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Zhao J, Dong Y, Clark E, Garcia JM, White DL, Kramer JR, Mazul AL, Hartman C, Chiao EY. Risk and predictors of penile cancer in US Veterans with HIV. AIDS 2024:00002030-990000000-00481. [PMID: 38652491 DOI: 10.1097/qad.0000000000003914] [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: 04/25/2024]
Abstract
OBJECTIVES People living with HIV (PWH) may have an increased burden of penile cancer. We aimed to evaluate the risk of penile cancer in PWH compared to that of the general population. DESIGN We conducted a nationwide retrospective matched cohort study of penile cancer incidence among veterans living with HIV (VWH) compared to veterans without HIV. METHODS We compared penile cancer incidence rates in 44,173 VWH to those of veterans without Human Immunodeficiency virus (HIV) (N = 159,443; 4:1 matched in age. We used Cox regression models to estimate Hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with HIV infection and for penile cancer risk factors. RESULTS HIV positivity was associated with an increased risk of penile cancer, with adjusted hazard ratios (HR) of 2.63 (95% CI: 1.64-4.23) when adjusting for age, race/ethnicity, baseline BMI, smoking and alcohol use, economic means test, and history of condyloma. The risk increased to HR = 4.25 (95% CI: 2.75-6.57) when adjusting for all factors except history of condyloma. Risk factors for penile cancer in VWH included lower nadir CD4 count, <50% of follow-up time with undetectable HIV viral load, and history of condyloma. CONCLUSIONS VWH--particularly those with low CD4 counts, detectable HIV viral loads, or history of condyloma--are at increased risk of penile cancer, suggesting the penile cancer prevention activities are needed in this population.
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Affiliation(s)
- Jing Zhao
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Yongquan Dong
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Eva Clark
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Jose M Garcia
- Geriatric Research, Education and Clinical Center (GRECC), VA Puget Sound Health Care System, and Department of Medicine, Division of Gerontology & Geriatric Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Donna L White
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
- Texas Medical Center Digestive Disease Center, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer R Kramer
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, USA
- Division of Public Health Science, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christine Hartman
- Health Services Research, Michael E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
| | - Elizabeth Y Chiao
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas USA
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Calvani NED, Verissimo CDM, Cantacessi C, Clark E, Kanduma E. Herminthology: promoting gender equity in science and parasitology: (Trends in Parasitology, 39:2 p:73-79, 2023). Trends Parasitol 2023; 39:402. [PMID: 36894388 DOI: 10.1016/j.pt.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Calvani NED, Verissimo CDM, Cantacessi C, Clark E, Kanduma E. Herminthology: promoting gender equity in science and parasitology. Trends Parasitol 2023; 39:73-79. [PMID: 36526549 DOI: 10.1016/j.pt.2022.11.013] [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: 10/08/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
Gender inequity in Science, Technology, Engineering, and Medicine (STEM) fields, including parasitology, continues to limit the participation of women in scientific leadership and development. Here we highlight the aims and activities of Herminthology, an initiative promoting the work of women in parasitology, alongside the current status quo of men and women scientists in the discipline.
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Affiliation(s)
| | | | | | - Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Division of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Esther Kanduma
- Department of Biochemistry, Faculty of Science and Technology, University of Nairobi, Nairobi, Kenya
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Poole K, Chappell D, Brown J, Clark E, Fleming J, Shepstone L, Turmezei T, Wagner A, Willoughby K, Kaptoge S. OP0243 OSTEOPOROSIS CASE-FINDING IN PEOPLE UNDERGOING ROUTINE DIAGNOSTIC CT SCANS ALMOST TRIPLED THE RATE OF OSTEOPOROSIS TREATMENT AT 12 MONTHS. A RANDOMISED, MULTI-CENTRE FEASIBILITY STUDY USING WAITING ROOM FRAX, OPPORTUNISTIC CT BONE DENSITY AND VERTEBRAL FRACTURE ASSESSMENT VERSUS USUAL CARE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundUp to 40% of all diagnostic computed tomography (CT) scans include views of the spine or hips. Among older people, osteoporosis or vertebral fractures have been found in 30% of such CT scans. Our ‘PHOENIX’ intervention repurposes CT scans taken for other reasons to identify fractures and measure bone density as an ‘added extra’. Early detection and treatment of osteoporosis in CT-attending patients could improve health outcomes.ObjectivesTo determine the feasibility and efficacy of PHOENIX versus usual care in a multi-centre, randomised, pragmatic study conducted in Eastern England involving our Cambridge Specialist Hospital ‘hub’ and four regional General Hospital ‘spokes’.MethodsWomen ≥65 and men ≥75 years attending for routine diagnostic CT scans were invited to participate via a novel consent form incorporating FRAX Fracture Risk Assessment questions. After calculating their FRAX 10-year risk score, higher risk patients were block randomised (1:1:1) to Group 1) PHOENIX intervention, 2) Active Control, where the GP was sent the patients’ FRAX answers only, or 3) Usual Care where data were only analysed after 13 months had elapsed. The CT scans of high FRAX risk patients in Group 1 were retrieved by the Cambridge team using NHS Connecting for Health (Burnbank, UK). The team performed vertebral fracture assessment and measured bone density using QCT Pro (Mindways, USA). They added patient-specific treatment and investigation management advice from ‘drop down’ menus before results were reviewed by a physician, authorised and sent to general practitioners (GPs). Baseline CT scans from groups 2 and 3 were assessed in the same way after 13 months to ensure no patient with osteoporosis/fractures was neglected long term. Assuming 25% attrition, the study was powered to find a superior osteoporosis treatment rate in Group 1 (estimated 20%) versus 16% (Active Control) and 5% (Usual Care). Co-primary feasibility endpoints were the ability to a) randomise 375 patients within 10 months and b) retain 75% of survivors able to complete a 1-year bone health outcome questionnaire. Secondary outcomes included osteoporosis/vertebral fracture identification rates and osteoporosis treatment rates. Stakeholder acceptability and economic aspects will be reported separately.ResultsFrom 1828 invites, 595 participants consented to participate of whom 213 were excluded due to ‘low’ FRAX score. Mortality at 12 months was 20%. Both feasibility objectives were achieved: 1) 382 people were randomised within 10 months; 2) 84.4% of survivors at 1 year (95%CI: 80.5, 88.3) were successfully followed-up. Groups were well matched at baseline. The average age of 375 patients (334 female, 41 male) was 75.2 years (74.6, 75.9). Osteoporosis of the hip/spine was present in 41% of 362 analysable CT scans. From the 264 spines that were suitable for VFA, 20% (n=53) were found to have vertebral fractures, with 8.3% having multiple vertebral fractures (n=22). Osteoporosis treatment was reported in 8.5% of Usual Care group (2.9, 14.2) and 24.2% (15.4, 33.0) of PHOENIX group participants, while in the Active Control group (FRAX only) it was 18.8% (10.9, 26.6 p=0.021). In the PHOENIX group, a recommendation to treat was sent to 50 patients’ GPs at baseline. Only 18 of the 50 patients (36%) were found to be taking osteoporosis treatment 12 months after this advice was sent.ConclusionOsteoporosis treatment rates were almost tripled by screening patients attending for routine diagnostic CT scans with waiting room FRAX, CT-bone densitometry and vertebral fracture analysis.AcknowledgementsThis project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0816-20027) and by the Cambridge NIHR Biomedical Research Centre (BRC-1215-20014). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Funding is in place to 31.03.2022. Three individuals, Mr Jeremy Dearling, Mrs Tessa Plume and Dr Ann Frost joined our trial group as PPI representatives; they were specifically involved in patient documentation design (particularly the PHOENIX pack, informed consent form which facilitated consent without having a researcher present) and contributed to suggestions for increasing patient recruitment and follow up.Disclosure of InterestsNone declared
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Bennett SE, Gooberman-Hill R, Clark E, Paskins Z, Walsh N, Drew S. POS1514-HPR UNDERSTANDING AND CHARACTERISING PATIENT PATHWAYS TO TREATMENT FOR VERTEBRAL FRACTURES: A QUALITATIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundOsteoporosis involves thinning of the bones, making them more prone to break. The most common osteoporotic fracture is a vertebral fracture (OVF). People with OVFs are at high risk of further fractures. To reduce this risk, guidelines recommend prescription of bone protection therapies to people who have experienced a fracture. However, many patients do not receive diagnosis. Understanding patient pathways to treatment for OVFs will provide information to improve practice and aid in effective identification and management.ObjectivesTo understand and characterise patient pathways to treatment for OVFs.MethodsTwenty-three semi-structured qualitative interviews were conducted with patients aged ≥50 years with diagnosis of OVF. Patients were recruited through two hospitals in England and were purposively sampled to capture variation in pathways to diagnosis, sex, age, comorbidities and other relevant characteristics. Interviews were audio-recorded, transcribed and analysed thematically, with themes transposed onto key stages of the patient pathway.ResultsSeveral factors influenced patient pathways to treatment:Patient appraisal and self-management: Characteristics and attitudes towards back pain impacted treatment-seeking behaviour. Patients who appraised their pain as ‘different’, severe or disruptive, or associated with an injury such as a fall, were more likely to seek help. Limited availability of information about OVFs and risk factors meant most patients did not associate symptoms with a potential OVF. Factors contributing to delayed consultation included the normalisation of back pain and prioritisation of comorbid conditions. Several misappraised their symptoms as a “pulled muscle” or other minor injury. Many adopted strategies to manage pain, including use of painkillers, lying flat or resting. For some, a lack of improvement in symptoms over time, combined with worsening pain, created a ‘tipping point’ in seeking care. There was a moral dimension for some patients who did not want to “bother” healthcare professionals.Healthcare professional appraisal: Differential diagnosis was a barrier to treatment and healthcare professionals interpreted OVF pain as broken ribs, muscular pain, kidney pain or sciatica. GPs tended to instigate watchful waiting, in which patients were asked to re-consult if pain did not improve. Feeling disbelieved caused some patients to become disillusioned and reluctant to re-consult and a small number of patients presented at Accident and Emergency. Those already having treatment for musculoskeletal conditions with access to specialist care, were more likely to receive timely diagnosis.Communication of diagnosis: Patients discussed multiple methods of communication, including written communication and clinical conversations. Several expressed confusion around the use of unfamiliar medical terminology, the implications of OVFs, how many OVFs they had experienced and how they had been identified.Treatment initiation: Bone protection therapies were not consistently prescribed after diagnosis. Patients who were familiar with these therapies were unsure whether treatment should be initiated in primary or secondary care. Patients described how they felt a need to be proactive by arranging appointments and asking for treatment.ConclusionThe study provides novel findings about patient pathways to treatment and will be used to identify targeted solutions to improve management of OVFs. This work addresses stages of the Model of Pathways to Treatment[1] and provides detailed understanding of patients’ experiences of these stages. Further work with healthcare professionals in primary care is underway to identify additional system-level factors that may impact patients’ journeys to treatment.References[1]Scott, S.E., et al., The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol, 2013. 18(1): p. 45-65.AcknowledgementsThis study is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) programme NIHR201523. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.Disclosure of InterestsNone declared
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Kaplan J, Centeno FH, Hayon J, Bottazzi ME, Hotez PJ, Weatherhead JE, Clark E, Woc-Colburn L. Reviewing a Decade of Outpatient Tropical Medicine in Houston, Texas. Am J Trop Med Hyg 2022; 106:1049-1056. [PMID: 35226869 PMCID: PMC8991353 DOI: 10.4269/ajtmh.21-1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/12/2021] [Indexed: 12/15/2022] Open
Abstract
Tropical diseases cause significant morbidity among the world's poorest populations. Although more common in low- and middle-income countries, tropical diseases are also found among underserved populations living in high-income countries such as the United States. The National School of Tropical Medicine at Baylor College of Medicine and the Harris Health System founded a tropical medicine clinic-the Harris Health Tropical Medicine Clinic (HHTMC)-in Houston in 2011 in response to tropical disease-related morbidity in Texas. We conducted a retrospective chart review of a sample of patients older than 18 years of age who were referred to the HHTMC between October 2011 and January 2020. Of the 523 patients reviewed, 185 (35.4%) had mycobacterial infections, 184 (35.2%) had parasitic infections, 38 (7.3%) had fungal infections, 16 (3.1%) had eosinophilia without a confirmed clinical diagnosis, 28 (5.4%) had bacterial infections, and 13 (2.5%) had viral infections. The most common infections overall were extrapulmonary and latent tuberculosis (n = 169), neurocysticercosis (n = 78), strongyloidiasis (n = 28), Chagas disease (n = 25), and schistosomiasis (n = 12). The epidemiology of tropical diseases in the United States is understudied at national and regional levels. This 10-year retrospective study contributes to bridging this knowledge gap by detailing the frequencies of tropical disease diagnoses made at the HHTMC in Houston, TX. These data highlight areas for advancement in the field of tropical medicine within the United States, such as improving front-line health-care provider education; establishing tropical medicine clinics in areas of high prevalence such as the Gulf Coast, Appalachia, and urban areas; and developing comprehensive, systematic national tropical disease screening programs and patient registries.
