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Armstrong S, Makris A, Belessiotis-Richards K, Abdul-Latif M, Ostler P, Shah N, Miles D, Tsang YM. Treatment Outcomes of Stereotactic Ablative Body Radiotherapy on Extra-cranial Oligometastatic and Oligoprogressive Breast Cancer: Mature Results from a Single Institution Experience. Clin Oncol (R Coll Radiol) 2024; 36:362-369. [PMID: 38575431 DOI: 10.1016/j.clon.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/08/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
AIMS Evidence shows stereotactic ablative body radiotherapy (SABR) is used as a non-invasive ablative therapy in the treatment of multisite oligometastatic (OM) and oligoprogressive (OP) diseases originating from metastatic breast cancer. This study aims to report the treatment outcomes and to investigate what factors that are prognostic in terms of local control, progression-free survival (PFS) and overall survival (OS) in patients receiving SABR for extracranial OM and OP diseases originating from metastatic breast cancer. MATERIALS AND METHODS A retrospective review on treatment records of patients with OM and OP from metastatic breast cancer who underwent SABR at a single was carried out. SABR was performed with daily image-guided radiotherapy (IGRT) using a dedicated robotic SABR machine. Local control, PFS and OS were calculated using Kaplan-Meier statistics and the post-treatment toxicity data was scored following the CTCAE v4.0 protocol. Univariate and multivariate Cox regression tests were used in the subgroup analysis of prognostic factors on PFS and OS including patients' age, types of follow-up imaging (staging CT only vs whole-body MR/PET), metastases status (OM vs OP), primary breast cancer tumour grade, hormone receptors (ER/PR/HER2) status, change of systemic treatments at SABR, number of metastases, SABR treatment sites and doses. RESULTS 56 metastatic breast cancer patients (38 patients with OM and 18 patients with OP) were involved in this retrospective review. The median follow-up was 35.6 months (range 4.0-132.9 months). The estimated local control at 1 , 2 and 5 years were 90.9%, 88.7% and 88.7%, respectively. The estimated median PFS was 19.2 months (95%CI 10.3-28.1 months); the PFS at 1, 2 and 5 years were 63.3%, 44.4% and 33.2%. The estimated OS at 1, 2 and 5 years were 98.0%, 91.9% and 74.3%, respectively with the estimated median OS of 105.1 months (95%CI 51.5-158.7 months). The vast majority of patients tolerated the treatment well with the commonest acute side effects as grade 1 fatigue. There were no statistically significant factors found in OS regression analysis. The types of follow-up imaging, metastases status, oestrogen receptor status, and number of metastases for SABR were statistically significant factors (p < 0.05) in the multivariate Cox regression analysis on PFS. CONCLUSION There are limited studies published on the efficacy and post-treatment toxicities of metastatic breast cancer OM and OP SABR with adequate length of follow-up. This study confirmed that SABR was a safe, non-invasive treatment option for patients with extracranial OM and OP diseases originated from primary breast cancer in terms of the acceptable post-treatment toxicities.
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Affiliation(s)
- S Armstrong
- Lismore Base Hospital, North Coast Cancer Institute, New South Wales, Australia
| | - A Makris
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | | | - M Abdul-Latif
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - N Shah
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - D Miles
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Y M Tsang
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Suarez L, Armstrong S, Fleming R, Howard J, Cholera R. Families Benefit After Utilization of a Clinic-Based Food Pantry Irrespective of Food Insecurity Experiences in a Pediatric Obesity Treatment Program. Am J Health Promot 2024; 38:661-671. [PMID: 38321414 DOI: 10.1177/08901171241229828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To evaluate the congruence between food insecurity screening outcome and clinic-based food pantry utilization and to examine caregiver reported comfort, motivation, and benefits of utilization. DESIGN Mixed-methods study. SETTING Academic pediatric obesity treatment clinic. SUBJECTS Convenience sample of caregivers. INTERVENTION Clinic-based food pantry offered irrespective of food insecurity screening outcome. MEASURES Food insecurity screening (Hunger Vital Sign) and severity, self-rated caregiver health, willingness to disclose food insecurity and receive food, and food-related stress. ANALYSIS Chi-square and t-tests were utilized to examine associations and descriptive analysis explored benefits. Rapid qualitative analysis was utilized to identify themes. RESULTS Caregivers of 120 children were included (child mean age 11.8; 56.7% female, 67.6% Non-Hispanic Black), with 47 of 59 eligible completing follow-up surveys and 14 completing in-depth interviews. Approximately half (N = 30/59, 50.8%) of families utilizing the food pantry screened negative for food insecurity. Families utilizing the food pantry were more likely to report severe food insecurity (N = 23/59; 38.9%) compared to those declining (N = 3/61; 4.9%, P < .001). Caregivers accepting food were able to meet a child health goal (N = 30/47, 63.8%). Caregivers reported feeling comfortable receiving food (N = 13/14) and felt utilizing the food pantry led to consumption of healthier foods (N = 7/14). CONCLUSIONS Families who screened both positive and negative for food insecurity utilized and benefited from a clinic-based food pantry. Clinics should consider strategies offering food resources to all families irrespective of screening outcome.
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Affiliation(s)
- Lilianna Suarez
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rachel Fleming
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Janna Howard
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rushina Cholera
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke Margolis Center for Health Policy, Duke University, NC, USA
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Hernandez N, Lokhnygina Y, Ramaker ME, Ilkayeva O, Muehlbauer MJ, Crawford ML, Grant RP, Hsia DS, Jain N, Bain JR, Armstrong S, Newgard CB, Freemark M, Gumus Balikcioglu P. Sex Differences in Branched-chain Amino Acid and Tryptophan Metabolism and Pathogenesis of Youth-onset Type 2 Diabetes. J Clin Endocrinol Metab 2024; 109:e1345-e1358. [PMID: 38066593 PMCID: PMC10940256 DOI: 10.1210/clinem/dgad708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Indexed: 03/16/2024]
Abstract
OBJECTIVES Insulin resistance is associated with elevations in plasma branched-chain amino acids (BCAAs). BCAAs compete with aromatic amino acids including tryptophan for uptake into β cells. To explore relationships between BCAAs and tryptophan metabolism, adiposity, and glucose tolerance, we compared urine metabolites in overweight/obese youth with type 2 diabetes (T2D) with those in nondiabetic overweight/obese and lean youth. METHODS Metabolites were measured in 24-hour and first-morning urine samples of 56 nondiabetic adolescents with overweight/obesity, 42 adolescents with T2D, and 43 lean controls, aged 12 to 21 years. Group differences were assessed by Kruskal Wallis or ANOVA. RESULTS Groups were comparable for age, pubertal status, and ethnicity. Youth with T2D were predominantly female and had highest percent body fat. BCAAs, branched-chain ketoacids (BCKAs), tryptophan, and kynurenine were higher in urine of subjects with T2D. There were no differences between lean controls and nondiabetic youth with overweight/obesity. T2D was associated with diversion of tryptophan from the serotonin to the kynurenine pathway, with higher urinary kynurenine/serotonin ratio and lower serotonin/tryptophan and 5-HIAA/kynurenine ratios. Urinary BCAAs, BCKAs, tryptophan, and ratios reflecting diversion to the kynurenine pathway correlated positively with metrics of body fat and hemoglobin A1c. Increases in these metabolites in the obese T2D group were more pronounced and statistically significant only in adolescent girls. CONCLUSION Increases in urinary BCAAs and BCKAs in adolescent females with T2D are accompanied by diversion of tryptophan metabolism from the serotonin to the kynurenine pathway. These adaptations associate with higher risks of T2D in obese adolescent females than adolescent males.
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Affiliation(s)
- Natalie Hernandez
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
| | - Yuliya Lokhnygina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27701, USA
| | - Megan Elizabeth Ramaker
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA
| | - Michael J Muehlbauer
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
| | - Matthew L Crawford
- Department of Research and Development, LabCorp, Burlington, NC 27215, USA
| | - Russell P Grant
- Department of Research and Development, LabCorp, Burlington, NC 27215, USA
| | - Daniel S Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Nina Jain
- Division of Endocrinology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27514, USA
| | - James R Bain
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA
| | - Sarah Armstrong
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27701, USA
- Division of General Pediatrics and Adolescent Health, Duke University Medical Center, Durham, NC 27710, USA
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27710, USA
| | - Christopher B Newgard
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Michael Freemark
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
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Barrett K, Oxenford C, Canfield P, Armstrong S, Malik R. Vale Dave McGavin. Aust Vet J 2024; 102:48. [PMID: 38302107 DOI: 10.1111/avj.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/20/2023] [Indexed: 02/03/2024]
Affiliation(s)
- K Barrett
- Launceston Veterinary Hospital, South Launceston, 7249, Tasmania, Australia
| | - C Oxenford
- WHO Lyon, 24 Rue Jean Baldassini, Lyon, F-69007, France
| | - P Canfield
- Sydney School of Veterinary Science, University of Sydney, Camperdown, New South Wales, 2006, Australia
| | - S Armstrong
- Zoetis, Springfield Drive, Surrey, KT22 7LP, United Kingdom of Great Britain and Northern Ireland
| | - R Malik
- Centre for Veterinary Education, University of Sydney, Camperdown, New South Wales, 2006, Australia
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Staplin N, Haynes R, Judge PK, Wanner C, Green JB, Emberson J, Preiss D, Mayne KJ, Ng SYA, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Petrini M, Seidi S, Landray MJ, Baigent C, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura 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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Kumar A, Zhang S, Neshteruk CD, Day SE, Konty KJ, Armstrong S, Skinner AC, Lang JE, D'Agostino EM. The longitudinal association between asthma severity and physical fitness by neighborhood factors among New York City public school youth. Ann Epidemiol 2023; 88:37-42. [PMID: 37944678 DOI: 10.1016/j.annepidem.2023.11.003] [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] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/28/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE This paper aims to examine the association between asthma severity and one-year lagged fitness in New York City Public school youth by neighborhood opportunity. METHODS Using the Child Opportunity Index 2.0 and individual-level repeated measures NYC Office of School Health (OSH) fitness surveillance data (2010-2018), we ran multilevel mixed models stratified by neighborhood opportunity, adjusting for sex, race/ethnicity, grade level, poverty status, and time. Asthma severity was based on a physician-completed Asthma Medication Administration Form (MAF) from each school year and drawn from the Automated Student Health Record (ASHR). RESULTS Across all youth in grades 4-12 (n = 939,598; 51.7 % male; 29.9 % non-Hispanic Black, 39.3 % Hispanic; 70.0 % high poverty), lower neighborhood opportunity was associated with lower subsequent fitness. Youth with severe asthma and very low and low neighborhood opportunity had the lowest 1-year lagged fitness z-scores - 0.24 (95 % CI, -0.34 to -0.14) and - 0.26 (95 % CI, -0.32 to -0.20), respectively, relative to youth with no asthma and very high opportunity. CONCLUSIONS An inverse longitudinal relationship between asthma severity and subsequent fitness was observed. Study findings have implications for public health practitioners to promote physical activity and improved health equity for youth with asthma, taking neighborhood factors into account.
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Affiliation(s)
- Advika Kumar
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Sue Zhang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, USA
| | - Sophia E Day
- New York City Department of Health and Mental Hygiene, Office of School Health, New York, NY, USA
| | - Kevin J Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, New York, NY, USA
| | - Sarah Armstrong
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Pediatrics, Duke University Medical School, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Jason E Lang
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Pediatrics, Duke University Medical School, Durham, NC, USA
| | - Emily M D'Agostino
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Orthopaedic Surgery, Duke University Medical School, Durham, NC, USA.
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Dunn J, Singh K, Armstrong S, Wagner B, Counts J, Skinner A, Kay M, Li J, Shah S, Zucker N, Neshteruk C, Suarez L, Kraus W, Zizzi A. Physical activity and sleep changes among children with obesity during a period of school closures related to the COVID-19 pandemic. Res Sq 2023:rs.3.rs-3293474. [PMID: 37790374 PMCID: PMC10543530 DOI: 10.21203/rs.3.rs-3293474/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Daily routines, including in-person school and extracurricular activities, are important for maintaining healthy physical activity and sleep habits in children. The COVID-19 pandemic significantly disrupted daily routines as in-person school and activities closed to prevent spread of SARS-CoV-2. We aimed to examine and assess differences in objectively measured physical activity levels and sleep patterns from wearable sensors in children with obesity before, during, and after a period of school and extracurricular activity closures associated with the COVID-19 pandemic. We compared average step count and sleep patterns (using the Mann Whitney U Test) before and during the pandemic-associated school closures by using data from activity tracker wristbands (Garmin VivoFit 3). Data was collected from 94 children (aged 5-17) with obesity, who were enrolled in a randomized controlled trial testing a community-based lifestyle intervention for a duration of 12-months. During the period that in-person school and extracurricular activities were closed due to the COVID-19 pandemic, children with obesity experienced objectively-measured decreases in physical activity, and sleep duration. From March 15, 2020 to March 31, 2021, corresponding with local school closures, average daily step count decreased by 1,655 steps. Sleep onset and wake time were delayed by about an hour and 45 minutes, respectively, while sleep duration decreased by over 12 minutes as compared with the pre-closure period. Step counts increased with the resumption of in-person activities. These findings provide objective evidence for parents, clinicians, and public health professionals on the importance of in-person daily activities and routines on health behaviors, particularly for children with pre-existing obesity. We demonstrate the utility of wearable sensors in objectively measuring longitudinal physical activity and sleep behavior patterns in children with obesity and in quantifying changes in their health behaviors due to disruption of structured, daily routines following in-person school closures during the COVID-19 pandemic. Trial Registration Clinical trial registration: NCT03339440.
