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1. Navigation programs relevant for African American men with prostate cancer: a scoping review protocol

Author

Palmer, Nynikka R, Smith, Ashley Nicole, Campbell, Brittany A, Andemeskel, Ghilamichael, Tahir, Peggy, Felder, Tisha M, and Cicerelli, Barbara

Subjects
Health Services and Systems, Nursing, Health Sciences, Urologic Diseases, Prostate Cancer, Cancer, Patient Safety, Good Health and Well Being, Black or African American, Delivery of Health Care, Humans, Male, Patient Navigation, Prostatic Neoplasms, Research Design, Review Literature as Topic, Patient navigation, Prostate cancer, African American, Scoping review, Medical and Health Sciences, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundThe excess incidence and mortality due to prostate cancer that impacts African American men constitutes the largest of all cancer disparities. Patient navigation is a patient-centered healthcare system intervention to eliminate barriers to timely, high-quality care across the cancer continuum and improves health outcomes among vulnerable patients. However, little is known regarding the extent to which navigation programs include cultural humility to address prostate cancer disparities among African American men. We present a scoping review protocol of an in-depth examination of navigation programs in prostate cancer care-including navigation activities/procedures, training, and management-with a special focus on cultural context and humility for African American men to achieve health equity.MethodsWe will conduct comprehensive searches of the literature in PubMed, Embase, Web of Science, and CINAHL Complete, using keywords and index terms (Mesh and Emtree) within the three main themes: prostate cancer, patient navigation, and African American men. We will also conduct a search of the gray literature, hand-searching, and reviewing references of included papers and conference abstracts. In a two-phase approach, two authors will independently screen titles and abstracts, and full-text based on inclusion/exclusion criteria. All study designs will be included that present detailed data about the elements of navigation programs, including intervention content, navigator training, and/or management. Data will be extracted from included studies, and review findings will be synthesized and summarized.DiscussionA scoping review focused on cultural humility in patient navigation within the context of eliminating disparities in PCa care among African American men does not yet exist. This review will synthesize existing evidence of patient navigation programs for African American prostate cancer patients and the inclusion of cultural humility. Results will inform the development and implementation of future programs to meet the unique needs of vulnerable prostate cancer patients in safety net settings.Systematic review registrationPROSPERO 2021 CRD42021221412.

Published
2022

2. A Functional Precision Medicine Pipeline Combines Comparative Transcriptomics and Tumor Organoid Modeling to Identify Bespoke Treatment Strategies for Glioblastoma.

Author

Reed, Megan, Lyle, A, De Loose, Annick, Maddukuri, Leena, Learned, Katrina, Beale, Holly, Kephart, Ellen, Cheney, Allison, van den Bout, Anouk, Lee, Madison, Hundley, Kelsey, Smith, Ashley, DesRochers, Teresa, Vibat, Cecile, Gokden, Murat, Salama, Sofie, Wardell, Christopher, Eoff, Robert, Vaske, Olena, and Rodriguez, Analiz

Subjects
Li Fraumeni, glioblastoma, organoid, precision medicine, transcriptomics, Adolescent, Adult, Child, Female, Gene Expression Regulation, Neoplastic, Germ-Line Mutation, Glioblastoma, Humans, Janus Kinase 1, Janus Kinase 2, Li-Fraumeni Syndrome, Male, Nitriles, Organoids, Precision Medicine, Pyrazoles, Pyrimidines, RNA-Seq, STAT1 Transcription Factor, STAT2 Transcription Factor, Transcriptome, Young Adult
Abstract

Li Fraumeni syndrome (LFS) is a hereditary cancer predisposition syndrome caused by germline mutations in TP53. TP53 is the most common mutated gene in human cancer, occurring in 30-50% of glioblastomas (GBM). Here, we highlight a precision medicine platform to identify potential targets for a GBM patient with LFS. We used a comparative transcriptomics approach to identify genes that are uniquely overexpressed in the LFS GBM patient relative to a cancer compendium of 12,747 tumor RNA sequencing data sets, including 200 GBMs. STAT1 and STAT2 were identified as being significantly overexpressed in the LFS patient, indicating ruxolitinib, a Janus kinase 1 and 2 inhibitors, as a potential therapy. The LFS patient had the highest level of STAT1 and STAT2 expression in an institutional high-grade glioma cohort of 45 patients, further supporting the cancer compendium results. To empirically validate the comparative transcriptomics pipeline, we used a combination of adherent and organoid cell culture techniques, including ex vivo patient-derived organoids (PDOs) from four patient-derived cell lines, including the LFS patient. STAT1 and STAT2 expression levels in the four patient-derived cells correlated with levels identified in the respective parent tumors. In both adherent and organoid cultures, cells from the LFS patient were among the most sensitive to ruxolitinib compared to patient-derived cells with lower STAT1 and STAT2 expression levels. A spheroid-based drug screening assay (3D-PREDICT) was performed and used to identify further therapeutic targets. Two targeted therapies were selected for the patient of interest and resulted in radiographic disease stability. This manuscript supports the use of comparative transcriptomics to identify personalized therapeutic targets in a functional precision medicine platform for malignant brain tumors.

Published
2021

3. Associations between cultural identity and attitudes toward routine progress monitoring in a sample of ethnically diverse community therapists.

Author

Rodriguez, Adriana, Terrones, Laura, Regan, Jennifer, Smith, Ashley, Lau, Anna, and Brookman-Frazee, Lauren

Subjects
Adult, Attitude of Health Personnel, Community Mental Health Services, Culture, Female, Hispanic or Latino, Humans, Male, Middle Aged, Minority Groups, Outcome and Process Assessment, Health Care, Psychotherapeutic Processes, Psychotherapists
Abstract

Community mental health services are increasingly embracing evidence-based interventions (EBIs), and the professional workforce is diversifying to meet the needs of historically underserved groups. As such, it is increasingly important to understand how psychotherapist cultural factors may be associated with attitudes toward EBIs. The use of standardized assessments within routine progress monitoring is a cornerstone of EBIs, yet therapist attitudes remain an obstacle to implementation. The current study examines the associations between therapist cultural identity and attitudes toward and use of routine progress monitoring. An online survey was used to gather data from 229 ethnic minority community therapists delivering EBIs in a large public mental health system serving children and families. Therapists had an average age of 35.2 years (SD = 7.7), 86.5% were female, 69.9% were Hispanic/Latinx and 30.2% were other ethnic minority, 36.2% were licensed, 90.8% held a masters degree, and 76.4% reported ability to deliver services in a non-English language. Hierarchical multiple regression analyses revealed that stronger heritage cultural identity was related to perceptions of potential harm with routine progress monitoring. In addition, more favorable views of standardized assessment instructions were associated with positive attitudes toward routine progress monitoring. We discuss how findings point to the need for additional user-centered research with diverse community therapists to learn how assessment and progress monitoring can be better designed to address their cultural and racial-based concerns. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Published
2020

4. Understanding care and outcomes in adolescents and young adults with cancer: A review of the AYA HOPE study

Author

Smith, Ashley Wilder, Keegan, Theresa, Hamilton, Ann, Lynch, Charles, Wu, Xiao‐Cheng, Schwartz, Stephen M, Kato, Ikuko, Cress, Rosemary, Harlan, Linda, and Group, AYA HOPE Study Collaborative

Subjects
Paediatrics, Biomedical and Clinical Sciences, Oncology and Carcinogenesis, Health Services, Hematology, Lymphoma, Cancer, Rare Diseases, Pediatric Research Initiative, Clinical Research, Pediatric, Behavioral and Social Science, Pediatric Cancer, Aetiology, 2.4 Surveillance and distribution, Good Health and Well Being, Adaptation, Psychological, Adolescent, Adult, Health Services Needs and Demand, Humans, Insurance Coverage, Male, Needs Assessment, Neoplasms, Psychotherapy, Quality of Life, Registries, SEER Program, Survivors, Treatment Outcome, Young Adult, AYA HOPE Study Collaborative Group, adolescent, cancer care, health outcomes, quality of life, young adult, Clinical Sciences, Paediatrics and Reproductive Medicine, Oncology & Carcinogenesis, Oncology and carcinogenesis
Abstract

Historically, adolescents and young adults (AYA) diagnosed with cancer have been an understudied population, and their unique care experiences, needs, and outcomes were not well understood. Thus, 10 years ago, the National Cancer Institute supported the fielding of the Adolescent and Young Adult Health Outcomes and Patient Experiences (AYA HOPE) study to address this gap. We recruited individuals diagnosed at ages 15 to 39 with germ cell, Hodgkin and non-Hodgkin lymphoma, acute lymphoblastic leukemia, and sarcoma from Surveillance, Epidemiology, and End Results cancer registries into the first multicenter population-based study of medical care, physical, and mental health outcomes for AYAs with cancer in the United States. This review of the 17 published manuscripts showed low awareness of clinical trials and substantial impact of cancer on financial burden, education and work, relationships and family planning, and physical and mental health. It highlights the feasibility of a longitudinal population-based study and key lessons learned for research on AYAs with cancer in and beyond the United States.

Published
2019

5. Compendium of TCDD-mediated transcriptomic response datasets in mammalian model systems

Author

Prokopec, Stephenie D, Houlahan, Kathleen E, Sun, Ren X, Watson, John D, Yao, Cindy Q, Lee, Jamie, P’ng, Christine, Pang, Renee, Wu, Alexander H, Chong, Lauren C, Smith, Ashley B, Harding, Nicholas J, Moffat, Ivy D, Lindén, Jere, Lensu, Sanna, Okey, Allan B, Pohjanvirta, Raimo, and Boutros, Paul C

Subjects
Biological Sciences, Biomedical and Clinical Sciences, Agent Orange & Dioxin, Genetics, Animals, Cell Line, Computational Biology, Environmental Pollutants, Female, Gene Expression Profiling, Gene Expression Regulation, Humans, Male, Mice, Polychlorinated Dibenzodioxins, Rats, Software, Transcriptome, Web Browser, TCDD, AHR, Microarray datasets, R, Information and Computing Sciences, Medical and Health Sciences, Bioinformatics, Biological sciences, Biomedical and clinical sciences
Abstract

Background2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is the most potent congener of the dioxin class of environmental contaminants. Exposure to TCDD causes a wide range of toxic outcomes, ranging from chloracne to acute lethality. The severity of toxicity is highly dependent on the aryl hydrocarbon receptor (AHR). Binding of TCDD to the AHR leads to changes in transcription of numerous genes. Studies evaluating the transcriptional changes brought on by TCDD may provide valuable insight into the role of the AHR in human health and disease. We therefore compiled a collection of transcriptomic datasets that can be used to aid the scientific community in better understanding the transcriptional effects of ligand-activated AHR.ResultsSpecifically, we have created a datasets package - TCDD.Transcriptomics - for the R statistical environment, consisting of 63 unique experiments comprising 377 samples, including various combinations of 3 species (human derived cell lines, mouse and rat), 4 tissue types (liver, kidney, white adipose tissue and hypothalamus) and a wide range of TCDD exposure times and doses. These datasets have been fully standardized using consistent preprocessing and annotation packages (available as of September 14, 2015). To demonstrate the utility of this R package, a subset of "AHR-core" genes were evaluated across the included datasets. Ahrr, Nqo1 and members of the Cyp family were significantly induced following exposure to TCDD across the studies as expected while Aldh3a1 was induced specifically in rat liver. Inmt was altered only in liver tissue and primarily by rat-AHR.ConclusionsAnalysis of the "AHR-core" genes demonstrates a continued need for studies surrounding the impact of AHR-activity on the transcriptome; genes believed to be consistently regulated by ligand-activated AHR show surprisingly little overlap across species and tissues. Until now, a comprehensive assessment of the transcriptome across these studies was challenging due to differences in array platforms, processing methods and annotation versions. We believe that this package, which is freely available for download ( http://labs.oicr.on.ca/boutros-lab/tcdd-transcriptomics ) will prove to be a highly beneficial resource to the scientific community evaluating the effects of TCDD exposure as well as the variety of functions of the AHR.

