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Harrison S, Quigley MA, Fellmeth G, Stein A, Ayers S, Alderdice F. The impact of the Covid-19 pandemic on postnatal anxiety and posttraumatic stress: Analysis of two population-based national maternity surveys in England. J Affect Disord 2024; 356:122-136. [PMID: 38574867 DOI: 10.1016/j.jad.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Few studies have evaluated postnatal anxiety and posttraumatic stress (PTS) before and during the Covid-19 pandemic using comparable data across time. We used data from two national maternity surveys in England to explore the impact of the pandemic on prevalence and risk factors for postnatal anxiety and PTS. METHODS Analysis was conducted using population-based surveys carried out in 2018 (n = 4509) and 2020 (n = 4611). Weighted prevalence estimates for postnatal anxiety and PTS were compared across surveys. Adjusted risk ratios (aRR) were estimated for the association between risk factors and postnatal anxiety and PTS. FINDINGS Prevalence of postnatal anxiety increased from 13.7 % in 2018 to 15.1 % in 2020 (+1.4 %(95%CI:-0.4-3.1)). Prevalence of postnatal PTS increased from 9.7 % in 2018 to 11.5 % in 2020 (+1.8 %(95%CI:0.3-3.4)), due to an increase in PTS related to birth trauma from 2.5 % to 4.3 % (+1.8 %(95%CI:0.9-2.6); there was no increase in PTS related to non-birth trauma. Younger age (aRR = 1.31-1.51), being born in the UK (aRR = 1.29-1.59), long-term physical or mental health problem(s) (aRR = 1.27-1.94), and antenatal anxiety (aRR = 1.97-2.22) were associated with increased risk of postnatal anxiety and PTS before and during the pandemic, whereas higher satisfaction with birth (aRR = 0.92-0.94) and social support (aRR = 0.81-0.82) were associated with decreased risk. INTERPRETATION Prevalence of postnatal PTS was significantly higher during the pandemic, compared to before the pandemic, due to an increase in PTS related to birth trauma. Prevalence of postnatal anxiety was not significantly higher during the pandemic. Risk factors for postnatal anxiety and PTS were similar before and during the pandemic.
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Affiliation(s)
- S Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - M A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - G Fellmeth
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - A Stein
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - S Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - F Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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Chakera A, Harrison S, Mitchell J, Oliver C, Ralph M, Shelton C. The Nitrous Oxide Project: assessment of advocacy and national directives to deliver mitigation of anaesthetic nitrous oxide. Anaesthesia 2024; 79:270-277. [PMID: 38205565 DOI: 10.1111/anae.16211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/12/2024]
Abstract
The environmental emissions attributed to anaesthetic nitrous oxide across the NHS are comparable to the carbon dioxide released by 135,000 flights from Frankfurt to New York. Much of these emissions are attributable to cumbersome and inadequately managed piped systems, resulting in excessive loss and waste. Since 2020, multiple hospital sites have been engaging with the Nitrous Oxide Project, a quality improvement method supporting a 'lean systems' approach to the provision of nitrous oxide. This review considers the frameworks supporting medical gas management in UK healthcare systems, and the impact of professional advocacy and medical gas stewardship to drive anaesthetic nitrous oxide mitigation in the NHS. Nitrous oxide mitigation efforts by grassroots and professional advocacy networks are enhanced through national centralised emission monitoring, distribution of data, technical information and provision of quality analysis. Given the climate harms of nitrous oxide, concerted efforts should be made to rationalise its use, and resources should be committed to supporting this at local, regional and national levels.
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Affiliation(s)
- A Chakera
- Health Infrastructure and Sustainability, Scottish Government, Edinburgh, UK
- The Nitrous Oxide Project, Edinburgh, UK
| | - S Harrison
- Northwest School of Anaesthesia, Manchester, UK
| | - J Mitchell
- Department of Anaesthesia, University Hospital Ayr, Ayr, UK
| | - C Oliver
- Department of Anaesthesia, University Hospital of Wales, Cardiff, UK
| | - M Ralph
- Engineering and Assurance, NHS Scotland Assure, Glasgow, UK
| | - C Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK
- Lancaster Medical School, Lancaster University, Lancaster, UK
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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Harrison S, Davies E, Shelton C. Aerosol-generating procedures: research, guidance and implementation. Anaesthesia 2023; 78:150-154. [PMID: 36196792 DOI: 10.1111/anae.15878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 01/11/2023]
Affiliation(s)
- S Harrison
- North West School of Anaesthesia, Manchester, UK
| | - E Davies
- North West School of Anaesthesia, Manchester, UK
| | - C Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
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Buckley BJR, Harrison S, Hill A, Underhill P, Lane DA, Lip GYH. Stroke-heart syndrome: sex-specific incidence, risk factors, and major adverse cardiovascular events in 486,515 patients with incident ischaemic stroke. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Newly diagnosed cardiovascular complications post-stroke, termed stroke-heart syndrome, are common and associate with worsened prognosis.
Purpose
To investigate the sex-specific incidence and 5-year major adverse cardiovascular events following stroke-heart syndrome, stratified by pre-existing risk factors (sex, age, obesity, hypertension, type 2 diabetes mellitus, and high LDL cholesterol).
Methods
A retrospective cohort study was conducted using anonymised electronic medical records from 56 participating healthcare organizations. Patients with incident ischaemic stroke aged ≥18 years with 5-years of follow-up were included. Patients diagnosed with new-onset cardiovascular complications (heart failure, severe ventricular arrhythmia, atrial fibrillation, ischaemic heart disease, takotsubo syndrome) within 4-weeks of incident ischaemic stroke (exposure) were 1:1 propensity score-matched (age, sex, ethnicity, comorbidities, cardiovascular care) with ischaemic stroke patients without newly diagnosed cardiovascular complications (control). Cox proportional hazards regression models produced hazard ratios (HR) with 95% confidence intervals (CIs) and Kaplan-Meier curves for 5-year risk of all-cause mortality, recurrent stroke, and acute myocardial infarction (AMI).
Results
Of 486,515 patients with ischaemic stroke, 18% (n=87,786) presented with stroke-heart syndrome (47% (n=41,088) female and 52% (n=45,891) male). Following propensity score matching, composite stroke-heart syndrome associated with significantly higher risk of 5-year mortality (HR 1.66 (95% CI 1.62,1.70), P<0.01), recurrent stroke (1.26 (1.24,1.28), P<0.01), and AMI (2.58 (2.50,2.67), P<0.01). These outcomes were similar for both males and females (Figure 1). The risk of mortality, recurrent stroke and AMI following stroke-heart syndrome was relatively higher for patients aged <75 compared to those >75. The risk of all adverse outcomes were relatively higher for females aged <75 compared to males aged <75. Pre-existing obesity associated with a lower risk of mortality for females and males, but a higher risk of recurrent stroke for females. Pre-existing hypertension associated with a lower risk of all outcomes, except recurrent stroke in males. Pre-existing diabetes associated with higher risks for mortality and AMI for both females and males. High LDL cholesterol associated with lower risk of mortality but a higher risk of recurrent stroke and AMI in males and females (Figure 1).
Conclusions
In this cohort study of patients with incident ischaemic stroke, stroke-heart syndrome occurred in 18% of patients. The overall incidence and subsequent 5-year major adverse cardiovascular events following stroke-heart syndrome were similar for females and males, but with important sex-specific differences when stratified by pre-existing risk factors, including age, obesity, and hypertension.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B J R Buckley
- University of Liverpool , Liverpool , United Kingdom
| | - S Harrison
- University of Liverpool , Liverpool , United Kingdom
| | - A Hill
- St Helens & Knowsley NHS Trust , Prescot , United Kingdom
| | | | - D A Lane
- University of Liverpool , Liverpool , United Kingdom
| | - G Y H Lip
- University of Liverpool , Liverpool , United Kingdom
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Lynch C, Harrison S, Butler J, Baldwin D, Dawkins P, van der Horst J, Jakobsen E, McAleese J, McWilliams A, Redmond K, Swaminath A, Finley C. EP04.02-002 International Consensus on Actions to Improve Lung Cancer Survival: Delphi Method in the International Cancer Benchmarking Partnership. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mynard N, McGraw T, Lee B, Villena-Vargas J, Chow O, Harrison S, Port J, Altorki N. EP02.04-004 Time to Surgery After Neoadjuvant Immunotherapy: Not a Day Too Soon. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Selvarajah K, Hulme A, Westbrook R, Ali S, Harrison S. P.81 Anaesthetic challenges of decompensated cirrhosis & COVID-19 in emergency caesarean section. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103377] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Harrison S, Mainland P. Forewarned is forearmed: case reports of device failures and improving patient safety. Anaesth Rep 2022; 10:e12173. [DOI: 10.1002/anr3.12173] [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] [Accepted: 05/27/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- S. Harrison
- North West School of Anaesthesia Health Education England Manchester United Kingdom
| | - P. Mainland
- Department of Anaesthesia Alfred Health Melbourne Australia
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Jones DB, Harrison S, Anderson K, Shannon S, Betts RA. Rock glaciers represent hidden water stores in the Himalaya. Sci Total Environ 2021; 793:145368. [PMID: 33933287 DOI: 10.1016/j.scitotenv.2021.145368] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
In the high mountains of Asia, ongoing glacier retreat threatens human and ecological systems through reduced water availability. Rock glaciers are climatically more resistant than glaciers and contain valuable water volume equivalents (WVEQ). Across High Mountain Asia (HMA) the WVEQ of rock glaciers is poorly quantified, and thus their hydrological significance versus glaciers is unknown. Here we present the first systematic assessment of Himalayan rock glaciers, totalling ~25,000 landforms with an areal coverage of ~3747 km2. We calculate the WVEQ of Himalayan rock glaciers to be 51.80 ± 10.36 km3. Their comparative importance versus glaciers (rock glacier: glacier WVEQ ratio) is 1:25, which means that they constitute hydrologically valuable long-term water stores. In the context of climate-driven glacier recession, their relative hydrological value will likely increase. These cryospheric stores should be included in future scenario modelling to understand their role in sustainable water management for HMA.
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Affiliation(s)
- D B Jones
- College of Life and Environmental Sciences, University of Exeter, Penryn Campus, Penryn, Cornwall TR10 9EZ, UK.
| | - S Harrison
- College of Life and Environmental Sciences, University of Exeter, Penryn Campus, Penryn, Cornwall TR10 9EZ, UK.
| | - K Anderson
- Environment and Sustainability Institute, University of Exeter, Penryn Campus, Penryn, Cornwall TR10 9EZ, UK.
| | - S Shannon
- Bristol Glaciology Centre, Department of Geographical Science, University Road, University of Bristol, BS8 1SS, UK.
| | - R A Betts
- Met Office Hadley Centre, FitzRoy Road, Exeter, EX1 3PB, UK; Global Systems Institute, University of Exeter, Laver Building, North Park Road, Exeter, EX4 4QW, UK.
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Shahid M, Singh H, Lane D, Logantha S, Lip G, Harrison S. Use of oral anticoagulation for people with atrial fibrillation post-stroke and associations with recurrent stroke and mortality: a systematic review. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Current guidelines recommend oral anticoagulation (OAC) to reduce recurrent stroke risk for people with atrial fibrillation (AF); however, outcomes for post-stroke AF patients receiving different types of anticoagulants and optimal timing of anticoagulation in this population remains unclear.
Purpose
The objective of this systematic review was to summarise observational study data reporting associations between OAC use and risk of mortality, recurrent stroke, and major bleeding within post-stroke AF populations.