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Armstrong S, Alberti H, Bhattacharya A, Dhokia B, Hall L, Lawes-Wickwar S, Lovat E, Pandya S, Park S, Pope L, Sajid M, Wilson P, Younie L. Students' and tutors' experiences of remote 'student-patient' consultations. Med Teach 2023; 45:1038-1046. [PMID: 36745733 DOI: 10.1080/0142159x.2023.2170777] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. AIM To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. METHOD A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. RESULTS Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student-patient interaction, and student-doctor interaction. DISCUSSION Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students' psychological safety. Frequent debriefs could ameliorate this risk and positively impact student-doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients.[Box: see text].
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Affiliation(s)
- Sarah Armstrong
- Primary Care Population Health Department, University College London, London, UK
| | - Hugh Alberti
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Lauren Hall
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Sadie Lawes-Wickwar
- Primary Care Population Health Department, University College London, London, UK
| | - Eitan Lovat
- Primary Care Population Health Department, University College London, London, UK
| | | | - Sophie Park
- Primary Care Population Health Department, University College London, London, UK
| | - Lindsey Pope
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | - Penny Wilson
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Younie
- Institute of Health Sciences Education, Queen Mary University of London (QMUL), London, UK
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Ravanbakht SN, Skinner AC, Armstrong S, Weinberger M, Hassmiller-Lich K, Frerichs L. Effects of caregiver-child acculturation on child obesity among US Latino individuals. Obesity (Silver Spring) 2023; 31:2103-2109. [PMID: 37394865 PMCID: PMC10523851 DOI: 10.1002/oby.23791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/03/2023] [Accepted: 03/27/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE The goal of this study was to assess the association of Latino caregiver-child nativity status (US- and foreign-born) with child obesity using a nationally representative sample. METHODS Using data from the National Health and Nutrition Examination Survey (NHANES 1999-2018), this study used generalized linear models to identify associations between caregiver-child nativity status (as a proxy for acculturation) and children's BMI. RESULTS Compared with foreign-born caregiver-child dyads, US-born caregiver-child dyads had 2.35 times the risk of class 2 obesity (95% CI: 1.59-3.47) and 3.60 times the risk of class 3 obesity (95% CI: 1.86-6.96). Foreign-born caregiver and US-born child dyads had 2.01 times the risk of class 2 obesity (95% CI: 1.42-2.84) and 2.47 times the risk of class 3 obesity (95% CI: 1.38-4.44; p < 0.05 for class 2 and class 3). CONCLUSIONS Compared with foreign-born Latino caregiver-child dyads, dyads with US-born caregivers and children and dyads with foreign-born caregivers and US-born children had significantly increased risk across the severe classes of obesity. Examining the influence and relationship of varying acculturation levels in an immigrant household will help guide more effective clinical and policy guidelines surrounding obesity and weight management in both pediatric and adult US Latino populations.
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Affiliation(s)
- Sophie N Ravanbakht
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Duke Center for Childhood Obesity Research, Durham, North Carolina, USA
| | - Asheley C Skinner
- Duke Center for Childhood Obesity Research, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Sarah Armstrong
- Duke Center for Childhood Obesity Research, Durham, North Carolina, USA
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Morris Weinberger
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Hassmiller-Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leah Frerichs
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Uthappa DM, Pak J, McGann KA, Brookhart MA, McKinzie K, Abdelbarr M, Cockrell J, Hickerson J, Armstrong S, D’Agostino EM, Weber DJ, Kalu IC, Benjamin DK, Zimmerman KO, Boutzoukas AE. In-Person Instruction and Educational Outcomes of K-8 Students During the COVID-19 Pandemic. Pediatrics 2023; 152:e2022060352L. [PMID: 37394499 PMCID: PMC10312276 DOI: 10.1542/peds.2022-060352l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Quantify the relationship between district policy permitting in-person instruction and educational outcomes during the 2020 to 2021 academic year for kindergarten through eighth grade students. METHODS An ecological, repeated cross-sectional analysis of grade-level proficiency of students enrolled in public school districts in North Carolina (n = 115 school districts) was conducted. Univariate and multivariate analyses were performed to evaluate the association between the proportion of the school year a district spent in-person and 2020 to 2021 end-of-year student proficiency in the district. We then fit a multivariable linear regression model, weighted by district size, and adjusted for district-level 2018 to 2019 proficiency and district-level factors (rural or urban, area deprivation). RESULTS Compared to 2018 to 2019, there was a 12.1% decrease (95% confidence interval [CI]: 16.8-19.3) in mathematics and an 18.1% decrease (95% CI: 10.8-13.4) in reading proficiency across the state at the end of 2020 to 2021. Compared to a district that remained entirely remote for the 2020 to 2021 school year, a district offering full in-person instruction had 12% (95% CI: 11%-12.9%) and 4.1% (95% CI: 3.5%-4.8%) more students achieve grade-level proficiency in mathematics and reading, respectively. In-person instruction was associated with greater increases in mathematics proficiency than reading, and greater increases in elementary-level students' proficiency than middle school-level. CONCLUSIONS The proportion of students achieving grade-level proficiency in 2020 to 2021 fell below prepandemic levels at each evaluated time point in the academic year. Increased time spent in-person by a school district was associated with an increased proportion of students achieving grade-level end-of-grade proficiency in both mathematics and reading.
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Affiliation(s)
| | - Joyce Pak
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Kaylee McKinzie
- Student, Trinity School of Arts & Sciences, Duke University, Durham, North Carolina
| | - Mariam Abdelbarr
- Student, North Carolina School of Science and Mathematics, Durham, North Carolina
| | - Jed Cockrell
- Yadkin County Schools, Yadkinville, North Carolina
| | | | | | - Emily M. D’Agostino
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - David J. Weber
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Lensen S, Armstrong S, Vaughan E, Caughey L, Peate M, Farquhar C, Pacey A, Balen AH, Wainwright E. "It all depends on why it's red": qualitative interviews exploring patient and professional views of a traffic light system for IVF add-ons. Reprod Fertil 2023:RAF-22-0136. [PMID: 37140974 DOI: 10.1530/raf-22-0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/04/2023] [Indexed: 05/05/2023] Open
Abstract
Background IVF add-ons are techniques, medicines or procedures used in addition to standard IVF with the aim of improving the chance of success. The United Kingdom's IVF regulator, ( the Human Fertilisation Embryology Authority (HFEA) developed a traffic light system to categorise add-ons as either green, amber, or red, based on results of randomised controlled trials. Method Qualitative interviews were undertaken to explore understanding and views of the HFEA traffic light system among IVF clinicians, embryologists and IVF patients across Australia and the United Kingdom. Results A total of 73 interviews were conducted. Overall, participants were supportive of the intention of the traffic light system, however many limitations were raised. It was widely recognized that a simple traffic light system necessarily omits information which may be important to understanding the evidence base. In particular, the red category was used in scenarios that patients viewed as having different implications for their decision-making, including 'no evidence' and 'evidence of harm'. Patients were surprised at the absence of any green add-ons and questioned the value of a traffic light system in this context. Many participants considered the website a helpful starting point, but desired more detail, including the contributing studies, results specific to patient demographics (e.g., <35 years and >35 years), and inclusion of more options (e.g. acupuncture). Overall, participants believed the website to be reliable and trustworthy, particularly due to the Government affiliation, and despite some concerns regarding transparency and an overly cautious regulator. Conclusion Participants identified many limitations with the current application of the traffic light system. These could be considered in any future updates to the HFEA website and for others developing similar decision support tools.
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Affiliation(s)
- Sarah Lensen
- S Lensen, Obstetrics and Gynaecology, University of Melbourne, Melbourne, 3052, Australia
| | - Sarah Armstrong
- S Armstrong, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Emily Vaughan
- E Vaughan, Academic Women's Health Unit, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Lucy Caughey
- L Caughey, Royal Women's Hospital, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Michelle Peate
- M Peate, Royal Women's Hospital, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | | | - Allan Pacey
- A Pacey, Reproductive and Developmental Medicine, University of Sheffield, Sheffield, S10 2SF, United Kingdom of Great Britain and Northern Ireland
| | - Adam H Balen
- A Balen, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - Elaine Wainwright
- E Wainwright, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom of Great Britain and Northern Ireland
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D'Agostino EM, Zhang S, Day SE, Konty KJ, Armstrong S, Skinner A, Neshteruk CD. The longitudinal association between asthma severity and physical fitness among new York City public school youth. Prev Med 2023; 170:107486. [PMID: 36931475 DOI: 10.1016/j.ypmed.2023.107486] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Severe persistent childhood asthma is associated with low physical activity and may be associated with poor physical fitness. Research on the asthma severity-fitness association longitudinally and across sociodemographic subgroups is needed to inform fitness interventions targeting youth with asthma. We evaluated the relationship between asthma severity (categorized as severe, mild, or no asthma) and subsequent fitness in New York City (NYC) public school youth enrolled in grades 4-12 using the NYC Fitnessgram dataset (2010-2018). Longitudinal mixed models with random intercepts were fit to test the association between asthma severity and one-year lagged fitness z-scores by clustering repeated annual observations at the student level. Models were adjusted for sex, race/ethnicity, grade level, poverty status, time, and stratified by sociodemographic factors. The analytic sample included 663,137 students (51% male; 31% non-Hispanic Black, 40% Hispanic; 55% in grades 4-8, 70% high poverty; 87%, 11% and 1% with no, mild, and severe asthma, respectively). Students with severe asthma and mild asthma demonstrated -0.19 (95% CI, -0.20 to -0.17) and - 0.10 (95% CI, -0.11 to -0.10), respectively, lower fitness z-scores in the subsequent year relative to students without asthma. After stratifying by demographics, the magnitude of the asthma severity-fitness relationship was highest for non-Hispanic white vs. all other racial/ethnic subgroups, and was similar across sex, grade level, and household poverty status. Overall, we observed an inverse longitudinal relationship between asthma severity and subsequent fitness among urban youth, particularly non-Hispanic Whites. Future research should examine how neighborhood-level factors impact the asthma severity-fitness relationship across racial/ethnic subgroups.
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Affiliation(s)
- Emily M D'Agostino
- Department of Orthopaedic Surgery, Duke University Medical School, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America.
| | - Sue Zhang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, United States of America
| | - Sophia E Day
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Kevin J Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Sarah Armstrong
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Pediatrics, Duke University Medical School, Durham, NC, United States of America; Duke Global Health Institute, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Asheley Skinner
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
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14
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Gumus Balikcioglu P, Jachthuber Trub C, Balikcioglu M, Ilkayeva O, White PJ, Muehlbauer M, Bain JR, Armstrong S, Freemark M. Branched-chain α-keto acids and glutamate/glutamine: Biomarkers of insulin resistance in childhood obesity. Endocrinol Diabetes Metab 2023; 6:e388. [PMID: 36415168 PMCID: PMC9836245 DOI: 10.1002/edm2.388] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Insulin resistance (IR) in adolescents with obesity is associated with a sex-dependent metabolic 'signature' comprising the branched-chain amino acids (BCAAs), glutamate/glutamine, C3/C5 acylcarnitines and uric acid. Here, we compared the levels of branched-chain α-keto acids (BCKAs) and glutamate/glutamine, which are the byproducts of BCAA catabolism and uric acid among adolescents with obesity prior to and following a 6-month lifestyle-intervention program. METHODS Fasting plasma samples from 33 adolescents with obesity (16 males, 17 females, aged 12-18 year) were analysed by flow-injection tandem MS and LC-MS/MS. Multiple linear regression models were used to correlate changes in BCKAs, glutamate/glutamine and uric acid with changes in weight and insulin sensitivity as assessed by HOMA-IR, adiponectin and the ratio of triglyceride (TG) to HDL. In predictive models, BCKAs, glutamate/glutamine and uric acid at baseline were used as explanatory variables. RESULTS Baseline BCKAs, glutamate/glutamine and uric acid were higher in males than females despite comparable BMI-metrics. Following lifestyle-intervention, α-keto-β-methylvalerate (α-KMV, a metabolic by product of isoleucine) decreased in males but not in females. The ratio of BCKA/BCAA trended lower in males. In the cohort as a whole, BCKAs correlated positively with the ratio of TG to HDL at baseline and HOMA-IR at 6-month-follow-up. Glutamate/glutamine was positively associated with HOMA-IR at baseline and 6-month-follow-up. A reduction in BCKAs was associated with an increase in adiponectin, and those with higher BCKAs at baseline had higher adiponectin levels at 6-month-follow-up. Interestingly those adolescents with higher uric acid levels at baseline had greater reduction in weight. CONCLUSIONS BCKAs and glutamate/glutamine may serve as biomarkers of IR in adolescents with obesity, and uric acid might serve as a predictor of weight loss in response to lifestyle-intervention. Differential regulation of BCAA catabolism in adolescent males and females implicates critical roles for sex steroids in metabolic homeostasis.
