Fein L, Ashley D, Singh M, Hayes T, Playford G, Morrissey O, Thaler J, Kuehr T, Greil R, Pecherstorfer M, Duck L, Van Eygen K, Aoun M, De Prijck B, Franke FA, Barrios CHE, Mendes AVA, Serrano SV, Garcia RF, Moore F, Camargo JFC, Pires LA, Alves RS, Radinov A, Oreshkov K, Minchev V, Hubenova AI, Koynova T, Ivanov I, Rabotilova B, Minchev V, Petrov PA, Chilingirov P, Karanikolov S, Raynov J, Grimard D, McNeil S, Kumar D, Larratt LM, Weiss K, Delage R, Diaz-Mitoma FJ, Cano PO, Couture F, Carvajal P, Yepes A, Torres Ulloa R, Fardella P, Caglevic C, Rojas C, Orellana E, Gonzalez P, Acevedo A, Galvez KM, Gonzalez ME, Franco S, Restrepo JG, Rojas CA, Bonilla C, Florez LE, Ospina AV, Manneh R, Zorica R, Vrdoljak DV, Samarzija M, Petruzelka L, Vydra J, Mayer J, Cibula D, Prausova J, Paulson G, Ontaneda M, Palk K, Vahlberg A, Rooneem R, Galtier F, Postil D, Lucht F, Laine F, Launay O, Laurichesse H, Duval X, Cornely OA, Camerer B, Panse J, Zaiss M, Derigs HG, Menzel H, Verbeek M, Georgoulias V, Mavroudis D, Anagnostopoulos A, Terpos E, Cortes D, Umanzor J, Bejarano S, Galeano RW, Wong RSM, Hui P, Pedrazzoli P, Ruggeri L, Aversa F, Bosi A, Gentile G, Rambaldi A, Contu A, Marei L, Abbadi A, Hayajneh W, Kattan J, Farhat F, Chahine G, Rutkauskiene J, Marfil Rivera LJ, Lopez Chuken YA, Franco Villarreal H, Lopez Hernandez J, Blacklock H, Lopez RI, Alvarez R, Gomez AM, Quintana TS, Moreno Larrea MDC, Zorrilla SJ, Alarcon E, Samanez FCA, Caguioa PB, Tiangco BJ, Mora EM, Betancourt-Garcia RD, Hallman-Navarro D, Feliciano-Lopez LJ, Velez-Cortes HA, Cabanillas F, Ganea DE, Ciuleanu TE, Ghizdavescu DG, Miron L, Cebotaru CL, Cainap CI, Anghel R, Dvorkin MV, Gladkov OA, Fadeeva NV, Kuzmin AA, Lipatov ON, Zbarskaya II, Akhmetzyanov FS, Litvinov IV, Afanasyev BV, Cherenkova M, Lioznov D, Lisukov IA, Smirnova YA, Kolomietz S, Halawani H, Goh YT, Drgona L, Chudej J, Matejkova M, Reckova M, Rapoport BL, Szpak WM, Malan DR, Jonas N, Jung CW, Lee DG, Yoon SS, Lopez Jimenez J, Duran Martinez I, Rodriguez Moreno JF, Solano Vercet C, de la Camara R, Batlle Massana M, Yeh SP, Chen CY, Chou HH, Tsai CM, Chiu CH, Siritanaratkul N, Norasetthada L, Sriuranpong V, Seetalarom K, Akan H, Dane F, Ozcan MA, Ozsan GH, Kalayoglu Besisik SF, Cagatay A, Yalcin S, Peniket A, Mullan SR, Dakhil KM, Sivarajan K, Suh JJG, Sehgal A, Marquez F, Gomez EG, Mullane MR, Skinner WL, Behrens RJ, Trevarthe DR, Mazurczak MA, Lambiase EA, Vidal CA, Anac SY, Rodrigues GA, Baltz B, Boccia R, Wertheim MS, Holladay CS, Zenk D, Fusselman W, Wade III JL, Jaslowsk AJ, Keegan J, Robinson MO, Go RS, Farnen J, Amin B, Jurgens D, Risi GF, Beatty PG, Naqvi T, Parshad S, Hansen VL, Ahmed M, Steen PD, Badarinath S, Dekker A, Scouros MA, Young DE, Graydon Harker W, Kendall SD, Citron ML, Chedid S, Posada JG, Gupta MK, Rafiyath S, Buechler-Price J, Sreenivasappa S, Chay CH, Burke JM, Young SE, Mahmood A, Kugler JW, Gerstner G, Fuloria J, Belman ND, Geller R, Nieva J, Whittenberger BP, Wong BMY, Cescon TP, Abesada-Terk G, Guarino MJ, Zweibach A, Ibrahim EN, Takahashi G, Garrison MA, Mowat RB, Choi BS, Oliff IA, Singh J, Guter KA, Ayrons K, Rowland KM, Noga SJ, Rao SB, Columbie A, Nualart MT, Cecchi GR, Campos LT, Mohebtash M, Flores MR, Rothstein-Rubin R, O'Connor BM, Soori G, Knapp M, Miranda FG, Goodgame BW, Kassem M, Belani R, Sharma S, Ortiz T, Sonneborn HL, Markowitz AB, Wilbur D, Meiri E, Koo VS, Jhangiani HS, Wong L, Sanani S, Lawrence SJ, Jones CM, Murray C, Papageorgiou C, Gurtler JS, Ascensao JL, Seetalarom K, Venigalla ML, D'Andrea M, De Las Casas C, Haile DJ, Qazi FU, Santander JL, Thomas MR, Rao VP, Craig M, Garg RJ, Robles R, Lyons RM, Stegemoller RK, Goel S, Garg S, Lowry P, Lynch C, Lash B, Repka T, Baker J, Goueli BS, Campbell TC, Van Echo DA, Lee YJ, Reyes EA, Senecal FM, Donnelly G, Byeff P, Weiss R, Reid T, Roeland E, Goel A, Prow DM, Brandt DS, Kaplan HG, Payne JE, Boeckh MG, Rosen PJ, Mena RR, Khan R, Betts RF, Sharp SA, Morrison VA, Fitz-Patrick D, Congdon J, Erickson N, Abbasi R, Henderson S, Mehdi A, Wos EJ, Rehmus E, Beltzer L, Tamayo RA, Mahmood T, Reboli AC, Moore A, Brown JM, Cruz J, Quick DP, Potz JL, Kotz KW, Hutchins M, Chowhan NM, Devabhaktuni YD, Braly P, Berenguer RA, Shambaugh SC, O'Rourke TJ, Conkright WA, Winkler CF, Addo FEK, Duic JP, High KP, Kutner ME, Collins R, Carrizosa DR, Perry DJ, Kailath E, Rosen N, Sotolongo R, Shoham S, Chen T. Safety and efficacy of inactivated varicella zoster virus vaccine in immunocompromised patients with malignancies: a two-arm, randomised, double-blind, phase 3 trial. The Lancet Infectious Diseases 2019; 19:1001-1012. [DOI: 10.1016/s1473-3099(19)30310-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022]
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Jones CM, Spencer K, Hitchen C, Pelly T, Wood B, Hatfield P, Crellin A, Sebag-Montefiore D, Goody R, Crosby T, Radhakrishna G. Hypofractionated Radiotherapy in Oesophageal Cancer for Patients Unfit for Systemic Therapy: A Retrospective Single-Centre Analysis. Clin Oncol (R Coll Radiol) 2019; 31:356-364. [PMID: 30737068 DOI: 10.1016/j.clon.2019.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 04/17/2018] [Revised: 11/24/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