Methods
SCOPUS and OVID Medline databases were searched from inception to 02/11/2020. Studies were limited to publications in the English language post-2012. Observational studies, including case-control and cohort studies were eligible for inclusion. The outcomes examined were all-cause mortality, recurrent stroke and major bleeding. Screening and risk of bias assessment with the Newcastle-Ottawa scale were completed independently by two reviewers. Data extraction was completed by one reviewer and checked by a second. The review was registered on PROSPERO: CRD42020221105.
Results
Searches identified 3803 studies; 29 studies were eligible for inclusion. Variations between studies including time of OAC initiation, types of OACs used, and length of follow-up meant a meta-analysis was not possible. Four of six studies reporting effect measures of pre-admission or post-stroke OAC use found significant associations with reduced all-cause post-stroke mortality compared to no OAC use (Figure 1A). One study reported lower recurrent stroke rates in patients with no preadmission OAC use compared to preadmission OAC use (2.9% vs. 5.3%; adjusted hazard ratio (aHR) 1.50, 95% confidence interval [CI] 1.02–2.21). A separate study found post-stroke OAC use resulted in a non-significant lower stroke recurrence rate compared to no post-stroke OAC use (3.7% vs. 4.3%; p=0.9). Eight studies examined non-vitamin K antagonist OACs (NOACs) compared to warfarin; five demonstrated significant associations between post-stroke NOAC use and improved outcomes such as post-stroke mortality (Figure 1B). Two studies examined post-stroke OAC therapy timing; both suggested OAC initiation within 4 days of the index event was associated with reduced all-cause mortality (4.5% and 0.6% vs. 8.7% and 3.1%) and recurrent stroke rates (9.4% and 0.8% vs. 10.5% and 1.6%). One study reported non-significant increased major bleeding rates for earlier OAC initiation (2.7% vs. 2.2%; aHR 1.39, 95% CI 0.42–4.60). Overall, the results were consistent with previously published randomised controlled trials.
Conclusions
Evidence from observational studies suggest that the overall benefit of NOACs in reducing recurrent stroke and post-stroke mortality outweighs the risk of major bleeding in post-stroke AF patients. There is a need for further studies to evaluate the optimum timing of post-stroke anticoagulation initiation and management differences in patients with AF.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The project is supported by the MRes programme in the Institute of Life Course and Medical Sciences at The University of Liverpool. All-Cause Mortality Forest Plots
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Affiliation(s)
- M.Z Shahid
- University of Liverpool, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, Liverpool, United Kingdom
| | - H Singh
- University of Liverpool, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, Liverpool, United Kingdom
| | - D.A Lane
- Liverpool Heart and Chest Hospital, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - S.J.R.J Logantha
- Liverpool Heart and Chest Hospital, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - G.Y.H Lip
- Liverpool Heart and Chest Hospital, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - S.L Harrison
- Liverpool Heart and Chest Hospital, Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
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Ade PAR, Ahmed Z, Amiri M, Barkats D, Thakur RB, Bischoff CA, Beck D, Bock JJ, Boenish H, Bullock E, Buza V, Cheshire JR, Connors J, Cornelison J, Crumrine M, Cukierman A, Denison EV, Dierickx M, Duband L, Eiben M, Fatigoni S, Filippini JP, Fliescher S, Goeckner-Wald N, Goldfinger DC, Grayson J, Grimes P, Hall G, Halal G, Halpern M, Hand E, Harrison S, Henderson S, Hildebrandt SR, Hilton GC, Hubmayr J, Hui H, Irwin KD, Kang J, Karkare KS, Karpel E, Kefeli S, Kernasovskiy SA, Kovac JM, Kuo CL, Lau K, Leitch EM, Lennox A, Megerian KG, Minutolo L, Moncelsi L, Nakato Y, Namikawa T, Nguyen HT, O'Brient R, Ogburn RW, Palladino S, Prouve T, Pryke C, Racine B, Reintsema CD, Richter S, Schillaci A, Schwarz R, Schmitt BL, Sheehy CD, Soliman A, Germaine TS, Steinbach B, Sudiwala RV, Teply GP, Thompson KL, Tolan JE, Tucker C, Turner AD, Umiltà C, Vergès C, Vieregg AG, Wandui A, Weber AC, Wiebe DV, Willmert J, Wong CL, Wu WLK, Yang H, Yoon KW, Young E, Yu C, Zeng L, Zhang C, Zhang S. Improved Constraints on Primordial Gravitational Waves using Planck, WMAP, and BICEP/Keck Observations through the 2018 Observing Season. Phys Rev Lett 2021; 127:151301. [PMID: 34678017 DOI: 10.1103/physrevlett.127.151301] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
We present results from an analysis of all data taken by the BICEP2, Keck Array, and BICEP3 CMB polarization experiments up to and including the 2018 observing season. We add additional Keck Array observations at 220 GHz and BICEP3 observations at 95 GHz to the previous 95/150/220 GHz dataset. The Q/U maps now reach depths of 2.8, 2.8, and 8.8 μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈600 square degrees at 95 GHz and ≈400 square degrees at 150 and 220 GHz. The 220 GHz maps now achieve a signal-to-noise ratio on polarized dust emission exceeding that of Planck at 353 GHz. We take auto- and cross-spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz and evaluate the joint likelihood of the spectra versus a multicomponent model of lensed ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and no longer requires a prior on the frequency spectral index of the dust emission taken from measurements on other regions of the sky. This model is an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.036 at 95% confidence. Running maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.009. These are the strongest constraints to date on primordial gravitational waves.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - Z Ahmed
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - M Amiri
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - D Barkats
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - R Basu Thakur
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - C A Bischoff
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - D Beck
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J J Bock
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - H Boenish
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - E Bullock
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - V Buza
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - J R Cheshire
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Connors
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - J Cornelison
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - M Crumrine
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - A Cukierman
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - E V Denison
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - M Dierickx
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - L Duband
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - M Eiben
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - S Fatigoni
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - J P Filippini
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Department of Astronomy, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - S Fliescher
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - N Goeckner-Wald
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - D C Goldfinger
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - J Grayson
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - P Grimes
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - G Hall
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - G Halal
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - M Halpern
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - E Hand
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - S Harrison
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - S Henderson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - S R Hildebrandt
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J Hubmayr
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - H Hui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Irwin
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J Kang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K S Karkare
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - E Karpel
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Kefeli
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S A Kernasovskiy
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J M Kovac
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C L Kuo
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K Lau
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E M Leitch
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - A Lennox
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - K G Megerian
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - L Minutolo
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - L Moncelsi
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - Y Nakato
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - T Namikawa
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), UTIAS, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - H T Nguyen
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R O'Brient
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R W Ogburn
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Palladino
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - T Prouve
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - C Pryke
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Racine
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Aix-Marseille Université, CNRS/IN2P3, CPPM, Marseille 13288, France
| | - C D Reintsema
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - S Richter
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - A Schillaci
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R Schwarz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B L Schmitt
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - C D Sheehy
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Soliman
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - T St Germaine
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - B Steinbach
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R V Sudiwala
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - G P Teply
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K L Thompson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J E Tolan
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Tucker
- School of Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, United Kingdom
| | - A D Turner
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - C Umiltà
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - C Vergès
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - A G Vieregg
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
- Department of Physics, Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - A Wandui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - A C Weber
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - D V Wiebe
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia V6T 1Z1, Canada
| | - J Willmert
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C L Wong
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - W L K Wu
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - H Yang
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K W Yoon
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - E Young
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Yu
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - L Zeng
- Center for Astrophysics, Harvard & Smithsonian, Cambridge, Massachusetts 02138, USA
| | - C Zhang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S Zhang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
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13
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Harrison S, Bellchambers J, Deane S, Dent N, Mackay N, Pottle A. Discharging patients; does it need to be done by a doctor? Eur J Cardiovasc Nurs 2021. [DOI: 10.1093/eurjcn/zvab060.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
None
Background
Patients undergoing angiography and percutaneous coronary intervention (PCI) were historically reviewed post procedure by a member of the medical team who assesses the patient’s suitability for discharge and completes the discharge letter. Over the past 10 years, the number of patients admitted for these procedures as day cases has increased significantly. In addition, there has been an expansion in nursing roles in the UK with the development of a variety of clinical nurse specialist (CNS) posts which have taken over many of the traditional medical roles.
The majority of patients undergoing elective angiography and PCI are admitted to a day case unit at this tertiary cardiac centre. There is no designated medical cover for the unit and medical staff from the acute cardiac unit are called to review patients and complete their discharge paperwork in addition to their other duties. This frequently results in delayed discharge and patients going home without a discharge summary.
It was therefore proposed that suitably qualified CNSs could be trained to discharge these patients and others undergoing day case cardiology procedures. From June 2017, the CNS team took over the role of reviewing patients post procedure and completing the discharge letter.
Purpose
The aim of the study was to evaluate if CNSs were able to discharge patients and provide a timely and effective service following elective cardiology procedures and to obtain patient feedback.
Method
Data on the number of patients reviewed by the CNSs from June 2017 to the end of December 2019, were prospectively collected in a dedicated database. A pilot study of patient experience was carried out in January 2020. Patients were given a questionnaire which asked about the explanation they received from the CNS regarding the procedure they had undergone, if their medication was reviewed and discussed with them, and if they received a discharge summary to take home.
Results
1287 patients were reviewed by the CNS team during the above period. 811 (63.0%) patients had undergone angiography and 423 (32.9%) PCI. Informal feedback from the staff working on the day case unit included that patients were discharged earlier, had improved knowledge about their procedure and that the discharge letter was more detailed when completed by the CNS team.
Eight patients completed the pilot questionnaire. Six were discharged by one of the CNS team, one by a doctor and one patient was not sure who did their discharge. All patients were very satisfied with the process and the information they were given.
Conclusion
Experienced CNSs can deliver high-quality, timely discharge of patients following cardiology procedures. This process is being used as a template to expand nurse-led discharge to other areas in cardiology. Patient experience will continue to be audited with a larger sample size in 2020.
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Affiliation(s)
- S Harrison
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - J Bellchambers
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - S Deane
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - N Dent
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - N Mackay
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
| | - A Pottle
- Royal Brompton and Harefield NHS, Harefield, United Kingdom of Great Britain & Northern Ireland
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14
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Shugar DH, Jacquemart M, Shean D, Bhushan S, Upadhyay K, Sattar A, Schwanghart W, McBride S, de Vries MVW, Mergili M, Emmer A, Deschamps-Berger C, McDonnell M, Bhambri R, Allen S, Berthier E, Carrivick JL, Clague JJ, Dokukin M, Dunning SA, Frey H, Gascoin S, Haritashya UK, Huggel C, Kääb A, Kargel JS, Kavanaugh JL, Lacroix P, Petley D, Rupper S, Azam MF, Cook SJ, Dimri AP, Eriksson M, Farinotti D, Fiddes J, Gnyawali KR, Harrison S, Jha M, Koppes M, Kumar A, Leinss S, Majeed U, Mal S, Muhuri A, Noetzli J, Paul F, Rashid I, Sain K, Steiner J, Ugalde F, Watson CS, Westoby MJ. A massive rock and ice avalanche caused the 2021 disaster at Chamoli, Indian Himalaya. Science 2021; 373:300-306. [PMID: 34112725 DOI: 10.1126/science.abh4455] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/27/2021] [Indexed: 11/02/2022]
Abstract
On 7 February 2021, a catastrophic mass flow descended the Ronti Gad, Rishiganga, and Dhauliganga valleys in Chamoli, Uttarakhand, India, causing widespread devastation and severely damaging two hydropower projects. More than 200 people were killed or are missing. Our analysis of satellite imagery, seismic records, numerical model results, and eyewitness videos reveals that ~27 × 106 cubic meters of rock and glacier ice collapsed from the steep north face of Ronti Peak. The rock and ice avalanche rapidly transformed into an extraordinarily large and mobile debris flow that transported boulders greater than 20 meters in diameter and scoured the valley walls up to 220 meters above the valley floor. The intersection of the hazard cascade with downvalley infrastructure resulted in a disaster, which highlights key questions about adequate monitoring and sustainable development in the Himalaya as well as other remote, high-mountain environments.