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Affiliation(s)
- Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, North Carolina, USA.,Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Metin Balikcioglu
- Advanced Analytics Division, SAS Institute Inc, Cary, North Carolina, USA
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA.,Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Phillip J White
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA.,Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Muehlbauer
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| | - James R Bain
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA.,Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina, USA
| | - Sarah Armstrong
- Division of General Pediatrics and Adolescent Health, Duke University Medical Center, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Freemark
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, North Carolina, USA.,Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
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15
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Giessner S, Ramaker ME, Blew K, Crawford ML, Grant RP, Bain JR, Muehlbauer M, Jain N, Hsia DS, Armstrong S, Freemark M, Gumus Balikcioglu P. Disrupted Circadian Rhythm of Epinephrine in Males With Youth-Onset Type 2 Diabetes. J Endocr Soc 2022; 7:bvac190. [PMID: 36632209 PMCID: PMC9825134 DOI: 10.1210/jendso/bvac190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Context Blood pressure and plasma catecholamines normally decline during sleep and rapidly increase in early morning. This is blunted in adults with type 2 diabetes (T2D). Objective We hypothesize that increased sympatho-adrenal activity during sleep differentiates youth with T2D from nondiabetic obese youth and lean youth. Methods Fasting spot morning and 24-hour urines were collected in obese adolescents with and without T2D, and normal-weight controls. Fractionated free urine catecholamines (epinephrine, norepinephrine, and dopamine) were measured, and the ratio of fasting spot morning to 24-hour catecholamines was calculated. Results Urinary 24-hour catecholamine levels were comparable across the 3 groups. Fasting morning epinephrine and the ratio of fasting morning/24-hour epinephrine were higher in youth with T2D (P = 0.004 and P = 0.035, respectively). In males, the ratio of fasting morning/24-hour epinephrine was also higher in youth with T2D (P = 0.005). In females, fasting morning norepinephrine and the ratio of fasting morning/24-hour dopamine were lower in obese youth with and without T2D (P = 0.013 and P = 0.005, respectively) compared with lean youth. Systolic blood pressure was higher in diabetic participants than other groups; males trended higher than females. Conclusion Circadian rhythm in catecholamines is disrupted in youth-onset T2D, with a blunted overnight fall in urinary epinephrine in males. Conversely, fasting morning norepinephrine and dopamine levels were lower in obese females with or without T2D. Higher nocturnal catecholamines in males with T2D might associate with, or predispose to, hypertension and cardiovascular complications. Lower catecholamine excretion in females with obesity might serve an adaptive, protective role.
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Affiliation(s)
- Stephanie Giessner
- Correspondence: Stephanie Giessner, MD, General Pediatrics, Duke University Medical Center (DUMC), 2301 Erwin Road, Box 3127 DUMC, Durham, NC 27710, USA.
| | | | - Kathryn Blew
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
| | - Matthew L Crawford
- Department of Research and Development, LabCorp, Burlington, NC 27215, USA
| | - Russell P Grant
- Department of Research and Development, LabCorp, Burlington, NC 27215, USA
| | - James R Bain
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA,Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA,Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC 27710, USA
| | - Michael Muehlbauer
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA,Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
| | - Nina Jain
- Division of Endocrinology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Daniel S Hsia
- Clinical Trials Unit, Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA
| | - Sarah Armstrong
- Division of General Pediatrics and Adolescent Health, Duke University Medical Center, Durham, NC 27710, USA,Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC 27710, USA,Department of Population Health Sciences, Duke University Medical Center, Durham, NC 27701, USA,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27701, USA
| | - Michael Freemark
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA,Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA
| | - Pinar Gumus Balikcioglu
- Duke Molecular Physiology Institute (DMPI), Duke University Medical Center, Durham, NC 27701, USA,Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC 27710, USA,Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, NC 27705, USA
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Picard E, Armstrong S, Andrew MK, Haynes L, Loeb M, Pawelec G, Kuchel GA, McElhaney JE, Verschoor CP. Markers of systemic inflammation are positively associated with influenza vaccine antibody responses with a possible role for ILT2(+)CD57(+) NK-cells. Immun Ageing 2022; 19:26. [PMID: 35619117 PMCID: PMC9134679 DOI: 10.1186/s12979-022-00284-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/15/2022] [Indexed: 02/06/2023]
Abstract
Background With increasing age, overall health declines while systemic levels of inflammatory mediators tend to increase. Although the underlying mechanisms are poorly understood, there is a wealth of data suggesting that this so-called “inflammaging” contributes to the risk of adverse outcomes in older adults. We sought to determine whether markers of systemic inflammation were associated with antibody responses to the seasonal influenza vaccine. Results Over four seasons, hemagglutination inhibition antibody titres and ex vivo bulk peripheral blood mononuclear cell (PBMC) responses to live influenza viruses assessed via interferon (IFN)-γ/interleukin (IL)-10 production, were measured pre- and 4-weeks post-vaccination in young adults (n = 79) and older adults randomized to standard- or high-dose inactivated vaccine (n = 612). Circulating tumour necrosis factor (TNF), interleukin (IL)-6 and C-reactive protein (CRP) were also measured pre-vaccination. Post-vaccination antibody titres were significantly associated with systemic inflammatory levels; specifically, IL-6 was positively associated with A/H3N2 titres in young adults (Cohen’s d = 0.36), and in older high-dose, but not standard-dose recipients, all systemic inflammatory mediators were positively associated with A/H1N1, A/H3N2 and B titres (d = 0.10–0.45). We further show that the frequency of ILT2(+)CD57(+) CD56-Dim natural killer (NK)-cells was positively associated with both plasma IL-6 and post-vaccination A/H3N2 titres in a follow-up cohort of older high-dose recipients (n = 63). Pathway analysis suggested that ILT2(+)CD57(+) Dim NK-cells mediated 40% of the association between IL-6 and A/H3N2 titres, which may be related to underlying participant frailty. Conclusions In summary, our data suggest a complex relationship amongst influenza vaccine responses, systemic inflammation and NK-cell phenotype in older adults, which depends heavily on age, vaccine dose and possibly overall health status. While our results suggest that “inflammaging” may increase vaccine immunogenicity in older adults, it is yet to be determined whether this enhancement contributes to improved protection against influenza disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12979-022-00284-x.
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Armstrong S, Bain JR, Crawford M, Freemark M, Grant RP, Gumus Balikcioglu P, Hsia DS, Ilkayeva O, Jain N, Muehlbauer M, Newgard C, Ramaker M, Delgado N. OR14-5 Branched-chain Amino Acid and Tryptophan Metabolism and the Pathogenesis of Youth-Onset Type 2 Diabetes Mellitus (T2D). J Endocr Soc 2022. [PMCID: PMC9625596 DOI: 10.1210/jendso/bvac150.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objectives We have previously demonstrated that insulin resistance (IR) in youth is associated with elevated levels of branched-chain amino acids (BCAAs). BCAAs compete with aromatic amino acids (AAA) including tryptophan, the precursor of serotonin, for uptake into β-cells and other tissues via the large neutral amino acid transporter. Serotonin has been reported to increase β-cell mass and glucose-dependent insulin secretion. In this study we have explored how BCAA, tryptophan (one of the AAA), and a subset of their metabolites are modulated in youth-onset T2D. Based on our prior studies in neuronal BCAA metabolism, we hypothesized that elevated BCAA could induce diversion of tryptophan metabolism towards production of kynurenine rather than serotonin in youth with T2D. To test this, we analyzed 24-hour urine samples and compared levels of byproducts of BCAAs and tryptophan metabolism in obese youth with T2D with those in non-diabetic obese and lean youth of comparable age, pubertal status and ethnicity. Methods 56 non-diabetic adolescents with overweight/obesity ("obese"), 42 adolescents with T2D ("T2D"), and 43 normal weight controls ("lean"), ages 12-21 years-old were studied. Weight, height, BMI, BMI% were extracted from medical charts. Body fat percent (BF%) was measured by TANITA. We also measured metabolites derived from BCAA catabolism, including the branched-chain ketoacids (BCKAs), and tryptophan metabolism, including intermediates of the serotonergic and kynurenine pathways, in spot and 24-hour urine samples by liquid chromatography/tandem-mass spectrometry (LC/MS-MS). Levels were normalized to urine creatinine. Group differences were assessed by Kruskal Wallis or ANOVA. Results Groups were comparable for age (obese 14.8 +/- 1.9; T2D 15.7 +/- 2.1 and lean 14.9 +/- 1.9-yr), pubertal status, and ethnicity. Youth with T2D were predominantly female (T2D, 28 F, 14 M; obese 33 F, 23 M and lean, 17 F, 26 M), and had highest BF% (obese 37.3 +/- 9.5; T2D 42.9 +/- 9.9; lean 20.1 +/- 6.3%; p=2.58e-22). In 24-hour urine samples, BCKAs, tryptophan, and kynurenine levels were higher in T2D (p=0.0002, p= 0.0045 and p= 0.00009 respectively) than in either lean controls or nondiabetic youth with obesity; in contrast, there were no differences between lean controls and non-diabetic youth with obesity. The levels of 5-HIAA, the principal metabolite of serotonin, were comparable across groups; however, the ratio of kynurenine/tryptophan was higher (p= 0.0112) in youth with T2D and the ratios of 5-HIAA/ tryptophan (p=0.027) and 5-HIAA/Kynurenine (p=0.0067) were lower compared to the other two groups. Those ratios were comparable between lean controls and non-diabetic youth with obesity. Conclusions Increased BCKAs are accompanied by diversion of tryptophan metabolism from the serotonin pathway to the kynurenine pathway, suggesting perturbations in both BCAA and AAA metabolism in youth-onset T2D. These alterations could contribute to development of beta-cell dysfunction and progression to T2D in youth. Presentation: Sunday, June 12, 2022 12:00 p.m. - 12:15 p.m.
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Kotb A, Armstrong S, Antoun I, Koev I, Mavilakandy A, Barker J, Vali Z, Panchal G, Li X, Lazdam M, Ibrahim M, Sandilands A, Chin S, Somani R, Andre Ng G. Atrial fibrillation virtual ward: reshaping the future of AF care. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2804] [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
Atrial fibrillation (AF) hospital admissions represent significant AF related treatment costs nationally. In the year 2019–2020 our hospital reported 1,333 admissions with a primary diagnosis of AF, with a 10% annual increase. A virtual ambulatory AF ward providing multidisciplinary care with remote hospital-level monitoring could reshape the future model of AF management.
Methods
An AF virtual ward was implemented at our UK tertiary centre, as a proof-of-concept model of care. Patients admitted with a primary diagnosis of AF satisfying the AF virtual ward (AFVW) entry criteria (i.e., haemodynamically stable, HR <140 bpm with other acute conditions excluded) were given access to a single lead ECG recording device, a Bluetooth integrated blood pressure machine and pulse oximeter with instruction to record daily ECGs, blood pressure readings, oxygen saturations and fill an online AF symptom questionnaire via a smart phone or electronic tablet. Data were uploaded to an integrated digital platform for review by the clinical team who undertook twice daily virtual ward rounds. Medication adjustment was arranged through the hospital pharmacy. Data was collected prospectively for patients admitted to the AF virtual ward between 31 January and 11 March 2022. Outcomes included length of hospital stay, admission avoidance and re-admissions. Re-admission avoidance was assessed using the index admission criteria as a parameter for re-admission likelihood. Patients' satisfaction was assessed using the NHS family and friends' test (FFT).
Results
Over the 6-week period a total of 14 patients were enrolled. One patient was unable to be onboarded because of technology related anxiety with 13 patients onboarded to the virtual ward, 30.7% (n=4) did not have smart phones and were provided with electronic tablets. The age on admission was 64±10 years (mean±SD) with the oldest at 78 years of age. All patients were in AF with a mean heart rate of 122±24 bpm, and 38.5% (n=5) were discharged from the virtual ward in sinus rhythm. One patient was onboarded directly from pacemaker clinic and hence hospital admission was completely avoided, and 5 re-admissions were avoided for 3 patients. One patient required brief readmission due to persistent tachycardia requiring acute cardioversion. The FFT yielded 100% positive responses among patients.
Conclusion
This proof-of-concept is a first real world experience of a virtual ward for hospital patients with fast AF. It demonstrates a promising new telemedicine-based care model and with clear appetite among both patients and health professionals. This model of care has the potential to reduce the financial and backlog pressures caused by AF admissions without compromising patients' care or safety. Work is ongoing to further confirm the safety and cost-effectiveness upon further progress in a larger patient cohort.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Kotb
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - S Armstrong
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - I Antoun
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - I Koev
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - A Mavilakandy
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - J Barker
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - Z Vali
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - G Panchal
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - X Li
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
| | - M Lazdam
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - M Ibrahim
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - A Sandilands
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - S Chin
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - R Somani
- University Hospitals of Leicester NHS Trust , Leicester , United Kingdom
| | - G Andre Ng
- University of Leicester, Cardiovascular sciences , Leicester , United Kingdom
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Armstrong S, Pacey A, Farquhar C, Lensen S. O-227 Has time-lapse technology finally proven its clinical benefit? Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Time-lapse technology for the observation of embryos is not new, having been first described in 1930 by Dr WH Lewis using rabbit embryos. However, the use of software (using artificial intelligence and deep learning) linked to known clinical outcomes theoretically helps the embryologist select the ‘best’ embryo for embryo transfer. Time-lapse also reduces the need to manually handle embryos and is hypothesised would reduce biases due to interobserver variation and improve clinical outcomes. Whilst the technology may help improve laboratory workflow, the quantitative evidence is less clear. This raises the ethical question about charging extra for a technology which does not improve patient outcome. In offering time-lapse, professionals have argued that it responds to patient demand and the need to be seen as ‘cutting edge’. However, the patient perspective for using time-lapse has, until recently, been largely unexplored.
Methods
This presentation relies on three sources of evidence: (i) Systematic reviews of randomised controlled trials (RCTs) and newly published RCTs not yet incorporated into systematic reviews; (ii) Qualitative studies concerning the consideration or use of time-lapse in those undergoing IVF; and (iii) A qualitative study (VALUE) of patient professional views regarding time-lapse, amongst other add-ons.
Results
The latest Cochrane systematic review undertook three comparisons to best establish where the potential advantage of time-lapse may lie: (i) undisturbed culture; (ii) the use of software to select the embryo to replace; or (iii) a combination of both stable culture and software. For all outcomes assessed, including crucially livebirth and miscarriage, there was no good evidence to show that time-lapse was any more or less effective than conventional methods of embryo incubation. These findings are supported by another systematic review by Chen et al (2017). A large RCT (TILT) is currently underway and will be the largest RCT to examine the clinical effectiveness and safety of time-lapse. TILT is expected to complete recruitment soon.