AIMS Chemoradiotherapy (CRT) is established as a superior treatment option to definitive radiotherapy in the non-surgical management of oesophageal cancer. For patients precluded from CRT through choice or comorbidity there is little evidence to guide delivery of single-modality radiotherapy. In this study we outline outcomes for patients unfit for CRT who received a hypofractionated radiotherapy (HRT) regimen. MATERIALS AND METHODS A retrospective UK single-centre analysis of 61 consecutive patients with lower- or middle-third adenocarcinoma (OAC; 61%) or squamous cell carcinoma of the oesophagus managed using HRT with radical intent between April 2009 and 2014. Treatment consisted of 50 Gy in 16 fractions (n = 49, 80.3%) or 50-52.5 Gy in 20 fractions (n = 12, 19.7%). Outcomes were referenced against a contemporaneous comparator cohort of 80 (54% OAC) consecutive patients managed with conventionally fractionated CRT within the same centre. RESULTS Three-year and median overall survival were, respectively, 56.9% and 29 months with HRT compared with 55.5% and 26 months for CRT; adjusted hazard ratio 0.79 (95% confidence interval 0.48-1.28). Grade 3 and 4 toxicity rates were low at 16.4% (n = 10) for those receiving HRT and 40.2% (n = 32) for the CRT group. In patients with OAC, CRT delivered superior overall survival (hazard ratio 0.46; 95% confidence interval 0.25-0.85) and progression-free survival (hazard ratio 0.45; 95% confidence interval 0.23-0.88) when compared with HRT. CONCLUSIONS The HRT regimen described here was safe and tolerable in patients unable to receive CRT, and delivered promising survival outcomes. The use of HRT for the treatment of oesophageal cancer, both alone and as a sequential or concurrent treatment with chemotherapy, requires further study. New precision radiotherapy technologies may provide additional scope for improving outcomes in oesophageal cancer using HRT-based approaches and should be evaluated.
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Affiliation(s)
- C M Jones
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - K Spencer
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Institute of Health Sciences, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - C Hitchen
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - T Pelly
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - B Wood
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - P Hatfield
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Crellin
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Sebag-Montefiore
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - R Goody
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
| | - G Radhakrishna
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Salomon-Ibarra CC, Ravaghi V, Hill K, Jones CM, Landes DP, Morris AJ. Low rates of dental attendance by the age of one and inequality between local government administrative areas in England. Community Dent Health 2019; 36:22-26. [PMID: 30779499 DOI: 10.1922/cdh_4390salomon-ibarra05] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe child dental attendance (DA) by 1 year of age in England and its relationship with area deprivation. BASIC RESEARCH DESIGN Analysis of National Health Service data for the 12 months to June 2017. Deprivation was measured by Index of Multiple Deprivation Rank of Average Score (2015) for upper-tier and unitary local authorities in England (LAs, n=151). DA rates were calculated for children under 1 year (⟨1yr) and children aged 1 year and under (⟨1yr). A Spearman's test assessed strength of association with deprivation. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) explored equity. CLINICAL SETTING Upper-tier and unitary LAs in England. MAIN OUTCOME MEASURE Attending an NHS primary care dental service. RESULTS DA rates ranged from 0 to 12.3% (Median:2; IQR:1.4,3.9) in children ⟨1yr and from 3.7 to 37.6% (Median:10; IQR:7.4,17) in children ≤1yr. DA rates decreased as deprivation decreased (Spearman=-0.25, p=0.0019 in children ⟨1yr; Spearman=-0.21, p=0.0104 in children ≤1yr). The SII suggested a 2 percentage point difference in DA rate across the deprivation distribution in children ⟨1yr (SII=-0.02, 95% CI=-0.01,-0.04; p=⟨0.001); and a 5 point difference in children ≤1yr (SII=-0.05, 95% CI=-0.02,-0.09; p=0.003). The DA rate in the most deprived LA was 2.1 higher than the least deprived LA (RII=2.1, 95% CI=1.4,3.2; p=⟨0.001) in children ⟨1yr and 1.5 higher (RII=1.5, 95% CI=1.2,2; p=0.004) in children ≤1yr. CONCLUSIONS DA rates were low for all LAs and only partially explained by deprivation. More deprived LAs were, unexpectedly, more likely to report higher DA rates.