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Affiliation(s)
- Julika Kaplan
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Jesica Hayon
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Maria Elena Bottazzi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Peter J. Hotez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Jill E. Weatherhead
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | - Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
- Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations, Houston, Texas
| | - Laila Woc-Colburn
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
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Hayon J, Weatherhead JE, Clark E. 957. Evaluation of Chagas Disease Knowledge Among Providers Caring for At-risk People with HIV. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chagas disease (CD) is underdiagnosed in the United States due to limited healthcare provider awareness of the disease. Improving provider CD knowledge is important because >200,000 people living in the US are estimated to have CD, and 20-30% of those will develop related cardiac or gastrointestinal disease. People with HIV (PWH) and CD additionally are at risk for CD reactivation, which carries a >70% mortality rate.
Methods
The overall objective of this quality improvement project was to improve provider knowledge of CD prior to implementation of a CD screening initiative at a large HIV clinic in Houston, TX where >5,000 PWH are seen annually (~60% Latinx). We administered the survey to providers at this clinic before and after a 1-hour CD educational session, which included information about CD epidemiology, risk factors, transmission, screening, diagnostic strategies, and available treatments.
Results
Of 33 providers who took the pre-survey (16 faculty, 14 fellows, and 3 medical students), 27 (81.8%) completed all questions. Of 21 providers who took the post-survey (12 faculty, 6 fellows, and 3 medical students), 19 (90.5%) completed all questions. We identified the following CD knowledge gaps (i.e., questions initially answered incorrectly by >25% in the pre-educational session survey): CD transmission, regions of CD endemicity, CD risk factors, organ systems impacted by CD in PWH, and CD testing/follow-up procedures. In the post-educational session survey, we observed significant improvement in providers’ knowledge of CD epidemiology (correct selection of estimated number of people living with CD in the US improved from 26.7% to 90.5%, Fisher’s exact p< 0.0001), transmission (correct selection of “mother-to-child” answer improved from 73.3% to 100%, p=0.0150), and selection of correct CD testing answers improved from 51.9% to 85%, p=0.0286.
Conclusion
Improved CD awareness among healthcare providers and reliable systematic screening protocols are important in at-risk populations. Through simple administration of a 1-hour educational session, we identified and improved several CD knowledge gaps. We noted significant improvement in providers’ confidence in their CD knowledge, specifically in epidemiology, transmission, and diagnostic and screening testing.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | | | - Eva Clark
- Baylor College of Medicine, Houston, Texas
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Kelly EA, Echeverri Alegre JI, Promer K, Hayon J, Iordanov R, Zhang JJ, Fang Z, Huang C, Bittencourt C, Reed SL, Andrade R, Bern C, Clark E, Whitman J. 742. Evaluation of Chagas Disease Diagnostic Testing Practices in Four Hospital Systems in California and Texas. Open Forum Infect Dis 2021. [DOI: 10.1093/ofid/ofab466.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chagas disease (CD) is a neglected parasitic disease that affects >6 million people in the Americas, including >200,000 people in the United States (US). Medical provider knowledge of CD is key to decreasing morbidity and transmission; however, few studies have assessed diagnostic practices in US health systems serving at-risk patients. Our study aimed to describe existing provider approaches to diagnosing CD in California and Texas.
Methods
Site-based research teams at four hospital systems (the University of California [UC] San Francisco [UCSF], San Diego [UCSD], Irvine [UCI], and the Harris Health System [HHS] in Houston, TX) retrospectively identified patients ≥18 years old tested for CD between 2016-2019 and systematically extracted electronic medical record data using complementary electronic data entry forms. Specifically, eligible patients were identified using laboratory orders at UCSF and UCI, while the remaining sites employed SlicerDicer (Epic Systems). This study was approved by institutional review boards at each site.
Results
We identified 333 patients tested for CD, including 109 from UCSF, 88 from UCSD, 25 from UCI, and 111 from HHS. These patients had 125, 99, 31, and 181 tests sent to commercial laboratories, respectively. Test reactivity varied by system with the greatest percent reactivity among tests ordered at UCI (23%) followed by UCSD (16%), HHS (15%), and UCSF (10%). Among patients who screened positive for CD by commercial assays, confirmatory testing through the Centers for Disease Control and Prevention was sought for 100% at UCI; 59% at HHS, 55% at UCSF, and 40% at UCSD. The medical specialty that most often ordered CD testing was Cardiology at all UC sites (UCSF, 50%; UCSF, 55%; UCI, 35%) and Internal Medicine at HHS (46%; Cardiology ordered 13%). Only one recorded CD test was ordered by an Obstetrics/Gynecology service at any site.
Conclusion
These early results report positivity rates between our healthcare systems and demonstrate inconsistency in attaining recommended confirmatory testing, as well as a paucity of CD testing ordered through Obstetrics/Gynecology despite risk of congenital transmission. These findings suggest areas of opportunity to improve provider awareness and lay a foundation for standardizing CD diagnostic practices in the US.
Disclosures
Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)
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Affiliation(s)
- Emily A Kelly
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | - Zian Fang
- University of California, Irvine, Irvine, CA
| | - Cindy Huang
- University of California, Irvine, Irvine, CA
| | | | | | | | - Caryn Bern
- University of California, San Francisco, San Francisco, CA
| | - Eva Clark
- Baylor College of Medicine, Houston, TX
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Clark E, Freytag J, Hysong SJ, Dang B, Giordano TP, Kulkarni PA. 964. Impact of the COVID-19 Pandemic on Bedside Medical Education: A Mixed-Methods Study. Open Forum Infect Dis 2021. [PMCID: PMC8644135 DOI: 10.1093/ofid/ofab466.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic obligated academic medical programs to substantially alter the traditional Internal Medicine (IM) rounding model to decrease risk of inpatient nosocomial viral transmission. Our study aimed to describe how IM rounding practices changed during the COVID-19 pandemic and to understand the impacts of these changes on medical education. Methods We conducted a two-phase, mixed-methods study of inpatient IM rounding team practices at a large academic hospital in Houston, TX. In the first phase (January-February 2021), we organized and audio-recorded 4 virtual (Zoom) focus groups. Each included 5-6 rounding team members, divided by: attendings; senior residents; interns; and medical and physician assistant students. In the second phase (March-May 2021), we performed 6 direct observations of IM teams during rounds. Two observers systematically recorded variables such as time spent on non-bedside versus bedside rounds, number of each team member type entering patient rooms for bedside teaching, and types of personal protective equipment (PPE) worn. Results Topics discussed during focus groups included comparisons of rounding team size, rounding duration, physical distancing and PPE use, bedside education, communication methods, and patient safety before and after March 2020. Perceptions of changes in each topic were generally consistent across groups (Table 1). Direct observation data showed that team rounding styles remained diverse in the proportion of rounding time spent in an office versus on the wards, and in the number and types of team members entering patient rooms. IM team members uniformly wore respiratory PPE when entering all patient rooms; use of eye protection varied. Teams spent more total time discussing patients with or suspected to have COVID-19 compared to patients without COVID-19 (median 24 min versus 13 min, p< 0.0001). ![]()
Conclusion Our results suggest that the COVID-19 pandemic adversely impacted bedside medical education, even into Spring of 2021. Conclusions from this study can be used to 1) address educational gaps related to COVID-19 pandemic-associated rounding changes and 2) create innovative methods of providing high-quality clinical education that will be minimally impacted by future respiratory virus pandemics. Disclosures Prathit A. Kulkarni, M.D., Vessel Health, Inc. (Grant/Research Support)
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Affiliation(s)
- Eva Clark
- Baylor College of Medicine, Houston, Texas
| | - Jennifer Freytag
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas
| | | | - Bich Dang
- Baylor College of Medicine, Houston, Texas
| | | | - Prathit A Kulkarni
- Baylor College of Medicine / Michael E. DeBakey VA Medical Center, Houston, TX
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Khan H, Connolly T, Loh MY, Clark E. Duodenal volvulus: a rare cause of small bowel obstruction. Ann R Coll Surg Engl 2021; 104:e102-e104. [PMID: 34846192 DOI: 10.1308/rcsann.2021.0242] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Small bowel volvulus is a rare but life-threatening emergency. Volvulus of the duodenum is even rarer without the presence of predisposing factors. The clinical presentation is vague, including abdominal pain, nausea and vomiting, prompt diagnosis of volvulus therefore relies heavily on radiographs. The treatment options lie between conservative or surgical management, where the decision is influenced by the patient and their presentation. This case is of a 100-year-old female with an extensive surgical and medical background presenting with signs of small bowel obstruction. With the help of imaging, a rare case of duodenal volvulus was diagnosed but managed conservatively due to the patient's background, age and personal wishes.