Published
2017

6. Cancer negatively impacts on sexual function in adolescents and young adults: The AYA HOPE study.

Author

Wettergren, Lena, Kent, Erin, Mitchell, Sandra, Zebrack, Brad, Lynch, Charles, Rubenstein, Mara, Keegan, Theresa, Wu, Xiao-Cheng, Parsons, Helen, and Smith, Ashley

Subjects
cancer, complications, oncology, sexuality, survivors, young adults, Adaptation, Psychological, Adolescent, Adult, Cancer Survivors, Cohort Studies, Fatigue, Female, Humans, Interpersonal Relations, Logistic Models, Male, Neoplasms, Personal Satisfaction, Sexual Dysfunctions, Psychological, Young Adult
Abstract

OBJECTIVE: This cohort study examined the impact of cancer on sexual function and intimate relationships in adolescents and young adults (AYAs). We also explored factors predicting an increased likelihood that cancer had negatively affected these outcomes. METHODS: Participants (n = 465, ages 15-39) in the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) study completed two surveys approximately 1 and 2 years post-cancer diagnosis. We used multivariable logistic regression to determine factors negatively affected by perceptions of sexual function at 2 years post-diagnosis. RESULTS: Forty-nine percent of AYAs reported negative effects on sexual function at 1 year post-cancer diagnosis and 70% of those persisted in their negative perceptions 2 years after diagnosis. Those reporting a negative impact at 2 years were more likely to be 25 years or older (OR, 2.53; 95% CI, 1.44-4.42), currently not raising children (OR, 1.81; 95% CI, 1.06-3.08), experiencing fatigue (OR, 0.99; 95% CI, 0.975-0.998) and more likely to report that their diagnosis has had a negative effect on physical appearance (OR, 3.08; 95% CI, 1.97-4.81). Clinical factors and mental health were not significant predictors of negative effects on sexual function. CONCLUSIONS: Many AYAs diagnosed with cancer experience a persistent negative impact on sexual life up to 2 years following diagnosis. The findings underscore the need to develop routine protocols to assess sexual function in AYAs with cancer and to provide comprehensive management in the clinical setting. Copyright © 2016 John Wiley & Sons, Ltd.

Published
2017

7. 2,3,7,8 Tetrachlorodibenzo-p-dioxin-induced RNA abundance changes identify Ackr3, Col18a1, Cyb5a and Glud1 as candidate mediators of toxicity

Author

Watson, John D, Prokopec, Stephenie D, Smith, Ashley B, Okey, Allan B, Pohjanvirta, Raimo, and Boutros, Paul C

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Liver Disease, Chronic Liver Disease and Cirrhosis, Genetics, Agent Orange & Dioxin, Digestive Diseases, 2.1 Biological and endogenous factors, Aetiology, Animals, Animals, Outbred Strains, Carcinogens, Environmental, Chemical and Drug Induced Liver Injury, Collagen Type VIII, Cytochromes b5, Dose-Response Relationship, Drug, Drug Resistance, Female, Gene Expression Profiling, Gene Expression Regulation, Glutamate Dehydrogenase, Kinetics, Liver, Male, Mice, Inbred C57BL, Polychlorinated Dibenzodioxins, RNA, Messenger, Rats, Long-Evans, Receptors, CXCR, Receptors, Glutamate, Aryl hydrocarbon receptor, 2, 3, 7, 8 Tetrachlorodibenzo-p-dioxin, TCDD, mRNA abundance, NanoString, Toxicity, Pharmacology and Pharmaceutical Sciences, Toxicology, Biochemistry and cell biology, Pharmacology and pharmaceutical sciences
Abstract

2,3,7,8 Tetrachlorodibenzo-p-dioxin (TCDD) is an aromatic, long-lived environmental contaminant. While the pathogenesis of TCDD-induced toxicity is poorly understood, it has been shown that the aryl hydrocarbon receptor (AHR) is required. However, the specific transcriptomic changes that lead to toxic outcomes have not yet been identified. We previously identified a panel of 33 genes that respond to TCDD treatment in two TCDD-sensitive rodent species. To identify genes involved in the onset of hepatic toxicity, we explored 25 of these in-depth using liver from two rat strains: the TCDD-resistant Han/Wistar (H/W) and the TCDD-sensitive Long-Evans (L-E). Time course and dose-response analyses of mRNA abundance following TCDD insult indicate that eight genes are similarly regulated in livers of both strains of rat, suggesting that they are not central to the severe L-E-specific TCDD-induced toxicities. The remaining 17 genes exhibited various divergent mRNA abundances between L-E and H/W strains after TCDD treatment. Several genes displayed a biphasic response where the initial response to TCDD treatment was followed by a secondary response, usually of larger magnitude in L-E liver. This secondary response was most often an exaggeration of the original TCDD-induced response. Only cytochrome b5 type A (microsomal) (Cyb5a) had equivalent TCDD sensitivity to the prototypic AHR-responsive cytochrome P450, family 1, subfamily a, polypeptide 1 (Cyp1a1), while six genes were less sensitive. Four genes showed an early inter-strain difference that was sustained throughout most of the time course (atypical chemokine receptor 3 (Ackr3), collagen, type XVIII, alpha 1 (Col18a1), Cyb5a and glutamate dehydrogenase 1 (Glud1)), and of those genes examined in this study, are most likely to represent genes involved in the pathogenesis of TCDD-induced hepatotoxicity in L-E rats.

Published
2017

8. Impact of the AYA HOPE Comorbidity Index on Assessing Health Care Service Needs and Health Status among Adolescents and Young Adults with Cancer

Author

Wu, Xiao-Cheng, Prasad, Pinki K, Landry, Ian, Harlan, Linda C, Parsons, Helen M, Lynch, Charles F, Smith, Ashley W, Hamilton, Ann S, and Keegan, Theresa HM

Subjects
Biomedical and Clinical Sciences, Health Services and Systems, Nursing, Health Sciences, Paediatrics, Basic Behavioral and Social Science, Mental Health, Behavioral and Social Science, Cancer, Pediatric, 7.1 Individual care needs, Management of diseases and conditions, Mental health, Good Health and Well Being, Adolescent, Adult, Age Factors, Comorbidity, Female, Health Services Needs and Demand, Health Status, Humans, Logistic Models, Male, Neoplasms, Quality of Life, SEER Program, United States, Young Adult, AYA HOPE Study Collaborative Group, Medical and Health Sciences, Epidemiology, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundExisting comorbidity indices were not developed for adolescent and young adults (AYA) 15 to 39 years of age. The aim of this study was to assess impact of comorbidities on health care service needs and health status among AYA cancer survivors using the newly developed AYA HOPE comorbidity index in comparison with the existing indices.MethodsData on comorbid conditions were obtained from medical records and service needs and health status were from a survey of AYA cancer survivors. Prevalence of comorbidities was based on the AYA HOPE index. Charlson and NCI indices were compared. Multivariable logistic regression was used.ResultsOf the 485 patients, 14.6% had ≥2 comorbidities based on the AYA HOPE Index. Prevalence of mental illness and obesity/overweight, which were not included in existing indices, were 8.2% and 5.8%, respectively. Prevalence of cardiovascular, endocrine, gastrointestinal, and neurologic conditions were higher with the AYA HOPE Index than the other two indices. Forty percent of AYA patients reported service needs, particularly for mental health services (25.2%) and support groups (17.7%). Having ≥2 comorbidities on the AYA index was associated with higher mental health service needs [OR, 2.05; 95% confidence interval (CI), 1.10-3.82] adjusting for demographic and clinical factors. Comorbidities were associated with fair/poor self-reported health status.ConclusionThe AYA HOPE Index is a more comprehensive comorbidity index for AYA cancer patients than existing indices, and the number of comorbidities is associated with service needs and health status.ImpactThe AYA HOPE index could identify patients' additional service needs early in therapy.

Published
2015

9. Validation of the PROMIS physical function measures in a diverse US population-based cohort of cancer patients.

Author

Jensen, Roxanne, Potosky, Arnold, Reeve, Bryce, Hahn, Elizabeth, Cella, David, Fries, James, Smith, Ashley, Wu, Xiao-Cheng, Paddock, Lisa, Moinpour, Carol, and Keegan, Theresa

Subjects
Oncology, Patient-reported outcomes, Physical function, Validation studies, Adult, Aged, Aged, 80 and over, Cohort Studies, Ethnicity, Fatigue, Female, Health Behavior, Humans, Lymphoma, Non-Hodgkin, Male, Middle Aged, Pain, Patients, Psychometrics, Quality of Life, Reproducibility of Results, Sickness Impact Profile, Socioeconomic Factors, Surveys and Questionnaires, Treatment Outcome, United States, Young Adult
Abstract

PURPOSE: To evaluate the validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function measures in a diverse, population-based cancer sample. METHODS: Cancer patients 6-13 months post-diagnosis (n = 4840) were recruited for the Measuring Your Health study. Participants were diagnosed between 2010 and 2013 with non-Hodgkin lymphoma or cancers of the colorectum, lung, breast, uterus, cervix, or prostate. Four PROMIS physical function short forms (4a, 6b, 10a, and 16) were evaluated for validity and reliability across age and race-ethnicity groups. Covariates included gender, marital status, education level, cancer site and stage, comorbidities, and functional status. RESULTS: PROMIS physical function short forms showed high internal consistency (Cronbachs α = 0.92-0.96), convergent validity (fatigue, pain interference, FACT physical well-being all r ≥ 0.68), and discriminant validity (unrelated domains all r ≤ 0.3) across survey short forms, age, and race-ethnicity. Known-group differences by demographic, clinical, and functional characteristics performed as hypothesized. Ceiling effects for higher-functioning individuals were identified on most forms. CONCLUSIONS: This study provides strong evidence that PROMIS physical function measures are valid and reliable in multiple race-ethnicity and age groups. Researchers selecting specific PROMIS short forms should consider the degree of functional disability in their patient population to ensure that length and content are tailored to limit response burden.

Published
2015

10. Fertility preservation knowledge, counseling, and actions among adolescent and young adult patients with cancer: A population‐based study

Author

Shnorhavorian, Margarett, Harlan, Linda C, Smith, Ashley Wilder, Keegan, Theresa HM, Lynch, Charles F, Prasad, Pinki K, Cress, Rosemary D, Wu, Xiao‐Cheng, Hamilton, Ann S, Parsons, Helen M, Keel, Gretchen, Charlesworth, Sarah E, Schwartz, Stephen M, and Group, AYA HOPE Study Collaborative

Subjects
Basic Behavioral and Social Science, Contraception/Reproduction, Clinical Research, Behavioral and Social Science, Cancer, Adolescent, Adult, Counseling, Female, Fertility Preservation, Humans, Male, Neoplasms, Surveys and Questionnaires, Young Adult, fertility, adolescent and young adult, disparities, treatment, late effects, AYA HOPE Study Collaborative Group, Oncology and Carcinogenesis, Public Health and Health Services, Oncology & Carcinogenesis
Abstract

BackgroundThe fertility of adolescent and young adult (AYA) patients with cancer can be threatened by treatments, but to the authors' knowledge little is known regarding the extent to which providers discuss this with patients or recommend fertility preservation, or the patient and physician characteristics associated with these interactions.MethodsQuestionnaires from 459 AYA patients with cancer who were diagnosed between 2007 and 2008 and recruited through 7 US population-based cancer registries were analyzed using sex-specific multivariable models. The authors assessed characteristics associated with not discussing therapy effects on fertility or fertility preservation options, and not making fertility preservation arrangements.ResultsMales without a medical oncologist were more likely not to be told that therapy might affect fertility than those with a medical oncologist (male odds ratio [OR], 2.28; 95% confidence interval [95% CI], 1.03-5.00). Individuals without insurance (male OR, 2.91 [95% CI, 1.41-5.91] and female OR, 5.46 [95% CI, 1.59-18.72]); those raising children aged