The VALUE study is an international qualitative semi-structured interview study of patients, embryologists, and clinicians to explore the reasons behind the decisions to use non-evidence-based treatment ‘add-ons’ alongside an IVF cycle. Over half of patient participants interviewed opted to use time-lapse. Inductive thematic analysis revealed five key themes for patients: (i) ‘vulnerability’; (ii) ‘power of the trusted professional opinion’; (iii) ‘role of previous experience’; (iv) ‘acceptability of add-on’; and (v) ‘the evidence doesn’t apply to me’. The analysis of the professional participants’ interviews revealed five themes, some of which mirror the patient themes: (i) ‘treating desperation’; (ii) ‘the patient shopper’; (iii) ‘success not profits’; (iv) ‘potential for harm’; and (v) ‘tensions within evidence-based practice’.
Discussion
Time-lapse has been adopted widely across fertility clinics globally, and with good reason. It brings efficiencies and convenience for embryologists by allowing them to observe embryos remotely. However, the highest quality evidence does not support the notion that it improves livebirth or reduces miscarriage rates. Qualitative research shows that patients can make choices about add-ons that can leave them in debt due to desperation and the desire to look for hope in an otherwise uncontrollable situation. Professionals acknowledge this, and in their desire to achieve a pregnancy, they sometimes look to add-ons such as time-lapse as a ‘why not’ when previous cycles have failed. Patients describe how they do not want to be denied time-lapse but want it in the context of informed consent. This must include being open about the paucity of evidence to support its effectiveness at this stage.
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Affiliation(s)
- S Armstrong
- University of Sheffield, Oncology and Metabolism , Sheffield, United Kingdom
| | - A Pacey
- University of Sheffield, Oncology and Metabolism , Sheffield, United Kingdom
| | - C Farquhar
- University of Auckland, Obstetrics and Gynaecology , Auckland, New Zealand
| | - S Lensen
- University of Melbourne, Obstetrics and Gynaecology , Melbourne, Australia
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20
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Armstrong S, Vaughan E, Lensen S, Caughey L, Farquhar C, Pacey A, Balen A, Peate M, Wainwright E. O-078 The VALUE study: a qualitative semi-structured interview study of add-on use by patients, clinicians, and embryologists in the UK and Australia. Hum Reprod 2022. [DOI: 10.1093/humrep/deac104.092] [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
Study question
Why do patients, clinicians and embryologists opt to use IVF add-ons in fertility treatment?
Summary answer
Add-ons offer options, hope and control in a desperate situation. The perceived drivers differ between patients and professionals; however, both feel add-ons offer bespoke care.
What is known already
Evidence that add-ons offer clinical advantages for the outcomes of IVF is lacking or insufficient. However, they remain popular in the UK and Australia, with over three-quarters of couples opting to use them. Professionals, clinical societies, and the media have latched onto the ethical aspects of offering non-evidence-based add-ons, often provided at an additional cost to vulnerable patients. Conversely, it has also been suggested that patients are driving add-on use. The VALUE study is the first large qualitative study to include both patients and professionals that explores the drivers behind their use, and how the existing evidence is weighed up.
Study design, size, duration
VALUE was a multinational semi-structured interview study in the UK and Australia. The interview schedule was reached through extensive patient and public involvement. Between January and May 2021, recruitment took place via social media advertisement, email invitation from professional societies, and snowballing. A purposive sampling strategy was planned; all eligible participants (25 patients, 25 embryologists, and 24 clinicians) were interviewed via recorded teleconference. Anonymised verbatim transcripts were analysed iteratively, and themes developed inductively.
Participants/materials, setting, methods
Patient and professional transcripts were coded separately using the software DedooseTM Two separate thematic analyses followed. An inductive approach to analysis was adopted, whereby themes emerged from the data, opposed to constructing a pre-conceived coding scheme. Codes were combined into broader themes, and sub-themes, which were discussed, debated, and named. The wider research team then commented upon and debated the themes and sub-themes, which were settled upon by consensus.
Main results and the role of chance
Thematic analysis of patient interviews identified five themes: ‘vulnerability’; ‘power of the trusted professional opinion’; ‘role of previous experience’; ‘acceptability of add-on’; and ‘the evidence doesn’t apply to me’. The professional interviews identified five themes: ‘Treating desperation’; ‘tensions within evidence-based practice’; ‘success, not profits’; ‘the patient shopper’; and ‘potential for harm’.
Analysis identified that that people undergoing IVF are vulnerable and opting for non-evidence-based treatments at additional cost because of a sense of desperation following unsuccessful cycles. For patients, utilising add-ons lends hope and a sense of control, with considerations of safety and efficacy being ranked lower than hope. For professionals, add-ons are reasonable given the absence of anything else to add, and allows patients the opportunity to exhaust every avenue. At odds with one-another are the themes regarding who is driving add-on use. Patients describe the power of a professional recommendation, believing it to be in their best interest. For professionals, it’s the patients who research and request add-ons, and failing to offer them risks losing patients. The tension between evidence and bespoke care was evident across both analyses, with testimonies being particularly powerful for patients, and for professionals, a belief that add-ons are helpful in the right context.
Limitations, reasons for caution
The VALUE study has captured patients and professionals who have volunteered to talk about this particularly contentious area of medicine. Participants are likely to be a motivated group of individuals who may potentially represent those with strong views regarding add-ons.
Wider implications of the findings
The theme of desperation runs through VALUE’s analyses and whilst we did find that patients drive add-on use, professional opinion for or against add-ons was powerful. Patients want autonomy, but only in the context of informed consent.
Trial registration number
https://osf.io/he7tn/
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Affiliation(s)
- S Armstrong
- University of Sheffield, Oncology and Metabolism , Sheffield, United Kingdom
| | - E Vaughan
- University Hospitals Bristol, Academic Women's Health Unit , Bristol, United Kingdom
- University of Bristol, Bristol Medical School- Translational Health Sciences , Bristol, United Kingdom
| | - S Lensen
- University of Melbourne, Obstetrics and Gynaecology, Melbourne , Australia
| | - L Caughey
- University of Melbourne, Faculty of Medicine- Dentistry and Health Sciences, Melbourne , Australia
| | - C Farquhar
- University of Auckland, Faculty of Medical and Health Sciences , Auckland, New Zealand
| | - A Pacey
- University of Sheffield, Oncology and Metabolism , Sheffield, United Kingdom
| | - A Balen
- Leeds Teaching Hospitals NHS Trust, Obstetrics and Gynaecology , Leeds, United Kingdom
| | - M Peate
- University of Melbourne, Obstetrics and Gynaecology, Melbourne , Australia
| | - E Wainwright
- University of Aberdeen, Epidemiology Group- ACAMH , Aberdeen, United Kingdom
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Williams E, Carter A, Rendle J, Fontani S, Walsh ND, Armstrong S, Hickman S, Vaglio S, Ward SJ. The Impact of COVID-19 Zoo Closures on Behavioural and Physiological Parameters of Welfare in Primates. Animals (Basel) 2022; 12:ani12131622. [PMID: 35804521 PMCID: PMC9265073 DOI: 10.3390/ani12131622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/16/2022] Open
Abstract
Primates are some of the most cognitively advanced species held in zoos, and their interactions with visitors are complex. The COVID-19 pandemic provided a unique opportunity to understand the impact of zoo visitors on animals, in comparison to “empty zoos”. This study sought to understand the impact of facility closures and subsequent reopenings on behavioural and physiological parameters of welfare in four primate species housed in the UK: bonobos (Pan paniscus) (n = 8), chimpanzees (Pan troglodytes) (n = 11), and western lowland gorillas (Gorilla gorilla gorilla) (n = 6) held at Twycross Zoo (TZ); and olive baboons (Papio anubis) (n = 192) held at Knowsley Safari (KS). Behavioural data were collected from April–September 2020 (KS) and November 2020–January 2021 (TZ). Faecal samples were collected during morning checks from October–November (TZ) and July–November 2020 (KS). Faecal glucocorticoid metabolites (FGMs) were measured using ELISA kits. Statistical analysis for behavioural observations was undertaken using general linear models. Enclosure usage was assessed using t-tests and Mann–Whitney U-tests as appropriate. Bonobos and gorillas spent less time alone when facilities were open to the public (p = 0.004, p = 0.02 respectively). Gorillas spent less time resting when the facility was open to the public (p = 0.04), and chimpanzees engaged in more feeding (p = 0.02) and engagement with enrichment (p = 0.03) when the zoo was open to the public than when it was closed. Olive baboons performed less sexual and dominance behaviour and approached visitor cars more frequently when the safari park was opened to the public than they did the ranger’s vehicle during closure periods. There were no significant changes in physiological parameters for any of the study species. The results suggest variable impacts of the zoo closures on zoo-housed primates. We recommend future work that seeks to understand the impact of individual-level differences on “visitor effects” and that differences between animal experiences in zoos and safari parks are further explored in a range of species.
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Affiliation(s)
- Ellen Williams
- School of Animal, Rural & Environmental Sciences, Brackenhurst Campus, Nottingham Trent University, Southwell NG25 0QF, Nottinghamshire, UK; (A.C.); (S.J.W.)
- Correspondence:
| | - Anne Carter
- School of Animal, Rural & Environmental Sciences, Brackenhurst Campus, Nottingham Trent University, Southwell NG25 0QF, Nottinghamshire, UK; (A.C.); (S.J.W.)
| | - Jessica Rendle
- School of Veterinary Medicine and Science, Sutton Bonington Campus, Loughborough LE12 5RD, Leicestershire, UK;
- Conservation Medicine, College of Science Health, Education and Engineering, Murdoch University, Perth 6150, Australia
- Twycross Zoo, Atherstone CV9 3PX, Warwickshire, UK
| | - Sara Fontani
- School of Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, West Midlands, UK; (S.F.); (S.H.); (S.V.)
| | | | - Sarah Armstrong
- Knowsley Safari, Prescot L34 4AN, Merseyside, UK; (N.D.W.); (S.A.)
| | - Sarah Hickman
- School of Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, West Midlands, UK; (S.F.); (S.H.); (S.V.)
| | - Stefano Vaglio
- School of Sciences, University of Wolverhampton, Wolverhampton WV1 1LY, West Midlands, UK; (S.F.); (S.H.); (S.V.)
- Behaviour, Ecology and Evolution Research (BEER) Centre, Durham University, Durham DH1 3LE, County Durham, UK
| | - Samantha J. Ward
- School of Animal, Rural & Environmental Sciences, Brackenhurst Campus, Nottingham Trent University, Southwell NG25 0QF, Nottinghamshire, UK; (A.C.); (S.J.W.)
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King RJ, Heisey-Grove DM, Garrett N, Scott KA, Daley MF, Haemer MA, Podila P, Block JP, Carton T, Gregorowicz AJ, Mork KP, Porter RM, Chudnov DL, Jellison J, Kraus EM, Harrison MR, Sucosky MS, Armstrong S, Goodman AB. The Childhood Obesity Data Initiative: A Case Study in Implementing Clinical-Community Infrastructure Enhancements to Support Health Services Research and Public Health. J Public Health Manag Pract 2022; 28:E430-E440. [PMID: 34446638 PMCID: PMC8781217 DOI: 10.1097/phh.0000000000001419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 11/25/2022]
Abstract
CONTEXT We describe a participatory framework that enhanced and implemented innovative changes to an existing distributed health data network (DHDN) infrastructure to support linkage across sectors and systems. Our processes and lessons learned provide a potential framework for other multidisciplinary infrastructure development projects that engage in a participatory decision-making process. PROGRAM The Childhood Obesity Data Initiative (CODI) provides a potential framework for local and national stakeholders with public health, clinical, health services research, community intervention, and information technology expertise to collaboratively develop a DHDN infrastructure that enhances data capacity for patient-centered outcomes research and public health surveillance. CODI utilizes a participatory approach to guide decision making among clinical and community partners. IMPLEMENTATION CODI's multidisciplinary group of public health and clinical scientists and information technology experts collectively defined key components of CODI's infrastructure and selected and enhanced existing tools and data models. We conducted a pilot implementation with 3 health care systems and 2 community partners in the greater Denver Metro Area during 2018-2020. EVALUATION We developed an evaluation plan based primarily on the Good Evaluation Practice in Health Informatics guideline. An independent third party implemented the evaluation plan for the CODI development phase by conducting interviews to identify lessons learned from the participatory decision-making processes. DISCUSSION We demonstrate the feasibility of rapid innovation based upon an iterative and collaborative process and existing infrastructure. Collaborative engagement of stakeholders early and iteratively was critical to ensure a common understanding of the research and project objectives, current state of technological capacity, intended use, and the desired future state of CODI architecture. Integration of community partners' data with clinical data may require the use of a trusted third party's infrastructure. Lessons learned from our process may help others develop or improve similar DHDNs.