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Affiliation(s)
- H Khan
- Stockport NHS Foundation Trust, UK
| | | | - M-Y Loh
- Stockport NHS Foundation Trust, UK
| | - E Clark
- Stockport NHS Foundation Trust, UK
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Siqueira IF, Clark E, Neil-Sztramko SE, Belita E, Dobbins M. Informing policy on school and daycare operations during COVID-19 with a living rapid evidence review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.593] [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: 11/12/2022] Open
Abstract
Abstract
Background
To support evidence-informed decision making (EIDM) for safe re-opening and operation of schools and daycares, the National Collaborating Centre for Methods and Tools (NCCMT) has maintained since May 2020 a living rapid review answering the following question: “What is the role of schools and daycares in COVID-19 transmission”. Traditional rapid review methodology was modified for the COVID-19 context. This presentation will describe the global reach and usefulness of this living rapid review.
Methods
Following completion of each update of the living rapid review, findings were disseminated broadly with the aim of informing policy and public health practice. Key dissemination strategies include e-mails to key contacts and a subscriber list; highlight in a monthly newsletter; media outreach; and social media. The review's reach was analyzed using Google Analytics, citation tracking, and qualitative feedback.
Results
Between May 2020 and April 2021, the living review has been updated 14 times. The posted review has been viewed over 5000 times across 46 countries. The review has been cited and indexed in over 40 sources, including key governmental and non-governmental reports and guidelines. The NCCMT has received positive qualitative feedback on the review's value in informing the public health response related to schools and daycares in various jurisdictions across Canada. Key stakeholders have expanded the review's reach organically as they use the evidence in practice and share the review with their networks.
Lessons
Using a living rapid review to continuously provide high-quality synthesized evidence amidst the evolving COVID-19 research literature demonstrates a responsive approach to decision makers' requests for evidence. An emerging challenge is reaching the proper stakeholders responsible for EIDM, particularly during public health emergencies with many competing high-priority questions and decisions to be made.
Key messages
As the evidence landscape changes due to a surge in literature, evidence-informed decision making can be supported by rapid but rigorous syntheses that evaluate quality and emerging recommendations. A long-standing, trusting relationship with decision makers is key to optimizing living rapid review methodology to meet the evidence needs of decision makers despite the changing literature.
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Affiliation(s)
- IF Siqueira
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - E Clark
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - SE Neil-Sztramko
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - E Belita
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
| | - M Dobbins
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Moura I, Spittal W, Clark E, Ewin D, Altringham J, Fumero E, Grada A, Wilcox M, Buckley A. 224 Profiling the effects of acne therapeutics, including the novel narrow-spectrum antibiotic sarecycline, on the human microbiota. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Carlo‐Stella C, Hutchings M, Offner FC, Morschhauser F, Bachy E, Crump M, Sureda A, Iacoboni G, Haioun C, Perez‐Callejo D, Lundberg L, Relf J, Clark E, Carlile D, Piccione E, Belousov A, Humphrey K, Dickinson MJ. GLOFITAMAB STEP‐UP DOSING: UPDATED EFFICACY DATA SHOW HIGH COMPLETE RESPONSE RATES IN HEAVILY PRETREATED RELAPSED/REFRACTORY (R/R) NON‐HODGKIN LYMPHOMA (NHL) PATIENTS. Hematol Oncol 2021. [DOI: 10.1002/hon.15_2879] [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: 11/08/2022]
Affiliation(s)
- C Carlo‐Stella
- Humanitas University and Humanitas Research Hospital Department of Biomedical Sciences Milan Italy
| | - M Hutchings
- Rigshospitalet Department of Hematology and Phase 1 Unit Copenhagen Denmark
| | - F. C Offner
- Universitair Ziekenhuis Gent Department of Hematology Gent Belgium
| | - F Morschhauser
- Hôpital Claude Huriez and Centre Hospitalier Régional Universitaire de Lille Department of Hematology Lille France
| | - E Bachy
- Hospices Civils de Lyon and Université Claude Bernard Department of Hematology Pierre‐Bénite France
| | - M Crump
- Princess Margaret Hospital Department of Medical Oncology Toronto Canada
| | - A Sureda
- Institut Català d'Oncologia Hospitalet IDIBELL, Universitat de Barcelona Department of Clinical Haematology Barcelona Spain
| | - G Iacoboni
- Vall d’Hebron University Hospital Department of Hematology Barcelona Spain
| | - C Haioun
- Hopital Henri Mondor, AP‐HP Lymphoid Malignancies Unit Créteil France
| | - D Perez‐Callejo
- N F. Hoffmann‐La Roche Ltd Clinical Science ‐ Product Development Hematology Basel Switzerland
| | - L Lundberg
- N F. Hoffmann‐La Roche Ltd Clinical Science ‐ Product Development Hematology Basel Switzerland
| | - J Relf
- Roche Products Ltd Clinical Safety ‐ Product Development Safety Welwyn Garden City UK
| | - E Clark
- Roche Products Ltd Product Development Biostatistics Welwyn Garden City UK
| | - D Carlile
- Roche Products Ltd Clinical Pharmacology, Pharma Research and Early Development Welwyn Garden City UK
| | - E Piccione
- Genentech, Inc Oncology Biomarker Development South San Francisco USA
| | - A Belousov
- F. Hoffmann‐La Roche Ltd Product Development Biostatistics Basel Switzerland
| | - K Humphrey
- Roche Products Ltd Clinical Science ‐ Product Development Hematology Welwyn Garden City UK
| | - M. J Dickinson
- The Peter MacCallum Cancer Centre Royal Melbourne Hospital and The University of Melbourne Clinical Haematology Melbourne Australia
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14
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Clark E, Chen L, Dong Y, Raychaudhury S, White D, Kramer JR, Chiao E. Veteran Women Living With Human Immunodeficiency Virus Have Increased Risk of Human Papillomavirus (HPV)-Associated Genital Tract Cancers. Clin Infect Dis 2021; 72:e359-e366. [PMID: 32785700 DOI: 10.1093/cid/ciaa1162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Disparities in access to screening often confound observed differences in human papillomavirus (HPV)-associated female genital tract cancer (FGTC) incidence between women living with human immunodeficiency virus (HIV; WLWH) and their HIV-negative counterparts. We aimed to determine if there have been changes in cancer risk among WLWH during the antiretroviral era in a single-payer health system. METHODS We retrospectively selected WLWH and HIV-negative controls receiving care between 1999 and 2016 at the US Department of Veterans Affairs (VA) and identified FGTC diagnoses via Cancer Registry and International Classification of Diseases-9/10 codes. We extracted demographic and clinical variables from the VA's Corporate Data Warehouse; evaluated incidence rates (IRs), incidence rate ratios, hazard ratios, and 95% confidence intervals (CIs) for cancer risk; and conducted survival analyses. RESULTS We identified 1454 WLWH and compared them with 5816 matched HIV-negative controls. More WLWH developed HPV-associated FGTCs (total n = 28 [2.0%]; cervical = 22, vulvovaginal = 4, and anal/rectal = 2) than HIV-negative women (total n = 32 [0.6%]; cervical = 24, vulvovaginal = 5, and anal/rectal = 5) (log rank P < .0001). Cervical cancer IR was >6-fold higher for WLWH (204.2 per 100 000 person-years [py] [95% CI, 83.8-324.7]) than HIV-negative women (IR = 31.2 per 100 000 py [95% CI, 17.9-44.5]). The IRs for vulvovaginal and anal cancers were also higher in WLWH. Overall, WLWH were more likely to develop HPV-associated FGTCs compared with their HIV-negative counterparts (all log rank P values < .0001). CONCLUSIONS Veteran WLWH are more likely to develop HPV-associated FGTCs despite equal access to health care. Even in single-payer health systems, WLWH continue to require special attention to ensure guideline-based high-risk HPV screening for prevention of FGTCs.
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Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.,Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
| | - Liang Chen
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Yongquan Dong
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Suchismita Raychaudhury
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Donna White
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA
| | - Jennifer R Kramer
- Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth Chiao
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.,Health Services Research, Michal E. DeBakey Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.,Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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15
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Clark E, Chiao EY, Amirian ES. Why Contact Tracing Efforts Have Failed to Curb Coronavirus Disease 2019 (COVID-19) Transmission in Much of the United States. Clin Infect Dis 2021; 72:e415-e419. [PMID: 32761123 PMCID: PMC7454341 DOI: 10.1093/cid/ciaa1155] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 11/14/2022] Open
Abstract
By late April 2020, public discourse in the United States had shifted toward the idea of using more targeted case-based mitigation tactics (eg, contact tracing) to combat coronavirus disease 2019 (COVID-19) transmission while allowing for the safe "reopening" of society, in an effort to reduce the social, economic, and political ramifications associated with stricter approaches. Expanded tracing-testing efforts were touted as a key solution that would allow for a precision approach, thus preventing economies from having to shut down again. However, it is now clear that many regions of the United States were unable to mount robust enough testing-tracing programs to prevent major resurgences of disease. This viewpoint offers a discussion of why testing-tracing efforts failed to sufficiently mitigate COVID-19 across much of the nation, with the hope that such deliberation will help the US public health community better plan for the future.