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Affiliation(s)
- C C Salomon-Ibarra
- School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham B5 7EG
| | - V Ravaghi
- School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham B5 7EG
| | - K Hill
- School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham B5 7EG
| | - C M Jones
- Edinburgh Dental Institute, University of Edinburgh, Lauriston Place, Edinburgh, EH3 9HA
| | - D P Landes
- Public Health England, North East Centre, Waterfront 4 Newburn Riverside, NE15 8NY
| | - A J Morris
- School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham B5 7EG
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Saldana DJ, Jones CM, Gehman AM, Heinrichs AJ. Effects of once- versus twice-a-day feeding of pasteurized milk supplemented with yeast-derived feed additives on growth and health in female dairy calves. J Dairy Sci 2019; 102:3654-3660. [PMID: 30799103 DOI: 10.3168/jds.2018-15695] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 09/14/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
Abstract
The objective of this study was to compare the effects of feeding preweaning dairy calves pasteurized milk once or twice a day with or without a combination of yeast-derived products. Holstein heifer calves (n = 48) from The Pennsylvania State University dairy herd were fed 3.8 L of colostrum in 1 feeding and randomly assigned to 1 of 4 treatments (once-a-day milk feeding with or without live yeast culture and mannan-rich fraction and twice-a-day milk feeding with or without live yeast culture and mannan-rich fraction). All calves were fed 6 L of milk daily. Weekly growth measurements and blood samples were taken 3 h after the morning milk feeding for all animals. Growth measurement included body weight, hip width, and withers height. Calf starter refusal was recorded weekly, and a sample was taken to determine dry matter intake. Daily health scores were recorded for each calf using a standard scoring system. Intake, growth measurements, haptoglobin, and health scores data were analyzed using repeated measures analysis with calf included as a random variable. Preweaning average daily gain was 553.4 and 512.1 g/d for calves fed milk once and twice a day, respectively, and we found no difference between treatments. Preweaning calf starter intake was 242.3 and 198.7 g/d for calves fed milk once and twice a day, respectively, and we found no treatment differences. Preweaning calf starter intake was 224.3 and 216.6 g/d for calves fed yeast and without yeast, respectively. Withers height and hip width were similar in calves fed milk either once or twice a day; however, calves fed yeast tended to have greater withers height and hip width than control calves. Haptoglobin concentration as a measure of stress had least squares means of 4.0 and 9.5 ± 3.5 µg/mL for calves fed milk once or twice a day, respectively, and we found no difference among treatments. Scours score and total daily score were similar for calves fed milk once or twice a day. These results suggest that feeding milk once a day can be successfully applied to a calf feeding system and that yeast products may improve structural growth.
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Affiliation(s)
- D J Saldana
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | - C M Jones
- Department of Animal Science, The Pennsylvania State University, University Park 16802
| | | | - A J Heinrichs
- Department of Animal Science, The Pennsylvania State University, University Park 16802.
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Ouédraogo S, Gautier L, Mac-Seing M, Tine S, Perez MC, Kadio K, Chegno R, Jones CM. De-patriarchalising and levelling science for French-speaking women. Lancet 2019; 393:e23-e24. [PMID: 30739705 DOI: 10.1016/s0140-6736(18)32092-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/27/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Samiratou Ouédraogo
- Institut National de Santé Publique du Québec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, H3A 1A2 Canada.
| | - Lara Gautier
- Centre d'Études en Sciences Sociales sur les Mondes Africains, Américains et Asiatiques (IRD/Paris-Diderot), Université Sorbonne Paris Cité, Paris, France; Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada; Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Université de Montréal, Montreal, QC, Canada
| | - Muriel Mac-Seing
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada; Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Université de Montréal, Montreal, QC, Canada
| | - Stella Tine
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Myriam Cielo Perez
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Kadidiatou Kadio
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada; Programme de doctorat en sciences humaines appliquées, Université de Montréal, Montreal, QC, Canada; Institut de Recherche en Science de la Santé, Ouagadougou, Burkina Faso
| | - Rolande Chegno
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Catherine M Jones
- LSE Health, The London School of Economics and Political Science, London, UK
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Scott-Parker B, Jones CM, Rune K, Tucker J. A qualitative exploration of driving stress and driving discourtesy. Accid Anal Prev 2018; 118:38-53. [PMID: 29860130 DOI: 10.1016/j.aap.2018.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/08/2017] [Accepted: 03/04/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Driving courtesy, and conversely driving discourtesy, recently has been of great interest in the public domain. In addition, there has been increasing recognition of the negative impact of stress upon the individual's health and wellbeing, with a plethora of interventions aimed at minimising stress more generally. The research literature regarding driving dis/courtesy, in comparison, is scant, with a handful of studies examining the dis/courteous driving behaviour of road users, and the relationship between driving discourtesy and driving stress. AIM To examine courteous and discourteous driving experiences, and to explore the impact of stress associated with such driving experiences. METHOD Thirty-eight drivers (20 females) from the Sunshine Coast region volunteered to participate in one of four 1-1.5 h focus groups. Content analysis used the verbatim utterances captured via an Mp3 device. RESULTS Three themes pertaining to stressful and discourteous interactions were identified. Theme one pertained to the driving context: road infrastructure (eg, roundabouts, roadwork), vehicles (eg, features), location (eg, country vs city, unfamiliar areas), and temporal aspects (eg, holidays). Theme two pertained to other road users: their behaviour (eg, tailgating, merging), and unknown factors (eg, illicit and licit drug use). Theme three pertained to the self as road user: their own behaviours (eg, deliberate intimidation), and their emotions (eg, angry reaction to other drivers, being in control). DISCUSSION AND CONCLUSIONS Driving dis/courtesy and driving stress is a complex phenomenon, suggesting complex intervention efforts are required. Driving discourtesy was reported as being highly stressful, therefore intervention efforts which encourage driving courtesy and which foster emotional capacity to cope with stressful circumstances appear warranted.