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Affiliation(s)
- D H Shugar
- Water, Sediment, Hazards, and Earth-surface Dynamics (waterSHED) Lab, Department of Geoscience, University of Calgary, AB, Canada.
| | - M Jacquemart
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, CO, USA.,Laboratory of Hydraulics, Hydrology, and Glaciology (VAW), ETH Zurich, Zurich, Switzerland.,Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Birmensdorf, Switzerland
| | - D Shean
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - S Bhushan
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - K Upadhyay
- Independent journalist/water policy researcher, Nainital, Uttarakhand, India
| | - A Sattar
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - W Schwanghart
- Institute of Environmental Science and Geography, University of Potsdam, Potsdam, Germany
| | - S McBride
- U.S. Geological Survey, Earthquake Science Center, Moffett Field, CA, USA
| | - M Van Wyk de Vries
- Department of Earth and Environmental Sciences, University of Minnesota, Minneapolis, MN, USA.,St. Anthony Falls Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - M Mergili
- Institute of Geography and Regional Science, University of Graz, Graz, Austria.,Institute of Applied Geology, University of Natural Resources and Life Sciences (BOKU), Vienna, Austria
| | - A Emmer
- Institute of Geography and Regional Science, University of Graz, Graz, Austria
| | - C Deschamps-Berger
- Centre d'Etudes Spatiales de la Biosphère (CESBIO), Université de Toulouse, CNES/CNRS/INRAE/IRD/UP, Toulouse, France
| | - M McDonnell
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
| | - R Bhambri
- Department of Geography, South Asia Institute, Heidelberg University, Heidelberg, Germany
| | - S Allen
- Department of Geography, University of Zurich, Zurich, Switzerland.,Institute for Environmental Sciences, University of Geneva, Switzerland
| | - E Berthier
- Laboratoire d'Etudes en Géophysique et Océanographie Spatiales (LEGOS), Université de Toulouse, CNES/CNRS/IRD/UPS, Toulouse, France
| | - J L Carrivick
- School of Geography, University of Leeds, Leeds, West Yorkshire, UK.,water@leeds, University of Leeds, Leeds, West Yorkshire, UK
| | - J J Clague
- Department of Earth Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M Dokukin
- Department of Natural Disasters, High-Mountain Geophysical Institute, Nalchik, Russia
| | - S A Dunning
- School of Geography, Politics, and Sociology, Newcastle University, Newcastle, UK
| | - H Frey
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - S Gascoin
- Centre d'Etudes Spatiales de la Biosphère (CESBIO), Université de Toulouse, CNES/CNRS/INRAE/IRD/UP, Toulouse, France
| | - U K Haritashya
- Department of Geology and Environmental Geosciences, University of Dayton, Dayton, OH, USA
| | - C Huggel
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - A Kääb
- Department of Geosciences, University of Oslo, Oslo, Norway
| | - J S Kargel
- Planetary Science Institute, Tucson, AZ, USA
| | - J L Kavanaugh
- Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, AB, Canada
| | - P Lacroix
- ISTerre, Université Grenoble Alpes, IRD, CNRS, Grenoble, France
| | - D Petley
- Department of Geography, The University of Sheffield, Sheffield, UK
| | - S Rupper
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
| | - M F Azam
- Indian Institute of Technology Indore, Madhya Pradesh, Indore, India
| | - S J Cook
- Department of Geography and Environmental Science, University of Dundee, Dundee, UK.,United Nations Educational, Scientific and Cultural Organization (UNESCO) Centre for Water Law, Policy, and Science, University of Dundee, Dundee, UK
| | - A P Dimri
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
| | - M Eriksson
- Stockholm International Water Institute, Stockholm, Sweden
| | - D Farinotti
- Laboratory of Hydraulics, Hydrology, and Glaciology (VAW), ETH Zurich, Zurich, Switzerland.,Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Birmensdorf, Switzerland
| | - J Fiddes
- WSL Institute for Snow and Avalanche Research SLF, Davos, Switzerland
| | - K R Gnyawali
- School of Engineering, University of British Columbia, Kelowna, BC, Canada
| | - S Harrison
- College of Life and Environmental Sciences, University of Exeter, Penryn, UK
| | - M Jha
- Department of Mines and Geology, National Earthquake Monitoring and Research Center, Kathmandu, Nepal
| | - M Koppes
- Department of Geography, University of British Columbia, Vancouver, BC, Canada
| | - A Kumar
- Wadia Institute of Himalayan Geology, Dehradun, Uttarakhand, India
| | - S Leinss
- Institute of Environmental Engineering (IfU), ETH Zurich, 8093 Zürich, Switzerland
| | - U Majeed
- Department of Geoinformatics, University of Kashmir, Hazratbal Srinagar, Jammu and Kashmir, India
| | - S Mal
- Department of Geography, Shaheed Bhagat Singh College, University of Delhi, Delhi, India
| | - A Muhuri
- Centre d'Etudes Spatiales de la Biosphère (CESBIO), Université de Toulouse, CNES/CNRS/INRAE/IRD/UP, Toulouse, France.,Institute of Geography, Heidelberg University, Germany
| | - J Noetzli
- WSL Institute for Snow and Avalanche Research SLF, Davos, Switzerland
| | - F Paul
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - I Rashid
- Department of Geoinformatics, University of Kashmir, Hazratbal Srinagar, Jammu and Kashmir, India
| | - K Sain
- Wadia Institute of Himalayan Geology, Dehradun, Uttarakhand, India
| | - J Steiner
- International Centre for Integrated Mountain Development, Kathmandu, Nepal.,Department of Physical Geography, Utrecht University, Netherlands
| | - F Ugalde
- Geoestudios, San José de Maipo, Chile.,Department of Geology, University of Chile, Santiago, Chile
| | - C S Watson
- Centre for Observation and Modelling of Earthquakes, Volcanoes and Tectonics (COMET), School of Earth and Environment, University of Leeds, Leeds, UK
| | - M J Westoby
- Department of Geography and Environmental Sciences, Northumbria University, Newcastle upon Tyne, UK
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15
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Abstract
BACKGROUND Few data are available on the pattern of use of fit notes issued in secondary care settings. AIMS To evaluate the pattern and quality of e-fit notes issued in an NHS Trust. METHODS Anonymized data on patients admitted to Guy's and St Thomas' NHS Foundation Trust (London, UK) who had an e-fit note issued from 1 January to 31 August 2017 were analysed using descriptive statistical methods. Thematic analysis was used to group the free-text comments into distinct categories and themes. RESULTS A total of 815 fit notes were issued during the study period. A total of 659 (81%) fit notes advised that patients were 'not fit' for work, whilst 156 (19%) advised that they 'may be fit' for work. The specialty with the highest proportion of patients assessed as may be fit was plastic surgery 46/104 (44%), whilst the lowest was ear, nose and throat surgery 0/57 (0%). The majority 151/156 (97%) of fit notes which advised that patients may be fit for work used the tick-box sections on the fit note to recommend work modifications. Of the free-text comments in section 4 of the 'may be fit' e-fit notes issued, 91/114 (80%) were related to the functional ability of patients. CONCLUSIONS Our study suggests that doctors in secondary care are more willing to use the 'may be fit' option on the fit note than primary care practitioners. Most fit notes, which advised that a patient may be fit for work, suggested workplace modifications.
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Affiliation(s)
- S Harrison
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Dorrington
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - V Parsons
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S G S Shah
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Madan
- Occupational Health Service, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
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16
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Proietti M, Vitolo M, Harrison S, Lane DA, Fauchier L, Marin F, Nabauer M, Potpara TS, Dan GA, Boriani G, Lip GYH. Impact on outcomes in Europe: a cluster analysis from the ESC-EHRA EORP AF general long-term registry. Europace 2021. [DOI: 10.1093/europace/euab116.301] [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
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
ESC-EHRA EORP AF General Long-Term Registry Investigators
Introduction
Data derived from recent observational studies in atrial fibrillation (AF) show how the complexity of the clinical phenotype, beyond baseline thromboembolic risk, can increase risk of major adverse outcomes. Importantly, risk factors tend to occur in clusters, rather than occur individually in isolation.
Aims
To describe AF patients’ clinical phenotypes among a large contemporary European AF cohort and to analyse the differential impact of these clinical phenotypes on the occurrence of major adverse outcomes.
Methods
We performed a hierarchical cluster analysis based on Ward’s Method and using Squared Euclidean Distance using 22 clinical covariates. All variables were considered as binary. Examining the distances between cluster coefficients and by visual inspection of the dendrogram produced we identified the optimal number of clusters. Patients with data available for all 22 variables were included. We considered occurrence of cardiovascular events and all-cause death.
Results
Among the original 11096 patients included, 9363 (84.4%) were available for this analysis. The cluster analysis identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients with prevalent noncardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients mainly admitted for first detected and paroxysmal AF with low prevalence of concomitant conditions; Cluster 3 (n = 2955; 31.6%) included patients with high prevalence of permanent AF, cardiac risk factors and comorbidities. Thromboembolic and bleeding risks were higher in Cluster 3 and progressively lower in Cluster 1 and Cluster 2 (both p < 0.001). Use of oral anticoagulant was significantly lower for Cluster 2 (83.2% vs. 86.5% and 86.7% in Cluster 1 and Cluster 3, respectively; p < 0.001). Over a mean follow-up of 22.5 (SD5.5) months, Cluster 3 had the highest rate of both cardiovascular events (10.0%) and all-cause death (13.2%), compared with Cluster 1 (6.6% and 9.4%, respectively) and Cluster 2 (3.7% and 3.8%, respectively) (both p < 0.001). Kaplan-Meier curves (Figure) show that Cluster 2 (green line) had the lowest cumulative risk of outcomes; risk was progressively higher in Cluster 1 (orange line) and Cluster 3 (yellow line). A Cox multivariable regression analysis, adjusted for type of AF, symptomatic status, CHA2DS2-VASc score and use of oral anticoagulants, showed that both Cluster 3 and Cluster 1 were associated with a significantly increased risk of cardiovascular events (HR: 1.80, 95%CI: 1.39-2.33 and HR: 1.40, 95%CI: 1.09-1.80, respectively) and all-cause death (HR: 1.80, 95%CI: 1.40-2.30 and HR: 1.66, 95%CI: 1.30-2.11) compared to Cluster 2.
Conclusions
In European AF patients, three main clinical clusters were identified, those with non-cardiac comorbidities, low risk and cardiac comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of cardiovascular events and all-cause death. Abstract Figure. Kaplan-Meier Curves for Outcomes
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Affiliation(s)
| | - M Vitolo
- University of Modena & Reggio Emilia, Modena, Italy
| | - S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - DA Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - L Fauchier
- University Hospital of Tours, Tours, France
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Murcia, Spain
| | - M Nabauer
- Ludwig Maximilians University Hospital, Munich, Germany
| | - TS Potpara
- University of Belgrade, Belgrade, Serbia
| | - GA Dan
- Colentina University Hospital, Bucharest, Romania
| | - G Boriani
- University of Modena & Reggio Emilia, Modena, Italy
| | - GYH Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Buckley B, Harrison S, Fazio-Eynullayeva E, Underhill P, Lane D, Thijssen D, Lip G. Associations of exercise-based cardiac rehabilitation with all-cause mortality among patients with atrial fibrillation. Europace 2021. [DOI: 10.1093/europace/euab116.505] [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
Funding Acknowledgements
Type of funding sources: None.