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Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.,Department of Medicine, Section of Health Services Research, Center for Innovations in Quality, Safety, and Effectiveness (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth Y Chiao
- Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of General Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - E Susan Amirian
- School of Social Sciences, Rice University, Houston, Texas, USA
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16
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Harris HC, Buckley AM, Spittal W, Ewin D, Clark E, Altringham J, Bentley K, Moura IB, Wilcox MH, Woodford N, Davies K, Chilton CH. The effect of intestinal microbiota dysbiosis on growth and detection of carbapenemase-producing Enterobacterales within an in vitro gut model. J Hosp Infect 2021; 113:1-9. [PMID: 33932556 DOI: 10.1016/j.jhin.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/18/2021] [Accepted: 04/14/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) can colonize the gut and are of major clinical concern. Identification of CPE colonization is problematic; there is no gold-standard detection method, and the effects of antibiotic exposure and microbiota dysbiosis on detection are unknown. AIM Based on a national survey we selected four CPE screening assays in common use. We used a clinically reflective in vitro model of human gut microbiota to investigate the performance of each test to detect three different CPE strains under different, clinically relevant antibiotic exposures. METHODS Twelve gut models were seeded with a pooled faecal slurry and exposed to CPE either before, after, concomitant with, or in the absence of piperacillin-tazobactam (358 mg/L, 3 × daily, seven days). Total Enterobacterales and CPE populations were enumerated daily. Regular screening for CPE was performed using Cepheid Xpert® Carba-R molecular test, and with Brilliance™ CRE, Colorex™ mSuperCARBA and CHROMID® CARBA SMART agars. FINDINGS Detection of CPE when the microbiota are intact is problematic. Antibiotic exposure disrupts microbiota populations and allows CPE proliferation, increasing detection. The performances of assays varied, particularly with respect to different CPE strains. The Cepheid assay performed better than the three agar methods for detecting a low level of CPE within an intact microbiota, although performance of all screening methods was comparable when CPE populations increased in a disrupted microbiota. CONCLUSION CPE strains differed in their dynamics of colonization in an in vitro gut model and in their subsequent response to antibiotic exposure. This affected detection by molecular and screening methods, which has implications for the sensitivity of CPE screening in healthcare settings.
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Affiliation(s)
- H C Harris
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - A M Buckley
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - W Spittal
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - D Ewin
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - E Clark
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - J Altringham
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - K Bentley
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - I B Moura
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M H Wilcox
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, Leeds, UK
| | - N Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), Reference Unit, Microbiology Services - Colindale, Public Health England, UK
| | - K Davies
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, Leeds, UK
| | - C H Chilton
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
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17
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Clark E, Pritchard H, Hemmige V, Restrepo A, Bautista K, Damania A, Ricciardi A, Nutman TB, Mejia R. Strongyloides stercoralis Infection in Solid Organ Transplant Patients Is Associated With Eosinophil Activation and Intestinal Inflammation: A Cross-sectional Study. Clin Infect Dis 2021; 71:e580-e586. [PMID: 32155244 DOI: 10.1093/cid/ciaa233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/04/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Strongyloidiasis can cause devastating morbidity and death in immunosuppressed patients. Identification of reliable biomarkers for strongyloidiasis in immunosuppressed patients is critical for the prevention of severe disease. METHODS In this cross-sectional study of solid organ transplant (SOT) candidates and recipients, we quantified Strongyloides-specific IgG to the recombinant NIE-Strongyloides antigen and/or to a soluble extract of S. stercoralis somatic antigens ("crude antigen") using enzyme-linked immunosorbent assays (ELISAs). We also measured peripheral eosinophilia, 4 different eosinophil granule proteins, and intestinal fatty acid-binding protein (IFABP). RESULTS We evaluated serum biomarkers in 149 individuals; 77 (52%) pre-SOT and 72 (48%) post-SOT. Four percent (6/149) tested positive by NIE ELISA and 9.6% (11/114) by crude antigen ELISA (overall seropositivity of 9.4% [14/149]). Seropositive patients had higher absolute eosinophil counts (AECs) than seronegative patients (P = .004). AEC was positively correlated to the levels of eosinophil granule proteins eosinophil cationic protein (ECP) and eosinophil peroxidase (EPO) (P < .05), while IFABP was positively related to the 2 other eosinophil granule proteins (major basic protein [MBP] and eosinophil-derived neurotoxin [EDN]; Spearman's r = 0.3090 and 0.3778, respectively; P < .05; multivariate analyses slopes = 0.70 and 2.83, respectively). CONCLUSIONS This study suggests that, in SOT patients, strongyloidiasis triggers both eosinophilia and eosinophil activation, the latter being associated with intestinal inflammation. These data provide insight into the pathogenesis of S. stercoralis infection in the immunocompromised population at high risk of severe strongyloidiasis syndromes.
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Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston Texas, USA.,Houston Health Services Research & Development, Innovations in Quality, Effectiveness and Safety (IQuESt), Baylor College of Medicine Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Haley Pritchard
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vagish Hemmige
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York, USA.,Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro Restrepo
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA
| | - Karla Bautista
- Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ashish Damania
- Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alessandra Ricciardi
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rojelio Mejia
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
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18
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Magner K, Ilin J, Clark E, King J, Davis A, Hiremath S. POS-039 N-Acetylcysteine and Contrast-induced Acute Kidney Injury: A Systematic Review and Meta-analysis exploring the Heterogeneity, Publication Bias and Small Study effects. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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19
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Clark E, Tullo D, Bertone A. Perceptual reasoning skills mediate the relationship between attention and math proficiency in individuals with a neurodevelopmental condition. Res Dev Disabil 2021; 111:103880. [PMID: 33556699 DOI: 10.1016/j.ridd.2021.103880] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/19/2020] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND An important component of academic success in typically developing students is the development of math skills, which is associated with attention and perceptual reasoning (PR) skills. For children with a neurodevelopmental condition (NDC), the relationship is confounded by diagnostic-specific cognitive characteristics. Specifically, enhanced PR is specific to individuals with Autism Spectrum Disorder (ASD). AIMS The purpose of this study was to test: (i) a mediation model where PR skills would mediate the relationship between attention and math proficiency for students with an NCD, and (ii) whether this mediation model is moderated by a diagnostic profile. METHODS AND PROCEDURES One hundred and thirty-seven students with an NDC participated in a school-based study examining the effectiveness of using a standardized measure of attention in predicting math capabilities. OUTCOMES AND RESULTS PR mediated the relationship between attention and math proficiency for students diagnosed with an NDC. However, the model was not moderated by diagnostic profile. CONCLUSIONS AND IMPLICATIONS The results of this study provide a better understanding of the roles of higher-level cognitive ability specific to students with NDCs. Additionally, the superior PR skills demonstrated by the ASD sample further supports the research suggesting this population possesses cognitive strengths in this domain.
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Affiliation(s)
- E Clark
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada.
| | - D Tullo
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada
| | - A Bertone
- Perceptual Neuroscience Lab for Autism and Development, Department of Educational and Counselling Psychology, McGill University, Canada
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20
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Akbari A, Kunkel E, Bota S, Harel Z, Le Gal G, Cox C, Hundemer G, Canney M, Clark E, Massicotte-Azarinouch D, Eddeen A, Knoll G, Sood M. POS-468 PROTEINURIA AND VENOUS THROMBOEMBOLISM IN PREGNANCY: A POPULATION-BASED COHORT STUDY. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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21
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Patton DE, Pearce CJ, Cartwright M, Smith F, Cadogan CA, Ryan C, Clark E, Francis JJ, Hughes CM. A non-randomised pilot study of the Solutions for Medication Adherence Problems (S-MAP) intervention in community pharmacies to support older adults adhere to multiple medications. Pilot Feasibility Stud 2021; 7:18. [PMID: 33413650 PMCID: PMC7788279 DOI: 10.1186/s40814-020-00762-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Older patients prescribed multiple medications commonly experience difficulties with adherence. High-quality evidence on interventions targeting older patients is lacking. Theory is rarely used to tailor adherence solutions. This study aimed to pilot test a novel intervention, developed using the Theoretical Domains Framework, which guides community pharmacists in identifying adherence barriers and delivering tailored solutions (behaviour change techniques). Key study procedures (e.g. recruitment, data collection) for a future randomised controlled trial (cRCT) were also assessed. METHODS Using purposive sampling, this non-randomised pilot study aimed to recruit 12 community pharmacies (six in Northern Ireland; six in London, England). Pharmacists were trained to deliver the intervention to non-adherent older patients (maximum 10 per pharmacy; target n = 60-120) aged ≥ 65 years (reduced to 50 years due to recruitment challenges) and prescribed ≥ 4 regular medicines. The intervention, guided by an iPad web-application, was delivered over 3-4 face-to-face or telephone sessions, tailored to specific barriers to adherence. We assessed the feasibility of collecting adherence data (primary outcome: self-report and dispensing records), health-related quality of life (HRQOL) and unplanned hospitalisations (secondary outcomes) at baseline and 6-months. The final decision on progressing to a cRCT, using pre-defined 'stop-amend-go' criteria, is presented. RESULTS Fifteen pharmacists from 12 pharmacies were recruited and trained. One pharmacy subsequently dropped out. Sixty patients were recruited (meeting the 'Amend' progression criteria), with 56 receiving the intervention. Adherence barriers were identified for 55 patients (98%) and a wide range of behaviour change solutions delivered (median: 5 per patient). Self-report and dispensing adherence data were available for 37 (61.7%) and 44 (73.3%) patients, respectively. HRQOL data were available for 35 (58.3%) patients. GP-reported and self-reported hospitalisations data were available for 47 (78.3%) and 23 (38.3%) patients, respectively. All progression concepts were met (nine 'Go' and three 'Amend' criteria). CONCLUSION This study demonstrates the feasibility of key study procedures (e.g. pharmacy recruitment) and delivery of a tailored adherence intervention in community pharmacies. However, modifications are required to enhance issues identified with patient recruitment, retention and missing data. A future definitive cRCT will explore the effectiveness of the intervention. TRIAL REGISTRATION ISRCTN, ISRCTN73831533 , Registered 12 January 2018.