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Affiliation(s)
- Raymond J. King
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Dawn M. Heisey-Grove
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Nedra Garrett
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Kenneth A. Scott
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Matthew F. Daley
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Matthew A. Haemer
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Pradeep Podila
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Jason P. Block
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Tom Carton
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Andrew J. Gregorowicz
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - K. Peter Mork
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Renee M. Porter
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Daniel L. Chudnov
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Jim Jellison
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Emily M. Kraus
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Megan R. Harrison
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Marissa Scalia Sucosky
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Sarah Armstrong
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
| | - Alyson B. Goodman
- Obesity Prevention and Control Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (Drs King and Goodman and Mss Harrison and Sucosky), and Center for Surveillance Epidemiology and Laboratory Services (Ms Garret), Centers for Disease Control and Prevention, Atlanta, Georgia; Health Technical Center, The MITRE Corporation, McLean, Virginia (Drs Heisey-Grove and Mork and Messrs Gregorowicz, Chudnov, and Jellison); Denver Public Health, Denver, Colorado (Dr Scott); Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (Dr Daley); University of Colorado Department of Pediatrics and Children's Hospital Colorado, Aurora, Colorado (Dr Haemer); Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Block); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); McKing Consulting Corporation, Atlanta, Georgia (Dr Porter); Public Health Informatics Institute, Decatur, Georgia (Dr Kraus); and Duke University School of Medicine, Durham, North Carolina (Dr Armstrong)
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Abman SH, Armstrong S, Baker S, Bogue CW, Carlo W, Chalak L, Daniels SR, Davis S, Debaun MR, Fike C, Frazer L, Gibson K, Gill M, Glass H, Gordon CM, Goyal M, Hirschhorn J, Holtz L, Hunstad DA, Leonard MB, Maitre N, Markham L, McAllister-Lucas L, Orange J, Shah P, Simon T, Steinhorn RH, Tarini B, Walker-Harding LR. The american pediatric society and society for pediatric research joint statement against racism and social injustice. Pediatr Res 2022; 91:72. [PMID: 32882704 PMCID: PMC7492687 DOI: 10.1038/s41390-020-01107-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 06/29/2020] [Accepted: 07/21/2020] [Indexed: 11/09/2022]
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Logan PA, Horne JC, Gladman JRF, Gordon AL, Sach T, Clark A, Robinson K, Armstrong S, Stirling S, Leighton P, Darby J, Allen F, Irvine L, Wilson ECF, Fox C, Conroy S, Mountain G, McCartney K, Godfrey M, Sims E. Multifactorial falls prevention programme compared with usual care in UK care homes for older people: multicentre cluster randomised controlled trial with economic evaluation. BMJ 2021; 375:e066991. [PMID: 34876412 PMCID: PMC8649897 DOI: 10.1136/bmj-2021-066991] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine the clinical and cost effectiveness of a multifactorial fall prevention programme compared with usual care in long term care homes. DESIGN Multicentre, parallel, cluster randomised controlled trial. SETTING Long term care homes in the UK, registered to care for older people or those with dementia. PARTICIPANTS 1657 consenting residents and 84 care homes. 39 were randomised to the intervention group and 45 were randomised to usual care. INTERVENTIONS Guide to Action for Care Homes (GtACH): a multifactorial fall prevention programme or usual care. MAIN OUTCOME MEASURES Primary outcome measure was fall rate at 91-180 days after randomisation. The economic evaluation measured health related quality of life using quality adjusted life years (QALYs) derived from the five domain five level version of the EuroQoL index (EQ-5D-5L) or proxy version (EQ-5D-5L-P) and the Dementia Quality of Life utility measure (DEMQOL-U), which were self-completed by competent residents and by a care home staff member proxy (DEMQOL-P-U) for all residents (in case the ability to complete changed during the study) until 12 months after randomisation. Secondary outcome measures were falls at 1-90, 181-270, and 271-360 days after randomisation, Barthel index score, and the Physical Activity Measure-Residential Care Homes (PAM-RC) score at 91, 180, 270, and 360 days after randomisation. RESULTS Mean age of residents was 85 years. 32% were men. GtACH training was delivered to 1051/1480 staff (71%). Primary outcome data were available for 630 participants in the GtACH group and 712 in the usual care group. The unadjusted incidence rate ratio for falls between 91 and 180 days was 0.57 (95% confidence interval 0.45 to 0.71, P<0.001) in favour of the GtACH programme (GtACH: six falls/1000 residents v usual care: 10 falls/1000). Barthel activities of daily living indices and PAM-RC scores were similar between groups at all time points. The incremental cost was £108 (95% confidence interval -£271.06 to 487.58), incremental QALYs gained for EQ-5D-5L-P was 0.024 (95% confidence interval 0.004 to 0.044) and for DEMQOL-P-U was 0.005 (-0.019 to 0.03). The incremental costs per EQ-5D-5L-P and DEMQOL-P-U based QALY were £4544 and £20 889, respectively. CONCLUSIONS The GtACH programme was associated with a reduction in fall rate and cost effectiveness, without a decrease in activity or increase in dependency. TRIAL REGISTRATION ISRCTN34353836.
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Affiliation(s)
- Pip A Logan
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- Nottingham CityCare Partnership, Nottingham, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Jane C Horne
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - John R F Gladman
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- NIHR Applied Research Collaboration - East Midlands, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Katie Robinson
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarah Armstrong
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sue Stirling
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Paul Leighton
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Janet Darby
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Fran Allen
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | | | - Ed C F Wilson
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Chris Fox
- Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Karen McCartney
- School of Medicine, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | | | - Erika Sims
- Norwich Medical School, University of East Anglia, Norwich, UK
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Alexander E, Skinner A, Gaskin K, Jones J, Wong C, Loflin C, Fleming R, Howard J, Armstrong S, Neshteruk C. A Mixed-Methods Examination of Referral Processes to Clinic-Community Partnership Programs for the Treatment of Childhood Obesity. Child Obes 2021; 17:516-524. [PMID: 34227849 DOI: 10.1089/chi.2020.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Partnerships with community programs have been used to improve access to obesity care and address clinical barriers to childhood obesity management; however, little is known about the program referral process. The objective of this study was to identify factors that affect the referral from clinics to community-based programs. Methods: Active Recreation through Community-Healthcare Engagement Study (ARCHES) is a mixed-method, implementation study designed to test the feasibility of establishing clinic-community partnerships to treat childhood obesity. We collected clinical referral and program attendance data from the six ARCHES clinic-community partnerships and conducted semistructured interviews (n = 19) with key stakeholders. Logistic regression models were used to identify referral characteristics associated with ever attending a community program. We used deductive thematic analysis to examine contextual factors affecting the clinical referral and subsequent attendance at the community programs. Results: Patients referred from individual providers [odds ratio (OR): 3.20, 95% confidence interval (CI): 1.08-9.48], specialty clinics (OR: 2.73, 95% CI: 1.48-5.05), and community wellness clinics (OR: 3.42, 95% CI: 1.05-11.13), had greater odds of ever attending the programs compared with patients from primary care clinics. Patients referred to cohort-based programs compared with open enrollment programs had greater odds of ever attending the programs. Stakeholders emphasized the value of communication within the partnership and with patients in clinical settings. Effective provider communication with patients involved engaging and program endorsing conversations to explain the value of the program. Conclusions: We identified factors that may improve the referral process in clinic-community partnerships to provide resources to primary care providers looking to address childhood obesity. Clinical Trial Registration number: NCT03246763.
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Affiliation(s)
- Emily Alexander
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Asheley Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Kiah Gaskin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical and Translational Science Institute, Durham, NC, USA
| | - Jason Jones
- Durham Parks and Recreation, Durham, NC, USA
| | - Charlene Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA.,Duke Center for Childhood Obesity Research, Durham, NC, USA
| | - Callan Loflin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Rachel Fleming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Janna Howard
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Center for Childhood Obesity Research, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA.,Duke Center for Childhood Obesity Research, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA.,Duke Global Health Institute, Durham, NC, USA
| | - Cody Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Abstract
BACKGROUND Implantation of an embryo within the endometrial cavity is a critical step in the process of in vitro fertilisation (IVF). Previous research has suggested that endometrial injury (also known as endometrial scratching), defined as intentional damage to the endometrium, can increase the chance of pregnancy in women undergoing IVF. OBJECTIVES To assess the effectiveness and safety of endometrial injury performed before embryo transfer in women undergoing in vitro fertilisation (IVF) including intracytoplasmic sperm injection (ICSI) and frozen embryo transfer. SEARCH METHODS In June 2020 we searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, LILACS, DARE and two trial registries. We also checked the reference sections of relevant studies and contacted experts in the field for any additional trials. SELECTION CRITERIA Randomised controlled trials comparing intentional endometrial injury before embryo transfer in women undergoing IVF, versus no intervention or a sham procedure. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Two independent review authors screened studies, evaluated risk of bias and assessed the certainty of the evidence by using GRADE (Grading of Recommendation, Assessment, Development and Evaluation) criteria. We contacted and corresponded with study investigators as required. Due to the high risk of bias associated with many of the studies, the primary analyses of all review outcomes were restricted to studies at a low risk of bias for selection bias and other bias. Sensitivity analysis was then performed including all studies. The primary review outcomes were live birth and miscarriage. MAIN RESULTS Endometrial injury versus control (no procedure or a sham procedure) A total of 37 studies (8786 women) were included in this comparison. Most studies performed endometrial injury by pipelle biopsy in the luteal phase of the cycle before the IVF cycle. The primary analysis was restricted to studies at low risk of bias, and included eight studies. The effect of endometrial injury on live birth is unclear as the result is consistent with no effect, or a small reduction, or an improvement (odds ratio (OR) 1.12, 95% confidence interval (CI) 0.98 to 1.28; participants = 4402; studies = 8; I2 = 15%, moderate-certainty evidence). This suggests that if the chance of live birth with IVF is usually 27%, then the chance when using endometrial injury would be somewhere between < 27% and 32%. Similarly, the effect of endometrial injury on clinical pregnancy is unclear (OR 1.08, 95% CI 0.95 to 1.23; participants = 4402; studies = 8; I2 = 0%, moderate-certainty evidence). This suggests that if the chance of clinical pregnancy from IVF is normally 32%, then the chance when using endometrial injury before IVF is between 31% and 37%. When all studies were included in the sensitivity analysis, we were unable to conduct meta-analysis for the outcomes of live birth and clinical pregnancy due to high risk of bias and statistical heterogeneity. Endometrial injury probably results in little to no difference in chance of miscarriage (OR 0.88, 95% CI 0.68 to 1.13; participants = 4402; studies = 8; I2 = 0%, moderate-certainty evidence), and this result was similar in the sensitivity analysis that included all studies. The result suggests that if the chance of miscarriage with IVF is usually 6.0%, then when using endometrial injury it would be somewhere between 4.2% and 6.8%. Endometrial injury was associated with mild to moderate pain (approximately 4 out of 10), and was generally associated with some minimal bleeding. The evidence was downgraded for imprecision due to wide confidence intervals and therefore all primary analyses were graded as moderate certainty. Higher versus lower degree of injury Only one small study was included in this comparison (participants = 129), which compared endometrial injury using two different instruments in the cycle prior to the IVF cycle: a pipelle catheter and a Shepard catheter. This trial was excluded from the primary analysis due to risk of bias. In the sensitivity analysis, all outcomes reported for this study were graded as very-low certainty due to risk of bias, and as such we were not able to interpret the study results. AUTHORS' CONCLUSIONS The effect of endometrial injury on live birth and clinical pregnancy among women undergoing IVF is unclear. The results of the meta-analyses are consistent with an increased chance, no effect and a small reduction in these outcomes. We are therefore uncertain whether endometrial injury improves the chance of live birth or clinical pregnancy in women undergoing IVF. Endometrial injury does not appear to affect the chance of miscarriage. It is a somewhat painful procedure associated with a small amount of bleeding. In conclusion, current evidence does not support the routine use of endometrial injury for women undergoing IVF.
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Affiliation(s)
- Sarah F Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Sarah Armstrong
- Department of Oncology & Metabolism, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK
| | - Ahmed Gibreel
- Obstetrics & Gynaecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Nick Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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Steinberger AE, Youngwirth LM, Kim SE, Duke NN, Skinner A, Gordee A, Kuchibhatla M, Armstrong S, Seymour KA. Adolescent Bariatric Surgery: Racial Disparities in 30-Day Outcomes Using the MBSAQIP from 2015 to 2018. Obes Surg 2021; 31:3776-3785. [PMID: 34043179 DOI: 10.1007/s11695-021-05500-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Racial disparities exist in obesity prevalence and obesity-related comorbid conditions among youth. We hypothesized that non-White adolescents would have poorer 30-day outcomes after adolescent bariatric surgery. METHODS Adolescent patients 19 years or younger who had bariatric surgery from January 2015 to December 2018 were identified in the Metabolic and Bariatric Surgery Accreditation and Quality Initiative Program datafiles. Patient characteristics and 30-day perioperative outcomes were compared across racial groups. Trends in utilization of adolescent bariatric surgery were evaluated by race and procedure. RESULTS Bariatric surgery was performed in 3177 adolescents with a mean age of 17.9 years [standard deviation (SD) 1.1 years]. The majority of patients were White 71.5% (2,271), while only 16.4% (520) were Black, and 12.1% (386) were other. Black adolescents 42.7% (222) more commonly presented with a BMI >50kg/m2 compared to 28.4% (645) White and 27.2% (105) other. Baseline hypertension and sleep apnea were more common among Black adolescents than other racial groups (P< 0.05). Black adolescents with LRYGB comprised 4.6% (48) of procedures in 2015 and only 1.5% (11) in 2018. Clavien-Dindo complications and all-cause readmission rates were similar among racial groups. Mean BMI decrease after 30 days was greatest for Black patients after Roux-en-Y gastric bypass, with a loss of 3.1 BMI points (SD 1.5). CONCLUSIONS Despite similar short-term outcomes, significant disparities exist for Black adolescents who qualify for bariatric surgery. Further investigation is warranted to better understand the racial differences that limit access and utilization of this safe and effective intervention.
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Affiliation(s)
- Allie E Steinberger
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Se Eun Kim
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Naomi N Duke
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Asheley Skinner
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alexander Gordee
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Sarah Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Keri A Seymour
- Department of Surgery, Duke University, 407 Crutchfield St, Durham, NC, 27704, USA.