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Affiliation(s)
- B Scott-Parker
- Adolescent Risk Research Unit (ARRU), Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Australia; School of Social Science, Faculty of Arts, Business, and Law, University of the Sunshine Coast, Australia; Sustainability Research Centre, Faculty of Arts and Business, University of the Sunshine Coast, Australia.
| | - C M Jones
- Faculty of Arts and Business, University of the Sunshine Coast, Australia
| | - K Rune
- Adolescent Risk Research Unit (ARRU), Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Australia; School of Social Science, Faculty of Arts, Business, and Law, University of the Sunshine Coast, Australia; Sustainability Research Centre, Faculty of Arts and Business, University of the Sunshine Coast, Australia
| | - J Tucker
- The Royal Automobile Club of Queensland, Australia
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Jones CM, Gautier L, Kadio K, Mac-Seing M, Miranda É, Omenka C, Ouédraogo S, Pérez MC, Turcotte-Tremblay AM, Tiné S. Equity in the gender equality movement in global health. Lancet 2018; 392:e2-e3. [PMID: 30017139 DOI: 10.1016/s0140-6736(18)31561-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lara Gautier
- Centre d'Études en Sciences Sociales sur les Mondes Africains, Américains et Asiatiques (IRD/Paris-Diderot), Université Sorbonne Paris Cité, Paris, France; École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada; Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montréal, Québec, Canada
| | - Kadidiatou Kadio
- Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montréal, Québec, Canada; Institut de Recherche en Science de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Muriel Mac-Seing
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada; Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Érica Miranda
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada; Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montréal, Québec, Canada; Chaire Approches Communautaires et Inégalités de Santé (CACIS), Montréal, Québec, Canada
| | - Charity Omenka
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Samiratou Ouédraogo
- Institut National de Santé Publique du Québec (INSPQ), Montréal, Québec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Myriam Cielo Pérez
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Anne-Marie Turcotte-Tremblay
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada; Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montréal, Québec, Canada
| | - Stella Tiné
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
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Jones CM, Davies GM, Monaghan N, Morgan MZ, Neville JS, Pitts NB. The caries experience of 5 year-old children in Scotland in 2013-2014, and in England and Wales in 2014-2015. Reports of cross-sectional dental surveys using BASCD criteria. Community Dent Health 2018; 34:157-162. [PMID: 28872810 DOI: 10.1922/cdh_4085jones06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/27/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We report the findings from and comment on the surveys of the oral health of 5-year-old children undertaken in Scotland (2013-14), Wales (2014-15) and England (2014-15). This was the fourteenth survey in Scotland since 1988. In England and Wales it is the third survey since 2007 when changes were required in consent arrangements. METHOD Representative samples were drawn within Health Boards across Scotland and local authorities across England and Wales. Consent was sought via opt-out parental consent in Scotland and opt-in parental consent in England and Wales. Children examined were those aged five in England and those in Primary 1 (school year aged 5 to 6) in Scotland and Wales. Examinations were conducted in schools by trained and calibrated examiners. Caries was visually diagnosed at the dentinal threshold. RESULTS There is a continuing decline in d₃mft in all three countries. d₃mft was 1.27 (opt-out consent) for Scotland, 0.84 for England (opt-in consent) and 1.29 for Wales (opt-in consent). Tooth decay levels remain higher in more deprived areas across Great Britain, with clear inequalities gradients demonstrated across all geographies. Attempts to measure changes in dental health inequalities across the three countries show no conclusive trends. CONCLUSION Inter-country comparisons provide further oral health intelligence despite differences in approach and timing. The third surveys in England and Wales using the new consent arrangements have enabled trend analysis. Dental health inequalities gradients were shown across all geographies and all of the indicators of inequality.
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Affiliation(s)
| | | | | | - M Z Morgan
- Welsh Oral Health Information Unit, Cardiff University
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Blackwell K, Gascon P, Jones CM, Nixon A, Krendyukov A, Nakov R, Li Y, Harbeck N. Pooled analysis of two randomized, double-blind trials comparing proposed biosimilar LA-EP2006 with reference pegfilgrastim in breast cancer. Ann Oncol 2018. [PMID: 28637287 PMCID: PMC5834021 DOI: 10.1093/annonc/mdx303] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Following the functional and physicochemical characterization of a proposed biosimilar, comparative clinical studies help to confirm biosimilarity by demonstrating similar safety and efficacy to the reference product in a sensitive patient population. Patients and methods LA-EP2006 is a proposed biosimilar that has been developed for pegfilgrastim, a long-acting form of granulocyte colony-stimulating factor for the prevention of neutropenia. The current analysis reports data pooled from two independent, multinational, prospective, randomized, controlled, double-blind phase III studies of similar design comparing the safety and efficacy of reference pegfilgrastim with LA-EP2006 in patients with breast cancer receiving myelotoxic (neo)adjuvant TAC (docetaxel, doxorubicin, and cyclophosphamide) chemotherapy and requiring granulocyte colony-stimulating factor. Results A total of 624 patients were randomized in the PROTECT-1 and PROTECT-2 studies (NCT01735175; NCT01516736) (LA-EP2006: n = 314; reference: n = 310). Baseline characteristics of patients were well balanced across treatment groups. The primary end point, mean duration of severe neutropenia in the first chemotherapy cycle was similar in both the LA-EP2006 and reference groups (1.05 ± 1.055 days versus 1.01 ± 0.958 days), with a treatment difference of - 0.04 days [95% confidence interval (CI): -0.19 to 0.11] that met the equivalence criteria (the 95% CI were within the defined margin of ±1 day). Secondary end points, such as the nadir of absolute neutrophil count and the incidence of febrile neutropenia, were also similar between LA-EP2006 and reference pegfilgrastim. The safety and tolerability profile of LA-EP2006 was similar to that observed with reference pegfilgrastim, and there were no reports of neutralizing antibodies. Conclusions This pooled analysis confirms, as a part of totality of evidence approach, that the proposed biosimilar pegfilgrastim LA-EP2006 has a comparable efficacy and safety profile to reference pegfilgrastim in patients with breast cancer receiving TAC chemotherapy. Clinical trial numbers NCT01735175 and NCT01516736.