Background
There is limited evidence of long-term impact of exercise-based CR on clinical endpoints for patients with AF. We therefore compared 18-month all-cause mortality, hospitalisation, stroke, and heart failure in patients with AF and an electronic medical record (EMR) of exercise-based CR to matched controls.
Methods and Results
This retrospective cohort study included patient data obtained on 11 December 2020, from a global federated health research network. AF patients undergoing exercise-based CR were propensity score matched to AF patients without exercise-based CR by age, sex, race, medication, and co-morbidities. We ascertained 18-month incidence of all-cause mortality, hospitalisation, stroke, and heart failure.
Of 1,350,886 patients with AF, 10,625 patients had an EMR of exercise-based CR within 6-months of incident AF. The propensity score matched cohort of 21,250 patients with AF demonstrated that exercise-based CR was associated with 64% lower odds of all-cause mortality (odds ratio 0.36, 95% confidence interval (CI) 0.33-0.40), 41% lower odds of hospitalisation (0.59, 95% CI 0.56-0.63), and 17% lower odds of incident stroke (0.83, 95% CI 0.71-0.98) compared to propensity score matched controls. No significant associations were shown for heart failure at 18-months (0.92, 95% CI 0.81-1.02). The beneficial association of exercise-based CR on all-cause mortality was independent of sex, older age, comorbidities, and AF subtype.
CONCLUSIONS
Exercise-based CR among patients with incident AF was associated with lower odds of all-cause mortality, hospitalisation, and stroke at 18-months follow-up. The longitudinal nature of this retrospective follow-up study strongly supports the provision of exercise programmes for patients with incident AF.
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Affiliation(s)
- B Buckley
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Harrison
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | | | - P Underhill
- TriNetX, London, United Kingdom of Great Britain & Northern Ireland
| | - D Lane
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Thijssen
- Liverpool John Moores University, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - G Lip
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Buckley B, Harrison S, Fazio-Eynullayeva E, Underhill P, Sankaranarayanan R, Wright D, Thijssen D, Lip G. Cardiac rehabilitation and all-cause mortality in patients with heart failure: A retrospective cohort study. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Despite the benefits of exercise training in the secondary prevention of cardiovascular disease, there are conflicting findings for the impact of exercise-based cardiac rehabilitation (CR) on mortality for patients with heart failure (HF).
Methods
A retrospective cohort study was conducted which utilised a global federated health research network. Patients with a diagnosis of HF were compared between those with and without an electronic medical record of exercise-based CR within 6-months of a HF diagnosis. Patients with HF undergoing exercise-based CR were propensity score matched to HF patients without exercise-based CR by age, sex, race, co-morbidities, medications, and procedures. We ascertained 2-year incidence of all-cause mortality, hospitalisation, stroke, and atrial fibrillation.
Results
Following propensity score matching, a total of 40,364 patients with HF were identified. Exercise-based CR was associated with 42% lower odds of all-cause mortality (odds ratio 0.58, 95% confidence interval (CI): 0.54-0.62), 26% lower odds of hospitalisation (0.74, 95% CI 0.71-0.77), 37% lower odds of incident stroke (0.63, 95% CI 0.51-0.79), and 53% lower odds of incident atrial fibrillation (0.47, 95% CI 0.4-0.55) compared to matched controls. The beneficial association of exercise-based CR on all-cause mortality was consistent across stratification for sex, older age, included comorbidities, and HF subtype (all P < 0.0001), including patients with HFpEF (0.65, 95% CI 0.60-0.71).
Conclusions
Exercise-based CR was associated with lower odds of all-cause mortality, hospitalisations, incident stroke and incident atrial fibrillation at 2-years follow-up for patients with HF. The beneficial association of CR and lower mortality was consistent for patients with HFrEF and HFpEF.
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Affiliation(s)
- B Buckley
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Harrison
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | | | - P Underhill
- TriNetX, London, United Kingdom of Great Britain & Northern Ireland
| | - R Sankaranarayanan
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Wright
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - D Thijssen
- Liverpool John Moores University, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - G Lip
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
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Rahouma M, Harrison S, Wish J, Kamel M, Lee B, Chow O, Morsi M, Port J, Altorki N, Stiles B. P08.04 Progress in Early Stage Lung Cancer Among Economically Disadvantaged Patients. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.423] [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]
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Vitolo M, Proietti M, Harrison S, Kalarus Z, Tavazzi L, Potpara T, Lane D, Boriani G, Lip G. Impact of physical activity on all-cause mortality in European patients with atrial fibrillation: a report from the ESC-EHRA EORP AF General Long-Term Registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Physical activity (PA) may have a beneficial contribution for outcomes in patients with atrial fibrillation (AF).
Purpose
We aimed to evaluate the impact of self-reported PA in a large contemporary cohort of European AF patients on the risk of all-cause mortality.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Self-reported PA was categorized, on the basis of reported time spent exercising, as follows: i) No PA; ii) Occasional PA; iii) Regular PA; iv) Intense PA. The primary outcome was all-cause death.
Results
Over 11096, a total of 8699 (78.4%) patients (mean age (SD) 69.1 (11.5); 40.7% female) had available data about PA and follow-up observation and were included in the analysis. Of these, 3703 (42.6%) reported no PA, 2829 (32.5%) occasional PA, 1824 (21.0%) regular PA, with only 343 (3.9%) reporting intense PA. With the 4 increasing PA categories, mean age, proportion of female patients, CHA2DS2-VASc and HAS-BLED scores were progressively lower (all p<0.001). Use of vitamin K antagonist (VKA) declined across the classes of PA (53.1% vs. 52.2% vs. 44.5% vs. 33.9%, p<0.001), while use of non-VKA OACs (NOACs) conversely increased. During a mean (SD) 680.6 (171.5) days of follow-up, there were a total of 848 (9.7%) all-cause death events. Based on Kaplan-Meier analysis, there was a progressively lower cumulative risk for all-cause death according to PA categories [Figure]. A multivariable Cox regression analysis, adjusting for CHA2DS2-VASc score, use of OAC at baseline and type of AF, found a lower risk of all-cause death associated with increasing levels of PA (Hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.59–0.81 for occasional PA, HR: 0.45, 95% CI: 0.35–0.58 for regular PA, HR: 0.41, 95% CI: 0.23–0.76 for intense PA, when compared to no PA). In a sensitivity analysis, a regular-intense PA was inversely associated with occurrence of cardiovascular (CV) death, after multivariable adjustments for comorbidities (HR: 0.54, 95% CI: 0.37–0.77).
Conclusions
In a large contemporary cohort of European AF patients, self-reported PA was found to be inversely associated with all-cause death and CV death.
Kaplan-Meier Curves
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants
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Affiliation(s)
- M Vitolo
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Z Kalarus
- Silesian Center for Heart Diseases (SCHD), Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - T Potpara
- University Belgrade Medical School, Belgrade, Serbia
| | - D.A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - G.Y.H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Abstract
Abstract
Background
High blood lipid levels are known risk factors for atherosclerotic cardiovascular events, but associations between lipid levels and atrial fibrillation (AF) are unclear. Some previous studies have suggested an inverse association between lipid levels and AF referred to as the “cholesterol paradox”.
Purpose
To examine the prevalence of AF by differing lipid levels in a large population-based study of almost 14,000 adults in Poland.
Methods
The LIPIDOGRAM 2015 study is a cross-sectional study of adults aged 18 years and older recruited in Poland in 2015/2016 by 438 family physicians. Poisson regression models with robust variance were used to estimate prevalence ratios (PRs) for AF with 95% confidence intervals (CIs) for participants with differing lipid profiles. Lipid measures including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC) and LDL/HDL ratios were grouped into quartiles with the lowest quartile as the reference group. Models were adjusted for potential confounding factors including age, sex, waist-to-hip ratio, smoking, alcohol intake, regular physical activity, hypertension, antihypertensive medication use and treatment of dyslipidaemia.
Results
13,724 participants were recruited to the study, the median (interquartile range: IQR) age was 58.0 (47.7–65.8) years and 5.2% (n=708) had a diagnosis of AF, with a median (IQR) 3 (1–8) years since diagnosis. After adjusting for potential confounding factors, a statistically significant lower prevalence of AF was estimated for participants in the highest quartile for LDL-C (PR (95% CI): 0.60 (0.48, 0.75) p<0.001), HDL-C (0.58 (0.46, 0.74), p<0.001), TC (0.61 (0.49, 0.75), p<0.001) and LDL/HDL ratio (0.75 (0.61, 0.94), p=0.010). No statistically significant difference in prevalence of AF was observed for participants in the highest quartile for TG levels compared to the lowest quartile for TG levels.
Conclusions
The prevalence of AF was lower for people with higher levels of LDL-C, HDL-C, TC and higher LDL/HDL ratios; some of the difference in prevalence was explained by controlling for confounding factors, but in multivariable models the association remained statistically significant. This research adds to the body of evidence which suggests an inverse relationship between cholesterol levels and AF-the “cholesterol paradox” for AF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G.Y.H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - D.A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - M Mastej
- University of Opole, Department of Family Medicine and Public Health, Opole, Poland
| | - S Kasperczyk
- University of Silesia, Department of Biochemistry, Katowice, Poland
| | - M Banach
- University of Lodz, Department of Hypertension, Zeromskiego, Poland
| | - J.J Jozwiak
- University of Opole, Department of Family Medicine and Public Health, Opole, Poland
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22
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Vitolo M, Proietti M, Harrison S, Fauchier L, Marin F, Potpara T, Lane D, Boriani G, Lip G. Temporal changes in quality of life amongst European atrial fibrillation patients: relationship to all-cause mortality. A report from the ESC-EHRA EORP-AF General Long-Term Registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) significantly impacts on patients' quality of life (QoL). An impaired QoL has been associated with worse outcomes even in AF patients, but contemporary data in a large-scale pan-European population are limited.
Purpose
We aimed to assess temporal changes in AF patients' QoL across 2 years follow-up observation, and the relationship of QoL changes with all-cause death.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. The EQ-5D-5L questionnaire was used to assess QoL. A Health Utility Score (HUS), indicating the overall health state (1 equals perfect health), was derived. Differences throughout the follow-up (Baseline, 1-Y FU, 2-Y FU) observation were assessed. The study outcome was all-cause mortality.
Results
Out of a total of 11906 patients, 8097 (73.0%) were available for this analysis. Mean (SD) age was 69.1 (11.5) years; 60.8% males; median CHA2DS2-VASc and HASBLED scores were 3 (IQR 2–4) and 1 (1–2), respectively. The mean (SD) HUS at baseline was 0.815 (0.200) and 0.834 (0.196), 0.829 (0.195) at 1-year follow-up and 2-year follow-up, respectively (p<0.0001 for changes over time). Patients with a higher CHA2DS2-VASc score (CHA2DS2-VASc 6–9) reported a significant reduction in the quality of life, compared to the other CHA2DS2-VASc strata, with a mean (SD) HUS decreasing from 0.754 (0.214) at baseline to 0.727 (0.238) at 2-year follow-up (F=6.538, p<0.0001) (Figure). Multivariate analysis demonstrated that age [−0.001 (95% CI [−0.002, −0.121]) and coronary artery disease (CAD) [−0.016 (95% CI [−0.029, −0.004] were independently inversely associated with increasing QoL. Positive changes in HUS over time were inversely associated with an increase in the risk of all-cause death, even after adjusting for chronic kidney disease, liver disease, chronic obstructive pulmonary disease, oral anticoagulants and type of AF (OR:0.24, 95% CI: 0.13–0.45 for increasing HUS difference, as a continuous variable).