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Affiliation(s)
- D. E. Patton
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
| | - C. J. Pearce
- School of Health Sciences, City University of London, London, UK
| | - M. Cartwright
- School of Health Sciences, City University of London, London, UK
| | - F. Smith
- School of Pharmacy, University College London, London, UK
| | - C. A. Cadogan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C. Ryan
- School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - E. Clark
- School of Health Sciences, City University of London, London, UK
| | - J. J. Francis
- School of Health Sciences, City University of London, London, UK
| | - C. M. Hughes
- School of Pharmacy, Queen’s University Belfast, Belfast, UK
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22
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Khanjee N, Turin CG, Breaux K, Armamento-Villareal R, Barradas MR, Clark E. 110. Bone Mineral Density Screening in Veterans Living with HIV. Open Forum Infect Dis 2020. [PMCID: PMC7778288 DOI: 10.1093/ofid/ofaa439.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Low bone mineral density (BMD) is more prevalent in people living with HIV (PLWH) than in the general population. Although no consensus exists regarding when to start screening for BMD loss in PLWH, the Infectious Diseases Society of America (IDSA) recommends dual x-ray absorptiometry (DXA) for men aged ≥50 years, postmenopausal women, and patients with a history of fragility fracture, chronic glucocorticoid treatment, or at high fall risk. The objective of this study is to evaluate how well this guideline is being carried out in a population of veterans living with HIV (VLWH). Methods We retrospectively identified VLWH seen at the Veterans Affairs Medical Center (VAMC) in Houston, TX, between 2014–2018 via the VAMC HIV Registry. We extracted demographic, laboratory, and clinical variables, as well as DXA results via this registry database and subsequent chart review. Results We identified 1,306 VLWH who received care between 2014–2018; 197 turned 50 years old during this time period. Of those, only 32 (16.2%) underwent DXA (2 women, 30 men). DXA revealed normal BMD in 17 (53.1%), osteopenia in 12 (37.5%), and osteoporosis in 3 (9.4%), as defined by traditional DXA T-score cutoffs. Average CD4 count at time of DXA was 698 cells/mm3 (n=30) (average CD4 for those with normal DXA was 654 [n=16] and for those with osteopenia/osteoporosis it was 749 [n=14]; t-test p = 0.47). Thirty had HIV viral load (VL) < 100 copies/mL; the remaining 2 had VLs of 11,200 and 2,980, both with normal DXAs. Vitamin D (VD) levels were available for 1,005 (77%) VLWH in the study cohort. Of those, 278 (27.7%) were VD deficient (25-hydroxy VD level of < 20 ng/mL). VD levels were available for 31 of the 32 VLWH who had DXA after turning 50 years old; the average VD level was 22.76 (24.61 [n=16] for those with normal BMD and 20.78 [n=15] for those with osteoporosis/osteopenia; t-test p = 0.30). Conclusion Our results indicate that adherence to IDSA BMD screening guidelines in VLWH can be improved. Given that nearly half of the screened patients showed evidence of BMD loss on their initial DXA, efforts should be made to increase awareness and screening in this vulnerable population. Prevention, earlier diagnosis, and treatment of BMD loss in VLWH would likely lead to decreased morbidity associated with fractures due to low BMD in this population. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | | | | | - Eva Clark
- Baylor College of Medicine, Houston, Texas
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Clark E, Kulkarni P, Mohajer MA, Rose S, Serpa J, Singhal G, Giordano TG. 1129. Optimizing Feedback Strategies on the Infectious Diseases Inpatient Service. Open Forum Infect Dis 2020. [PMCID: PMC7776358 DOI: 10.1093/ofid/ofaa439.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Timely, efficient, and effective feedback strategies are crucial for enhancing faculty-trainee communication and trainee education. Here we describe attitudes, practices, and perceived behaviors regarding giving feedback to medical trainees rotating on Infectious Diseases (ID) inpatient consult services. Methods An anonymous survey on feedback strategies was distributed to our adult ID Section in February 2020 as part of a facilitated discussion on optimizing trainee clinical education. Results Twenty-six ID Section members completed the survey (18 faculty, 8 trainees). Most trainees (62.5%) and faculty (66.7%) felt that trainees are “sometimes” comfortable voicing concerns to faculty; however, no trainees but 11.1% of faculty indicated that trainees are “always” comfortable voicing concerns to faculty. Most trainees (87.5%) felt that conversations about team expectations occur “sometimes” or “often.” In contrast, most faculty (72.2%) felt that these conversations “always” occur. Although most faculty felt that both informal (94.4%) and formal (83.3%) feedback should be given to trainees, 22.2% of faculty responded that they do not explicitly use the term “feedback” when discussing feedback with a trainee. No trainees and 22.2% of faculty indicated that they utilize a feedback tool. Regarding quantity of feedback trainees perceive they receive from faculty, 37.5% of trainees felt they needed more feedback while 50% felt they received adequate feedback. Most faculty (88.9%) responded that they encourage trainees to give feedback to faculty, although most trainees (62.5%) responded “sometimes” regarding how comfortable they feel doing so. Conclusion In summary, we found differences between faculty and trainees regarding two important aspects of medical education: setting expectations and providing feedback. While most faculty feel that conversations regarding these topics occur invariably, trainees do not always share this perception. Trainees felt less comfortable voicing concerns and giving feedback to faculty than faculty perceived them to be. Overall, the data suggest that there is room for improvement to ensure that trainees and faculty are operating from a shared mental model regarding setting team expectations and providing/receiving feedback. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Eva Clark
- Baylor College of Medicine, Houston, Texas
| | | | - Mayar Al Mohajer
- CHI St. Luke’s Health - Baylor St. Luke’s Medical Center; Baylor College of Medicine, Houston, TX
| | | | - Jose Serpa
- Baylor College of Medicine, Houston, Texas
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Weatherhead JE, Clark E, Vogel TP, Atmar RL, Kulkarni PA. Inflammatory syndromes associated with SARS-CoV-2 infection: dysregulation of the immune response across the age spectrum. J Clin Invest 2020; 130:6194-6197. [PMID: 33108354 PMCID: PMC7685746 DOI: 10.1172/jci145301] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jill E. Weatherhead
- Department of Medicine, Section of Infectious Diseases
- Department of Pediatrics, Section of Pediatric Tropical Medicine, and
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Eva Clark
- Department of Medicine, Section of Infectious Diseases
- National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Section of Health Services Research, Center for Innovations in Quality, Safety, and Effectiveness (IQuESt), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA
| | - Tiphanie P. Vogel
- Department of Pediatrics, Section of Rheumatology, and
- Department of Medicine, Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Prathit A. Kulkarni
- Department of Medicine, Section of Infectious Diseases
- Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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Axell-House DB, Lavingia R, Rafferty M, Clark E, Amirian ES, Chiao EY. The estimation of diagnostic accuracy of tests for COVID-19: A scoping review. J Infect 2020; 81:681-697. [PMID: 32882315 PMCID: PMC7457918 DOI: 10.1016/j.jinf.2020.08.043] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the methodologies used in the estimation of diagnostic accuracy of SARS-CoV-2 real-time reverse transcription polymerase chain reaction (rRT-PCR) and other nucleic acid amplification tests (NAATs) and to evaluate the quality and reliability of the studies employing those methods. METHODS We conducted a systematic search of English-language articles published December 31, 2019-June 19, 2020. Studies of any design that performed tests on ≥10 patients and reported or inferred correlative statistics were included. Studies were evaluated using elements of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) guidelines. RESULTS We conducted a narrative and tabular synthesis of studies organized by their reference standard strategy or comparative agreement method, resulting in six categorizations. Critical study details were frequently unreported, including the mechanism for patient/sample selection and researcher blinding to results, which lead to concern for bias. CONCLUSIONS Current studies estimating test performance characteristics have imperfect study design and statistical methods for the estimation of test performance characteristics of SARS-CoV-2 tests. The included studies employ heterogeneous methods and overall have an increased risk of bias. Employing standardized guidelines for study designs and statistical methods will improve the process for developing and validating rRT-PCR and NAAT for the diagnosis of COVID-19.
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Affiliation(s)
- Dierdre B. Axell-House
- Section of Infectious Diseases, Department of Internal Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Richa Lavingia
- Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA,School of Social Sciences, Rice University, MS 272, 5620 Greenbriar Dr, Houston, TX 77005, USA,UTHealth School of Public Health, Houston, TX, USA
| | - Megan Rafferty
- School of Social Sciences, Rice University, MS 272, 5620 Greenbriar Dr, Houston, TX 77005, USA,UTHealth School of Public Health, Houston, TX, USA
| | - Eva Clark
- Section of Infectious Diseases, Department of Internal Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA,Houston HSR&D IQuESt, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd, Houston, TX, 77021, USA
| | - E. Susan Amirian
- School of Social Sciences, Rice University, MS 272, 5620 Greenbriar Dr, Houston, TX 77005, USA
| | - Elizabeth Y. Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1340, Houston, TX 77030, USA,Corresponding author
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Hilger C, Clark E, Swiontek K, Chiriac AM, Caimmi DP, Demoly P, Bourrain JL. Anaphylaxis to Bovine Serum Albumin Tissue Adhesive in a Non–Meat-Allergic Patient. J Investig Allergol Clin Immunol 2020; 30:369-371. [DOI: 10.18176/jiaci.0522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Clark E, Snelling S, Beyers J, Howarth C, Neil-Sztramko S, Dobbins M. A new tool to assess community-level evidence to inform public health decision making. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
As public health responds to evolving challenges around the globe, it is critical to draw on community-level evidence to inform decisions on emerging needs. There are existing tools for assessing the quality of research evidence, but none that explicitly focus on quality assessment of evidence from community sources, including local health status and ever-changing community and political preferences and actions.
Methods
The National Collaborating Centre for Methods and Tools (NCCMT) in Canada has developed new tools, called Quality Assessment of Community Evidence (QACE), to help public health decision makers assess the quality of community evidence. The QACE tools were drafted through extensive review of existing frameworks, tools and measures for appraising population health and community evidence, and diverse key informants. We identified three consistent themes that became the core dimensions in these tools. By using the QACE tools, practitioners can answer the question: “Is the quality of this evidence about local context, community needs and political preferences good enough to influence decision making?”
Results
The QACE tools provide probing questions for each of three dimensions: relevant, trustworthy and equity-informed. Supplementary resources help users delve more deeply into different aspects of quality assessment. The QACE tools are intended for public health practitioners who provide and use evidence to support or make decisions about public health practice and policy, including public health practitioners, senior leaders, policy makers and funders.
Conclusions
The QACE tool is a new addition to the public health toolbox for evidence-informed decision making, providing questions to ask about evidence from community sources. By using the tool as part of a decision-making process, public health practitioners can be assured that their decisions are based on the best-available evidence for their communities.
Key messages
The new Quality Assessment of Community Evidence (QACE) tools fill the gap in assessing quality of community-level evidence for public health decision-makers. Community evidence, including local health status and needs and community and political preferences and actions, should be assessed for quality in three critical domains.