Published
2015

11. Who Treats Adolescents and Young Adults with Cancer? A Report from the AYA HOPE Study.

Author

Parsons, Helen, Harlan, Linda, Schmidt, Susanne, Keegan, Theresa, Lynch, Charles, Kent, Erin, Wu, Xiao-Cheng, Schwartz, Stephen, Chu, Roland, Keel, Gretchen, and Smith, Ashley

Subjects
AYA HOPE Study, physicians, place of care, treatment, Adolescent, Adult, Cohort Studies, Female, Humans, Male, National Cancer Institute (U.S.), Neoplasms, Survivors, United States, Young Adult
Abstract

PURPOSE: Physicians play a critical role in delivering effective treatment and enabling successful transition to survivorship among adolescent and young adult (AYA) cancer patients. However, with no AYA cancer medical specialty, information on where and by whom AYAs with cancer are treated is limited. METHODS: Using the National Cancer Institutes population-based AYA HOPE Study, 464 AYAs aged 15-39 at diagnosis treated by 903 physicians were identified. Differences in physician and hospital characteristics were examined by age at diagnosis and cancer type (germ cell cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, acute lymphocytic leukemia [ALL], and sarcoma) using chi-square tests. RESULTS: Treating physicians were predominately 51-64 years old, male, United States-trained in non-pediatric specialties, and in group practices within large metropolitan areas. Older patients were less often treated by pediatric physicians (p < 0.01) and more likely to be treated by United States-trained physicians without research/teaching responsibilities and in hospitals without residency programs (p < 0.05). The majority of the few pediatricians (n = 44) treated ALL patients. Physicians with research/teaching responsibilities and those based in medical schools were more likely to treat patients with ALL and sarcoma compared with other cancer types (p < 0.01). Of HL patients, 73% were treated at a cancer center compared with 56% of patients with germ cell cancer (p < 0.01), while ALL (85%) and sarcoma (87%) patients were more likely to be treated in hospitals with residency programs (p < 0.01). CONCLUSIONS: Most AYAs with cancer were treated by non-pediatric physicians in community settings, although physician characteristics varied significantly by patient cancer type and age at diagnosis.

Published
2015

12. Cancer-related information needs and cancers impact on control over life influence health-related quality of life among adolescents and young adults with cancer.

Author

DeRouen, Mindy, Smith, Ashley, Tao, Li, Bellizzi, Keith, Lynch, Charles, Parsons, Helen, Kent, Erin, and Keegan, Theresa

Subjects
adolescent and young adult (AYA), cancer survivor, control, health-related quality of life (HRQOL), information need, oncology, Adolescent, Adult, Female, Health Services Needs and Demand, Humans, Internal-External Control, Male, Neoplasms, Patient Education as Topic, Quality of Life, Surveys and Questionnaires, Survivors, Young Adult
Abstract

OBJECTIVE: Adolescents and young adults (AYAs) diagnosed with cancer between 15 and 39 years of age often report need for greater amounts of cancer-related information and perceive that cancer has had a negative impact on control over their life. We examined whether unmet information need and perceived control over life are associated with health-related quality of life (HRQOL). METHODS: We examined data from 484 AYA cancer survivors recruited from population-based cancer registries in 2007-2008. Participants completed surveys a median of 11 months after diagnosis. Multivariable linear regression analyses estimated associations of unmet cancer-related information needs and impact of cancer on control over life on HRQOL (SF-12). RESULTS: Two-thirds of AYAs reported an intermediate or high level of unmet information need, and half (47%) reported a negative impact of cancer on control. Greater unmet information need was associated with lower overall mental and physical HRQOL and lower levels of all HRQOL subscales except vitality. A negative impact on control over life was associated with lower overall mental HRQOL as well as lower HRQOL across all subscales except general health perceptions (all p 0.1). CONCLUSIONS: Adolescent and young adult patients with cancer have high levels of unmet cancer-related information needs and perceived negative impact of cancer on control over life; both were independently associated with lower HRQOL. Addressing unmet information needs among AYA cancer survivors and finding ways to increase their sense of control may help improve HRQOL in this understudied population.

Published
2015

13. Health‐related quality of life in older adult survivors of selected cancers: Data from the SEER‐MHOS linkage

Author

Kent, Erin E, Ambs, Anita, Mitchell, Sandra A, Clauser, Steven B, Smith, Ashley Wilder, and Hays, Ron D

Subjects
Biomedical and Clinical Sciences, Health Services and Systems, Nursing, Health Sciences, Oncology and Carcinogenesis, Cancer, Hematology, Digestive Diseases, Clinical Research, Pancreatic Cancer, Rare Diseases, Health Services, 7.1 Individual care needs, Good Health and Well Being, Aged, Female, Health Status, Health Surveys, Humans, Male, Mental Health, Middle Aged, Neoplasms, Quality of Life, SEER Program, Surveys and Questionnaires, United States, epidemiology, neoplasms, older adult, quality of life, rare diseases, Public Health and Health Services, Oncology & Carcinogenesis, Oncology and carcinogenesis, Public health
Abstract

BackgroundResearch on health-related quality of life (HRQOL) among older adult cancer survivors is mostly confined to breast cancer, prostate cancer, colorectal cancer, and lung cancer, which account for 63% of all prevalent cancers. Much less is known about HRQOL in the context of less common cancer sites.MethodsHRQOL was examined with the 36-Item Short Form Health Survey, version 1, and the Veterans RAND 12-Item Health Survey in patients with selected cancers (kidney cancer, bladder cancer, pancreatic cancer, upper gastrointestinal cancer, cancer of the oral cavity and pharynx, uterine cancer, cervical cancer, thyroid cancer, melanoma, chronic leukemia, non-Hodgkin lymphoma, and multiple myeloma) and in individuals without cancer on the basis of data linked from the Surveillance, Epidemiology, and End Results cancer registry system and the Medicare Health Outcomes Survey. Scale scores, Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, and a utility metric (Short Form 6D/Veterans RAND 6D), adjusted for sociodemographic characteristics and other chronic conditions, were calculated. A 3-point difference in the scale scores and a 2-point difference in the PCS and MCS scores were considered to be minimally important differences.ResultsData from 16,095 cancer survivors and 1,224,549 individuals without a history of cancer were included. The results indicated noteworthy deficits in physical health status. Mental health was comparable, although scores for the Role-Emotional and Social Functioning scales were worse for patients with most types of cancer versus those without cancer. Survivors of multiple myeloma and pancreatic malignancies reported the lowest scores, with their PCS/MCS scores less than those of individuals without cancer by 3 or more points.ConclusionsHRQOL surveillance efforts revealed poor health outcomes among many older adults and specifically among survivors of multiple myeloma and pancreatic cancer.

Published
2015

14. Young and uninsured: Insurance patterns of recently diagnosed adolescent and young adult cancer survivors in the AYA HOPE study.

Author

Parsons, Helen, Schmidt, Susanne, Harlan, Linda, Kent, Erin, Lynch, Charles, Smith, Ashley, and Keegan, Theresa

Subjects
Patient Protection and Affordable Care Act, Surveillance, Epidemiology, and End Results (SEER), adolescents and young adults, insurance, Adult, Age Factors, Female, Humans, Insurance Coverage, Male, Medically Uninsured, Neoplasms, Patient Protection and Affordable Care Act, SEER Program, Survivors, United States, Young Adult
Abstract

BACKGROUND: Young adults have historically been the least likely to have health insurance in the United States. Previous studies of survivors of childhood cancer found lower rates of insurance and less access to medical care compared with siblings; however, to the authors knowledge, no studies to date have examined continuity of insurance after a cancer diagnosis in adolescents and young adults (AYAs). METHODS: Using the AYA Health Outcomes and Patient Experience study, a cohort of 465 individuals aged 15 to 39 years from participating Surveillance, Epidemiology, and End Results registries, we evaluated changes in and sponsors of health insurance coverage after diagnosis, coverage of physician-recommended tests, and factors associated with lack of insurance after a cancer diagnosis using chi-square tests and multivariable logistic regression. RESULTS: Greater than 25% of AYA survivors of cancer (118 survivors) experienced some period without insurance up to 35 months after diagnosis. Insurance rates were high in the initial year after diagnosis (6 months-14 months; 93.3%) but decreased substantially at follow-up (15 months-35 months; 85.2%). The most common sponsor of health insurance was employer/school coverage (43.7%). Multivariable analysis indicated that older survivors (those aged 25-39 years vs 15-19 years; odds ratio, 3.35 [P  20% of survivors indicated there were physician-recommended tests/treatments that were not covered by insurance, but > 80% received them regardless of coverage. CONCLUSIONS: Insurance rates appear to decrease with time since diagnosis in AYA survivors of cancer. Future studies should examine how new policies under the Patient Protection and Affordable Care Act extend access and insurance coverage beyond initial treatment.

Published
2014

15. A novel approach to the discovery of survival biomarkers in glioblastoma using a joint analysis of DNA methylation and gene expression

Author

Smith, Ashley A, Huang, Yen-Tsung, Eliot, Melissa, Houseman, E Andres, Marsit, Carmen J, Wiencke, John K, and Kelsey, Karl T

Subjects
Biological Sciences, Genetics, Orphan Drug, Prevention, Cancer, Human Genome, Precision Medicine, Brain Disorders, Brain Cancer, Rare Diseases, Cancer Genomics, Biotechnology, Neurosciences, 2.1 Biological and endogenous factors, Adolescent, Adult, Aged, Aged, 80 and over, Biomarkers, Tumor, Brain Neoplasms, Child, CpG Islands, DNA Methylation, Epigenesis, Genetic, Female, Gene Expression, Glioblastoma, Humans, Isocitrate Dehydrogenase, Male, Middle Aged, Mutation, Neoplasm Staging, Survival Rate, Young Adult, glioma, DNA methylation, gene expression, biomarker, mediation analysis, Biochemistry and Cell Biology, Medical Biochemistry and Metabolomics, Developmental Biology, Biochemistry and cell biology
Abstract

Glioblastoma multiforme (GBM) is the most aggressive of all brain tumors, with a median survival of less than 1.5 years. Recently, epigenetic alterations were found to play key roles in both glioma genesis and clinical outcome, demonstrating the need to integrate genetic and epigenetic data in predictive models. To enhance current models through discovery of novel predictive biomarkers, we employed a genome-wide, agnostic strategy to specifically capture both methylation-directed changes in gene expression and alternative associations of DNA methylation with disease survival in glioma. Human GBM-associated DNA methylation, gene expression, IDH1 mutation status, and survival data were obtained from The Cancer Genome Atlas. DNA methylation loci and expression probes were paired by gene, and their subsequent association with survival was determined by applying an accelerated failure time model to previously published alternative and expression-based association equations. Significant associations were seen in 27 unique methylation/expression pairs with expression-based, alternative, and combinatorial associations observed (10, 13, and 4 pairs, respectively). The majority of the predictive DNA methylation loci were located within CpG islands, and all but three of the locus pairs were negatively correlated with survival. This finding suggests that for most loci, methylation/expression pairs are inversely related, consistent with methylation-associated gene regulatory action. Our results indicate that changes in DNA methylation are associated with altered survival outcome through both coordinated changes in gene expression and alternative mechanisms. Furthermore, our approach offers an alternative method of biomarker discovery using a priori gene pairing and precise targeting to identify novel sites for locus-specific therapeutic intervention.

Published
2014

16. Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers?