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Affiliation(s)
- K Blackwell
- Department of Oncology, Duke University, DUMC, Durham, USA
| | - P Gascon
- Medical Oncology Department, Hospital General Vall d'Hebron, Barcelona, Spain
| | | | - A Nixon
- Fowler Family Center for Cancer Care, Jonesboro, USA
| | | | - R Nakov
- Hexal AG, Holzkirchen/Oberhaching, Germany
| | - Y Li
- Sandoz Inc., Princeton, USA
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynecology, and CCCLMU, University of Munich (LMU), Munich, Germany
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Clavier C, Potvin L, Jones CM. The rules for intersectoral policy processes in the Swiss national policy on global health arena. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Clavier
- Université du Québec à Montréal, Montréal, Canada
| | - L Potvin
- Université du Québec à Montréal, Montréal, Canada
| | - CM Jones
- Université du Québec à Montréal, Montréal, Canada
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Benmarhnia T, Huang JY, Jones CM. Lost in Translation: Piloting a Novel Framework to Assess the Challenges in Translating Scientific Uncertainty From Empirical Findings to WHO Policy Statements. Int J Health Policy Manag 2017; 6:649-660. [PMID: 29179291 PMCID: PMC5675583 DOI: 10.15171/ijhpm.2017.28] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/21/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Calls for evidence-informed public health policy, with implicit promises of greater program effectiveness, have intensified recently. The methods to produce such policies are not self-evident, requiring a conciliation of values and norms between policy-makers and evidence producers. In particular, the translation of uncertainty from empirical research findings, particularly issues of statistical variability and generalizability, is a persistent challenge because of the incremental nature of research and the iterative cycle of advancing knowledge and implementation. This paper aims to assess how the concept of uncertainty is considered and acknowledged in World Health Organization (WHO) policy recommendations and guidelines. METHODS We selected four WHO policy statements published between 2008-2013 regarding maternal and child nutrient supplementation, infant feeding, heat action plans, and malaria control to represent topics with a spectrum of available evidence bases. Each of these four statements was analyzed using a novel framework to assess the treatment of statistical variability and generalizability. RESULTS WHO currently provides substantial guidance on addressing statistical variability through GRADE (Grading of Recommendations Assessment, Development, and Evaluation) ratings for precision and consistency in their guideline documents. Accordingly, our analysis showed that policy-informing questions were addressed by systematic reviews and representations of statistical variability (eg, with numeric confidence intervals). In contrast, the presentation of contextual or "background" evidence regarding etiology or disease burden showed little consideration for this variability. Moreover, generalizability or "indirectness" was uniformly neglected, with little explicit consideration of study settings or subgroups. CONCLUSION In this paper, we found that non-uniform treatment of statistical variability and generalizability factors that may contribute to uncertainty regarding recommendations were neglected, including the state of evidence informing background questions (prevalence, mechanisms, or burden or distributions of health problems) and little assessment of generalizability, alternate interventions, and additional outcomes not captured by systematic review. These other factors often form a basis for providing policy recommendations, particularly in the absence of a strong evidence base for intervention effects. Consequently, they should also be subject to stringent and systematic evaluation criteria. We suggest that more effort is needed to systematically acknowledge (1) when evidence is missing, conflicting, or equivocal, (2) what normative considerations were also employed, and (3) how additional evidence may be accrued.