Conclusions
In a contemporary European-wide cohort of AF patients, significant temporal changes in QoL were found. Patients at higher stroke risk according to CHA2DS2-VASc score showed a significant reduction in the QoL. Age and CAD were independently associated with changes in QoL. A greater reduction in HUS (i.e. worsening QoL) over time was associated with a higher risk of all-cause death.
Temporal changes in HUS
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants
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Affiliation(s)
- M Vitolo
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - L Fauchier
- University Hospital of Tours, Service de Cardiologie, Tours, France
| | - F Marin
- Hospital Universitario Virgen Arrixaca, Department of Cardiology, Univeristy of Murcia, Murcia, Spain
| | - T Potpara
- University Belgrade Medical School, Belgrade, Serbia
| | - D.A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - G.Y.H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Proietti M, Vitolo M, Harrison S, Dan G, Maggioni A, Potpara T, Lane D, Boriani G, Lip G. Relationship between frailty and all-cause mortality in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational research programme AF general long-term registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Frailty is a major health determinant for cardiovascular disease. Thus far, data on frailty in patients with atrial fibrillation (AF) are limited.
Aims
To evaluate frailty in a large contemporary cohort of European AF patients, the relationship with oral anticoagulant (OAC) prescription and with risk of all-cause death.
Methods
We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. A 38-items frailty index (FI) was derived from baseline characteristics according to the accumulation of deficits model proposed by Rockwood and Mitnitsky. All-cause mortality was the primary study outcome.
Results
Out of the 11096 AF enrolled patients, data for evaluating frailty were available for 6557 (59.1%) patients who have been included in this analysis (mean [SD] age 68.9 [11.5], 37.7% females). Baseline median [IQR] CHA2DS2-VASc and HAS-BLED were 3 [2–4] and 1 [1–2], respectively. At baseline, median [IQR] FI was 0.16 (0.12–0.23), with 1276 (19.5%) patients considered “not-frail” (FI<0.10), 4033 (61.5%) considered “pre-frail” (FI 0.10–0.25) and 1248 (19.0%) considered “frail” (FI≥0.25). Age, female prevalence, CHA2DS2-VASc and HAS-BLED progressively increased across the FI classes (all p<0.001). Use of OAC progressively increased among FI classes; after adjustments FI was not associated with OAC prescription (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 0.98–1.19 for each 0.10 FI increase). Conversely, FI was directly associated with vitamin K antagonist (VKA) use (OR: 1.26, 95% CI: 1.18–1.34 for each 0.10 FI increase) and inversely associated with non-VKA OACs (NOACs) use (OR: 0.82, 95% CI: 0.77–0.88). FI was significantly correlated with CHA2DS2-VASc (Rho= 0.516, p<0.001). Over a median [IQR] follow-up of 731 [704–749] days, there were 569 (8.7%) all-cause death events. Kaplan-Meier curves [Figure] showed an increasing cumulative risk for all-cause death according to FI categories. A Cox multivariable analysis, adjusted for age, sex, type of AF and use of OAC, found that increasing FI as a continuous variable was associated with an increased risk of all-cause death (hazard ratio [HR]: 1.56, 95% CI: 1.40–1.73 for each 0.10 FI increase). An association with all-cause death risk was found across the FI categories (HR: 1.71, 95% CI: 1.23–2.38 and HR: 2.88, 95% CI: 2.02–4.12, respectively for pre-frail and frail patients compared to non-frail ones). FI was also predictive of all-cause death (c-index: 0.660, 95% CI: 0.637–0.682; p<0.001).
Conclusions
In a European contemporary cohort of AF patients the burden of frailty is significant, with almost 1 out of 5 patients found to be “frail”. Frailty influenced significantly the choice of OAC therapy and was associated with (and predictive of) all-cause death at follow-up.
Kaplan-Meier Curves
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants.
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Affiliation(s)
| | - M Vitolo
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - S Harrison
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G.A Dan
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - A.P Maggioni
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - T Potpara
- Clinical center of Serbia, Intensive Arrhythmia Care, Cardiology Clinic, Belgrade, Serbia
| | - D.A Lane
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - G Boriani
- University of Modena & Reggio Emilia, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - G.Y.H Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
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Hughes A, Harrison S, Dixon P, Dickson M, Davies A, Rice F, Davies N, Howe L. The wider consequences of obesity: estimated social and economic costs from Mendelian Randomization. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1028] [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
Obesity is a key public health issue worldwide. Accurate estimates of its full impacts on health, social, and economic outcomes are required, but are difficult to obtain due to bias from confounding and reverse causality (the impact of social and economic factors on obesity).
Methods
Using data from the UK Biobank and ALSPAC, we applied a genetic causal inference approach (Mendelian Randomization, MR) to estimate the impact of body mass index (BMI) on key social and economic outcomes. Because genetic variants are assigned before birth and cannot change, estimates from MR studies are less liable to confounding and reverse causation.
Results
Effects of higher BMI were often larger in MR than conventional (non-genetic) models, suggesting previous studies may have underestimated the impact of BMI. For example, in adolescents, MR models implied a standard deviation increase in BMI led to exam scores around 1/3 of a grade lower in all subjects at age 16, and 8.7% (CI: 1.8% to 16.1%) more school absence. In adults a 5kg/m2 increase in BMI corresponded, among other negative outcomes, to £2,778 less annual household income (CI: £1,864 to £3,693), less chance of owning one's home (-1.6%, CI: -2.4% to -0.8%), and higher chance of being lonely (2.4%, CI: 1.4% to 3.5%). At £21.22 (CI: £14.35 to £28.07) per person per marginal kg/m2 per year, MR estimates for inpatient hospital costs were around 40% higher than conventional estimates.
Conclusions
Findings from causal inference based on genetic variation indicate that high BMI has negative impacts on social and economic outcomes that may be larger than previously estimated. This evidence highlights the potential social and economic value of preventing high BMI across the life course.
Key messages
High BMI has considerable negative impacts not only for health, but for individuals’ education and socioeconomic outcomes, and overall health care costs. Previous attempts to quantify these effects may have underestimated BMI’s full impact.
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Affiliation(s)
- A Hughes
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - S Harrison
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - P Dixon
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - M Dickson
- Institute for Policy Research, University of Bath, Bath, UK
| | - A Davies
- Research and Evaluation Division, Knowledge Directorate, Public Health Wales, Cardiff, UK
| | - F Rice
- School of Medicine, University of Cardiff, Cardiff, UK
| | - N Davies
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - L Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Singla R, Wall D, Anderson S, Zia N, Korte J, Kravets L, McKiernan G, Butler J, Gammilonghi A, Arora J, Wright M, Solomon B, Hicks R, Cain T, Darcy P, Cullinane C, Neeson P, Ramanathan R, Shukla R, Bansal V, Harrison S. First in Human Study of In-vivo Imaging of Ex-Vivo Labelled CAR T Cells with Dual PET-MR. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.04.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Langsetmo L, Harrison S, Jonnalagadda S, Pereira SL, Shikany JM, Farsijani S, Lane NE, Cauley JA, Stone K, Cawthon PM. Low Protein Intake Irrespective of Source is Associated with Higher Mortality Among Older Community-dwelling Men. J Nutr Health Aging 2020; 24:900-905. [PMID: 33009543 PMCID: PMC7734969 DOI: 10.1007/s12603-020-1422-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Our aim was to determine the association between protein intake (overall and by source) and all-cause and cause-specific mortality among older men. DESIGN Prospective cohort study. SETTING 5790 ambulatory community-dwelling older men from multicenter Osteoporotic Fractures in Men (MrOS) study. MEASUREMENTS Total energy and protein intake, and protein intake by source (dairy, non-dairy animal, plant) were assessed using a 69-item food frequency questionnaire. We included up to 10-year follow-up with adjudicated cardiovascular, cancer and other mortality outcomes. We used time-to-event analysis with protein exposures, mortality outcome, and adjusted for possible confounders including age, center, education, race, smoking, alcohol use, physical activity, weight, total energy intake (TEI), and comorbidities. Hazard ratios were expressed per each unit=2.9% TEI decrement for all protein intake variables. RESULTS The mean (SD) baseline age of 5790 men was 73.6 (5.8) y. There were 1611 deaths and 211 drop-outs prior to 10 years, and 3868 men who were alive at the 10-year follow-up. The mean (SD) total protein intake was 64.7 (25.8) g/d, while the mean (SD) intake expressed as percent of total energy intake (%TEI) was 16.1 (2.9) %TEI. Lower protein intake was associated with an increased risk of death, with unadjusted HR=1.11 (95% CI: 1.06, 1.17) and adjusted HR=1.09 (95% CI: 1.04, 1.14) and the associations for protein intake by source were similar. The adjusted HR for cancer mortality was HR=1.13 (95% CI: 1.03, 1.25) while the association for CVD mortality was HR=1.08 (95% CI: 0.99, 1.18). CONCLUSIONS Low protein intake, irrespective of source, was associated with a modest increase in risk of all-cause and cause-specific mortality among older men. Special consideration should be given to level of protein intake among older adults.
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Affiliation(s)
- L Langsetmo
- Lisa Langsetmo, Ph.D., Division of Epidemiology and Community Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, USA, 55454. E-mail:
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Harrison S. A078 Can We Make Aortic Valve Replacement A Zero Transfusion Procedure? Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.083] [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: 11/17/2022]
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Harrison S. 595 A Single Centre Experience of Septal Myectomy. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.602] [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: 10/23/2022]
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Thornton H, Turner K, Harrison S, Hammond A, Hawcroft C, Hay A. Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes. Clin Microbiol Infect 2019; 25:1339-1346. [PMID: 31254715 PMCID: PMC7129693 DOI: 10.1016/j.cmi.2019.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/31/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Microbial point-of-care testing (POCT) has potential to revolutionize clinical care. Understanding the prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs). The aim was to investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use. METHODS Data sources were the MEDLINE and Embase databases. Study eligibility criteria consisted of quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI. Patients presenting to healthcare or research settings with RTI participated. Interventions included upper respiratory tract swab. The methods used were systematic review and meta-analysis. RESULTS Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. A total of 144 full texts were screened; 21 articles were retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). One hundred and seven (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalization duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies. CONCLUSIONS A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test results, use of antimicrobials and microbial resistance.
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Affiliation(s)
- H.V. Thornton
- Centre for Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - K.M.E. Turner
- School of Veterinary Science, University of Bristol, Langford, Bristol, UK
| | - S. Harrison
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - A. Hammond
- Centre for Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - C. Hawcroft
- Centre for Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - A.D. Hay
- Centre for Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK,Corresponding author
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Sholi A, Kamel M, Nasar A, Naik A, Harrison S, Lee B, Port J, Altorki N, Stiles B. MA06.03 Poor Pulmonary Function Does Not Define “Medical Inoperability”: Short and Long Term Results of a Matched Lung Cancer Cohort. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.540] [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: 10/25/2022]
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Taub R, Frias JP, Baum SJ, Hsia S, Harrison S. P1521In a 36-week placebo-controlled phase 2 trial in patients with non-alcoholic steatohepatitis (NASH), treatment with MGL-3196 (resmetirom) significantly reduces atherogenic lipoprotein particles. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0283] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
MGL-3196 is a liver-directed, orally active, highly selective thyroid hormone receptor-β agonist being developed for the treatment of non-alcoholic steatohepatitis (NASH). In a 36-week Phase 2 NASH study, MGL-3196 treatment compared with placebo (PbO) resulted in significant reductions in hepatic fat, liver enzymes, NASH on liver biopsy, and atherogenic lipids including low-density lipoprotein cholesterol (LDL-C) and triglycerides. Most NASH patients die of cardiovascular disease (CVD), and, in NASH patients, CV risk correlates better with LDL particle than LDL-C levels.