Author

Keegan, Theresa, Tao, Li, DeRouen, Mindy, Wu, Xiao-Cheng, Prasad, Pinki, Lynch, Charles, Shnorhavorian, Margarett, Zebrack, Brad, Chu, Roland, Harlan, Linda, Smith, Ashley, and Parsons, Helen

Subjects
Adolescent, Adult, Female, Health Services Accessibility, Health Status, Humans, Insurance, Health, Logistic Models, Male, Neoplasms, Survivors, Young Adult
Abstract

PURPOSE: Adolescent and young adult (AYA) cancer survivors experience barriers to utilizing healthcare, but the determinants of cancer-related medical care of AYAs has not been fully explored. METHODS: We studied factors associated with medical care utilization among 465 AYA cancer survivors in the AYA Health Outcomes and Patient Experience Study, a cohort of 15 to 39 year olds recently diagnosed with germ cell cancer, lymphoma, sarcoma, or acute lymphocytic leukemia. Descriptive statistics and multivariate logistic regression methods were used. RESULTS: Most AYA cancer survivors (95%), who were 15-35 months post diagnosis, received medical care in the past 12 months and 17% were undergoing cancer treatment. In multivariate analyses, compared with AYAs with no cancer-related medical visits in the previous year, AYAs receiving cancer-related care were more likely to currently have health insurance (odds ratio (OR) = 4.9; 95% confidence interval (CI) = 1.7-13.8) or have had health insurance in the past year (OR = 4.0; 95% CI = 0.99-16.3). Cancer recurrence, lacking employment, and negative changes in self-reported general health were associated with ongoing cancer treatment versus other cancer-related medical care. Eleven percent of all AYAs and 25% of AYAs who did not receive medical care in the past 12 months lost health insurance between the initial and follow-up surveys. CONCLUSION: AYA cancer survivors with health insurance were much more likely to receive cancer-related medical care than those without insurance. IMPLICATIONS FOR CANCER SURVIVORS: Despite the need for post-treatment medical care, lacking health insurance is a barrier to receiving any medical care among AYAs.

Published
2014

17. Associations of cancer and other chronic medical conditions with SF-6D preference-based scores in Medicare beneficiaries

Author

Hays, Ron D, Reeve, Bryce B, Smith, Ashley Wilder, and Clauser, Steven B

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Cancer, Aging, Good Health and Well Being, Aged, Aged, 80 and over, Chronic Disease, Comorbidity, Female, Health Surveys, Humans, Male, Medicare, Neoplasms, Quality of Life, SEER Program, Sickness Impact Profile, United States, Cancer and comorbidity, Health-related quality of life, Preference-based measures, Utilities, Public Health and Health Services, Psychology, Health Policy & Services, Health sciences, Human society
Abstract

PurposeDocumenting the impact of different types of cancer on daily functioning and well-being is important for understanding burden relative to other chronic medical conditions. This study examined the impact of 10 different cancers and 13 other chronic medical conditions on health-related quality of life.MethodsHealth-related quality of life data were gathered on the Medicare Health Outcomes Survey (MHOS) between 1998 and 2002. Cancer information was ascertained using the National Cancer Institute's surveillance, epidemiology, and end results program and linked to MHOS data.ResultsThe average SF-6D score was 0.73 (SD = 0.14). Depressive symptoms had the largest unique association with the SF-6D, followed by arthritis of the hip, chronic obstructive pulmonary disease/asthma, stroke, and sciatica. In addition, the majority of cancer types were significantly associated with the SF-6D score, with significant negative weights ranging from -0.01 to -0.02 on the 0-1 health utility scale. Distant stage of cancer was associated with large decrements in the SF-6D ranging from -0.04 (prostate) to -0.08 (female breast).ConclusionA large number of chronic conditions, including cancer, are associated uniquely with decrements in health utility. The cumulative effects of comorbid conditions have substantial impact on daily functioning and well-being of Medicare beneficiaries.

Published
2014

18. Recruitment and follow-up of adolescent and young adult cancer survivors: the AYA HOPE Study

Author

Harlan, Linda C, Lynch, Charles F, Keegan, Theresa HM, Hamilton, Ann S, Wu, Xiao-Cheng, Kato, Ikuko, West, Michele M, Cress, Rosemary D, Schwartz, Stephen M, Smith, Ashley W, Deapen, Dennis, Stringer, Sonja M, Potosky, Arnold L, and the AYA HOPE Study Collaborative Group

Subjects
Cancer, Rare Diseases, Hematology, Pediatric Cancer, Clinical Research, Lymphoma, Pediatric, Aetiology, 2.4 Surveillance and distribution, Adolescent, Adult, Algorithms, Continuity of Patient Care, Data Collection, Female, Follow-Up Studies, Humans, Male, Neoplasms, Patient Participation, Patient Selection, Psychology, Quality of Life, SEER Program, Survivors, Young Adult, Adolescent cancer, Young adult cancer, Survey, Response rates, Medical records, Consent forms, AYA HOPE Study Collaborative Group, Oncology and Carcinogenesis, Public Health and Health Services, Oncology & Carcinogenesis
Abstract

IntroductionCancer is rare in adolescents and young adults (AYA), but these patients have seen little improvement in survival in contrast to most other age groups. Furthermore, participation in research by AYAs is typically low. We conducted a study to examine the feasibility of recruiting a population-based sample of AYA survivors to examine issues of treatment and health outcomes.MethodsIndividuals diagnosed in 2007-08 and age 15-39 at the time of diagnosis with acute lymphocytic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, germ cell cancer or sarcoma were identified by 7 Surveillance, Epidemiology, and End-Results (SEER) cancer registries, mailed surveys within 14 months after diagnosis and again a year later, and had medical records reviewed.Results525 (43%) of the eligible patients responded, 39% refused and 17% were lost to follow-up. Extensive efforts were required for most potential respondents (87%). 76% of respondents completed the paper rather than online survey version. In a multivariate model, age, cancer site, education and months from diagnosis to the first mailing of the survey were not associated with participation, although males (p

Published
2011

19. Cigarette smoking and health-related quality of life in Medicare beneficiaries.

Author

Hays, Ron D, Smith, Ashley Wilder, Reeve, Bryce B, Spritzer, Karen L, Marcus, Stephen E, and Clauser, Steven B

Subjects
Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Cancer, Behavioral and Social Science, Tobacco Smoke and Health, Prevention, Substance Misuse, Clinical Research, Aging, Tobacco, Good Health and Well Being, Aged, Aged, 80 and over, Chronic Disease, Cohort Studies, Database Management Systems, Demography, Female, Humans, Least-Squares Analysis, Male, Managed Care Programs, Medical Record Linkage, Medicare, Neoplasms, Outcome Assessment, Health Care, Quality of Life, SEER Program, Sickness Impact Profile, Smoking, Socioeconomic Factors, Survivors, United States, Public Health and Health Services, Health Policy & Services, Biochemistry and cell biology, Clinical sciences
Abstract

This study examined associations between cigarette smoking, cancer, and self-reported physical (SF-36 Physical Component Summary Score, [PCS]) and mental health (SF-36 Mental Component Summary Score, [MCS]) among 123,567 Medicare beneficiaries enrolled in managed care plans. As expected for a sample of older individuals, the SF-36 PCS mean (42.6) was lower than the U.S. general population mean of 50. The SF-36 MCS mean (51.7) for the sample was higher than the general population mean. In addition, least squares means revealed significantly poorer health for current smokers and those who recently quit, regardless of their cancer status. Although statistically significant, the differences between current smokers and never smokers were small among those with or without cancer. Encouraging smokers to quit and providing abstinence support to persons who have recently quit may help reduce health-related impacts of cigarette use.

Published
2008

20. Cancer, comorbidities, and health-related quality of life of older adults.

Author

Smith, Ashley Wilder, Reeve, Bryce B, Bellizzi, Keith M, Harlan, Linda C, Klabunde, Carrie N, Amsellem, Marni, Bierman, Arlene S, and Hays, Ron D

Subjects
Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Cancer, Clinical Research, Aging, Good Health and Well Being, Aged, Aged, 80 and over, Comorbidity, Demography, Female, Humans, Male, Managed Care Programs, Medical Record Linkage, Medicare, Neoplasms, Outcome Assessment, Health Care, Poisson Distribution, Prevalence, Quality of Life, SEER Program, Sickness Impact Profile, Survivors, United States, Public Health and Health Services, Health Policy & Services, Biochemistry and cell biology, Clinical sciences
Abstract

This study examined the physical and mental health of 126,685 males and females age 65 or over, with and without cancer that completed a Medicare Health Outcomes Survey (MHOS) between 1998-2002. Cancer information was ascertained through the National Cancer Institute's (NCI's) Surveillance, Epidemiology and End Results (SEER) program and linked to MHOS data. Results indicated that across most cancer types, cancer patients reported significantly more comorbid conditions and poorer physical and mental health compared with patients without cancer. Negative associations were most pronounced in those with two or more comorbidities and in those diagnosed with cancer within the past year.

Published
2008

21. Reducing bias in cancer research: application of propensity score matching.

Author

Reeve, Bryce B, Smith, Ashley Wilder, Arora, Neeraj K, and Hays, Ron D

Subjects
Biochemistry and Cell Biology, Biomedical and Clinical Sciences, Biological Sciences, Clinical Sciences, Neurosciences, Cancer, Aged, Aged, 80 and over, Chronic Disease, Cohort Studies, Comorbidity, Cost of Illness, Database Management Systems, Epidemiologic Research Design, Female, Humans, Male, Managed Care Programs, Medicare, Neoplasms, Observation, Outcome Assessment, Health Care, Quality of Life, SEER Program, Socioeconomic Factors, Survivors, United States, Public Health and Health Services, Health Policy & Services, Biochemistry and cell biology, Clinical sciences
Abstract

In cancer observational studies, differences between groups on confounding variables may have a significant effect on results when examining health outcomes. This study demonstrates the utility of propensity score matching to balance a non-cancer and cancer cohort of older adults on multiple relevant covariates. This approach matches cases to controls on a single indicator, the propensity score, rather than multiple variables. Results indicated that propensity score matching is an efficient and useful way to create a matched case-control study out of a large cohort study, and allows confidence in the strength of the observed outcomes of the study.

Published
2008

22. COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study

Author

Lee, Lennard Y. W., Cazier, Jean-Baptiste, Starkey, Thomas, Briggs, Sarah E. W., Arnold, Roland, Bisht, Vartika, Booth, Stephen, Campton, Naomi A., Cheng, Vinton W. T., Collins, Graham, Curley, Helen M., Earwaker, Philip, Fittall, Matthew W., Gennatas, Spyridon, Goel, Anshita, Hartley, Simon, Hughes, Daniel J., Kerr, David, Lee, Alvin J. X., Lee, Rebecca J., Lee, Siow Ming, Mckenzie, Hayley, Middleton, Chris P., Murugaesu, Nirupa, Newsom-Davis, Tom, Olsson-Brown, Anna C., Palles, Claire, Powles, Thomas, Protheroe, Emily A., Purshouse, Karin, Sharma-Oates, Archana, Sivakumar, Shivan, Smith, Ashley J., Topping, Oliver, Turnbull, Chris D., Várnai, Csilla, Briggs, Adam D. M., Middleton, Gary, Kerr, Rachel, Gault, Abigail, Agnieszka, Michael, Bedair, Ahmed, Ghaus, Aisha, Akingboye, Akinfemi, Maynard, Alec, Pawsey, Alexander, Mohamed, Ali Abdulnabi, Okines, Alicia, Massey, Alison, Kwan, Amy, Ferreira, Ana, Angelakas, Angelos, Wu, Anjui, Tivey, Ann, Armstrong, Anne, Madhan, Annet, Pillai, Annet, Poon-King, Ashley, Kurec, Bartlomiej, Usborne, Caroline, Dobeson, Caroline, Thirlwell, Christina, Mitchell, Christian, Sng, Christopher, Scrase, Christopher, Jingree, Christopher, Brunner, Clair, Fuller, Claire, Griffin, Clare, Barrington, Craig, Muller, Daniel, Ottaviani, Diego, Gilbert, Duncan, Tacconi, Eliana, Copson, Ellen, Renninson, Emily, Cattell, Emma, Burke, Emma, Smith, Fiona, Holt, Francesca, Soosaipillai, Gehan, Boyce, Hayley, Shaw, Heather, Hollis, Helen, Bowyer, Helen, Anil, Iris, Illingworth, Jack, Gibson, Jack, Bhosle, Jaishree, Best, James, Barrett, Jane, Noble, Jillian, Sacco, Joseph, Chacko, Joseph, Chackathayil, Julia, Banfill, Kathryn, Feeney, Laura, Horsley, Laura, Cammaert, Lauren, Mukherjee, Leena, Eastlake, Leonie, Devereaux, Louise, Melcher, Lucinda, Cook, Lucy, Teng, Mabel, Hewish, Madeleine, Bhattacharyya, Madhumita, Choudhury, Mahbuba, Baxter, Mark, Scott-Brown, Martin, Fittall, Matthew, Tilby, Michael, Rowe, Michael, Alihilali, Mohammed, Galazi, Myria, Yousaf, Nadia, Chopra, Neha, Cox, Nicola, Chan, Olivia, Sheikh, Omar, Ramage, Paul, Greaves, Paul, Leonard, Pauline, Hall, Peter S., Naksukpaiboon, Piangfan, Corrie, Pippa, Peck, Rahul, Sharkey, Rachel, Bolton, Rachel, Sargent, Rebecca, Jyothirmayi, Rema, Goldstein, Robert, Oakes, Roderick, Shotton, Rohan, Kanani, Ruhi, Board, Ruth, Pettengell, Ruth, Claydon, Ryan, Moody, Sam, Massalha, Samah, Kathirgamakarthigeyan, Sangary, Dolly, Saoirse, Derby, Sarah, Lowndes, Sarah, Benafif, Sarah, Eeckelaers, Sarah, Kingdon, Sarah, Ayers, Sarah, Brown, Sean, Ellis, Shawn, Parikh, Shefali, Pugh, Sian, Shamas, Simon, Wyatt, Simon, Grumett, Simon, Lau, Sin, Wong, Yien Ning Sophia, McGrath, Sophie, Cornthwaite, Stephanie, Hibbs, Stephen, Tillet, Tania, Rabbi, Taslima, Robinson, Tim, Roques, Tom, Angelis, Vasileios, Woodcock, Victoria, Brown, Victoria, Peng, YingYing, Drew, Yvette, Hudson, Zoe, and HASH(0x5651ca095ff8)