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Affiliation(s)
- E Clark
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - S Snelling
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - J Beyers
- Jo Beyers Consulting, Thessalon, Canada
| | - C Howarth
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - S Neil-Sztramko
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - M Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
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Clark E, Neil-Sztramko S, Dobbins M. Enhancing partnerships and collaboration in times of change. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.212] [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: 11/14/2022] Open
Abstract
Abstract
Issue
In 2019, the government of the Canadian province of Ontario announced major changes to the structure, governance and funding of public health services. Throughout these changes, publicly funded local and regional public health organizations are still expected to provide effective, evidence-informed programming to their communities. The National Collaborating Centre for Methods and Tools (NCCMT) has facilitated collaborations to support Ontario public health through this transition.
Description of the problem
In order to support evidence-informed public health in Ontario during this transition, the NCCMT reached out to current and potential partners, within and beyond the public health sector for a multidisciplinary approach. We conducted a needs assessment for an evidence review repository, which would allow public health practitioners to share and build upon each other's work. Finally, demonstrating the value of public health to policymakers can be inherently challenging as the return on investment in public health is often very long term. We partnered with health units in varying capacities to find and synthesize evidence to advocate for continued investment in public health.
Results
This initiative has provided important lessons in developing and maintaining strong partnerships. Looking beyond the public health sector can establish mutually beneficial partners and allies in other disciplines. A key finding was the need to establish infrastructure to support collaboration and resource sharing. Finally, we learned that big picture questions like demonstrating the value of public health require many different perspectives, inputs and areas of expertise.
Lessons
Through this initiative, we have developed a multidisciplinary, collaborative approach to supporting evidence-informed public health through times of major restructuring. This approach can be applied to future changes to public health on smaller or larger scales, or within other geographic regions.
Key messages
Multidisciplinary approaches can support collaboration, unity and advocacy in times of change. Establishing infrastructure to support collaboration and sharing of resources is valuable.
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Affiliation(s)
- E Clark
- Enhancing partnerships and collaboration in times of change, McMaster University, Hamilton, Canada
| | - S Neil-Sztramko
- Enhancing partnerships and collaboration in times of change, McMaster University, Hamilton, Canada
| | - M Dobbins
- Enhancing partnerships and collaboration in times of change, McMaster University, Hamilton, Canada
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Huddle C, Hirsch H, Kasay C, Beverley M, Mochel J, Clark E, Sharry B. Better Nutrition, Better Care: An Initiative to Improve Early Identification and Intervention of Malnutrition in Pediatric Oncology and BMT Patients. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Clark E, Neil-Sztramko S, Dobbins M. The NCCMT’s dynamic model for evidence-informed public health. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
It is well accepted that public health decision makers should use the best available research evidence in their decision-making process. However, research evidence alone is insufficient to inform public health decision making.
Description of the problem
As new challenges to public health emerge, there can be a paucity of high quality research evidence to inform decisions on new topics. Public health decision makers must combine various sources of evidence with their public health expertise to make evidence-informed decisions. The National Collaborating Centre for Methods and Tools (NCCMT) has developed a model which combines research evidence with other critical sources of evidence that can help guide decision makers in evidence-informed decision making.
Results
The NCCMT's model for evidence-informed public health combines findings from research evidence with local data and context, community and political preferences and actions and evidence on available resources. The model has been widely used across Canada and worldwide, and has been integrated into many public health organizations' decision-making processes. The model is also used for teaching an evidence-informed public health approach in Masters of Public Health programs around the globe. The model provides a structured approach to integrating evidence from several critical sources into public health decision making. Use of the model helps ensure that important research, contextual and preference information is sought and incorporated.
Lessons
Next steps for the model include development of a tool to facilitate synthesis of evidence across all four domains. Although Indigenous knowledges are relevant for public health decision making and should be considered as part of a complete assessment the current model does not capture Indigenous knowledges.
Key messages
Decision making in public health requires integrating the best available evidence, including research findings, local data and context, community and political preferences and available resources. The NCCMT’s model for evidence-informed public health provides a structured approach to integrating evidence from several critical sources into public health decision making.
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Affiliation(s)
- E Clark
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - S Neil-Sztramko
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
| | - M Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
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Clark E, Fredricks K, Woc-Colburn L, Bottazzi ME, Weatherhead J. Disproportionate impact of the COVID-19 pandemic on immigrant communities in the United States. PLoS Negl Trop Dis 2020; 14:e0008484. [PMID: 32658925 PMCID: PMC7357736 DOI: 10.1371/journal.pntd.0008484] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Medicine, Section of Health Services Research, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Karla Fredricks
- Section of Global and Immigrant Health, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
| | - Laila Woc-Colburn
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Maria Elena Bottazzi
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Center for Vaccine Development, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
- Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Biology, Baylor University, Waco, Texas, United States of America
| | - Jill Weatherhead
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Center for Vaccine Development, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, United States of America
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Mintoff D, Camilleri L, Aquilina S, Boffa MJ, Clark E, Scerri L. Prevalence of hidradenitis suppurativa in Malta: comparison with established epidemiological data. Clin Exp Dermatol 2020; 45:758-759. [PMID: 32367586 DOI: 10.1111/ced.14271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 01/02/2023]
Affiliation(s)
- D Mintoff
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| | - L Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | - S Aquilina
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| | - M J Boffa
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| | - E Clark
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
| | - L Scerri
- Department of Dermatology and Venereology, Sir Paul Boffa Hospital, Floriana, Malta
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Clark E, Royse KE, Dong Y, Chang E, Raychaudhury S, Kramer J, White DL, Chiao E. Stable Incidence and Poor Survival for HIV-Related Burkitt Lymphoma Among the US Veteran Population During the Antiretroviral Era. J Acquir Immune Defic Syndr 2020; 84:18-25. [PMID: 32251095 PMCID: PMC7793609 DOI: 10.1097/qai.0000000000002303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite advances in diagnosis and treatment of both HIV and Burkitt lymphoma (BL), persons living with HIV remain at high risk for BL. We conducted this study to evaluate if there have been any changes in the risk of or survival after BL diagnosis among persons living with HIV during the antiretroviral era. SETTING Veterans living with HIV (VLWH) and age-matched HIV-negative controls receiving care between 1999 and 2016 were retrospectively identified using Veterans Health Administration electronic medical records. METHODS We identified BL diagnoses through Veterans Health Administration Cancer Registry review and International Classification of Diseases, Ninth/Tenth Revisions, codes, and we extracted demographic, lifestyle, and clinical variables from electronic medical record. We estimated hazard ratios (HR) and 95% confidence intervals (CIs) for BL risk and survival using Cox proportional models. RESULTS We identified 45,299 VLWH. Eighty-four developed BL (incidence rate = 21.2 per 100,000 person years; CI: 17.1 to 26.3). Median CD4 count at BL diagnosis was 238 cells per milliliter (SD: 324.74) and increased over time. Survival was truncated in VLWH with BL (P < 0.05). The risk of BL in VLWH was 38% less in blacks compared with whites (HR: 0.620; CI: 0.393 to 0.979; P = 0.0401). VLWH with an undetectable viral load for at least 40% of follow-up were 74% less likely to develop BL (HR: 0.261; CI: 0.143 to 0.478; P < 0.0001) and 86% less likely to die after diagnosis (HR: 0.141; CI: 0.058 to 0.348; P < 0.0001). CONCLUSIONS BL incidence among VLWH did not improve between 2000 and 2016. Survival after BL diagnosis in VLWH remains dismal as compared with their HIV-negative counterparts, although veterans with prolonged periods of undetectable viral load had improved prognosis.