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Tsang Y, Tharmalingam H, Belessiotis-Richards K, Armstrong S, Ostler P, Hughes R, Alonzi R, Hoskin P. OC-0040 Ultrafractionated radiotherapy(RT) in localised prostate cancer:HDR brachytherapy vs stereotactic RT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06282-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Armstrong S, Dermont M. Does prevention-focused dental care provision during recruit training reduce adverse dental outcomes in UK Armed Forces personnel? A retrospective cohort analysis. Br Dent J 2021; 230:400-406. [PMID: 33837335 DOI: 10.1038/s41415-021-2741-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/07/2020] [Indexed: 11/09/2022]
Abstract
Background Dental emergencies experienced during military operations may render individuals unable to operate effectively. To minimise this risk, UK Armed Forces (UKAF) recruits receive a prevention-focused dental care intervention during military training (known as 'Project MOLAR') before their entry to the trained strength of the Armed Forces.Aim To evaluate whether Project MOLAR is effective in preventing future dental emergency events and subsequent oral disease in UKAF recruits.Methods This is a retrospective cohort analysis of UKAF recruits who enlisted between 1 January 2011 and 31 December 2011, conducted by analysing electronic primary dental care records. Adverse outcomes were defined as: i) incidence of dental emergency events during the five-year follow-up period; and ii) further oral disease at 18 months measured by an increase in Decayed, Missing and Filled Teeth (DMFT).Results In total, 7,361 recruits met the inclusion criteria. The total follow-up time for the cohort was 31,957 person-years (mean follow-up 4.3 years/recruit). Individuals whose treatment was completed under Project MOLAR were found to experience a 30% reduction in dental emergency incidence (RR: 0.70-95% CI: 0.63-0.76) (p <0.001) and a 64% reduction in the odds of DMFT increase at 18 months (OR: 0.36-95% CI: 0.28-0.47) (p <0.001) compared to individuals whose treatment was incomplete.Conclusions Defence dentistry's focus on delivering prevention-focused dentistry early in a recruit's military career confers a downstream benefit to personnel who complete the intervention, such that dental emergency occurrences and DMFT progression are significantly reduced.
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Affiliation(s)
- Sarah Armstrong
- Major Royal Army Dental Corps, Dental Public Health Staff Officer, HQ Defence Medical Services, Staffordshire, UK; Lieutenant Colonel Royal Army Dental Corps, SO1 COVID Operations, HQ Defence Primary Healthcare, Staffordshire, UK.
| | - Mark Dermont
- Wing Commander Royal Air Force, Consultant in Dental Public Health, HQ Defence Medical Services, Staffordshire, UK
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Affiliation(s)
- A. Wheatley
- McGill University Library, McGill University, Montréal, QC, Canada
| | - S. Armstrong
- University of New Brunswick Libraries, University of New Brunswick, Fredericton, NB, Canada
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Jachthuber Trub C, Balikcioglu M, Freemark M, Bain J, Muehlbauer M, Ilkayeva O, White PJ, Armstrong S, Østbye T, Grambow S, Gumus Balikcioglu P. Impact of lifestyle Intervention on branched-chain amino acid catabolism and insulin sensitivity in adolescents with obesity. Endocrinol Diabetes Metab 2021; 4:e00250. [PMID: 34277974 PMCID: PMC8279626 DOI: 10.1002/edm2.250] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 02/16/2021] [Accepted: 03/13/2021] [Indexed: 12/30/2022]
Abstract
Insulin resistance in adolescents with obesity associates with a sex‐dependent metabolic ‘signature’ comprising branched‐chain amino acids (BCAAs), glutamate and C3/C5 acylcarnitines (C3/C5), implicating altered flux through BCAA catabolic pathways. Here, we investigated the effects of lifestyle intervention on BCAA catabolism and insulin sensitivity. We hypothesized (1) weight reduction and improved insulin sensitivity associate with enhanced BCAA catabolism; (2) baseline BCAAs and their metabolic by‐products predict changes in weight and insulin sensitivity during lifestyle intervention.
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Affiliation(s)
| | | | - Michael Freemark
- Division of Pediatric Endocrinology and Diabetes and the Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - James Bain
- Duke Molecular Physiology Institute Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - Michael Muehlbauer
- Duke Molecular Physiology Institute Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - Olga Ilkayeva
- Duke Molecular Physiology Institute Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - Phillip J White
- Duke Molecular Physiology Institute Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
| | - Sarah Armstrong
- Division of General Pediatrics Duke University Medical Center Durham NC USA.,Department of Family Medicine and Community Health Duke University Medical Center Durham NC USA.,Department of Population Health Sciences Duke University Medical Center Durham NC USA.,Duke Clinical Research Institute Duke University Medical Center Durham NC USA
| | - Truls Østbye
- Department of Family Medicine and Community Health Duke University Medical Center Durham NC USA
| | - Steven Grambow
- Department of Biostatistics and Bioinformatics Duke University Medical Center Durham NC USA
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes and the Duke Molecular Physiology Institute Duke University Medical Center Durham NC USA
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32
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Freeman S, Nguyen TV, Beliveau J, Chung RJ, Armstrong S, Wolfe C, Cholera R, Wong CA. COVID-19 Response Strategies at Large Institutes of Higher Education in the United States: A Landscape Analysis, Fall 2020. J Adolesc Health 2021; 68:683-685. [PMID: 33781472 DOI: 10.1016/j.jadohealth.2021.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the pandemic response plans of institutes of higher education (i.e., colleges and universities), including COVID-19 prevention, enforcement, and testing strategies. METHOD Data from the largest public (n = 50) and private (n = 50) US institutes of higher education were collected from October 30 to November 20, 2020. RESULTS Most institutes of higher education (n = 93) offered some in-person teaching in the Fall 2020 semester; most adopted masking (100%) and physical distancing (99%) mandates. Other preventive strategies included on-campus housing de-densification (58%), classroom de-densification (61%), mandated COVID-19-related training (39%), and behavioral compacts (43%). Testing strategies included entry testing (65%), testing at regular intervals (32%), population sample testing (46%), and exit testing (15%). More private than public institutes implemented intercollegiate athletics bans, behavioral compacts, and suspension clauses for noncompliance. CONCLUSIONS Variability in COVID-19 prevention and testing strategies highlights the need for national recommendations and the equitable distribution of sufficient pandemic response resources to institutes of higher education.
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Affiliation(s)
- Sarah Freeman
- Duke University School of Medicine, Durham, North Carolina.
| | - Thuy-Vi Nguyen
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Jessica Beliveau
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Richard J Chung
- Department of Pediatrics, Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, North Carolina
| | - Sarah Armstrong
- Duke University School of Medicine, Durham, North Carolina; Department of Pediatrics, Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, North Carolina
| | - Cameron Wolfe
- Duke University School of Medicine, Durham, North Carolina
| | - Rushina Cholera
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina; Department of Pediatrics, Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, North Carolina; National Clinician Scholars Program, Duke University School of Medicine, Durham, North Carolina
| | - Charlene A Wong
- Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina; Department of Pediatrics, Children's Health and Discovery Initiative, Duke University School of Medicine, Durham, North Carolina; Sanford School of Public Policy, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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33
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Galipeau HJ, Caminero A, Turpin W, Bermudez-Brito M, Santiago A, Libertucci J, Constante M, Raygoza Garay JA, Rueda G, Armstrong S, Clarizio A, Smith MI, Surette MG, Bercik P, Croitoru K, Verdu EF. Novel Fecal Biomarkers That Precede Clinical Diagnosis of Ulcerative Colitis. Gastroenterology 2021; 160:1532-1545. [PMID: 33310084 DOI: 10.1053/j.gastro.2020.12.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [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: 04/10/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Altered gut microbiota composition and function have been associated with inflammatory bowel diseases, including ulcerative colitis (UC), but the causality and mechanisms remain unknown. METHODS We applied 16S ribosomal RNA gene sequencing, shotgun metagenomic sequencing, in vitro functional assays, and gnotobiotic colonizations to define the microbial composition and function in fecal samples obtained from a cohort of healthy individuals at risk for inflammatory bowel diseases (pre-UC) who later developed UC (post-UC) and matched healthy control individuals (HCs). RESULTS Microbiota composition of post-UC samples was different from HC and pre-UC samples; however, functional analysis showed increased fecal proteolytic and elastase activity before UC onset. Metagenomics identified more than 22,000 gene families that were significantly different between HC, pre-UC, and post-UC samples. Of these, 237 related to proteases and peptidases, suggesting a bacterial component to the pre-UC proteolytic signature. Elastase activity inversely correlated with the relative abundance of Adlercreutzia and other potentially beneficial taxa and directly correlated with known proteolytic taxa, such as Bacteroides vulgatus. High elastase activity was confirmed in Bacteroides isolates from fecal samples. The bacterial contribution and functional significance of the proteolytic signature were investigated in germ-free adult mice and in dams colonized with HC, pre-UC, or post-UC microbiota. Mice colonized with or born from pre-UC-colonized dams developed higher fecal proteolytic activity and an inflammatory immune tone compared with HC-colonized mice. CONCLUSIONS We have identified increased fecal proteolytic activity that precedes the clinical diagnosis of UC and associates with gut microbiota changes. This proteolytic signature may constitute a noninvasive biomarker of inflammation to monitor at-risk populations that can be targeted therapeutically with antiproteases.
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Affiliation(s)
- Heather J Galipeau
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Alberto Caminero
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Williams Turpin
- Zane Cohen Centre for Digestive Diseases, Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Miriam Bermudez-Brito
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Alba Santiago
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Josie Libertucci
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Marco Constante
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Juan Antonio Raygoza Garay
- Zane Cohen Centre for Digestive Diseases, Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gaston Rueda
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Sarah Armstrong
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Alex Clarizio
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Michelle I Smith
- Zane Cohen Centre for Digestive Diseases, Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael G Surette
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Premysl Bercik
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada
| | - Kenneth Croitoru
- Zane Cohen Centre for Digestive Diseases, Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Elena F Verdu
- Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada.
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34
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Armstrong S, Dermont M. Defence dentistry: an occupationally focused health service with worldwide deployable capability. Br Dent J 2021; 230:417-423. [PMID: 33837337 PMCID: PMC8033269 DOI: 10.1038/s41415-021-2834-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022]
Abstract
Oral disease can cause substantial disruption to service personnel, resulting in debilitation and reduced effectiveness while deployed on military operations. As such, Defence dentistry delivers an occupationally focused dental service that is deployable, agile and holistic, to ensure service personnel are dentally fit for operations and that the impact of dental morbidity is minimised.Defence dentists provide a unique service, balancing the needs of the individual while considering their operational role requirements. This enables the UK Armed Forces' oral health to be optimised by mitigating morbidity and maintaining operational capability while deployed.The aim of this paper is to highlight the key principles of Defence dentistry by discussing the public health values and occupational focus which underpin a patient-centred approach and the agility of the uniformed military dental workforce in providing a responsive and deployable care capability.
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Affiliation(s)
- Sarah Armstrong
- Major Royal Army Dental Corps, Dental Public Health Staff Officer, HQ Defence Medical Services, Staffordshire, UK; Lieutenant Colonel Royal Army Dental Corps, SO1 COVID Operations, HQ Defence Primary Healthcare, Staffordshire, UK.
| | - Mark Dermont
- Wing Commander Royal Air Force, Consultant in Dental Public Health, HQ Defence Medical Services, Staffordshire, UK
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35
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Skelton JA, Woolford SJ, Skinner A, Barlow SE, Hampl SE, Lazorick S, Armstrong S. Weight Management without Stigma or Harm: A Roundtable Discussion with Childhood Obesity Experts. Child Obes 2021; 17:79-85. [PMID: 33728995 DOI: 10.1089/chi.2021.29010.roundtable] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Joseph A Skelton
- Professor, Department of Pediatrics, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Brenner FIT® (Families in Training), Brenner Children's Hospital, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Susan J Woolford
- Associate Professor, Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Asheley Skinner
- Professor, Duke University Population Health Sciences, Durham, NC, USA
| | - Sarah E Barlow
- Professor of Pediatrics, Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Director of Children's Health Integrated Program in Childhood Obesity, Dallas, TX, USA
| | - Sarah E Hampl
- General Academic Pediatrics and Weight Management, Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA.,Professor of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Suzanne Lazorick
- Professor, Departments of Pediatrics and Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Sarah Armstrong
- Professor of Pediatrics and Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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37
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Chan J, Thakkar H, Comella A, Kim J, Armstrong S, Ihdayhid A, Dey D, Nerlekar N, Brown A. Coronary Perivascular Inflammation is Not Associated With Downstream Microcirculatory Dysfunction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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38
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Avery AJ, Sheehan C, Bell B, Armstrong S, Ashcroft DM, Boyd MJ, Chuter A, Cooper A, Donnelly A, Edwards A, Evans HP, Hellard S, Lymn J, Mehta R, Rodgers S, Sheikh A, Smith P, Williams H, Campbell SM, Carson-Stevens A. Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review. BMJ Qual Saf 2020; 30:961-976. [PMID: 33172907 PMCID: PMC8606464 DOI: 10.1136/bmjqs-2020-011405] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/25/2020] [Revised: 08/25/2020] [Accepted: 09/12/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the incidence of avoidable significant harm in primary care in England; describe and classify the associated patient safety incidents and generate suggestions to mitigate risks of ameliorable factors contributing to the incidents. DESIGN Retrospective case note review. Patients with significant health problems were identified and clinical judgements were made on avoidability and severity of harm. Factors contributing to avoidable harm were identified and recorded. SETTING Primary care. PARTICIPANTS Thirteen general practitioners (GPs) undertook a retrospective case note review of a sample of 14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients). MAIN OUTCOME MEASURES The incidence of significant harm considered at least 'probably avoidable' and the nature of the safety incidents. RESULTS The rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines. CONCLUSION There is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms. Based on the contributory factors we found, improvements could be made through more effective implementation of existing information technology, enhanced team coordination and communication, and greater personal and informational continuity of care.