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Affiliation(s)
- Tarik Benmarhnia
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada.,Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Jonathan Y Huang
- Institute for Health and Social Policy, McGill University, Montreal, QC, Canada
| | - Catherine M Jones
- Chaire approches communautaires et inégalités de santé, Institut de recherche en santé publique, École de santé publique, Université de Montréal, Montreal, QC, Canada
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Jones CM, Clavier C, Potvin L. The rules for intersectoral policy processes in the Norwegian national policy on global health arena. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.072] [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: 11/13/2022] Open
Affiliation(s)
- CM Jones
- Université du Québec à Montréal, Montréal, Canada
| | - C Clavier
- Université du Québec à Montréal, Montréal, Canada
| | - L Potvin
- Université du Québec à Montréal, Montréal, Canada
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Jones CM, Clavier C, Potvin L. Are national policies on global health in fact national policies on global health governance? A comparison of policy designs from Norway and Switzerland. BMJ Glob Health 2017; 2:e000120. [PMID: 28589007 PMCID: PMC5435252 DOI: 10.1136/bmjgh-2016-000120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 12/03/2022] Open
Abstract
Background Since the signing of the Oslo Ministerial Declaration in 2007, the idea that foreign policy formulation should include health considerations has gained traction on the United Nations agenda as evidenced by annual General Assembly resolutions on global health and foreign policy. The adoption of national policies on global health (NPGH) is one way that some member states integrate health and foreign policymaking. This paper explores what these policies intend to do and how countries plan to do it. Methods Using a most similar systems design, we carried out a comparative study of two policy documents formally adopted in 2012. We conducted a directed qualitative content analysis of the Norwegian White Paper on Global health in foreign and development policy and the Swiss Health Foreign Policy using Schneider and Ingram's policy design framework. After replicating analysis methods for each document, we analysed them side by side to explore the commonalities and differences across elements of NPGH design. Results Analyses indicate that NPGH expect to influence change outside their borders. Targeting the international level, they aim to affect policy venues, multilateral partnerships and international institutions. Instruments for supporting desired changes are primarily those of health diplomacy, proposed as a tool for negotiating interests and objectives for global health between multiple sectors, used internally in Switzerland and externally in Norway. Conclusion Findings suggest that NPGH designs contribute to constructing the global health governance system by identifying it as a policy target, and policy instruments may elude the health sector actors unless implementation rules explicitly include them. Research should explore how future NPGH designs may construct different kinds of targets as politicised groups of actors on which national governments seek to exercise influence for global health decision-making.
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Affiliation(s)
- Catherine M Jones
- Chaire Approches communautaires et inégalités de santé, Montréal, Québec, Canada
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, Québec, Canada
- Département de Médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
- Regroupement stratégique Politiques publiques et santé des populations, Réseau de recherche en santé des populations du Québec, Montréal, Québec, Canada
| | - Carole Clavier
- Regroupement stratégique Politiques publiques et santé des populations, Réseau de recherche en santé des populations du Québec, Montréal, Québec, Canada
- Département de Science Politique, de l'Université du Québec à Montréal, Montréal, Québec, Canada
| | - Louise Potvin
- Chaire Approches communautaires et inégalités de santé, Montréal, Québec, Canada
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, Québec, Canada
- Département de Médecine sociale et préventive, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
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Zadeh S, Jones CM, Basi T, Golombok S. Children's thoughts and feelings about their donor and security of attachment to their solo mothers in middle childhood. Hum Reprod 2017; 32:868-875. [PMID: 28184441 PMCID: PMC5400065 DOI: 10.1093/humrep/dex016] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/27/2017] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION What is the relationship between children's thoughts and feelings about their donor and their security of attachment to their solo mothers in middle childhood? SUMMARY ANSWER Children with higher levels of secure–autonomous attachment to their mothers were more likely to have positive perceptions of the donor, and those with higher levels of insecure–disorganized attachment to their mothers were more likely to perceive him negatively. WHAT IS KNOWN ALREADY There is limited understanding of the factors that contribute to children's thoughts and feelings about their donor in solo mother families. In adolescence, an association was found between adolescents’ curiosity about donor conception and their security of attachment to their mothers. STUDY DESIGN, SIZE, DURATION 19 children were administered the Friends and Family Interview and Donor Conception Interview between December 2015 and March 2016 as part of the second phase of a longitudinal, multi-method, multi-informant study of solo mother families. PARTICIPANTS/MATERIALS, SETTING, METHODS All children were aged between 7 and 13 years and had been conceived by donor insemination to solo mothers. Interviews were conducted in participants’ homes. The Friends and Family Interview was rated according to a standardized coding scheme designed to measure security of attachment in terms of secure–autonomous, insecure–dismissing, insecure–preoccupied and insecure–disorganized attachment patterns. Quantitative analyses of the Donor Conception Interview yielded two factors: interest in the donor and perceptions of the donor. Qualitative analyses of the Donor Conception Interview were conducted using qualitative content analysis and thematic analysis. MAIN RESULTS AND THE ROLE OF CHANCE Statistically significant associations were found between the perception of the donor scale and the secure–autonomous and insecure–disorganized attachment ratings. Children with higher levels of secure–autonomous attachment to their mothers were more likely to have positive perceptions of the donor (r = 0.549, P = 0.015), and those with higher levels of insecure–disorganized attachment to their mothers were more likely to perceive him negatively (r = −0.632, P = 0.004). Children's narratives about the donor depicted him as a stranger (n = 8), a biological father (n = 4), a social parent (n = 3), or in ambivalent terms (n = 4). LIMITATIONS, REASONS FOR CAUTION Findings are limited by the wide age range of children within a small overall sample size. Participants were those willing and able to take part in research on donor conception families. The statistical significance of correlation coefficients was not corrected for multiple comparisons. WIDER IMPLICATIONS OF THE FINDINGS Findings highlight the importance of situating children's ideas about the donor within family contexts. It is recommended that those working with donor conception families consider this when advising parents about whether, what and how to tell children about donor conception. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.