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Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Kathryn E. Royse
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Yongquan Dong
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Elaine Chang
- Department of Medicine, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Suchismita Raychaudhury
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA
| | - Jennifer Kramer
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Donna L. White
- Department of Medicine, Section of Health Services Research, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA; Clinical Epidemiology and Comparative Effectiveness Program at Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA; Center for Translation in Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, Texas, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth Chiao
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA; Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations (IQuESt), Houston, Texas, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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Clark E, Kulkarni PA, Mohajer MA, Rose S, Serpa J, Singhal G, Giordano T. 2551. Optimizing Rounding Efficiency on the Infectious Diseases Inpatient Service: A Multi-Generational Conversation. Open Forum Infect Dis 2019. [PMCID: PMC6809596 DOI: 10.1093/ofid/ofz360.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background To optimize faculty and trainee wellness without compromising patient care and trainee education, it is important to develop efficient team rounding strategies. This quality improvement project describes rounding practices and suggestions for optimizing rounding efficiency on Infectious Diseases (ID) inpatient consult services at a large academic institution. Methods An anonymous survey on rounding strategies was distributed to the ID Section at Baylor College of Medicine in February 2019 as part of a facilitated discussion on optimizing clinical education for fellows. Results Twenty-seven members of the ID section completed the survey (17 faculty, 10 fellows). Fellows reported rounding for a median of 4 hours per day (range 3–5), while faculty reported 4.5 hours (range 2–5.5). When asked what time fellows should start their workday, the median response was 7:30 am from both fellows (range 6:30–8 am) and faculty (range 7–8 am). When asked what time fellows should end their work day, the median response was 5:30 pm from both fellows (range 5–6 pm) and faculty (range 5–7 pm). Fellows reported signing their last note at 5:30 pm (range 5–9 pm), vs. 9 pm for faculty (range 6–11 pm). Regarding rounding method, most respondents (100% of fellows and 77% of faculty) preferred a combination of traditional rounding at patient bedside and “table” rounds. Regarding teaching method, most faculty (64%) preferred bedside teaching, while most fellows (60%) preferred teaching presentations in the work room (P = 0.011, Fisher’s exact). Both fellows and faculty had many suggestions for optimizing rounding efficiency; the most common was to avoid having fellows see all patients twice daily (“double rounding,” suggested by 80% of fellows and 30% of faculty). Conclusion Overall, the reported behaviors of fellows regarding the structure of their days on inpatient ID services coincided with faculty expectations, although preferences differed between fellows and faculty regarding teaching methods. Avoiding “double rounding” was the most common suggestion to optimize efficiency. Larger studies are needed to better understand rounding behavior and strategies that will optimize the efficiency and effectiveness of inpatient ID consult teams. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Eva Clark
- Baylor College of Medicine, Houston, Texas
| | - Prathit A Kulkarni
- Baylor College of Medicine/Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Mayar Al Mohajer
- CHI St. Luke’s Health - Baylor St. Luke’s Medical Center; Baylor College of Medicine, Houston, Texas
| | | | - Jose Serpa
- Baylor College of Medicine, Houston, Texas
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Patton DE, Francis JJ, Clark E, Smith F, Cadogan CA, Ryan C, Hughes CM. A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: study protocol. Pilot Feasibility Stud 2019; 5:116. [PMID: 31719999 PMCID: PMC6806512 DOI: 10.1186/s40814-019-0506-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022] Open
Abstract
Background Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory (‘a systematic way of understanding events or situations’) can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3–4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient’s underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention’s mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients’ adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration This study is registered at ISRCTN: 10.1186/ISRCTN73831533
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Affiliation(s)
- D E Patton
- 1School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
| | - J J Francis
- 2School of Health Sciences, City University of London, London, UK
| | - E Clark
- 2School of Health Sciences, City University of London, London, UK
| | - F Smith
- 3School of Pharmacy, University College London, London, UK
| | - C A Cadogan
- 4School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C Ryan
- 5School of Pharmacy & Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - C M Hughes
- 1School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
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Ballas L, Aron M, Xiong Y, McCarthy S, Phuong C, Sali A, Chen M, Clark E, Tsao-Wei D, Dorff T, Bhanvadia S, Magliocco A, Daneshmand S. Can Bladder Cancer Biomarkers from Patients Undergoing Cystectomy Predict the Need for Adjuvant Radiotherapy? Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Clark E, Serpa JA. Tropical Diseases in HIV. Curr Treat Options Infect Dis 2019. [DOI: 10.1007/s40506-019-00194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rooney CM, Sheppard AE, Clark E, Davies K, Hubbard ATM, Sebra R, Crook DW, Walker AS, Wilcox MH, Chilton CH. Dissemination of multiple carbapenem resistance genes in an in vitro gut model simulating the human colon. J Antimicrob Chemother 2019; 74:1876-1883. [DOI: 10.1093/jac/dkz106] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/02/2019] [Accepted: 02/25/2019] [Indexed: 01/17/2023] Open
Affiliation(s)
- C M Rooney
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| | - A E Sheppard
- Nuffield Department of Medicine, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, UK
- NIHR Health Protection Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, UK
| | - E Clark
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| | - K Davies
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| | - A T M Hubbard
- Nuffield Department of Medicine, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, UK
| | - R Sebra
- Icahn Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA
| | - D W Crook
- Nuffield Department of Medicine, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, UK
- NIHR Health Protection Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, UK
| | - A S Walker
- Nuffield Department of Medicine, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, UK
- NIHR Health Protection Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Oxford, UK
| | - M H Wilcox
- Leeds Teaching Hospitals NHS Trust, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
| | - C H Chilton
- University of Leeds, Healthcare Associated Infection Research Group, Department of Microbiology, Old Medical School, Thoresby Place, Leeds, UK
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Clark E, Foster Page LA, Larkins K, Leon de la Barra S, Murray Thomson W. Caries-preventive efficacy of a supervised school toothbrushing programme in Northland, New Zealand. Community Dent Health 2019; 36:9-16. [PMID: 30667188 DOI: 10.1922/cdh_4337clark08] [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
BACKGROUND Toothbrushing with fluoride toothpaste reduces the incidence of dental caries. OBJECTIVE To evaluate a supervised school toothbrushing programme to reduce dental caries experience in children. BASIC RESEARCH DESIGN Quasi-experimental study. All children had routine dental examinations at baseline using the ICDAS to record dental caries, along with bitewing radiographs. Half of the children were involved in a supervised toothbrushing programme. Examinations were repeated at the end of the school year. CLINICAL SETTING Northland, New Zealand. PARTICIPANTS 335 10-13-year-old New Zealand children with high caries experience. INTERVENTIONS Half of the children participated in the supervised toothbrushing session each school day; the other half had no intervention. MAIN OUTCOME MEASURES Caries increment, determined by comparing the baseline and follow-up status of each tooth surface. RESULTS At baseline, there were 335 children, of whom 240 (71.6%) were followed up. The ICDAS net caries increment for those in the toothbrushing group was a mean of 11.7 surfaces improved; the control group had a mean of 8.6 surfaces which had deteriorated. Caries incidence for those in the toothbrushing group was 7.3%; that for the control group was 71.5%. Multivariate analysis showed that membership of the brushing group was the only statistically significant predictor of a lower net caries increment. CONCLUSION A supervised school toothbrushing programme can reduce caries increment in a population experiencing high levels of dental disease.
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Affiliation(s)
- E Clark
- Oral Health Service, Northland District Health Board, Whangarei Base Hospital, Private Bag 9742, Whangarei 0148
| | - L A Foster Page
- Associate Professor of Dental Epidemiology and Public Health, Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 647, Dunedin 9054
| | - K Larkins
- Assistant service manager, Oral Health Service, Northland District Health Board, Whangarei Base Hospital, Private Bag 9742, Whangarei 0148
| | - S Leon de la Barra
- Consultant Biostatistician, Department of Oral Sciences, Faculty of Dentistry, University of Otago, PO Box 647, Dunedin 9054
| | - W Murray Thomson
- Professor of Dental Epidemiology and Public Health, Department of Oral Sciences, Faculty of Dentistry, PO Box 647, Dunedin 9054
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Indorewalla K, Sugarman M, Daley R, Clark E, Scoglio A, O’Connor M. A - 17The Aging Well Through Interaction and Scientific Education (AgeWISE) Program: Examining Changes in Attitudes Toward Cognitive Aging in Older Veterans at Six-Month Follow-Up. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bines J, de Azambuja E, Zardavas D, Procter M, Restuccia E, Viale G, Suter T, Arahmani A, van Dooren V, Clark E, Eng-Wong J, Gelber R, Piccart M, von Minckwitz G, Baselga J. Abstract P1-13-07: Incidence and management of diarrhea with adjuvant pertuzumab and trastuzumab in HER2-Positive breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Diarrhea is the most commonly reported adverse event (AE) on pertuzumab (Ptz) in both early and metastatic breast cancer (BC) settings. We report safety analyses of diarrhea from the large adjuvant APHINTY study in HER2 positive early breast cancer (EBC).
Patients and methods
In this exploratory analysis, the safety population included 2364 patients in the Ptz arm and 2405 in the placebo (Pla) arm. No specific prophylaxis was mandated by the protocol, however early intervention with loperamide as well as fluid and electrolyte replacement was recommended. Diarrhea incidence, severity (NCI-CTCAE v4.0), onset and management were analyzed.
Results
Diarrhea was the most common AE in the Ptz arm (71.3% vs. 45.2% in the Pla arm) and the events were mostly G1. Diarrhea ≥G3 was observed in 9.8% and 3.7% in Ptz and Pla arms, respectively. The highest incidence was reported during administration of HER2 targeted therapy and taxane (61.4% vs. 33.8% with Ptz and Pla, respectively) with a marked decrease observed upon chemotherapy cessation (18.1% vs. 9.2% with Ptz and Pla, respectively). The median time from first targeted treatment to onset of diarrhea during the chemotherapy phase was 7 and 10 days (Ptz/Pla). On average, diarrhea events lasted longer in the Ptz than in the Pla arm (median 8 vs. 6 days). Diarrhea events were more frequent with the administration of docetaxel + carboplatin and targeted agents, irrespective of the severity. Detailed results are reported in Table 1.
Conclusions
In the curative setting, diarrhea due to Ptz was mild, generally manageable with common antidiarrheals and did not affect patients' ability to receive treatment. The APHINITY findings are consistent with the well-characterized pattern of pertuzumab-related diarrhea across the HER2 BC spectrum.
Diarrhea incidence, severity (NCI-CTCAE v4.0), onset and management Ptz, n=2364Pla, n=2405Incidence and severityTotal number of patients with at least one adverse event$1685 (71.3%)1086 (45.2%)Total number of events$34151792NCI CTC AE Grade (highest grade per patient)!n1683 (71.2%)1085 (45.1%)Grade 1829 (35.1%)690 (28.7%)Grade 2622 (26.3%)305 (12.7%)Grade 3229 (9.7%)90 (3.7%)Grade 43 (0.1%)0Onset and duration$Median time (days) from 1st HER2 targeted treatment to onset (min-max)7 (1 – 358)10 (1 - 384)Median Duration (days) of each event (min-max)8 (1 - 811)6 (1 - 1022)ManagementAntidiarrheals$898 (38.0%)386 (16.0%)Dose modification* of any study drug!210 (8.9%)74 (3.1%)Dose modification* of HER2 targeted treatment!69 (2.9%)18 (0.7%)Discontinuation of any study drug!38 (1.6%)7 (0.3%)Discontinuation of HER2 Targeted treatment!20 (0.8%)2 (<0.1%)$ Based on a basket of preferred terms for diarrhea ! Based only on the preferred term diarrhea * Includes dose reductions (chemotherapy only), delays or interruptions during infusion
Citation Format: Bines J, de Azambuja E, Zardavas D, Procter M, Restuccia E, Viale G, Suter T, Arahmani A, van Dooren V, Clark E, Eng-Wong J, Gelber R, Piccart M, von Minckwitz G, Baselga J. Incidence and management of diarrhea with adjuvant pertuzumab and trastuzumab in HER2-Positive breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-07.
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Affiliation(s)
- J Bines
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E de Azambuja
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - D Zardavas
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - M Procter
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E Restuccia
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - G Viale
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - T Suter
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - A Arahmani
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - V van Dooren
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E Clark
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - J Eng-Wong
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - R Gelber
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - M Piccart
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - G von Minckwitz
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - J Baselga
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
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Grell WA, Solis-Ramos E, Clark E, Lucon E, Garboczi EJ, Predecki PK, Loftus Z, Kumosa M. Effect of powder oxidation on the impact toughness of electron beam melt Ti-6Al-4V. Acta Mater 2017; 17:123-134. [PMID: 38496266 PMCID: PMC10941301 DOI: 10.1016/j.addma.2017.08.002] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Powder quality in additive manufacturing (AM) electron beam melt (EBM) of Ti-6Al-4V components is crucial in determining the critical material properties of the end item. In this study, we report on the effect of powder oxidation on the Charpy impact energy of Ti-6Al-4V parts manufactured using EBM. In addition to oxidation, the effects on impact energy due to hot isostatic pressing (HIP), specimen orientation, and EBM process defects were also investigated. This research has shown that excessive powder oxidation (oxygen mass fraction above 0.25 % and up to 0.46 %) dramatically decreases the impact energy. It was determined that the room temperature impact energy of the parts after excessive oxidation was reduced by about seven times. We also report that HIP post-processing significantly increases the impact toughness, especially for specimens with lower or normal oxygen content. The specimen orientation effect was found to be more significant for low oxidation levels.