Purpose
To determine the effects of MGL-3196 on lipoprotein particle concentrations in patients with NASH.
Methods
MGL-3196–05 (NCT02912260) is a 36-week multicenter, randomized, double-blind, placebo controlled study of NASH patients assessed with serial liver imaging and liver biopsies. Patients received 2:1 MGL-3196 80 mg (blinded ± 20 mg dose adjustment possible at Week 4 based on Week 2 pharmacokinetic data) or placebo once daily, for 36 weeks. Lipoprotein particle concentrations were assessed in fasting blood samples at baseline and Week (Wk) 36.
Results
As shown (Table), MGL-3196 significantly reduced the level of lipoprotein particles, with greater reductions in patients with baseline (BL) LDL-C ≥100 mg/dL and the patient group with higher MGL-3196 exposures (High exp).
Lipoprotein particles Particles (by NMR) (nmol/L) Time Point Placebo, n=34 MGL-3196 (all), n=73 MGL-3196 BL LDL-C ≥100 mg/dL, n=44; High Exp, n=25 (PbO BL ≥100 mg/dL, n=23 mean data not shown) Total LDL, mean (SD) BL 1234 (276) 1275 (328) 1443 (290) 1407 (267) Wk 36 1251 (323) 1045 (264) 1155 (248) 1090 (216) % change from BL vs PbO (SE), p value −19.6 (4.2), <0.0001 −19.8 (5.6), 0.0008 −22.8 (6.3), 0.0006 Small LDL, mean (SD) BL 746 (295) 835 (294) 887 (329) 916 (314) Wk 36 749 (343) 641 (207) 641 (234) 618 (149) % change from BL vs PbO (SE), p value −27.7 (8.9), 0.002 −34.3 (13.1), 0.01 −39.4 (14.7), 0.009 Total VLDL and Chylomicron, mean (SD) BL 56.8 (23.9) 55.9 (22.9) 61.4 (24.5) 66.0 (24.8) Wk 36 58.8 (24.4) 46.0 (21.1) 47.6 (22.9) 47.4 (23.1) % change from BL vs PbO (SE), p value −22.7 (6.9), 0.001 −27.2 (7.5), 0.0006 −34.7 (8.3), <0.0001 Large VLDL and Chylomicron, mean (SD) BL 6.3 (4.3) 8.7 (5.8) 8.9 (6.1) 10.2 (6.8) Wk 36 7.2 (4.5) 6.6 (3.9) 6.7 (4.1) 7.2 (4.7) % change from BL vs PBO (SE), p value −52.5 (11.8), <0.0001 −65.6 (15.5), <0.0001 −71.3 (17.4), 0.0001 BL, baseline; High exp, high MGL-3196 exposure based on % increase from baseline in sex hormone binding globulin, BL LDL-C ≥100, a prespecified group.
Conclusions
MGL-3196 significantly reduced atherogenic lipoprotein particles, particularly in NASH patients with greater BL hypercholesterolemia. These findings are consistent with a potentially beneficial effect of MGL-3196 on the CV risk profile in NASH patients.
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Affiliation(s)
- R Taub
- Madrigal Pharmaceuticals, conshohocken, United States of America
| | - J P Frias
- University of California San Diego, San Diego, United States of America
| | - S J Baum
- DelRay Medical Center, Boca Raton, United States of America
| | - S Hsia
- University of California San Diego, San Diego, United States of America
| | - S Harrison
- John Radcliffe Hospital, Oxford, United Kingdom
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Kamel M, Sholi A, Naik A, Harrison S, Lee B, Stiles B, Altorki N, Port J. P1.12-02 Nationwide Assessment of the Role of Adjuvant Systemic Therapy in High-Risk Lung Carcinoids. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1115] [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: 10/25/2022]
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Kamel M, Sholi A, Harrison S, Lee B, Port J, Altorki N, Stiles B. P2.18-06 Trends and Outcomes of Minimally Invasive Approaches for Lung Cancer Resection After Induction Therapy in the United States. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1960] [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: 10/25/2022]
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Lafrenière J, Harrison S, Laurin D, Brisson C, Talbot D, Couture P, Lemieux S, Lamarche B. Development and validation of a Brief Diet Quality Assessment Tool in the French-speaking adults from Quebec. Int J Behav Nutr Phys Act 2019; 16:61. [PMID: 31387609 PMCID: PMC6685233 DOI: 10.1186/s12966-019-0821-6] [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: 10/12/2018] [Accepted: 07/22/2019] [Indexed: 12/20/2022] Open
Abstract
Background The objective of this study was to develop and validate a short, self-administered questionnaire to assess diet quality in clinical settings, using the Alternative Healthy Eating Index (AHEI) as reference. Methods A total of 1040 men and women (aged 44.6 ± 14.4 y) completed a validated web-based food frequency questionnaire (webFFQ) and had their height and weight measured (development sample). Participants were categorized arbitrarily according to diet quality (high: AHEI score ≥ 65/110, low: AHEI score < 65/110) based on dietary intake data from the webFFQ. The Brief Diet Quality Assessment Tool was developed using a classification and regression tree (CART) approach and individual answers to the webFFQ among participants considered to have a plausible energy intake (ratio of reported energy intake to basal metabolic rate ≥ 1.2 and < 2.4; n = 1040). A second sample of 3344 older adults (aged 66.5 ± 6.4 y) was used to test the external validity of the Brief Diet Quality Assessment Tool (external validation sample). Results The decision tree included sequences of 3 to 6 binary questions, yielding 21 different pathways classifying diet quality as being high or low. In the development sample, the area under the receiver operating characteristic (ROC) curve of the predictive model was 0.92, with sensitivity, specificity and agreement values of 89.5, 83.9 and 87.2%. Compared with individuals having a low-quality diet according to the Brief Diet Quality Assessment Tool (mean AHEI 56.7 ± 11.4), individuals classified as having a high-quality diet (mean AHEI 71.3 ± 11.0) were significantly older, and had lower BMI, percent body fat and waist circumference, and had lower blood pressure, triglycerides, cholesterol/HDL ratio and fasting insulin as well as higher HDL-cholesterol concentrations (all P < 0.05). Similar results were observed in the external validation sample, although overall performance of the Brief Diet Quality Assessment Tool was slightly lower than in the development sample, with an area under the ROC curve of 0.79 and sensitivity, specificity and agreement values of 73.0, 69.0 and 71.3%, respectively. Conclusion The CART approach yielded a simple and rapid Brief Diet Quality Assessment Tool that identifies individuals at risk of having a low-quality diet. Further studies are needed to test the performance of this tool in primary care settings. Electronic supplementary material The online version of this article (10.1186/s12966-019-0821-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Lafrenière
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada.,School of Nutrition, Laval University, Québec, Canada
| | - S Harrison
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada.,School of Nutrition, Laval University, Québec, Canada
| | - D Laurin
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University Research Center, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - C Brisson
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University Research Center, Québec, Canada.,Faculty of Pharmacy, Laval University, Québec, Canada
| | - D Talbot
- Population Health and Optimal Health Practices Research Unit, CHU de Québec-Laval University Research Center, Québec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec, Canada
| | - P Couture
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada.,Endocrinology and Nephrology unit, Centre de recherche du CHU de Québec, Laval University, Québec, Canada
| | - S Lemieux
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada.,School of Nutrition, Laval University, Québec, Canada
| | - B Lamarche
- Institute of Nutrition and Functional Foods, Laval University, Québec, Canada. .,School of Nutrition, Laval University, Québec, Canada.
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Downs NJ, Butler HJ, Baldwin L, Parisi AV, Amar A, Vanos J, Harrison S. A site-specific standard for comparing dynamic solar ultraviolet protection characteristics of established tree canopies. MethodsX 2019; 6:1683-1693. [PMID: 31406685 PMCID: PMC6682329 DOI: 10.1016/j.mex.2019.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022] Open
Abstract
A standardised procedure for making fair and comparable assessments of the ultraviolet protection of an established tree canopy that takes into account canopy movement and the changing position of the sun is presented for use by government, planning, and environmental health authorities. The technique utilises video image capture and replaces the need for measurement by ultraviolet radiometers for surveying shade quality characteristics of trees growing in public parks, playgrounds and urban settings. The technique improves upon tree shade assessments that may be based upon single measurements of the ultraviolet irradiance observed from a fixed point of view. The presented technique demonstrates how intelligent shade audits can be conducted without the need for specialist equipment, enabling the calculation of the Shade Protection Index (SPI) and Ultraviolet Protection Factor (UPF) for any discreet time interval and over a full calendar year. Tree shade UPF measurements are presented using video capture analysis of moving canopies A standard method for making accurate assessments of tree shade has been developed Tree shade comparisons are made without the need for specialist equipment
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Affiliation(s)
- N J Downs
- Centre for Applied Climate Sciences, University of Southern Queensland, Toowoomba, Australia
| | - H J Butler
- Centre for Applied Climate Sciences, University of Southern Queensland, Toowoomba, Australia
| | - L Baldwin
- Queensland University of Technology, Faculty of Health, Brisbane, Australia
| | - A V Parisi
- Centre for Applied Climate Sciences, University of Southern Queensland, Toowoomba, Australia
| | - A Amar
- School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, Australia
| | - J Vanos
- Arizona State University, School of Sustainability, Tempe, AZ, United States
| | - S Harrison
- School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, Australia
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Harrison S, Couillard C, Robitaille J, Vohl MC, Bélanger M, Desroches S, Provencher V, Rabasa-Lhoret R, Bouchard L, Langlois MF, Houle J, Lemieux S, Lamarche B. Assessment of the American Heart Association's "Life's simple 7" score in French-speaking adults from Québec. Nutr Metab Cardiovasc Dis 2019; 29:684-691. [PMID: 31078363 DOI: 10.1016/j.numecd.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/15/2019] [Accepted: 03/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The "Life's Simple 7" (LS7) metrics were developed by the American Heart Association (AHA) to assess and promote cardiovascular health in the American population. The purpose of this study was to assess the overall cardiovascular health of French-speaking adults from the Province of Quebec using the LS7 score. METHODS AND RESULTS A total of 777 age and sex-representative participants of five different administrative regions in the Province of Quebec (387 men and 390 women; mean age ± SEM: 41.9 ± 0.1 years) were included in these analyses. Metrics of the LS7 score (smoking, physical activity, diet, body mass index, blood pressure, fasting total cholesterol and blood glucose) were analysed to generate a final score ranging from 0 to 7. Only 0.5% of participants met all criteria for ideal cardiovascular health. The diet metric showed the lowest prevalence of "ideal" scores (4.8%) whereas not smoking was the metric with the highest prevalence (88.1%). Women had a higher LS7 score than men, while age and education level (negative and positive association, respectively; p < 0.0001) were also associated with the LS7 score. CONCLUSION Consistent with studies conducted among other populations, very few French-speaking adults from the Province of Quebec achieve an ideal cardiovascular health. These data indicate that further public health efforts aimed at promoting the LS7 metrics, focusing primarily on diet, are urgently needed. Specific groups, including older adults and those with lower levels of education, should be targeted when developing cardiovascular health promotion interventions.