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Pneumonia, Viral, Population, Risk Assessment, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Neoplasms, Internal medicine, Correspondence, Epidemiology, medicine, Humans, Prospective Studies, Lung cancer, education, Prospective cohort study, Pandemics, Aged, Cause of death, Aged, 80 and over, education.field_of_study, Manchester Cancer Research Centre, SARS-CoV-2, business.industry, ResearchInstitutes_Networks_Beacons/mcrc, COVID-19, Cancer, Odds ratio, Middle Aged, medicine.disease, Hospitalization, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Cohort, Female, Coronavirus Infections, business, RA
Abstract

BACKGROUND: Patients with cancer are purported to have poor COVID-19 outcomes. However, cancer is a heterogeneous group of diseases, encompassing a spectrum of tumour subtypes. The aim of this study was to investigate COVID-19 risk according to tumour subtype and patient demographics in patients with cancer in the UK. METHODS: We compared adult patients with cancer enrolled in the UK Coronavirus Cancer Monitoring Project (UKCCMP) cohort between March 18 and May 8, 2020, with a parallel non-COVID-19 UK cancer control population from the UK Office for National Statistics (2017 data). The primary outcome of the study was the effect of primary tumour subtype, age, and sex and on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and the case-fatality rate during hospital admission. We analysed the effect of tumour subtype and patient demographics (age and sex) on prevalence and mortality from COVID-19 using univariable and multivariable models. FINDINGS: 319 (30·6%) of 1044 patients in the UKCCMP cohort died, 295 (92·5%) of whom had a cause of death recorded as due to COVID-19. The all-cause case-fatality rate in patients with cancer after SARS-CoV-2 infection was significantly associated with increasing age, rising from 0·10 in patients aged 40-49 years to 0·48 in those aged 80 years and older. Patients with haematological malignancies (leukaemia, lymphoma, and myeloma) had a more severe COVID-19 trajectory compared with patients with solid organ tumours (odds ratio [OR] 1·57, 95% CI 1·15-2·15; p

Published
2020
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23. PURLs: A better approach to the diagnosis of PE

Author

Slattengren, Andrew H., Prasad, Shailendra, Bury, David C., Dickman, Michael M., Bennet, Nick, Smith, Ashley, Oh, Robert, Marshall, Robert, and Seehusen, Dean A.

Subjects
Male, Computed Tomography Angiography, Angiography, Venous Thromboembolism, Middle Aged, Unnecessary Procedures, PURLs®, Cohort Studies, Fibrin Fibrinogen Degradation Products, Humans, Female, Prospective Studies, Pulmonary Embolism, Lung, Algorithms, Biomarkers, Aged
Abstract

Validated diagnostic algorithms in patients with suspected pulmonary embolism are often not used correctly or only benefit subgroups of patients, leading to overuse of computed tomography pulmonary angiography (CTPA). The YEARS clinical decision rule that incorporates differential D-dimer cutoff values at presentation, has been developed to be fast, to be compatible with clinical practice, and to reduce the number of CTPA investigations in all age groups. We aimed to prospectively evaluate this novel and simplified diagnostic algorithm for suspected acute pulmonary embolism.We did a prospective, multicentre, cohort study in 12 hospitals in the Netherlands, including consecutive patients with suspected pulmonary embolism between Oct 5, 2013, to July 9, 2015. Patients were managed by simultaneous assessment of the YEARS clinical decision rule, consisting of three items (clinical signs of deep vein thrombosis, haemoptysis, and whether pulmonary embolism is the most likely diagnosis), and D-dimer concentrations. In patients without YEARS items and D-dimer less than 1000 ng/mL, or in patients with one or more YEARS items and D-dimer less than 500 ng/mL, pulmonary embolism was considered excluded. All other patients had CTPA. The primary outcome was the number of independently adjudicated events of venous thromboembolism during 3 months of follow-up after pulmonary embolism was excluded, and the secondary outcome was the number of required CTPA compared with the Wells' diagnostic algorithm. For the primary outcome regarding the safety of the diagnostic strategy, we used a per-protocol approach. For the secondary outcome regarding the efficiency of the diagnostic strategy, we used an intention-to-diagnose approach. This trial is registered with the Netherlands Trial Registry, number NTR4193.3616 consecutive patients with clinically suspected pulmonary embolism were screened, of whom 151 (4%) were excluded. The remaining 3465 patients were assessed of whom 456 (13%) were diagnosed with pulmonary embolism at baseline. Of the 2946 patients (85%) in whom pulmonary embolism was ruled out at baseline and remained untreated, 18 patients were diagnosed with symptomatic venous thromboembolism during 3-month follow-up (0·61%, 95% CI 0·36-0·96) of whom six had fatal pulmonary embolism (0·20%, 0·07-0·44). CTPA was not indicated in 1651 (48%) patients with the YEARS algorithm compared with 1174 (34%) patients, if Wells' rule and fixed D-dimer threshold of less than 500 ng/mL would have been applied, a difference of 14% (95% CI 12-16).In our study pulmonary embolism was safely excluded by the YEARS diagnostic algorithm in patients with suspected pulmonary embolism. The main advantage of the YEARS algorithm in our patients is the absolute 14% decrease of CTPA examinations in all ages and across several relevant subgroups.This study was supported by unrestricted grants from the participating hospitals.