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Affiliation(s)
- W A Grell
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
- Lockheed Martin Space Systems Company, Littleton, CO 80125
| | - E Solis-Ramos
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
| | - E Clark
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
| | - E Lucon
- National Institute of Standards and Technology, Applied Chemicals and Materials Division, Boulder, CO 80305
| | - E J Garboczi
- National Institute of Standards and Technology, Applied Chemicals and Materials Division, Boulder, CO 80305
| | - P K Predecki
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
| | - Z Loftus
- Lockheed Martin Space Systems Company, Littleton, CO 80125
| | - M Kumosa
- NSF Center for Novel High Voltage/Temperature Materials and Structures, University of Denver, Denver, CO 80208
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Clark E, Daley R, Sugarman M, Scoglio A, O'Connor M. A-03Differential Encoding Strategies Following Cognitive Intervention in Older Adults. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tomita M, Olewnik A, Ghosh D, Ahrens L, Clark E, Grzebinski K, Haering C. NOVEL ACCURATE APPROACH TOWARD PREDCTING FRAIL OLDER ADULTS’ FALLS WITHIN THREE MONTHS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3324] [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)
- M.R. Tomita
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| | - A. Olewnik
- Mechanical Engineering, University at Buffalo, Buffalo, New York
| | - D. Ghosh
- Mechanical Engineering, University at Buffalo, Buffalo, New York
| | - L. Ahrens
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| | - E. Clark
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| | - K. Grzebinski
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
| | - C. Haering
- Rehabilitation Science, University at Buffalo, Buffalo, New York,
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Clark E, Lumsdaine A, Ekici K, Ruggles A. Computational Investigation of the Thermal-Hydraulic Performance for Twisted Tape Enabled High Heat Flux Components. Fusion Science and Technology 2017. [DOI: 10.1080/15361055.2017.1333823] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E. Clark
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996
| | - A. Lumsdaine
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - K. Ekici
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996
| | - A. Ruggles
- University of Tennessee, Knoxville, Knoxville, Tennessee 37996
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Collins TA, Hattersley MM, Yates J, Clark E, Mondal M, Mettetal JT. Translational Modeling of Drug-Induced Myelosuppression and Effect of Pretreatment Myelosuppression for AZD5153, a Selective BRD4 Inhibitor. CPT Pharmacometrics Syst Pharmacol 2017; 6:357-364. [PMID: 28378926 PMCID: PMC5488126 DOI: 10.1002/psp4.12194] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/03/2017] [Accepted: 03/22/2017] [Indexed: 01/04/2023]
Abstract
In this work, we evaluate the potential risk of thrombocytopenia in man for a BRD4 inhibitor, AZD5153, based on the platelet count decreases from a Han Wistar rat study. The effects in rat were modeled and used to make clinical predictions for human populations with healthy baseline blood counts. At doses >10 mg, a dose-dependent effect on circulating platelets is expected, with similar predicted changes for both q.d. and b.i.d. dose schedules. These results suggest that at predicted efficacious doses, AZD5153 is likely to have some reductions in the clinical platelet counts, but within the normal range at projected efficacious doses. The model was then extended to incorporate preexisting myelosuppression where bone marrow function is inhibited by acute myeloid leukemia. Under these conditions, duration of platelet count recovery has the potential to be prolonged due to drug-induced myelosuppression.
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Affiliation(s)
- T A Collins
- Drug Safety and Metabolism, AstraZeneca, Cambridge, UK
| | | | - Jwt Yates
- Oncology iMED, AstraZeneca, Cambridge, UK
| | - E Clark
- Oncology iMED, AstraZeneca, Waltham, Massachusetts, USA
| | - M Mondal
- Drug Safety and Metabolism, AstraZeneca, Waltham, Massachusetts, USA
| | - J T Mettetal
- Drug Safety and Metabolism, AstraZeneca, Waltham, Massachusetts, USA
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47
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Timmis J, Alden K, Andrews P, Clark E, Nellis A, Naylor B, Coles M, Kaye P. Building confidence in quantitative systems pharmacology models: An engineer's guide to exploring the rationale in model design and development. CPT Pharmacometrics Syst Pharmacol 2017; 6:156-167. [PMID: 27863172 PMCID: PMC5351409 DOI: 10.1002/psp4.12157] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/30/2016] [Accepted: 11/06/2016] [Indexed: 11/11/2022]
Abstract
This tutorial promotes good practice for exploring the rationale of systems pharmacology models. A safety systems engineering inspired notation approach provides much needed rigor and transparency in development and application of models for therapeutic discovery and design of intervention strategies. Structured arguments over a model's development, underpinning biological knowledge, and analyses of model behaviors are constructed to determine the confidence that a model is fit for the purpose for which it will be applied.
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Affiliation(s)
- J Timmis
- Department of Electronics, The University of York, York, UK.,SimOmics Limited, York, UK
| | - K Alden
- Department of Electronics, The University of York, York, UK
| | | | | | | | - B Naylor
- Department of Electronics, The University of York, York, UK.,SimOmics Limited, York, UK
| | - M Coles
- Centre for Immunology and Infection, Hull York Medical School/University of York, York, UK
| | - P Kaye
- Centre for Immunology and Infection, Hull York Medical School/University of York, York, UK
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48
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Santo-Orihuela PL, Vassena CV, Carvajal G, Clark E, Menacho S, Bozo R, Gilman RH, Bern C, Marcet PL. Toxicological, Enzymatic, and Molecular Assessment of the Insecticide Susceptibility Profile of Triatoma infestans (Hemiptera: Reduviidae, Triatominae) Populations From Rural Communities of Santa Cruz, Bolivia. J Med Entomol 2017; 54:187-195. [PMID: 28011736 PMCID: PMC5388572 DOI: 10.1093/jme/tjw163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 09/08/2016] [Indexed: 05/09/2023]
Abstract
A wide range of insecticide resistance profiles has been reported across Bolivian domestic and sylvatic populations of Triatoma infestans (Klug, 1834) (Hemiptera, Reduviidae), including some with levels proven to be a threat for vector control. In this work, the insecticide profile of domestic T. infestans was studied with standardized toxicological bioassays, in an area that has not undergone consistent vector control. F1 first-instar nymphs hatched in laboratory from bugs captured in three communities from the Santa Cruz Department were evaluated with different insecticides. Moreover, the enzymatic activity of esterases and cytochrome P450 monooxygenases was measured in individual insects to evaluate the possible mechanism of metabolic resistance to pyrethroids. In addition, the DNA sequence of sodium channel gene (kdr) was screened for two point mutations associated with pyrethroid resistance previously reported in T. infestans.All populations showed reduced susceptibility to deltamethrin and α-cypermethrin, albeit the RR50 values varied significantly among them. Increased P450 monooxygenases and permethrate esterases suggest the contribution, as detoxifying mechanisms, to the observed resistance to deltamethrin in all studied populations. No individuals presented either mutation associated to resistance in the kdr gene. The level of susceptibility to α-cypermethrin, the insecticide used by the local vector control program, falls within an acceptable range to continue its use in these populations. However, the observed RR50 values evidence the possibility of selection for resistance to pyrethroids, especially to deltamethrin. Consequently, the use of pyrethroid insecticides should be closely monitored in these communities, which should be kept under entomological surveillance and sustained interventions.
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Affiliation(s)
- Pablo L Santo-Orihuela
- Centro de Investigaciones de Plagas e Insecticidas (UNIDEF, CITEDEF, CONICET, CIPEIN) Juan B. De La Salle 4397 Buenos Aires (B1603ALO), Argentina (; ; )
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Química Analítica Instrumental, Buenos Aires, (C1113AAD), Argentina
| | - Claudia V Vassena
- Centro de Investigaciones de Plagas e Insecticidas (UNIDEF, CITEDEF, CONICET, CIPEIN) Juan B. De La Salle 4397 Buenos Aires (B1603ALO), Argentina (; ; )
- 3iA, Universidad Nacional de San Martín, Buenos Aires (CP 1650), Argentina
| | - Guillermo Carvajal
- Centro de Investigaciones de Plagas e Insecticidas (UNIDEF, CITEDEF, CONICET, CIPEIN) Juan B. De La Salle 4397 Buenos Aires (B1603ALO), Argentina (; ; )
| | - Eva Clark
- University of Alabama at Birmingham, Birmingham, Alabama
- Currently adress: Baylor College of Medicine in Houston, Texas, 77030
| | | | | | - Robert H Gilman
- Bloomberg School of Public Health. Johns Hopkins University, Baltimore, 21205
| | - Caryn Bern
- University of California San Francisco, San Francisco, 94105, California
| | - Paula L Marcet
- Centro de Investigaciones de Plagas e Insecticidas (UNIDEF, CITEDEF, CONICET, CIPEIN) Juan B. De La Salle 4397 Buenos Aires (B1603ALO), Argentina (; ; )
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49
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Vete A, Clark E. Dental clearance unsuccesful: cleidocranial dysplasia diagnosed at a relief of pain clinic. N Z Dent J 2016; 112:122-124. [PMID: 29694758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 55-year-old woman presented to Whangarei Base Hospital Emergency Department with a mandibular swelling adjacent to her unerupted tooth 48. She had never had dental radiographs taken, having had a dental clearance 20 years earlier. She wore full dentures. A panoramic dental radiograph revealed 44 unerupted teeth. Based on the clinical, oral and radiographic examinations a diagnosis of cleidocranial dysplasia (CCD) was confirmed. The patient had not been diagnosed with CCD prior to her hospital visit. Treatment included staged extractions of superficial mandibular supernumeraries and enucleation of the mandibular cyst, attempting to avoid pathological fracture. This would be followed by a six-month review and then annually as required. The case outlines the value of dental radiography in dental practice. Little is known about the prevalence of CCD in New Zealand and this is an area where future research could be conducted.
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50
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Clark E. Health-related quality of life in older people with osteoporotic vertebral fractures: response to comments by Sani et al. Osteoporos Int 2016; 27:3663. [PMID: 27503174 DOI: 10.1007/s00198-016-3726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- E Clark
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, BS10 5NB, UK.
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