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Affiliation(s)
- S Harrison
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - C Couillard
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - J Robitaille
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - M-C Vohl
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - M Bélanger
- Department of Family Medicine, Université de Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada
| | - S Desroches
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - V Provencher
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - R Rabasa-Lhoret
- Montreal Clinical Research Institute, Université de Montréal, Montréal, QC, H2W 1R7, Canada
| | - L Bouchard
- ECOGENE-21 Biocluster, Chicoutimi, Qc, G7H 7K9, Canada; Faculté de médecine et des Sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada
| | - M-F Langlois
- Faculté de médecine et des Sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, J1H 5N4, Canada
| | - J Houle
- Département des Sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, G9A 5H7, Canada
| | - S Lemieux
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada
| | - B Lamarche
- Institute of Nutrition and Functional Foods (INAF), Université Laval, Quebec, G1V 0A6, Canada; School of Nutrition, Université Laval, Quebec, G1V 0A6, Canada.
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Malalasekera V, Raj TS, Routledge D, Hill A, Marino P, Badman J, Mechinaud F, Harrison S. PB2349 EXTRACORPOREAL PHOTOPHERESIS FOR PEDIATRIC PATIENTS WITH GRAFT-VS-HOST DISEASE AFTER HAEMATOPOIETIC STEM CELL TRANSPLANTATION: AN AUSTRALIAN EXPERIENCE. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000567860.98329.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Routledge D, Joyce T, Wood C, Harrison S. PF770 OUTCOMES FOR MELPHALAN-VELCADE BASED AUTOGRAFT IN HIGH RISK MULTIPLE MYELOMA PATIENTS: A SINGLE-CENTRE EXPERIENCE. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000561364.90468.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Carolan C, Clarke C, Lowther M, Girling C, Harrison S, Edenborough F, Curley R, Wildman M. P433 Supporting patients to move from rescue to prevention: meeting patients on their own terms - a preliminary evaluation of out of hours adherence telephone support offered to cystic fibrosis patients using the digital health system CFHealthhub. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kosanic A, Kavcic I, van Kleunen M, Harrison S. Climate change and climate change velocity analysis across Germany. Sci Rep 2019; 9:2196. [PMID: 30778124 PMCID: PMC6379444 DOI: 10.1038/s41598-019-38720-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/18/2018] [Indexed: 01/24/2023] Open
Abstract
Although there are great concerns to what extent current and future climate change impacts biodiversity across different spatial and temporal scales, we still lack a clear information on different climate change metrics across fine spatial scales. Here we present an analysis of climate change and climate change velocity at a local scale (1 × 1 km) across Germany. We focus on seasonal climate variability and velocity and investigate changes in three time periods (1901–2015, 1901–1950 and 1951–2015) using a novel statistical approach. Our results on climate variability showed the highest trends for the 1951–2015 time period. The strongest (positive/negative) and spatially the most dispersed trends were found for Summer maximum temperature and Summer minimum temperatures. For precipitation the strongest positive trends were most pronounced in the summer (1951–2015) and winter (1901–2015). Results for climate change velocity showed that almost 90% of temperature velocities were in the range of 0.5 to 3 km/year, whereas all climate velocities for precipitation were within the range of −3.5 to 4.5 km/year. The key results amplify the need for more local and regional scale studies to better understand species individualistic responses to recent climate change and allow for more accurate future projections and conservation strategies.
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Affiliation(s)
- A Kosanic
- Ecology, Department of Biology, University of Konstanz, Universitätsstrasse 10, 78457, Konstanz, Germany.
| | - I Kavcic
- Met Office, Fitz Roy Road, Exeter, EX1 3PB, UK
| | - M van Kleunen
- Ecology, Department of Biology, University of Konstanz, Universitätsstrasse 10, 78457, Konstanz, Germany
| | - S Harrison
- University of Exeter, Centre for Geography Environment and Society, Penryn, TR10 9FE, UK
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Sheel ARG, Harrison S, Sarantitis I, Nicholson JA, Hanna T, Grocock C, Raraty M, Ramesh J, Farooq A, Costello E, Jackson R, Chapman M, Smith A, Carter R, Mckay C, Hamady Z, Aithal GP, Mountford R, Ghaneh P, Hammel P, Lerch MM, Halloran C, Pereira SP, Greenhalf W. Identification of Cystic Lesions by Secondary Screening of Familial Pancreatic Cancer (FPC) Kindreds Is Not Associated with the Stratified Risk of Cancer. Am J Gastroenterol 2019; 114:155-164. [PMID: 30353057 DOI: 10.1038/s41395-018-0395-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Intraductal papillary mucinous neoplasms (IPMNs) are associated with risk of pancreatic ductal adenocarcinoma (PDAC). It is unclear if an IPMN in individuals at high risk of PDAC should be considered as a positive screening result or as an incidental finding. Stratified familial pancreatic cancer (FPC) populations were used to determine if IPMN risk is linked to familial risk of PDAC. METHODS This is a cohort study of 321 individuals from 258 kindreds suspected of being FPC and undergoing secondary screening for PDAC through the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC). Computerised tomography, endoscopic ultrasound of the pancreas and magnetic resonance imaging were used. The risk of being a carrier of a dominant mutation predisposing to pancreatic cancer was stratified into three even categories (low, medium and high) based on: Mendelian probability, the number of PDAC cases and the number of people at risk in a kindred. RESULTS There was a median (interquartile range (IQR)) follow-up of 2 (0-5) years and a median (IQR) number of investigations per participant of 4 (2-6). One PDAC, two low-grade neuroendocrine tumours and 41 cystic lesions were identified, including 23 IPMN (22 branch-duct (BD)). The PDAC case occurred in the top 10% of risk, and the BD-IPMN cases were evenly distributed amongst risk categories: low (6/107), medium (10/107) and high (6/107) (P = 0.63). CONCLUSIONS The risk of finding BD-IPMN was independent of genetic predisposition and so they should be managed according to guidelines for incidental finding of IPMN.
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Affiliation(s)
- A R G Sheel
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - S Harrison
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - I Sarantitis
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - J A Nicholson
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - T Hanna
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - C Grocock
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - M Raraty
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - J Ramesh
- Department of Gastroenterology, The Royal Liverpool University Hospital, London, UK
| | - A Farooq
- Department of Radiology, The Royal Liverpool University Hospital, London, UK
| | - E Costello
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - R Jackson
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - M Chapman
- Institute for Liver & Digestive Health, University College London, London, UK
| | - A Smith
- Department of Pancreatico-Biliary Surgery, Leeds Teaching Hospital Trust, Leeds, UK
| | - R Carter
- West of Scotland Pancreatic unit, Glasgow Royal Infirmary, Glasgow, UK
| | - C Mckay
- West of Scotland Pancreatic unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Z Hamady
- Department of Hepatobiliary and Pancreatic Diseases, University Hospital Southampton, Southampton, UK
| | - G P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, NG7 2UH, UK
| | - R Mountford
- Mersey Regional Molecular Genetics Laboratory, Liverpool Women's Hospital, Liverpool, UK
| | - P Ghaneh
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - P Hammel
- Service de Gastroentérologie-Pancréatologie, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, 92118, Clichy Cedex, France
| | - M M Lerch
- Department of Medicine A, University Medicine Greifswald, Sauerbruch-Strasse, 17475, Greifswald, Germany
| | - C Halloran
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
| | - S P Pereira
- Institute for Liver & Digestive Health, University College London, London, UK
| | - W Greenhalf
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3GA, UK
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Ade PAR, Ahmed Z, Aikin RW, Alexander KD, Barkats D, Benton SJ, Bischoff CA, Bock JJ, Bowens-Rubin R, Brevik JA, Buder I, Bullock E, Buza V, Connors J, Cornelison J, Crill BP, Crumrine M, Dierickx M, Duband L, Dvorkin C, Filippini JP, Fliescher S, Grayson J, Hall G, Halpern M, Harrison S, Hildebrandt SR, Hilton GC, Hui H, Irwin KD, Kang J, Karkare KS, Karpel E, Kaufman JP, Keating BG, Kefeli S, Kernasovskiy SA, Kovac JM, Kuo CL, Larsen NA, Lau K, Leitch EM, Lueker M, Megerian KG, Moncelsi L, Namikawa T, Netterfield CB, Nguyen HT, O'Brient R, Ogburn RW, Palladino S, Pryke C, Racine B, Richter S, Schillaci A, Schwarz R, Sheehy CD, Soliman A, St Germaine T, Staniszewski ZK, Steinbach B, Sudiwala RV, Teply GP, Thompson KL, Tolan JE, Tucker C, Turner AD, Umiltà C, Vieregg AG, Wandui A, Weber AC, Wiebe DV, Willmert J, Wong CL, Wu WLK, Yang H, Yoon KW, Zhang C. Constraints on Primordial Gravitational Waves Using Planck, WMAP, and New BICEP2/Keck Observations through the 2015 Season. Phys Rev Lett 2018; 121:221301. [PMID: 30547645 DOI: 10.1103/physrevlett.121.221301] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/28/2018] [Indexed: 06/09/2023]
Abstract
We present results from an analysis of all data taken by the bicep2/Keck CMB polarization experiments up to and including the 2015 observing season. This includes the first Keck Array observations at 220 GHz and additional observations at 95 and 150 GHz. The Q and U maps reach depths of 5.2, 2.9, and 26 μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈400 square degrees. The 220 GHz maps achieve a signal to noise on polarized dust emission approximately equal to that of Planck at 353 GHz. We take auto and cross spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz. We evaluate the joint likelihood of the spectra versus a multicomponent model of lensed-ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and we impose priors on some of these using external information from Planck and WMAP derived from larger regions of sky. The model is shown to be an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.07 at 95% confidence, which tightens to r_{0.05}<0.06 in conjunction with Planck temperature measurements and other data. The lensing signal is detected at 8.8σ significance. Running a maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.020. These are the strongest constraints to date on primordial gravitational waves.