Published
2019

24. Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes

Author

Marso, Steven P., McGuire, Darren K., Zinman, Bernard, Poulter, Neil R., Emerson, Scott S., Pieber, Thomas R., Pratley, Richard E., Haahr, Poul-Martin, Lange, Martin, Brown-Frandsen, Kirstine, Moses, Alan, Skibsted, Simon, Kvist, Kajsa, Buse, John B., Hansen, Liliana, Rabol, Rasmus, Bethel, Angelyn, de Lemos, James A., Senn, Stephen, Schwamm, Lee, Timmis, Adam, Alshekhlee, Amer, Bach, Richard G., Bertram, Therese M., Chaitman, Bernard R., Cruz-Flores, Salvador, Eckstein, Jane F., Feen, Eliahu S., Fisher, Simon J., Gosselin, Gilbert, Lim, Michael J., Rosenzweig, James L., Sherwin, Robert S., Tobin, Garry S., Vetrovec, George, Ziemer, David C., Daugaard, Gedske, Ozlem, Er, Pollak, Michael, Sengelov, Lisa, Ahn, Yu-Bae, Amod, Aslam, Benroubi, Mariana, Boonyavarakul, Apussanee, Canecki-Varzic, Silvija, Consoli, Agostino, Eliaschewitz, Freddy G., Franek, Edward, Jinnouchi, Hideaki, Khokhlov, Alexander L., Mithal, Ambrish, Philis-Tsimikas, Athena, Ong, Tiong Kiam, Pop, Lavinia, Reyna, Leobardo Sauque, Rodbard, Helena W., Roula, Daoud, Saravanan, Ponnusamy, Sesti, Giorgio, Sorli, Christopher, Sposetti, Georgina, Tinahones-Madueno, Francisco-Jose, Woo, Vincent, Berard, Lori, Caballero Mateos, Irene, Cooper, Alison, DeLuca, Clarisa, Fillary, Julie, Gan, Diyana Gan Abdul Rahman, Goondiwala, Amina, Tapia, Jessica, Busch, Robert, Chaykin, Louis, Hollander, Priscilla, Karounos, Dennis, Lane, Wendy, Lingvay, Ildiko, Odugbesan, A. Ola, Ohlson-Elliott, Theresa, Ovalle, Fernando, Pantalone, Kevin M., Phelps, Spencer, Pop-Busui, Rodica, Robertson, David, Shlesinger, Yshay, Silver, Robert, Warren, Mark, Arrar, Mohammed, Belkheir, Hassani, Benabbas, Youcef, Benferhat, Schahrazed, Benoun, Fatima, Bensalem, Samia, Bourezane, Samia, Elaoufi, Selmane Rafik, Gourine, Mouna, Hadjhabib, Mohamed, Hadjhamou, Fouzia, Hakem, Jamila, Kaouache, Nadjib, Khensal, Sabrina, Kitouni, Yacine, Lakhal, Lamine, Lezzar, Al-Kassem, Meftah, Imane Aicha, Mehenni, Lahouaria, Nouri, Nassim, Oumerzouk, Fatma, Sakouhi, Mounia, Talha, Kheira, Zemri, Zouaouia, Caeiro, Gabriela, Calveyra, Martha, Cluigt, Natalia, Geronazzo, Veronica, Lema, Silvina, Monferran, Pablo Martinez, Oviedo, Alejandra, Pozzi, Jose, Sala, Jorgelina, Schindler, Ana, Sernia, Virginia, Sicer, Maximiliano, Solis, Silvana, Varela, Patricia, Waitman, Jorge, Augusto, Gustavo Akerman, Alves, Breno, Alves, Erica, Barbosa, Luciana, Bona, Renata, Borges, Joao, Bosco, Adriana, Canani, Luis, Castro, Denise, Cavalcante, Lilian, Cechin, Laura, Cercato, Cintia, Chrisman, Carlos, Chrisman, Carolina, Cintra, Rebecca, Costa, Giselle, Fontenele, Ana Paula, Forti, Adriana, Francisco, Beatriz, Franco, Denise, Genestreti, Paulo, Gross, Jorge, Haddad, Ludmila, Halpern, Alfredo, Hissa, Miguel, Leanca, Camila, Leao, Beatriz, Marinho, Ana Elisabeth, Miranda, Isabela, Nunes, Adriano, Palhares, Fabiana, Poco, Christiani, Salles, Joao, Sampaio, Celia, Santomauro Jr., Augusto, Sartori, Carla, Sena, Rita, da Silva, Marina, da Silva, Paula, Siqueira, Katia, Turatti, Luiz, Valenti, Adriana, Vasques, Enio, Vencio, Sergio, Visconti, Guilherme, Belanger, Andre, Chilvers, Martyn, Dumas, Richard, Hurd, Carmen, Lafleche, Francois, Lam, Paul, Martinho, Valdemar, Palardy, Jean, Peterson, Sean, Raff, Errol, Sinnaeve, Linda, Sullivan, David, Baraban, Vedrana, Blaslov, Kristina, Bulum, Tomislav, Varzic, Silvija Canecki, Berkovic, Maja Cigrovski, Balen, Marica Jandric, Kruljac, Ivan, Lesnjakovic, Silvija, Lucijanic, Tomo, Majic, Ana, Rahelic, Dario, Smircic-Duvnjak, Lea, Vrkljan, Milan, Zibar, Karin, Zukanovic, Sidbela, Athanasopoulou, Elpida, Benis, Apostolos, Benroubi, Marian, Diakoumopoulou, Evanthia, Doupis, John, Griva, Theodora, Kazakos, Kyriakos, Kypraios, Nikolaos, Liatis, Stavros, Makrilakis, Konstantinos, Markou, Athina, Pagkalos, Emmanouil, Papanastasiou, Labrini, Piaditis, George, Sampanis, Christos, Siami, Evangelia, Tentolouris, Nikolaos, Tsiama, Vasiliki, Zografou, Ioanna, Adling, Pravishal, Ali, Mazher, Anjana, R. M., Arora, Arpita, Ayyar, Vageesh, Banerjee, Suvro, Bantwal, Ganapathi, Bhagwat, Nikhil, Bhattacharyya, Arpandev, Bhawarlal, Anandakumar, Chakraborty, Rabin, Chatterjee, Sanjay, Chaudhury, Tirthankar, Chowdhury, Subhankar, Damelia, Priyal, Das, Mrinal, Das, Sambit, Desai, Ankush, Devru, Nandani, Farooqui, Khalid, Ganie, Mohd Ashraf, George, Belinda, Ghosh, Debasis, Girithara, Gopalakrishnan, Haribhai, Zinzuwadia, Jain, Nupur, Jassar, Amandeep, Joshi, Ameya, Kale, Dilip, Kale, Shailaja, Kelwade, Jayant, Khatri, Ashok, Kulshreshtha, Bindu, Majumder, Bikas, Manikath, Neeraj, Margekar, Shubhalaxmi, Marwah, Tiven, Mathew, Vivek, Moulick, N. D., Mutha, Abhay, Muthu, Ramuu, Nalawade, Asmitha, Narvencar, Kedareshwar, Pandit, Kaushik, Pangtey, Ghanshyam, Parthasarathy, B., Phatak, Sanjeev, Prakash, Anupam, Prusty, Pitambar, Radhakrishnan, Chandni, Raja, Indu, Ravikumar, Ranjani, Saboo, Banshi, Sachdeva, Isha, Sangeetha, S., Selvam, Kasthuri, Sethi, Bipin, Shah, Asha, Shah, Harshal K., Shah, Priyanshu, Shah, Rushit, Shaikh, Sajid, Shaikh, Shehla, Singh, K. P., Sivagnanam, Nallaperumal, Tandon, Nikhil, Thonangi, Rajesh, Thulaseedharan, N., Toraskar, Kedar, Varthakavi, Premalatha, Yadav, Sameer, Andreozz, Francesco, Arturi, Franco, Baldassarre, Maria Pompea Antonia, Barone, Milena, Bonura, Alice, Bucciarelli, Loredana, Buscemi, Chiara, Buscemi, Silvio, Carnovale, Anna, Caselli, Chiara, Ceci, Gloria, Cimino, Elena, Colella, Alessandra, Crippa, Valentina, Cufone, Sabrina, D'Erasmo, Laura, De Remigis, Alessandra, Di Bartolo, Paolo, Dionisio, Rosa, Disoteo, Olga, Fabietti, Marcella, Febo, Fabrizio, Filetti, Sebastiano, Genovese, Stefano, Ginestra, Federica, Grancini, Valeria, Grieco, Elvira, Magistro, Andrea, Maranghi, Marianna, Monti, Lucilla, Orsi, Emanuela, Pellicano, Francesca, Pergolini, Daniela, Perticone, Francesca, Piatti, PierMarco, Pizzi, Gianluigi, Rondinelli, Maurizio, Rossi, Margherita, Rubino, Mariangela, Setola, Emanuela, Succurro, Elena, Tarquini, Giovanna, Tiseo, Giusy, Tonolo, Giancarlo, Villa, Valentina, Hong, Stefania Vo, Amano, Kazushi, Hachiya, Remi, Hieshima, Kunio, Hirao, Koichi, Hisatake, Tomoko, Honda, Ritsuko, Ihana, Noriko, Inoue, Kaori, Iwamoto, Yasuhiko, Jinnouchi, Tomio, Kajiwara, Keizou, Kawazu, Shoji, Kikuchi, Masatoshi, Kikuchi, Takako, Koike, Yoko, Komatsu, Mitsuhisa, Kumakura, Atsushi, Kurinami, Noboru, Kushiyama, Akifumi, Maeda, Hajime, Matsuda, Toshihisa, Nakamura, Shuji, Nakayama, Koujin, Nishio, Shin-ichi, Onishi, Yukiko, Sato, Nobuyuki, Sato, Yoshihiko, Shirabe, Shinichiro, Sugiyama, Seigo, Suzuki, Tomoko, Tahara, Tazu, Takao, Toshiko, Takei, Masahiro, Takemoto, Ikutaka, Takeshige, Keiko, Tanaka, Kentaro, Taniguchi, Shotaro, Tsujimoto, Tetsuro, Tsukuda, Katsunori, Wakabayashi, Sayaka, Yamazaki, Masanori, Yoshida, Yoko, Yoshimoto, Ayako, Abidin, Imran Zainal, Abdullah, Shahrin Tarmizi Che, Adam, Noor Lita, Ahmad, Madihah, Ahmad, Nik Nur Fatnoon Nik, Amin, Nor Hanim Mohd, Aw, Cheng Yew, Cham, Yee Ling, Chong, Hui Min, Chua, Seng Keong, Fauzi, Sharifah Aisyah Shahabudin Syed Ahmad, Fong, Alan Yean Yip, Ghapar, Abd Kahar Abd, Hanafi, Norliza, Abu Hassan, Muhammad Radzi, Iberahim, Rahimah, Khiew, Ning Zan, Lee, Gary Chin Keong, Lingam, Rakesh, Long, Richard Chay Shien, Mahendran, Kauthaman A., Oon, Yen Yee, Said, Asri, Sothiratnam, Radhakrishna, Sridhar, Ganiga Srinivasiah, Suan, Mohd Azri Mohd, Tan, Sian Kong, Tey, Julian Hock Chuan, Undok, Abdul Wahab, Waid, Anuar, Vijayasingham, Shalini, Voon, Chi Yen, Yew, Kuan Leong, Yong, Lit Sin, Aguilar-Parra, Lilia, Aguirre, Karen, Alvarez-Carrillo, Rebeca, Arechavaleta-Granell, Maria, Baez-Campos, Aurelia, Bayram Llamas, Edmundo Alfredo, Calvo-Vargas, Cesar, Cedano-Limon, Marielena, Beltran Jaramillo, Teresita de Jesus, de Jesus Marin-Lopez, Jose, Ruiz Cornejo, Maria de Jesus, Juarez Cervantes, Maria del Carmen, Estevez de Alba, Isabel, Estrada Garcia, Raul, Estrada, Suellen, Garza-Vergara, Marisol, Gonzalez-Perez, Rosa, Gonzalez-Valencia, Carlos, Guerrero-Reyes, Rosalinda, Haro Ortiz, Jose Alfredo, Hernandez Salazar, Eduardo, Illescas Diaz, Iris, Illescas Diaz, Jesus, Loredo, Imelda, Jimenez-Ramos, Silvia, Larios-Mora, Diana, Lopez Garcia, Maria Elena, Lopez-Serrano, Julieta, Martinez-Nolasco, Bertha, Nunez Marquez, Ricardo, Pacheco Aranda, Elizabeth, Peralta-Cantu, Irving, Perez Chagollan, Ana, Ramirez, Maria, Robledo Duron, Israel, Rodriguez Briones, Ignacio, Rodriguez, Maria, Sauque Reyna, Leobardo, Vazquez-Ceja, Adriana, Vera-Bocanegra, Alejandro, Vidrio Velazquez, Maricela, Contreras Sandoval, Aleida Yael, Bartelik, Karol, Bilska, Aleksandra, Biniszkiewicz, Tomasz, Bogdanski, Pawel, Chamienia, Agnieszka, Cieslak-Puchalska, Anna, Czochra, Wojciech, Gajewski, Bogdan, Gromniak, Elwira, Holda, Ewa, Jaskulska-Gorzelewska, Barbara, Jedynasty, Krystyna, Kloda, Elzbieta, Kmak-Balawender, Beata, Kobielusz-Gembala, Iwona, Konieczny, Marek, Kramarczuk, Elzbieta, Kuleta, Jerzy, Lesniewski, Robert, Lominska, Teresa, Lukaszewicz, Monika, Majewska, Izabella, Mlynarski, Tomasz, Mostowy, Aleksandra, Rybak, Anna, Skrypnik, Damian, Wolny, Malgorzata, Zmuda, Witold, Buduru, Alina