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Affiliation(s)
- Anthony J Avery
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK .,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK
| | - Christina Sheehan
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Brian Bell
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Armstrong
- NIHR RDS for the East Midlands, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew J Boyd
- Division of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Sciences, University of Nottingham, Nottingham, UK
| | - Antony Chuter
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Alison Cooper
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ailsa Donnelly
- Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Huw Prosser Evans
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stuart Hellard
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Joanne Lymn
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rajnikant Mehta
- Birmingham Clinical Trials Unit, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Sarah Rodgers
- PRIMIS, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Pam Smith
- School of Health and Social Sciences, Edinburgh University, Edinburgh, UK
| | - Huw Williams
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK.,Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Armstrong S, McHale G, Ledesma-Aguilar R, Wells GG. Evaporation and Electrowetting of Sessile Droplets on Slippery Liquid-Like Surfaces and Slippery Liquid-Infused Porous Surfaces (SLIPS). Langmuir 2020; 36:11332-11340. [PMID: 32882130 PMCID: PMC8011908 DOI: 10.1021/acs.langmuir.0c02020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Sessile droplet evaporation underpins a wide range of applications from inkjet printing to coating. However, drying times can be variable and contact-line pinning often leads to undesirable effects, such as ring stain formation. Here, we show voltage programmable control of contact angles during evaporation on two pinning-free surfaces. We use an electrowetting-on-dielectric approach and Slippery Liquid-Infused Porous (SLIP) and Slippery Omniphobic Covalently Attached Liquid-Like (SOCAL) surfaces to achieve a constant contact angle mode of evaporation. We report evaporation sequences and droplet lifetimes across a broad range of contact angles from 105°-67°. The values of the contact angles during evaporation are consistent with expectations from electrowetting and the Young-Lippman equation. The droplet contact areas reduce linearly in time, and this provides estimates of diffusion coefficients close to the expected literature value. We further find that the total time of evaporation over the broad contact angle range studied is only weakly dependent on the value of the contact angle. We conclude that on these types of slippery surfaces, droplet lifetimes can be predicted and controlled by the droplet's volume and physical properties (density, diffusion coefficient, and vapor concentration difference to the vapor phase) largely independent of the precise value of contact angle. These results are relevant to applications, such as printing, spraying, coating, and other processes, where controlling droplet evaporation and drying is important.
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Affiliation(s)
- S. Armstrong
- Smart
Materials & Surfaces Laboratory, Faculty of Engineering &
Environment, Northumbria University, Newcastle upon Tyne, NE1
8ST, U.K.
- School
of Engineering, University of Edinburgh, Sanderson Building, Edinburgh, EH9 3FB, U.K.
| | - G. McHale
- Smart
Materials & Surfaces Laboratory, Faculty of Engineering &
Environment, Northumbria University, Newcastle upon Tyne, NE1
8ST, U.K.
- School
of Engineering, University of Edinburgh, Sanderson Building, Edinburgh, EH9 3FB, U.K.
| | - R. Ledesma-Aguilar
- Smart
Materials & Surfaces Laboratory, Faculty of Engineering &
Environment, Northumbria University, Newcastle upon Tyne, NE1
8ST, U.K.
- School
of Engineering, University of Edinburgh, Sanderson Building, Edinburgh, EH9 3FB, U.K.
| | - G. G. Wells
- Smart
Materials & Surfaces Laboratory, Faculty of Engineering &
Environment, Northumbria University, Newcastle upon Tyne, NE1
8ST, U.K.
- School
of Engineering, University of Edinburgh, Sanderson Building, Edinburgh, EH9 3FB, U.K.
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40
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Armstrong S, Arroyo M, Decker-Pulice K, Lane M, Mckinney M, Molesworth-Kenyon SJ. IL-1α Modulates IFN-γ-Induced Production of CXCL9/MIG during Herpes Simplex Virus Type-1 Corneal Infection. Curr Eye Res 2020; 46:309-317. [PMID: 32730721 DOI: 10.1080/02713683.2020.1803921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Investigating the modulation of neutrophil production of MIG and IP-10 during the inflammatory response to HSV-1 infection. MATERIALS AND METHODS An ex vivo model of human corneal infection by HSV-1 was used for this study. This model permits the study of cytokine production by human corneal buttons in the presence, or absence, of gradient purified human neutrophils, under conditions of HSV-1 infection. All experimental samples were stimulated with a baseline concentration of recombinant human IFN-γ at 1 ng/mL. The relative levels of production for 12 pro-inflammatory mediators were screened using a multi-analyte ELISA assay. Neutrophil production of chemokines MIG and IP-10, under conditions of IFN-γ and/or HSV-1 stimulation were measured by quantitative ELISA. Lastly, antibody neutralization (goat IgG anti-human IL-1α, 2 µg/mL) of de novo production of IL-1α by corneal tissue was performed to investigated the effect on MIG and IP-10 production in the ex vivo model for HSV-1 infection. RESULTS Four of the 12 pro-inflammatory mediators screened (IL-8, IL-6, IL-1α and IL-1β) demonstrated elevated levels of production during corneal cell infection with HSV-1 and communication with neutrophils. Neutrophils were demonstrated to produce significant levels of both MIG and IP-10 under conditions of IFN-γ stimulation, and production of MIG was further upregulated by co-stimulation with IFN-γ and HSV-1. Neutralization of de novo IL-1α production in the model resulted in increased production of the chemokine production MIG but had no observable effect on IP-10 production. CONCLUSIONS Our data provide evidence demonstrating the potential for expression patterns of MIG and IP-10 to be modulated by IL-1α, during the inflammatory response to HSV-1 corneal infection. Both corneal cells and neutrophils contribute to the production of T cell recruiting chemokines. However, IL-1α has the potential to upregulate MIG production by corneal cells while down-regulating MIG production by neutrophils.
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Affiliation(s)
- S Armstrong
- Department of Biology, University of West Georgia , Carrollton, GA, USA
| | - M Arroyo
- Department of Biology, University of West Georgia , Carrollton, GA, USA
| | - K Decker-Pulice
- Department of Biology, University of West Georgia , Carrollton, GA, USA
| | - M Lane
- Department of Biology, University of West Georgia , Carrollton, GA, USA
| | - M Mckinney
- Department of Biology, University of West Georgia , Carrollton, GA, USA
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Armstrong S, Hoskin P. Complex Clinical Decision-Making Process of Re-Irradiation. Clin Oncol (R Coll Radiol) 2020; 32:688-703. [PMID: 32893056 DOI: 10.1016/j.clon.2020.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022]
Abstract
As patients live longer with their cancer as a result of more effective treatment, recurrences and second malignancies in a previously irradiated field are an increasing challenge. The technical advances that enable high-dose radiation to limited volumes, excluding critical normal tissues, have increased the use of re-irradiation for many tumour sites. Minimising the volume, selecting patients with good performance status, negative metastatic screening and longer disease-free intervals are important principles. Despite this there is a narrow therapeutic window, and careful consideration with open discussion, including the patient, of the probable benefit and the implications of potential toxicities will always be essential. In this overview we evaluate the various radiobiological factors that need to be considered for re-irradiation, tissue recovery and dose tolerances in the setting of re-irradiation and summarise the available literature to guide clinicians in their decision-making for re-irradiation to primary and metastatic site/s of disease.
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Affiliation(s)
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
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42
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Izza MAD, Lunt E, Gordon AL, Gladman JRF, Armstrong S, Logan P. Polypharmacy, benzodiazepines, and antidepressants, but not antipsychotics, are associated with increased falls risk in UK care home residents: a prospective multi-centre study. Eur Geriatr Med 2020; 11:1043-1050. [PMID: 32813154 PMCID: PMC7716922 DOI: 10.1007/s41999-020-00376-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/30/2020] [Indexed: 12/18/2022]
Abstract
Aim
To explore the link between polypharmacy, psychotropic medications, and falls risk in a cohort of UK care home residents. Findings
Polypharmacy and psychotropic drugs are predictive of falls in UK care home residents. Message Deprescribing interventions relating to psychotropic drugs should continue to be encouraged. Purpose Falls and polypharmacy are both common in care home residents. Deprescribing of medications in residents with increased falls risk is encouraged. Psychotropic medications are known to increase falls risk in older adults. These drugs are often used in care home residents for depression, anxiety, and behavioural and psychological symptoms of dementia. However, a few studies have explored the link between polypharmacy, psychotropic medications, and falls risk in care home residents. Methods This was a prospective cohort study of residents from 84 UK care homes. Data were collected from residents’ care records and medication administration records. Age, diagnoses, gender, number of medications, and number of psychotropic medications were collected at baseline and residents were monitored over three months for occurrence of falls. Logistic regression models were used to assess the effect of multiple medications and psychotropic medication on falls whilst adjusting for confounders. Results Of the 1655 participants, mean age 85 (SD 8.9) years, 67.9% female, 519 (31%) fell in 3 months. Both the total number of regular drugs prescribed and taking ≥ 1 regular psychotropic medication were independent risk factors for falling (adjusted odds ratio (OR) 1.06 (95% CI 1.03–1.09, p < 0.01) and 1.39 (95% CI 1.10–1.76, p < 0.01), respectively). The risk of falls was higher in those taking antidepressants (p < 0.01) and benzodiazepines (p < 0.01) but not antipsychotics (p > 0.05). Conclusion In UK care homes, number of medications and psychotropic medications (particularly antidepressants and benzodiazepines) predicted falls. This information can be used to inform prescribing and deprescribing decisions.
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Affiliation(s)
| | - Eleanor Lunt
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - John R F Gladman
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Sarah Armstrong
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre - Musculoskeletal Theme, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK.,Nottingham CityCare Partnership, Nottingham, UK
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Dash I, Pearce BCS, Armstrong S, Saunders C, Pacey A. Fertility preservation for women undergoing breast cancer treatment: A postcode lottery? Breast J 2020; 26:2117-2118. [PMID: 33462871 DOI: 10.1111/tbj.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Sarah Armstrong
- Department of Oncology & Metabolism, Academic Unit of Reproductive and Developmental Medicine, Sheffield, UK
| | | | - Allan Pacey
- Department of Oncology & Metabolism, Academic Unit of Reproductive and Developmental Medicine, Sheffield, UK
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Armstrong S, Li JS, Skinner AC. Flattening the (BMI) Curve: Timing of Child Obesity Onset and Cardiovascular Risk. Pediatrics 2020; 146:peds.2020-1353. [PMID: 32632022 DOI: 10.1542/peds.2020-1353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sarah Armstrong
- Departments of Pediatrics and Population Health Sciences, School of Medicine, Duke University and Duke Clinical Research Institute, Duke Center for Childhood Obesity Research, Durham, North Carolina
| | - Jennifer S Li
- Departments of Pediatrics and Population Health Sciences, School of Medicine, Duke University and Duke Clinical Research Institute, Duke Center for Childhood Obesity Research, Durham, North Carolina
| | - Asheley C Skinner
- Departments of Pediatrics and Population Health Sciences, School of Medicine, Duke University and Duke Clinical Research Institute, Duke Center for Childhood Obesity Research, Durham, North Carolina
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Armstrong S, MacKenzie J, Woodward B, Pacey A, Farquhar C. GM-CSF (granulocyte macrophage colony-stimulating factor) supplementation in culture media for women undergoing assisted reproduction. Cochrane Database Syst Rev 2020; 7:CD013497. [PMID: 32672358 PMCID: PMC7390393 DOI: 10.1002/14651858.cd013497.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND GM-CSF (granulocyte macrophage colony-stimulating factor) is a growth factor that is used to supplement culture media in an effort to improve clinical outcomes for those undergoing assisted reproduction. It is worth noting that the use of GM-CSF-supplemented culture media often adds a further cost to the price of an in vitro fertilisation (IVF) cycle. The purpose of this review was to assess the available evidence from randomised controlled trials (RCTs) on the effectiveness and safety of GM-CSF-supplemented culture media. OBJECTIVES To assess the effectiveness and safety of GM-CSF-supplemented human embryo culture media versus culture media not supplemented with GM-CSF, in women or couples undergoing assisted reproduction. SEARCH METHODS We used standard methodology recommended by Cochrane. We searched the Cochrane Gynaecology and Fertility Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, LILACS, DARE, OpenGrey, PubMed, Google Scholar, and two trials registers on 15 October 2019, checked references of relevant papers and communicated with experts in the field. SELECTION CRITERIA We included RCTs comparing GM-CSF (including G-CSF (granulocyte colony-stimulating factor))-supplemented embryo culture media versus any other non-GM-CSF-supplemented embryo culture media (control) in women undergoing assisted reproduction. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcomes were live birth and miscarriage rate. The secondary outcomes were clinical pregnancy, multiple gestation, preterm birth, birth defects, aneuploidy, and stillbirth rates. We assessed the quality of the evidence using GRADE methodology. We undertook one comparison, GM-CSF-supplemented culture media versus culture media not supplemented with GM-CSF, for those undergoing assisted reproduction. MAIN RESULTS We included five studies, the data for three of which (1532 participants) were meta-analysed. We are uncertain whether GM-CSF-supplemented culture media makes any difference to the live-birth rate when compared to using conventional culture media not supplemented with GM-CSF (odds ratio (OR) 1.19, 95% confidence interval (CI) 0.93 to 1.52, 2 RCTs, N = 1432, I2 = 69%, low-quality evidence). The evidence suggests that if the rate of live birth associated with conventional culture media not supplemented with GM-CSF was 22%, the rate with the use of GM-CSF-supplemented culture media would be between 21% and 30%. We are uncertain whether GM-CSF-supplemented culture media makes any difference to the miscarriage rate when compared to using conventional culture media not supplemented with GM-CSF (OR 0.75, 95% CI 0.41 to 1.36, 2 RCTs, N = 1432, I2 = 0%, low-quality evidence). This evidence suggests that if the miscarriage rate associated with conventional culture media not supplemented with GM-CSF was 4%, the rate with the use of GM-CSF-supplemented culture media would be between 2% and 5%. Furthermore, we are uncertain whether GM-CSF-supplemented culture media makes any difference to the following outcomes: clinical pregnancy (OR 1.16, 95% CI 0.93 to 1.45, 3 RCTs, N = 1532 women, I2 = 67%, low-quality evidence); multiple gestation (OR 1.24, 95% CI 0.73 to 2.10, 2 RCTs, N = 1432, I2 = 35%, very low-quality evidence); preterm birth (OR 1.20, 95% CI 0.70 to 2.04, 2 RCTs, N = 1432, I2 = 76%, very low-quality evidence); birth defects (OR 1.33, 95% CI 0.59 to 3.01, I2 = 0%, 2 RCTs, N = 1432, low-quality evidence); and aneuploidy (OR 0.34, 95% CI 0.03 to 3.26, I2 = 0%, 2 RCTs, N = 1432, low-quality evidence). We were unable to undertake analysis of stillbirth, as there were no events in either arm of the two studies that assessed this outcome. AUTHORS' CONCLUSIONS Due to the very low to low quality of the evidence, we cannot be certain whether GM-CSF is any more or less effective than culture media not supplemented with GM-CSF for clinical outcomes that reflect effectiveness and safety. It is important that independent information on the available evidence is made accessible to those considering using GM-CSF-supplemented culture media. The claims from marketing information that GM-CSF has a positive effect on pregnancy rates are not supported by the available evidence presented here; further well-designed, properly powered RCTs are needed to lend certainty to the evidence.