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Affiliation(s)
- S Zadeh
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge, UK
| | - C M Jones
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge, UK
| | - T Basi
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge, UK
| | - S Golombok
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge, UK
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Brown MJF, Sainsbury AW, Vaughan-Higgins RJ, Measures GH, Jones CM, Gammans N. Bringing Back a Healthy Buzz? Invertebrate Parasites and Reintroductions: A Case Study in Bumblebees. Ecohealth 2017; 14:74-83. [PMID: 26732074 DOI: 10.1007/s10393-015-1093-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/11/2015] [Accepted: 12/06/2015] [Indexed: 06/05/2023]
Abstract
Reintroductions can play a key role in the conservation of endangered species. Parasites may impact reintroductions, both positively and negatively, but few case studies of how to manage parasites during reintroductions exist. Bumblebees are in decline at regional and global scales, and reintroductions can be used to re-establish extinct local populations. Here we report on how the risks associated with parasites are being managed in an ongoing reintroduction of the short-haired bumblebee, Bombus subterraneus, to the UK. Disease risk analysis was conducted and disease risk management plans constructed to design a capture-quarantine-release system that minimised the impacts on both the bumblebees and on their natural parasites. Given that bumblebee parasites are (i) generalists, (ii) geographically ubiquitous, and (iii) show evidence of local adaptation, the disease risk management plan was designed to limit the co-introduction of parasites from the source population in Sweden to the destination site in the UK. Results suggest that this process at best eliminated, or at least severely curtailed the co-introduction of parasites, and ongoing updates of the plan enabled minimization of impacts on natural host-parasite dynamics in the Swedish source population. This study suggests that methods designed for reintroductions of vertebrate species can be successfully applied to invertebrates. Future reintroductions of invertebrates where the parasite fauna is less well known should take advantage of next-generation barcoding and multiple survey years prior to the start of reintroductions, to develop comprehensive disease risk management plans.
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Affiliation(s)
- Mark J F Brown
- School of Biological Sciences, Royal Holloway University of London, Egham Hill, Egham, TW20 0EX, UK.
| | - Anthony W Sainsbury
- Institute of Zoology, Zoological Society of London, Regent's Park, London, NW1 4RY, UK
| | - Rebecca J Vaughan-Higgins
- Wildlife & Conservation, College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA, 6150, Australia
| | - Gavin H Measures
- Natural England, Suite D, Unex House, Bourges Boulevard, Peterborough, PE1 1NG, UK
| | - Catherine M Jones
- School of Biology, Faculty of Biological Sciences, University of Leeds, Leeds, LS2 NJT, UK
| | - Nikki Gammans
- Bumblebee Conservation Trust, Stirling University Innovation Park, Stirling, FK9 4NF, UK
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Jones CM, Clavier C, Potvin L. Adapting public policy theory for public health research: A framework to understand the development of national policies on global health. Soc Sci Med 2017; 177:69-77. [DOI: 10.1016/j.socscimed.2017.01.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/04/2016] [Accepted: 01/22/2017] [Indexed: 10/20/2022]
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Blackwell K, Gascon P, Jones CM, Nixon A, Nakov R, Mo M, Krendyukov A, Nadia H. Abstract P2-11-05: Safety, immunogenicity and efficacy of proposed biosimilar pegfilgrastim (LA-EP2006) compared with reference pegfilgrastim in breast cancer: Pooled analysis of two randomized, double-blind, phase III trials. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-11-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Biosimilars are highly similar to a biological reference product with no clinically meaningful differences in terms of efficacy and safety. Here we present the pooled analysis of two randomized trials (PROTECT1 and 2) comparing the efficacy, safety and immunogenicity of proposed biosimilar pegfilgrastim (LA-EP2006) with reference pegfilgrastim (Neulasta®*).
Methods: Two multinational, independent, prospective, double-blind, phase III studies (EudraCT: 2011-004532-58; 2012-002039-28) enrolled adult chemotherapy-naïve women with breast cancer scheduled to receive ≤6 cycles of (neo)-adjuvant chemotherapy with docetaxel 75 mg/m2, doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 (TAC). Patients were randomized to receive a single 6 mg injection of LA-EP2006 or reference on Day 2 of each cycle. Primary endpoint was duration of severe neutropenia (DSN) (number of consecutive days with ANC <0.5x109/L) in Cycle 1. Equivalence was confirmed if the 95% confidence intervals (CI) for the difference in mean DSN between groups were within a pre-defined margin of ±1 day. Secondary efficacy endpoints included incidences of febrile neutropenia (FN), fever and infections, and depth of ANC nadir and time to ANC recovery (≥2×109/L after the nadir) in Cycle 1. Safety was assessed at each visit with follow-up visits at 4 weeks and 6 months (PROTECT1 only) after last administration of pegfilgrastim. Immunogenicity was assessed before the first pegfilgrastim injection, on Day 15 of cycle 6, and 4 weeks and 6 months (PROTECT1 only).
Results: A total of 624 patients were randomized (LA-EP2006: n=314; reference: n=310). Baseline demographics were well balanced (mean age: LA-EP2006: 49.3 years, reference: 49.8; median duration (months) since initial diagnosis: LA-EP2006: 1.33 [0.1−76.0], reference: 1.35 [0.2−11.2]; ECOG status 0: LA-EP2006: 78%, reference: 75%). Mean DSN difference in Cycle 1 was -0.04 days (95% CI: -0.19, 0.11), showing statistical equivalence. FN was reported in 5.7% of patients with LA-EP2006 vs. 8.4% with reference in Cycle 1 (all cycles: 8.0% vs. 10.3%). Across all cycles, frequency of fever (LA-EP2006: 18.5%; reference: 19.7%) and infections (LA-EP2006: 15.6%; reference: 18.1%) were similar in both groups. Mean ANC time courses were almost superimposable in the two groups, with similar time and depth of ANC nadir and median time to ANC recovery was 2 days in both groups in Cycle 1. Treatment-emergent adverse events (TEAEs) were similar across groups (LA-EP2006: 92%; reference: 89%), and TEAEs with a suspected relationship to pegfilgrastim were reported in 22.6% of patients with LA-EP2006 and 21.3% with reference across all cycles, with the most frequent being musculoskeletal and connective tissue disorders (LA-EP2006: 10.2%; reference: 9.7%). Serious TEAEs were reported in 14.3% (LA-EP2006) vs. 17.1% (reference) across all cycles. No neutralizing or clinically relevant anti-pegfilgrastim antibodies were identified.
Conclusions: LA-EP2006 demonstrated similar clinical efficacy and safety to reference pegfilgrastim in patients with breast cancer receiving myelotoxic chemotherapy.