Nicoleta, Cif, Adriana, Cozma, Mihaela, Crisan, Carmen, Barbonta, Cristian Gelu, Barbonta, Diana, Mihalcea, Madalina, Mociran, Mihaela, Muresan, Sorina, Popescu, Alexandrina, Pruna, Luchiana, Sandu, Nadia Ramona, Suleac, Oana Andreea, Vincze, Eva Cornelia, Andreeva, Elena, Berns, Svetlana, Barykina, Irina, Bernitcyna, Angela, Bezdenezhnykh, Natalia, Chumachek, Elena, Demarina, Svetlana, Didenko, Anna, Dubinina, Nadezhda, Dzherieva, Irina, Elsukova, Olga, Esenyan, Lev, Filippova, Ekaterina, Gabova, Nadezhda, Garina, Irina, Glikman, Yulia, Glova, Svetlana, Goncharova, Ekaterina, Gorbatova, Elena, Gordeev, Ivan, Grigorian, Inessa, Gromova, Svetlana, Ipatko, Irina, Karaban, Elena, Katushkina, Yulia, Kaygorodtseva, Olga, Kerova, Irina, Khaisheva, Larisa, Khmelnitskiy, Oleg, Khokhlov, Alexander, Khokhlov, Mikhail, Khorolets, Ekaterina, Klyuenkova, Elena, Konovalova, Olga, Korneva, Ksenia, Kosmacheva, Elena, Kunitsyna, Marina, Kupriyanova, Tatiana, Kuznetsova, Natalia, Lantseva, Olga, Ledyaeva, Alla, Lileeva, Elena, Markovich, Alexander, Martirosian, Narine, Maslova, Alisa, Milyukova, Galina, Mokhova, Irina, Nagirniak, Olga, Nastina, Elena, Nedogoda, Sergei, Orlova, Valeriia, Svetlana, Otarova, Ostapenko, Marina, Papaskiri, Nino, Pavlikova, Elena, Peskov, Andrey, Petrik, Galina, Petrov, Alexander, Petunina, Nina, Platonov, Dmitry, Poliakova, Yulia, Potapova, Zhanna, Pribylova, Svetlana, Razumovsky, Igor, Redkin, Alexander, Rodionova, Tatyana, Rudenko, Evgenia, Rykalina, Natalia, Salasyuk, Alla, Semikina, Tatiana, Serebryakova, Inna, Shanina, Larisa, Shmidt, Evgenia, Sinitsina, Olga, Smetanina, Svetlana, Smirnova, Marya, Smirnova, Victoria, Smolentseva, Nadezhda, Sobolev, Alexander, Soldatenkova, Anna, Soldatova, Yulia, Speshilova, Svetlana, Startseva, Olga, Strezhova, Larisa, Strongin, Leonid, Suplotova, Lyudmila, Suvorova, Daria, Tepaeva, Alisa, Trukhina, Liubov, Tyugaeva, Alisa, Vasyutkova, Olga, Vinokurova, Valentina, Yukhno, Elena, Yuzhakova, Natalia, Zagrebelnaya, Olga, Zalevskaya, Alsu, Zhukova, Elena, Aomar Millan, Ismael, Beltran Romero, Luis M., Ignacio Fernandez Navarro, Jose, Carlos Ferrer Garcia, Juan, Garcia Blasco, Lourdes, Garcia Garcia, Clara, Garcia Puig, Juan, Girbes Borras, Juan, Inigo Zaera, Pilar, Lopez de la Torre, Mart-n, Martinez Alfaro, Baldomera, Morales Portillo, Cristobal, Romero Sanchez, Paloma, Sebastian Ochoa, Nerea, Serrano Olmedo, Isabel, Tinahones Madueno, Francisco, Torres Jimenez, Rosa, Adeyemo, A. O., Bassa, Ayesha, Bhorat, A., Bhorat, Qasim, Blacking, Laura, Burgess, Lesley, Coetzee, Kathleen, Conradie, Hillet, Cyster, Henry, Distiller, Larry, Ellis, G. C., Gani, Mashra, Gordon, Debra, Govender, Parimala, Govender, Thirumani, Govender, Vimladhevi, Jivan, Daksha, Joffe, Barry, Jooma, Yaseer, Kaplan, Hilton, Komati, Stephanus, Kramer, Brian, Kruger, Sieglinde, Landau, Stanley, Latiff, Gulam, Maritz, L., Matthews, Peter, Middlemost, S. J., Ngcakani, Nomangesi, Nortje, Hennie, Osman, Yasmin, Padayachee, Trevenesan, Podgorski, Gracjan, Potts, Jenny, Pretorius, Catharina, Prozesky, Hans, Snyman, Hans, Tayob, Mohammed, Urbach, Dorothea, van der Merwe, Maryke, Vorajee, Haroon, Wilson, Nadine, Wing, J. R., Lee, Jie Eun, Ahn, Chang Ho, Kim, Nam Hoon, Kim, Sun Hwa, Hwangbo, Yul, Ko, Sun Hye, An, Jee Hyun, Ko, Seung Hyun, Lee, Ji Hyun, Noh, Jung Hyun, Ji, Myeong Jin, Kim, Kyeong Jin, Jung, Chan-Hyeon, Kim, DongJun, Kim, Kyongyoung, Kim, Lee-Kyung, Kim, SinGon, Kim, Eun Ky, Lee, Dong-Hwa, Cho, Young Min, Moon, Shin-Je, Oh, Chang-Myung, Hong, A. Ram, Park, Kyeong Seon, Yun, Jae Seung, Hong, Jae Won, Kim, Hee Young, Buranapin, Supawan, Deerochanawong, Chaicharn, Hengjeerajarus, Natavuth, Kosachunhanun, Natapong, Kuanprasert, Srun, Kunavisarut, Tada, Laortanakul, Rungnapa, Mangklabruks, Ampica, Phornphutkul, Mattabhorn, Prasitdamrong, Hutsaya, Snabboon, Thiti, Sriwijitkamol, Apiradee, Suwanwalaikorn, Sompongse, Tantiwong, Puntip, Tejavanija, Sirakarn, Vorasettakarnkit, Yongkasem, Alasabbagh, Samer, Bagais, Christos, Bingley, Polly, Borthwick, Les, Brett, Barbara, Davidson, Sue, Ewing, Jane, Garesse, Robert, Gillani, Syed, Gkastaris, Konstantinos, Herring, Roselle, Illsley, Graham, Johnson, Andrew, Kaplan, Felicity, Lonnen, Kathryn, Malcolm, Ellen, McCrimmon, Rory, Mcknight, John, Nair, Rajiv, Patel, Vinod, Pearson, Ewan, Raghavan, Rajeev, Raj, Suchitra, Russell-Jones, David, Sampson, Mike, Singh, Baldev, Sukamer, Nithya, Turner, Jeremy, Venkataraman, Hema, Viljoen, Adie, Wake, Deborah, Barnes, Cassandra, Boyd, Gary, Childress, Gwen, Coleman, Debora, Combs, Judy, Davis, Leon, Davison, Kentress, DeAtkine, David, Dunaway, Linda, Duncan, Janet, Hibbard, Nina, Martin, Melissa, Nichols, Melissa, Painter, Karolynn, Perkins, Tammy, Quinney, Rosylen, Raymond, Katrina, Roney, Christopher, Sanchez, Gilberto, Sosnowchik, James, Sultan, Farah, Talley, Shellie, Trippe, Bruce, Tuck, Pamela, Vaughan, T., Warriner, Amy, Watts, Tamara, Williams, Hayes, Abidov, Aiden, Abidov, Yulia, Anderson, Corey, Avila, Vanessa, Baraniak, James, Berry, Barbara, Bessette, Lynn, Blackwell, Gina, Burrows, Jennifer, Caldron, Meghan, Chang, Chui-An, Collins, Elizabeth, Crawford, Meli'sa, Delfin, Katherine, De'Loera, Jessie, Dokken, Betsy, Feld, Lawrence, Gill, Ryan, Gordon, James, Gordon, Rachel, Gullick, Nicole, Gutierrez, Diane, Harrison, Larissa, Haught, Annamarie, Hemmila, Karin, Hendrickson, Darell, Horsley, Craig, Hsu, Connie, Jerrell, Maggie, Kertesz, Briana, Khananisho, Paulina, Lenzmeier, Sonia, Lenzmeier, Thomas, Lipschitz, Barbara, Lonquist, Mark, Mather, Dana, (Shelley) Miceli, Michelene, Norris, Gwenth, Padilla, Ann Marie, Petersen, Dena, Riffer, Ernie, Scott, Susan, Sheridan, Kathryn, Smith, Misty, Stump, Craig, Thomson, Stephen, Torok, Ernese, Vesely, Kelly, Vincent, Tom, Wilson, Christy, Wilson, Sandra, Agarwal, Monica, Appleberry, Kady, Barden, M. Gregg, Brickell, Lorrie, Bravo, Eric, Cassis, Cady, Covington, Becky, Devine, De'Andrea, Dishongh, Katherine, Dugger, Joseph, Evans, Lauren, Francis, Spencer, Johnson, David, Koneru, Kalyana, Kurck, Sheryl, Lingisetty, Chandra, Menke, Jennifer, Miller, Beatrice, Montgomery, Cristal, Nimmo, Teresa, Pace, Daniel, Pellegrino, Richard, Rose, Joseph, Straub, Karl, Stubbs, Amanda, Thomas, Leslie, Thrasher, James, Thrasher, Lesa, Wijewardane, Priyantha, Williamson, Kimberly, Acevedo, Lizeth, Ahmad, Aakif, Andresen, Teri, Anderson-Berman, Nancy, Ayele, Etsegenet, Baker, Janice, Banares, Arlene, Barsalou, Thea, Becker, Steven, Benavidez, JoAnn, Benitez, Guadalupe, Bernstein, Richard, Bhasker, Kala, Blain, Arthur, Blustin, Joy, Bughi, Stephanie, Carney, Kimberly, Castro, Gerardo, Catangay, Jennifer, Chambers, Joseph, Chan, Eve, Chang, Amy, Chang, Anna, Chavous Jr., Donald, Chen, Constance, Chiu, Ken, Chochinov, Ronald, Chu, James, Cleghorn, Monica, Cohen-Gadol, Shariar, Cokely, David, Collins, Michelle, Collins, Yolanda, Colomy, Carissa, Cruz-Corona, Yolanda, Cunnea, Virginia, Dailey, George, Dang, Andy, Dang, Trinh, De La Luz, Mabel, Delgadillo, Rico, Delgado, Michael, Desta, Taddese, Doriguzzi, David, Dulgeroff, Anthony, Einhorn, Daniel, Emery, Pamela, Figueroa, Martin, Fink, Raymond, Flowe, Chelsea, Flowers, Francesca, Fregosi, Julie, Garcia, Gabriel, Garcia, Maria, Gaudiani, Linda, Gawad, Michael, Ghattas, Sam, Gilroy, Christine, Gonzalez, Viviana, Gonzalez, Yadira, Guadron-Hernandez, Liliana, Ha, Thu, Haas, Terry, Harbison, Judy, Hernandez, Graciela, Hernandez, Robert, Herrera, Nancy, Ho, Vincent, Hsu, Kang, Humphries, Denise, Huynh, Vincent, Jacobs, Shahram, Jardula, Michael, Jarman, Cheryl, Kabongo, Martin, Kafri, Hassan, Kaplan, Roy, Kim, Grace, Kobayashi, Gary, Korff, Gary, Kowalick, Alexandra, Levin, Ellis, Lewis, Erin, Lisovskiy, Svetlana, Luu, Hieu, Malkhassian, Daniel, Maletz, Louis, Martinez, Geraldine, Martinez, Gilbert, Martinez-Miss, Salomon, McCallum, James, Melikian, George, Metcalf, Francine, Michlin, Bernard, Michlin, Shira, Mitchell, Anitha, Moattari, Ali Reza, Montano-Pereira, Cynthia, Moon, Mia, Naderi, Bahar, Nagata, Jenna, Nguyen, Christopher, Norwood, Paul, Garcia, Sagrario Olmos, Olsen, Sharon, Pardino, Aarika, Parkes, Kathleen, Pascal, Aileen, Patel, Mihir, Paulson, Carolyn, Pernia, Kay, Perez, Marisol, Pham, David, Presant, Larry, Preston, Krista, Reeves, Laurie, Richards, Jessica, Rios-Santiago, Jessica, Risser, Joseph, Rodriguez, Silvia, (Cherrie) Rosal, Rosario, Rosenblit, Paul, Rosero, Raquel, Sadler, Chris, Samoa, Raynald, Sanchez, Liliana, Schaeffer, Cynthia, Schwartz, Alan, Scott, Christopher, Scott, Courtney, Scott, Cranford, Shartel, Jo-Ann, Shaw, Sylvia, Sivalingam, Kanagaratnam, Sligh, Scott, Sligh, Teresa, Smith, Bradley, Soler, Daniel, Spencer, Torre, Stalters, Sophia, Stone, Jenine, Szlachcic, Yaga, Thorsell, Ashley, Tu, Zhongheng, Unger, Jeffrey, Vela, Teresa, Walton, Anita, Whittle, Jessica, Wilson, Lou Ellen, Wing, Zandra, Wright, Philippa, Wyman, Shannan, Yao, Ni, Zlock, Douglas, Baker, Chelsea, Bakkum, Robyn, Bird, C. David, Carangi, Gwen, Cohen, Kenneth, Daza-Taylor, Kristen, Diesburg-Stanwood, Amy, Douglass, Sara, Finck, Lani, Karaboitis, Krisoula, Kerstein, Howard, Lesh, Kurt, Loesch, Ryan, McClure, Lori, Nevarez, Max, Pavol, Bristol, Rasouli, Neda, Rockler, Briana, Sanagorski, Rebecca, Solano, Royce, Underkofler, Chantal, Van