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Affiliation(s)
- P A R Ade
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - Z Ahmed
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
| | - R W Aikin
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Alexander
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - D Barkats
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - S J Benton
- Department of Physics, Princeton University, Princeton, New Jersey 08544, USA
| | - C A Bischoff
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - J J Bock
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R Bowens-Rubin
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J A Brevik
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - I Buder
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - E Bullock
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - V Buza
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J Connors
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - J Cornelison
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - B P Crill
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - M Crumrine
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Dierickx
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - L Duband
- Service des Basses Températures, Commissariat à l'Energie Atomique, 38054 Grenoble, France
| | - C Dvorkin
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - J P Filippini
- Department of Physics, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
- Department of Astronomy, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA
| | - S Fliescher
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - J Grayson
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - G Hall
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - M Halpern
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada
| | - S Harrison
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - S R Hildebrandt
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - G C Hilton
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - H Hui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K D Irwin
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
- National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - J Kang
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K S Karkare
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - E Karpel
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J P Kaufman
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - B G Keating
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - S Kefeli
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - S A Kernasovskiy
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J M Kovac
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - C L Kuo
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - N A Larsen
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - K Lau
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - E M Leitch
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - M Lueker
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - K G Megerian
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - L Moncelsi
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - T Namikawa
- Leung Center for Cosmology and Particle Astrophysics, National Taiwan University, Taipei 10617, Taiwan
| | - C B Netterfield
- Department of Physics, University of Toronto, Toronto, Ontario, M5S 1A7, Canada
- Canadian Institute for Advanced Research, Toronto, Ontario, M5G 1Z8, Canada
| | - H T Nguyen
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R O'Brient
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - R W Ogburn
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - S Palladino
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - C Pryke
- Minnesota Institute for Astrophysics, University of Minnesota, Minneapolis, Minnesota 55455, USA
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - B Racine
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - S Richter
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - A Schillaci
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R Schwarz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C D Sheehy
- Physics Department, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - A Soliman
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - T St Germaine
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
| | - Z K Staniszewski
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - B Steinbach
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - R V Sudiwala
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - G P Teply
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
- Department of Physics, University of California at San Diego, La Jolla, California 92093, USA
| | - K L Thompson
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - J E Tolan
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Tucker
- School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom
| | - A D Turner
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - C Umiltà
- Department of Physics, University of Cincinnati, Cincinnati, Ohio 45221, USA
| | - A G Vieregg
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
- Department of Physics, Enrico Fermi Institute, University of Chicago, Chicago, Illinois 60637, USA
| | - A Wandui
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
| | - A C Weber
- Jet Propulsion Laboratory, Pasadena, California 91109, USA
| | - D V Wiebe
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, V6T 1Z1, Canada
| | - J Willmert
- School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - C L Wong
- Harvard-Smithsonian Center for Astrophysics, 60 Garden Street MS 42, Cambridge, Massachusetts 02138, USA
- Department of Physics, Harvard University, Cambridge, Massachusetts 02138, USA
| | - W L K Wu
- Kavli Institute for Cosmological Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - H Yang
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - K W Yoon
- Kavli Institute for Particle Astrophysics and Cosmology, SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Menlo Park, California 94025, USA
- Department of Physics, Stanford University, Stanford, California 94305, USA
| | - C Zhang
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
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Rahouma M, Kamel M, Nasar A, Harrison S, Lee B, Port J, Altorki N, Stiles B. P1.16-49 Treatment of NSCLC Patients with Clinical N1 Disease: Is There an Advantage to Neoadjuvant Therapy? J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1018] [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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Stiles B, Hussein M, Rahouma M, Lee B, Harrison S, Port J, Altorki N. OA06.03 Sublobar Resection is Equivalent to Lobectomy for Screen Detected Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.265] [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]
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Rahouma M, Kamel M, Nasar A, Harrison S, Lee B, Port J, Altorki N, Stiles B. OA06.07 Predictors and Consequences of Refusing Surgery for Clinical Stage I NSCLC: A National Cancer Database Analysis. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Norell C, Robinson D, Butler J, Harrison S. Exploring Variations in the Content of Cancer-Specific Treatment Guidelines: An International Cancer Benchmarking Partnership (ICBP) Study. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.69600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cancer-specific treatment guidelines aim to provide robust evidence-based recommendations for clinicians to ensure optimal disease management for patients. The content of these guidelines can greatly affect a patients' access to optimal treatment. However, the extent of international variation in guideline content remains understudied. Aim: Phase 2 of ICBP explores several factors that may be contributing to differences in cancer survival outcomes. Module 7 investigates differences in 'access to treatment' across seven participating countries (Canada, Australia, New Zealand, the UK, Ireland, Norway and Denmark). This project specifically aims to explore how variation in guideline content for cancer-specific treatment modalities may be contributing to differences in international survival outcomes. Methods: We reviewed cancer treatment guidelines across the seven ICBP countries that fulfill standard methodological criteria and are widely used in clinical care. This study includes a selected range of national and international guidelines recognizing that some participating countries do not produce their own site-specific guidelines and instead draw on international bodies (e.g., ESMO oncology clinical practice guidelines). We reviewed treatment guidelines for three cancer sites (stomach, pancreas and lung), recording points of content variation that were considered clinically significant and relevant to emerging findings from the ICBP survival benchmarking study. Results: Differences in the content of guidelines were found for each cancer site to varying degrees. Some guidelines showed a large degree of similarity which reflects strong consensuses in the evidence base. Others exhibited stark differences in recommendations for the type of surgical technique implemented, when to administer chemotherapy, use and type of radiotherapy and the extent of palliative care. Some differences may partly be explained by differences in the timeliness of some bodies to produce new guidelines, while others may stem from differences in how bodies evaluate the robustness and validity of high-profile phase III trials. Conclusion: This study found variation in the content of treatment guidelines. The extent to which this variation contributes to differences in international cancer outcomes warrants further exploration, as does additional content analyses of national guidelines for low- and middle-income countries. Our findings may prompt a move by clinical and policy stakeholders toward the standardization of international treatment guidelines, particularly in cases where content variation is marginal and given that guideline development processes are highly labor- and resource-intensive. This study also highlights the need to improve communications between national and international guideline bodies, when recommendations vary significantly, to reach international consensuses on areas of controversy regarding cancer site-specific treatment modalities.
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Affiliation(s)
- C. Norell
- Cancer Research UK, London, United Kingdom
| | | | - J. Butler
- Cancer Research UK, London, United Kingdom
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Reguilon I, Robinson D, Butler J, Harrison S. Understanding International Variation in Cancer-Specific 'Access to Diagnostics' Data and Steps Toward Cohesive Cancer Intelligence Frameworks: An International Cancer Benchmarking Partnership (ICBP) Study. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.55200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Robust and accurate data underpins cancer research, planning, control and comparisons; it shapes the policies and structures of health systems internationally. Access to diagnostics is crucial for timely cancer diagnosis and treatment planning as previous evidence has shown that delays in diagnosis can impact cancer outcomes. It is possible that differences in cancer outcomes internationally are a consequence of differing levels of access to diagnostic tests. By better understanding variation in this access, this relationship can be further explored. However, diagnostic data availability is not currently well documented. Aim: The primary goal of this exercise was to identify already existing routine or national datasets exploring 'access' variables relating to diagnostics for imaging and endoscopy tests. These access variables included capacity, use, workforce, location and financial factors, and where possible specific to the cancer population. Secondly, to address what high-income countries need to improve to fulfill the existing criteria for 'cancer intelligence frameworks', such as those set out by the National Health Service in England. Methods: Mixed methods including online searches and discussion with local contacts were used to explore key diagnostic data variables across the seven participating countries of ICBP phase 2 (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK). Results: Gaps and inconsistencies in diagnostics data were identified in each country. These key issues make comparisons within and between countries challenging: inconsistent definitions, collection at different levels within a health system, and queries about the coverage, reliability, and linkage of data (especially for cancer) were raised. The usage and allocation of workforce is also poorly documented, and a lack of appropriate infrastructure raised as a key barrier to better collection of data. Currently, most countries do not have a centralised data collection organization, and there are no international or standardized definitions for the diagnostic data that should be collected and could be compared. Conclusion: Health data are disparately collected internationally, with little diagnostics data that can be linked to cancer populations. The data sources and gaps identified add weight to existing efforts to improve data collections and health service planning. International agreement on the key performance indicators, their definitions and how best to organize collected data are required to address gaps and enable robust comparisons. These definitions and an understanding of best practice will be useful for middle- and low-income countries who want to develop or start collecting cancer-specific data. Existing 'cancer intelligence' frameworks could be adapted for international use, but rely on the agreement and adoption of standardized definitions and metrics for the cancer population.
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Affiliation(s)
| | | | - J. Butler
- Cancer Research UK, London, United Kingdom
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Demmel F, McPhail D, French C, Maxwell D, Harrison S, Boxall J, Rhodes N, Mukhopadhyay S, Silverwood I, Sakai VG, Fernandez-Alonso F. ToF-Backscattering spectroscopy at the ISIS Facility: Status and Perspectives. ACTA ACUST UNITED AC 2018. [DOI: 10.1088/1742-6596/1021/1/012027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rogers TS, Harrison S, Judd S, Orwoll ES, Marshall LM, Shannon J, Langsetmo L, Lane NE, Shikany JM. Dietary patterns and longitudinal change in hip bone mineral density among older men. Osteoporos Int 2018; 29:1135-1145. [PMID: 29450584 PMCID: PMC6842326 DOI: 10.1007/s00198-018-4388-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/05/2018] [Indexed: 01/15/2023]
Abstract
UNLABELLED Studying dietary patterns is often more informative than individual nutrients or foods. We found that a Prudent dietary pattern (rich in vegetables and fish) was associated with reduced loss of total hip BMD in older men. A Prudent dietary pattern may be a potential lifestyle strategy for minimizing bone loss. INTRODUCTION This study aimed to identify baseline dietary patterns using factor analysis in a cohort of older men and to evaluate whether the dietary patterns were associated with bone mineral density change (%ΔBMD) at the total hip and femoral neck over time. METHODS Participants (n = 4379; mean age 72.9 ± 5.5 years) were from the Osteoporotic Fractures in Men (MrOS) prospective cohort study and had dietary data collected at baseline (March 2000-April 2002) and BMD measured at baseline and Visit 2 (March 2005-May 2006). Dietary intake was assessed with a brief Block food frequency questionnaire (FFQ); factor analysis was used to derive dietary patterns. BMD was measured by dual-energy x-ray absorptiometry (DXA); %ΔBMD was calculated from baseline to Visit 2. We used generalized linear regression to estimate least square (LS) means of %ΔBMD in quartiles of the dietary pattern scores adjusted for potential confounding factors. RESULTS Two major dietary patterns were derived: Prudent (abundant in vegetables, salad, and non-fried fish) and Western (rich in hamburger, fries, processed meats, cheese, and sweets/desserts). There was an inverse association between adherence to the Prudent pattern and total hip %ΔBMD (p-trend = 0.028 after adjusting for age and clinical site; p-trend = 0.033 after further adjustment for smoking, calcium supplement use, diabetes, hypertension, and total energy intake). No other consistent associations between dietary patterns and %ΔBMD were observed. CONCLUSIONS Greater adherence to a Prudent dietary pattern may attenuate total hip BMD loss (%ΔBMD) in older men.
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Affiliation(s)
- T S Rogers
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California - Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA.
| | - S Harrison
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - S Judd
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - E S Orwoll
- Oregon Health and Science University, Portland, OR, USA
| | - L M Marshall
- Oregon Health and Science University, Portland, OR, USA
| | - J Shannon
- Oregon Health and Science University, Portland, OR, USA
| | - L Langsetmo
- University of Minnesota Epidemiology and Community Health, Minneapolis, MN, USA
| | - N E Lane
- Center for Musculoskeletal Health and Department of Internal Medicine, University of California - Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA
| | - J M Shikany
- University of Alabama at Birmingham, Birmingham, AL, USA
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50
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Abstract
In the acquisition event of ordinary delayed matching to sample the monkey sees a sample, displaces it, and finds a food reward underneath; subsequently the retention test consists of a choice between that sample and a distractor, and the strength of the memory laid down by the acquisition event may be assessed by the correctness of choice at the retention test. The present experiments varied the acquisition events and examined the effect of those variations on normal and fornix-transected monkeys' memory. One variation was to proceed as normally but never to bait the sample at acquisition; this variation allowed assessment of the role of the food reward in ordinary matching. Another was to present the sample, baited and to be displaced, as normally, but to present also the distractor, baited but not requiring to be displaced, in a second acquisition event; this “push–match” variation allowed assessment of memory for the displacement. The main result from normal monkeys was that matching to unbaited samples was learned much faster than matching to baited samples. Following fornix transection, final performance levels in matching to baited and to unbaited samples were unimpaired but push–match showed a permanent deficit. These results support earlier indications that fornix-transected monkeys have normal sensory memory but are deficient in the memory of instrumental responses.
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