*Neulasta® is a registered trademark of Amgen Inc.
Citation Format: Blackwell K, Gascon P, Jones CM, Nixon A, Nakov R, Mo M, Krendyukov A, Nadia H. Safety, immunogenicity and efficacy of proposed biosimilar pegfilgrastim (LA-EP2006) compared with reference pegfilgrastim in breast cancer: Pooled analysis of two randomized, double-blind, phase III trials [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-11-05.
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Affiliation(s)
- K Blackwell
- Duke Cancer Institute, Durham, NC; Fundacio Clinic, Barcelona, Spain; The Jones Clinic, Memphis, TN; Fowler Family Center for Cancer Care, Jonesboro, AR; Sandoz Inc/ Hexal AG, Holzkirchen, Germany; Sandoz Inc, Holzkirchen, Germany; Brustzentrum der Universität München (LMU), Munich, Germany
| | - P Gascon
- Duke Cancer Institute, Durham, NC; Fundacio Clinic, Barcelona, Spain; The Jones Clinic, Memphis, TN; Fowler Family Center for Cancer Care, Jonesboro, AR; Sandoz Inc/ Hexal AG, Holzkirchen, Germany; Sandoz Inc, Holzkirchen, Germany; Brustzentrum der Universität München (LMU), Munich, Germany
| | - CM Jones
- Duke Cancer Institute, Durham, NC; Fundacio Clinic, Barcelona, Spain; The Jones Clinic, Memphis, TN; Fowler Family Center for Cancer Care, Jonesboro, AR; Sandoz Inc/ Hexal AG, Holzkirchen, Germany; Sandoz Inc, Holzkirchen, Germany; Brustzentrum der Universität München (LMU), Munich, Germany
| | - A Nixon
- Duke Cancer Institute, Durham, NC; Fundacio Clinic, Barcelona, Spain; The Jones Clinic, Memphis, TN; Fowler Family Center for Cancer Care, Jonesboro, AR; Sandoz Inc/ Hexal AG, Holzkirchen, Germany; Sandoz Inc, Holzkirchen, Germany; Brustzentrum der Universität München (LMU), Munich, Germany
| | - R Nakov
- Duke Cancer Institute, Durham, NC; Fundacio Clinic, Barcelona, Spain; The Jones Clinic, Memphis, TN; Fowler Family Center for Cancer Care, Jonesboro, AR; Sandoz Inc/ Hexal AG, Holzkirchen, Germany; Sandoz Inc, Holzkirchen, Germany; Brustzentrum der Universität München (LMU), Munich, Germany
| | - M Mo
- Duke Cancer Institute, Durham, NC; Fundacio Clinic, Barcelona, Spain; The Jones Clinic, Memphis, TN; Fowler Family Center for Cancer Care, Jonesboro, AR; Sandoz Inc/ Hexal AG, Holzkirchen, Germany; Sandoz Inc, Holzkirchen, Germany; Brustzentrum der Universität München (LMU), Munich, Germany
| | - A Krendyukov
- Duke Cancer Institute, Durham, NC; Fundacio Clinic, Barcelona, Spain; The Jones Clinic, Memphis, TN; Fowler Family Center for Cancer Care, Jonesboro, AR; Sandoz Inc/ Hexal AG, Holzkirchen, Germany; Sandoz Inc, Holzkirchen, Germany; Brustzentrum der Universität München (LMU), Munich, Germany
| | - H Nadia
- Duke Cancer Institute, Durham, NC; Fundacio Clinic, Barcelona, Spain; The Jones Clinic, Memphis, TN; Fowler Family Center for Cancer Care, Jonesboro, AR; Sandoz Inc/ Hexal AG, Holzkirchen, Germany; Sandoz Inc, Holzkirchen, Germany; Brustzentrum der Universität München (LMU), Munich, Germany
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Jones CM, Palmer M, Schaffler JJ. Beyond Zar: the use and abuse of classification statistics for otolith chemistry. J Fish Biol 2017; 90:492-504. [PMID: 27325371 DOI: 10.1111/jfb.13051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
Classification method performance was evaluated using otolith chemistry of juvenile Atlantic menhaden Brevoortia tyrannus when assumptions of data normality were met and were violated. Four methods were tested [linear discriminant function analysis (LDFA), quadratic discriminant function analysis (QDFA), random forest (RF) and artificial neural networks (ANN)] using computer simulation to determine their performance when variable-group means ranged from small to large and their performance under conditions of typical skewness to double the amount of skewness typically observed. Using the kappa index, the parametric methods performed best after applying appropriate data transformation, gaining 2% better performance with LDFA performing slightly better than QDFA. RF performed as well as QDFA and showed no difference in performance between raw and transformed data while the performance of ANN was the poorest and worse with raw data. All methods performed well when group differences were large, but parametric methods outperformed machine-learning methods. When data were skewed the performance of all methods declined and worsened with greater skewness, but RF performed consistently as well or better than the other methods in the presence of skewness. The parametric methods were found to be more powerful when assumptions of normality can be met and can be used confidently when skewness and kurtosis are minimized. When these assumptions cannot be minimized, then machine-algorithm methods should also be tried.
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Affiliation(s)
- C M Jones
- Center for Quantitative Fisheries Ecology, Old Dominion University, Norfolk, VA, 23529, U.S.A
| | - M Palmer
- Mediterranean Institute for Advanced Studies (IMEDEA), Ecology and Marine Resources, C/Miquel Marques, 21-07190 Esporales, Illes Balears, Spain
| | - J J Schaffler
- Muckleshoot Indian Tribe, 39015 172nd Ave SE, Auburn, WA, 98092, U.S.A
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