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Affiliation(s)
- Sarah Armstrong
- Department of Oncology & Metabolism, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK
| | - Jeanette MacKenzie
- Fertility Plus, Women's Health, Auckland District Health Board, Auckland, New Zealand
| | | | - Allan Pacey
- Department of Oncology & Metabolism, Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Sheffield, UK
| | - Cindy Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
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Thambar S, Kulkarni S, Armstrong S, Nikolarakos D. Botulinum toxin in the management of temporomandibular disorders: a systematic review. Br J Oral Maxillofac Surg 2020; 58:508-519. [PMID: 32143934 DOI: 10.1016/j.bjoms.2020.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 02/10/2020] [Indexed: 01/01/2023]
Abstract
The aim of this review was to critically investigate and assess the evidence relating to the use and efficacy of botulinum toxin (BTX) in the management of temporomandibular joint disorders (TMD) and masticatory myofascial pain. A comprehensive search was conducted of PubMed, Scopus, Embase, and Cochrane CENTRAL, to find relevant studies from the last 30 years up to the end of July 2018. Seven were identified. Three showed a significant reduction in pain between the BTX and placebo groups and one showed a clinical, but not a significant, difference. In one that compared BTX with another novel treatment, myofascial pain reduced equally in both groups, and in the remaining two there was no significant difference in pain reduction between the BTX and control groups. Of the four studies that assessed mouth opening, two reported that BTX had resulted in a slight improvement; one reported no improvement, and the other a worsening of the condition. A meta-analysis was not possible because of the considerable variation in the studies' designs, the heterogeneity between the groups, and the different assessment tools used. Despite showing benefits, consensus on the therapeutic benefit of BTX in the management of myofascial TMD is lacking. Further randomised controlled trials with larger sample sizes, minimal bias, and longer follow-up periods are now needed.
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Affiliation(s)
- S Thambar
- Dept. of Oral & Maxillofacial Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia; Griffith University, School of Medicine, Griffith Health Centre (G40), Gold Coast Campus, Cnr Parklands Drive and Olsen Avenue, Southport, QLD, 4215, Australia; Griffith University, School of Dentistry, Griffith Health Centre (G40), Gold Coast Campus, Cnr Parklands Drive and Olsen Avenue, Southport, QLD, 4215.
| | - S Kulkarni
- Griffith University, School of Dentistry, Griffith Health Centre (G40), Gold Coast Campus, Cnr Parklands Drive and Olsen Avenue, Southport, QLD, 4215
| | - S Armstrong
- Dept. of Oral & Maxillofacial Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - D Nikolarakos
- Dept. of Oral & Maxillofacial Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
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Galipeau HJ, Turpin W, Caminero Fernandez A, Santiago A, Libertucci J, Bermudez-Brito M, Armstrong S, Bedrani L, Croitoru K, Verdu E. A35 MICROBIAL PROTEOLYTIC SIGNATURE IN ULCERATIVE COLITIS INDUCES AN INFLAMMATORY SIGNATURE IN MICROBIOTA-HUMANIZED MICE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.034] [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
Altered gut microbiota composition has been associated with inflammatory bowel diseases (IBD) including ulcerative colitis (UC), but causality and bacterially-driven mechanisms, are unclear. Proteases within the gastrointestinal tract play a critical role in maintaining homeostasis and are tightly regulated by anti-proteases. Host-derived proteolytic imbalances have been described in IBD, including UC, however, the role of intestinal microbiota as a source of proteases and anti-proteases has largely been ignored.
Aims
To study microbial proteolytic activity and intestinal microbiota profiles in a cohort of individuals at-risk for IBD, and in those individuals that develop UC at follow-up.
Methods
Fecal samples were collected from healthy individuals at-risk for IBD and who went on to develop UC (pre-UC; n=14) and again after UC diagnosis (post-UC, n=10). Fecal samples from matched at-risk individuals that did not develop UC were used as healthy controls (n=52). Overall fecal proteolytic and elastolytic activity was measured. We performed metagenomics sequencing in 4 UC subjects (pre and post) and 4 matched HC using Illumina Hi-Seq from stool DNA. To investigate bacterial origin and functional significance, pregnant germ-free (GF) mice were colonized with a fecal sample from a selected UC subject (pre and post) and a matched HC. Naturally colonized litters were followed for 12 weeks, after which proteolytic activities and signs of inflammation were measured.
Results
Fecal proteolytic and elastase activity was increased in pre- and post-UC samples compared to HCs. Metagenomics revealed over 20k genes were significantly different between HC and pre-UC samples, and of these, 440 related to proteases and peptidases. Increased fecal proteolytic activity, higher lipocalin levels, and increased colonic polymorphonuclear cells in colonic H&E sections was observed in pre- and post-UC colonized mice compared to HC colonized mice. Mice colonized with pre-UC microbiota showed increased mRNA expression of genes linked to immunological disease, antimicrobial and inflammatory responses (ie. Tlr2, Tlr5, Nod2, and Il1b) as compared to HC colonized mice.
Conclusions
These results suggest increased fecal proteolytic activity is observed prior to the onset and clinical diagnosis of UC in patients at-risk for IBD, and upon transfer to mice born from colonized GF dams, low-grade inflammation develops. These pathways could be developed as novel non-invasive biomarkers to monitor at-risk populations. Submitted on behalf of the CCC-GEM Project consortium. Supported by CCC GIA to EF Verdu
Funding Agencies
CCC
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Affiliation(s)
- H J Galipeau
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - W Turpin
- University of Toronto, Toronto, ON, Canada
| | - A Caminero Fernandez
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - A Santiago
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - J Libertucci
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - M Bermudez-Brito
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - S Armstrong
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - L Bedrani
- University of Toronto, Toronto, ON, Canada
| | - K Croitoru
- Mount Sinai Hospital, Toronto, ON, Canada
| | - E Verdu
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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Farquhar CM, Armstrong S, Masson V, Thompson JMD, Sadler L. Clinician Identification of Birth Asphyxia Using Intrapartum Cardiotocography Among Neonates With and Without Encephalopathy in New Zealand. JAMA Netw Open 2020; 3:e1921363. [PMID: 32074288 DOI: 10.1001/jamanetworkopen.2019.21363] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite improvements in antenatal care and increasing cesarean delivery rates, birth asphyxia leading to neonatal encephalopathy (NE) continues to contribute to neonatal death and long-term neurodevelopmental disability. Cardiotocography (CTG) has been used in labor for several decades to detect a stressed fetus so that delivery can be expedited and NE avoided. OBJECTIVE To investigate whether experienced clinicians can detect and respond to abnormal readings from CTGs during the penultimate hour before birth in infants with moderate to severe NE but no acute peripartum event. DESIGN, SETTING, AND PARTICIPANTS This case-control study included 10 practicing obstetricians and midwives at maternity hospitals in New Zealand. Participants, who were masked to the perinatal outcome, were asked to assess CTG tracings from 35 neonates with NE and evidence of birth hypoxia (ie, cases) and 105 neonates without NE or birth hypoxia (ie, controls), all of whom were born in 2010 to 2011. Data analysis was conducted from May to December 2017. EXPOSURES Brief clinical details and 1 hour of CTG tracings from the penultimate hour before birth were provided for each baby. Clinicians assessed the CTG tracings and recommended a plan. MAIN OUTCOMES AND MEASURES Intra-assessor and interassessor agreement on CTG findings and action plans as well as sensitivity (ie, detection of NE) and specificity (ie, ruling out those without NE) for the assessment of abnormal CTG readings leading to immediate action (ie, fetal blood sample or immediate delivery) were reported. RESULTS A total of 35 infants (mean [SD] gestational age, 40 [1.4] weeks; 16 [45.7%] cesarean deliveries) were designated cases, and 105 infants (mean [SD] gestational age, 39.4 [1.2] weeks; 22 [21.0%] cesarean deliveries) were designated controls. No infants had congenital anomalies. The mean (range) sensitivity for detection of abnormal CTG results and for recommending immediate action for all assessors was 75% (63%-91%) and 41% (23%-57%), respectively, with a mean (range) specificity of 67% (53%-77%) and 87% (65%-99%), respectively. A sensitivity analysis including only assessors with 80% or more interassessor agreement only differed from the main analysis by 6% or less (mean [range] sensitivity for detection, 76% [63%-91%]; sensitivity for action plan, 36% [25%-49%]; specificity for detection, 71% [53%-77%]; and specificity for action plan, 93% [88%-99%]). CONCLUSIONS AND RELEVANCE Experienced clinicians detected 3 of 4 infants who were subsequently diagnosed with NE. Action to expedite delivery was recommended for more than 40% of infants with NE. These results indicate that CTG does not identify all infants at risk of NE, and that there is a need for further investment in new approaches to fetal surveillance in labor.
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Affiliation(s)
- Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Sarah Armstrong
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Vicki Masson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lynn Sadler
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
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Frerichs L, Smith NR, Lyden J, Gaskin K, Skinner A, Armstrong S. Weight-related quality of life and temperament as predictors and moderators of outcomes among treatment-seeking, low-income, ethnically diverse children with obesity. Transl Behav Med 2020; 10:244-253. [PMID: 30476258 DOI: 10.1093/tbm/iby115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Within any childhood obesity treatment program, some children have better outcomes than others. Little is known about predictors or moderators of more positive outcomes. We aimed to identify whether child temperament and weight-related quality of life predict or moderate childhood obesity treatment outcomes at 6 months. From 2015 to 2016, children (n = 97) ages 5-11 years old with obesity were randomized to a clinic-community (Bull City Fit) or a clinic-only treatment program. Linear regression was used to explore whether dimensions of child temperament and weight-related quality of life predicted or moderated 6-month anthropometric and physical activity outcomes. Children who had more social avoidance due to their weight at baseline had significantly better improvements in body fat percent in the clinic-community model compared with the clinic-only model at 6 months. Across programs, better baseline social quality of life predicted greater increases in waist circumference; conversely, better physical quality of life predicted a decrease in percent of the 95th percentile. Also, children with longer attention spans had greater increases in physical activity. Our findings suggest that children who have social avoidance due to their weight may benefit most from comprehensive clinic-community treatment. Weight-related quality of life may influence outcomes across all treatments, and practitioners need to carefully counsel children experiencing weight negatively.
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Affiliation(s)
- Leah Frerichs
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalie R Smith
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jessica Lyden
- School of Medicine, Duke University, Durham, NC, USA
| | - Kiah Gaskin
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Asheley Skinner
- Clinical Research Institute, Duke University, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
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Abstract
This study describes changes in body mass index z score (BMIz) and percent of 95th percentile (P95) between referral to pediatric weight management (PWM) and initial PWM visit. We conducted a prospective cohort analysis among subjects (n = 77) aged 5 to 11 years referred to PWM and compared height and weight at time of referral versus initial PWM visit. Mean BMIz decreased by 0.05, and P95 decreased by 1.48 across all age groups (both P < .01) from time of referral to initial visit. Children 5 to 8 years old experienced a greater BMIz change than older children (-0.07 vs -0.02; P < .05). Interval BMIz change was greater for non-Hispanic White and Hispanic children compared with non-Hispanic Blacks (-0.10 vs -0.01; P < .001). There were no subgroup differences in P95. Interval BMI changes between referral and treatment approach half the effect reported by some PWM programs. Referral to PWM may motivate pretreatment lifestyle changes in some patients.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Jessica Hoffman
- Departments of Pediatrics and Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Armstrong
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke Clinical Research Institute, Duke Unversity, Durham, NC, USA
| | - Asheley C Skinner
- Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA.,Department of Population Health Sciences, Duke Clinical Research Institute, Duke Unversity, Durham, NC, USA
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