Winkle, Rebecca, Weiss, Sarah, White, Katherine, Wirtemburg, Patricia, Zarrabi, Lida, Zemel, Leonard, Barchini, George, Casagni, Kimberely, Cordisco, Marie Elena, Davis, Amanda, Duffy-Hidalgo, Bobbi, Huntley, Richard, McNicol, Donald, Miller, Neil, Mukwaya, Margaret, Northrup, Patricia, Platt, Jonathan, Rabideau, Diane, Randolph, Pamela, Rose, Suzanne, Samuel, James, Savino, Robert, Soufer, Joseph, Torello, Carole, Abinader, Azarel, Agosto, Milagos, Aguirre, Frank, Alexander, Lori, Almanza, Orlando, Alvarez, Dalia, Anees, Muhammad, Aqua, Keith, Arazo, Luz, Asberry, Claudia, Ashley, Alyssa, Balentine, Tracy, Barta, Melissa, Bertot, Ivan, Binns-Leon, Michelle, Borello, Nora, Bostick, Janette, Boucher, Loria, Braddy, Dalton, Breton, Cristian, Broxton, Bridgitte, Burke, Deborah, Cabielles, Tania, Calderon, Juan, Canaan, Yamil, Canelon, Gustavo, Cardona, Jose, Castillo-Gonzalez, Sheila, Castro, Kenia, Chacon, Jessica, Chehade, Joe, Church, Lara, Cohen, Lisa, Crews, Erin, Cromer, Carol, Cromer, Michael, Cuello, Jorge, Cusi, Kenneth, de Leon, Karel, Delgado, Edmund, Delima, Selma, Denson, Janneral, DeVries, Benjamin, Diaz, Maritza, Digon, Beningo, Dowell, Michelle, Dunn, Kelly, Ellington, Dickson, Emerick, George, Encarnacion, Frances, Ezell, Leslie, Fahmie, Ashley, Fernandez, Noel, Figueredo, Rommel, Flores, Patricia, Fonseca, Juan, Freeman, Alain, Freeman, Erica, Frias, Juan, Garcia, Lazaro, Geronilla, Giovanni, Hamilton, Maxine, Hanabergh, Rodolfo, Hanson, Lenita, Harris, Kim, Hasan, Syed, Hendrick, Mary, Hicks, Melissa, Hoffman, Lara, Holt, Antoniwa, Hutchinson, Rachel, Iparraguirre, Harold, Janicka, Ania, Janovitz, Richard, Jones, Dawn, Jones, Sarah, Kaplun, Polina, Kelijman, Mirtha, Kersey, Angela, Khan, Ashraf, Khan, Misal, Kirk, Gregory, Konwai, Ada, Kovar, Meghan, Kutner, Mark, Lafaille, Jimmy, Leach, Dana, Levenson, David, Lewy-Alterbaum, Lorena, Light, Timothy, Lo, Margaret, Loman, Lusiana, Long, Sarah, Love, Jeremy, Madera, Arelis, Magee, James, Mallitz, Michelle, Marquez, Farid, Marshall, Richard, Mary, James, Mateu, Janet, McKenzie, Leanna, McKenzie, Rona, McKenzie, Wilfred, Mendelson, Reina, Mendez, Janet, Merlos, Ledis, Mierau, Jennifer, Miller, Robert, Miranda-Palma, Bresta, Montoya, Carla, Navarro, Eduardo, Neller, Christian, Nossa, Janette, Osborn, Tracey, Patel, Bijal, Penabad, Jesus, Perez, Gilberto, Pineda, Daniel, Pinero-Pilona, Antonio, Platt, George, Prestwood, Elfrida, Quintero, Luis, Rengifo, Rodney, Reyes, Dannier, Rivas, Aolani, Rivero, Mileydis, Robinson, Sonya, Robison, Dawn, Rodriguez, Dalier, Rodriguez, Ivete, Rodriguez, Toni, Rosario, Cristobal, Rosenwasser, Rebecca, Roura, Miguel, Schramm, Erich, Schramm, Rashi, Schweppe, Laurie, Segel, Scott, Sepulveda, Maria, Sheets, Lori, Shields, Karen, Smith, Krystal, Smith, Meridith, Somerstein, Claudia, Solano, Maria, Suarez, Manuel, Suarez, Omar, Suarez, Rogelio, Suarez, Victor, Sultan, Senan, Sutton, David, Szilagyi, Istvan, Thorne, Margaret, Travaglini, Stefano, Trevino, Miguel, Uriarte, Oscar, Vizcaino, Luis, Wadud, Khurram, Wehmeier, Kent, Weinstein, Debra, Welch, Celeste, White, Alexander, White, Basil, Williams, Tammy, Williamson, Cathi, Zwick, Lisa, Adams, Cynthia, Arkin, David, Bode, Bruce, Bonner, Sheila, Bonner, Wes, Bowen, Danielle, Bradley, Brooke, Bradley, Paul, Brennan, Elizaebeth, Brown, Cynthia, Brown, De'Aira, Burgess, Elizabeth, Collett, Taryn, Cook, Jennifer, Corse, Steven, Dukes, Kaitlyn, Durrence, Jenna, Dutton, Robin, Estes, Susie, Falcone, Laura, Gaskin, Katherine, Goswami, Ketan, Hart, Mari, Jester, Donni, Kies, Staci, Leiker, Abigail, Lu, Peter, Mahakala, Aparna, Maher, Maxine, Miller, Alan, Miller, Todd, Munoz, Miguel, Musto, Michele, Odugbesan, Adeniyi, Olson, Darin, Osborn, Nicole, Pace, Kerri, Pajkovic, Gordana, Paulus, Carolyn, Phillips, Lawrence, Reddick, William, Reed, John, Rowe, Shasta, Sadler, Barney, Sapp, Tabby, Savoye, Louise, Shore, David, Shuman, Susan, Sittle, Jessica, Standard, Shana, Wardell, Karla, Workman, Amy, Carreira, Tabitha, Fitz-Patrick, David, Hean, Vutheary, Limcolioc, April, Nihei, Megan, Park, Youngmee, Pau, Cindy, Shannon, Lindsey, Trotter, Alanna, Williams, Sierra, Coughenour, Tiffany, Liljenquist, John, Vance, Carl, Williams, Jonathan, Agaiby, Eva, Agaiby, John, Argo, Kelly, Azad, Nasrin, Backus, Arnetta, Bartlett, Andrew, Bellucci-Jackson, Jennifer, Boncu, Otilia, Brodt, Pamela, Carlson, Hope, Collins, Kathleen, Delibasic, Maja, Dor, Isaac, Dukett, Mary, Emanuele, Nicholas, Gabel, Faith, Giardino, Alexandra, Hoelzer, David, Hsieh, Annming, Jayaramaiah, Poornima, Kearney, Tracy, Kelley, Kathleen, Kravarusic, Jelena, Lawless, Andrea, Maheshwari, Hiralal, Martin, Elonia, McCall, Linda, Mikell, Frank, Nallala, Deepika, Said, Sufyan, Sakla, Nadia, Schiferi, Joanna, Smith, Patricia, Stokes, John, Sugimoto, Danny, Sugimoto, Michael, Swan, Delores, Alfata, Sarab, Beavins, Jill, Bogardus, Christine, Bogardus, Donald, Calvert, Brittany, Calvin, Krystle, Carlton, Kristin, Condit, Jonathan, Cornett, George, Covert, Carissa, Dela Llana, Alexander, Dixon, Rosie, Felker, Dean, Fogle, Sara, Harris, Leslie, Hoebeke, Roberta E., Silva, Ricardo, Johnson, Tabitha, Johnston, Kelly, King, Jennifer, Lang, Amber, Maynard, Kenneth, McDaniel, Vickie, McGrath, Caitlin, Moretto, Thomas, Ndukwu, Ikeadi, O'Connor, Leo, O'Connor, Thomas, Oliver, Tonya, Overmars, Stephanie, Patel, Minesh, Patterson, Geraldine, Powell, Talessa, Raphael, Annmarie, Raphael, Rod, Reedy, Mark, Reyes, Hubert S., Ridge, Terry, Rutherford, Mary S., Sebastian, Mike, Shaeffer, Laura, Sheets, Michelle, Thomas, Karen, Trueblood, Nancy, Tucker, Tiffany, White, Adrian, Wooldridge, Evan, Wright, Alison, Zapinski, Dawn, Cieloha, Megan, Coker, Clarine, Fletcher, Cherisa, Kay, Jennifer, Larsen, Katelyn, Marar, Isam, Motz, Zachary, Paul, Jamie, Pokorski, Alan, Rabadi-Marar, Diana, Scheideler, Kylie, Sobczyk, Jill, Sweeney, Kolbie, Brink, Nathalie, Buth, Dennis, Grimes, Katlyn, Lakin, Gregory, Loewen, Barbara, Secrist, Neal, Simon, William, Steere, Diane, Talbot, Kimberly, Wheeler, Christina, Adams, Derick, Armour, Wilhelmina, Asher, Whitney, Bays, Harold, Behl, Noreen, Conn, Brittany, Dye, Lyndsey, Earl, Jennifer, Farris, Neil, Figueroa, Sergio, Fruit, Olivia, Hobbs, Coury, Howard, Kristen, Jackson, Tamara, Kain, Angela, Karounos, Chrisi, Keiran, Sarah, Kennedy, Ryan, King, Kara, Krishnasamy, Sathya, Lambdin, Winona, Micklewright, Gezina, Mokshagundam, Sri, Mooney, Stephen, Moore, Melanie, Morgan, Denise, Morley, Robert, Newsome, Stacy, Nichols, Jennifer, Nims, Diana, Nockerts, Nichole, Oremus, Ruth, Ritchey, Barbara Michelle, Shelton, Christina, Smith, Danielle, Walker, Debra, Weiter, Kathleen, Whitehead, Rebecca, Wood, Robert, Woodruff, Robin, Young, J. DeShay, Alper, Arnold, Berry, Martha, Gauthier, Nadine, Griffin, Catina, Haynes, Elvia, Lawrence, Jereta, McCormack, Teraina (Terry), Midyett, Catherine, Rangaraj, Uma, Smith, William, Stricker, Makenzie, Tandron, Ileana, Vargas, Ramon, Wagner, Michele, Albert, Marie, Baillargeon, Gail, Stephens, John, Aroda, Vanita, Dempsey, Michael, Junker, Herman, Lopez, Meyling, Shepard, Marc, Ciccarelli, Carol, Datu, Joycelyn, Gallagher-Dorval, Karen, Hartigan, Celia, Kowaloff, Edward, Lock, John-Paul, Rosano, Nina, Shaw, Bernadette, Thompson, Michael, Abbo, Camerin, Anton, Salwan, Baker, Lydia, Bhan, Arti, Blackmer, Karla, Boley, Bryon, Hyde, Desirae, Bonema, John, Carlin, Tamara, Curran, Nancy, Dandois, Bethani, Dermyer, Abigail, Dubeck, Janet, Elkins, Jennifer, Ferris, Pamela, Fraser, Neil, Kozma, Julia Gargan, Gasparovich, David, Grodman, Robert, Hampson, Jaison, Hewitt, Mitzie, Hiatt, Judy, Hopkins, Ashley, Howard, Jennifer, Joliat, John, Joliat, Jonathan, Kalt, Steven, Katzman, Steven, Kogelman, Jesse, Kruger, Davida, Kurkowski, April, Lambert, Jodi, Levcovici, Elisabeta, Lockwood, Karen, Lumberg, Michael, McMullen, Lindsay, Meyers, Peter, Minto, Carrie, Nelson, Tina, Neuner, Gregory, Nurmi, Kevin, Perkins, Judy, Plunkett, Cynthia, Ruoff, Gary, Samantray, Julie, Sawah, Ahmed, Secord, Samantha, Seyoum, Berhane, Sherman, Sarah, Simpson, Michael, Sinkoff, Mark, Skoney, Joseph, Small, Jami, Szerlong, Heidi, Tinetti, Timothy, Toomey, Adam, VanDerWerff, Holly, Whitehouse, Fred, Wilkins, Raechelle, Wolf, Stephanie, Yarows, Steven, Eldred, Edward, Hester, Kim, Huling, Randall, Moore, Kerry, Preslar, Kristina, Proge, Nakia, Smith, Lora, Young, Gerri, Bybee, Kevin, Carr, George, Case, Christopher, Forker, Alan, Goeke, Lindsay, Kocher, Darlene, Lin, Oscar, Littlefield, James, Mendoza, Robinson, Moore, Michelle, Oberhaus, Barbara, Reed, Larry, Rutherford, Cheryl, Windsor, Sheryl, Ackerman, Kim, Christensen, Reed, De Souza, Jose, Douglas, Kirsten, Hrncirik, Therese, Lefkowicz, Magen, McDonnell, Lindsey, Severa, Larry, Tjaden, Jeffrey, Ward, Laura, Addison, Shayla, Anderson, Robert, Baker, Claire, Baum, Robert, Belitz, Jenny, Boerner, Shannon, Desouza, Cyrus, Drincic, Andjela, Fitzgibbons, William, Francis, Jessica, Garvin, Maureen, Goldner, Whitney, Goodrich, Melissa, Grubbs, Lisa, Hatcher, Theresa, Hochstein, Renee, Hunter, Christine, Keuchel, Janet, Konigsberg, Sarah, Kuechenmeister, Lisa, Mack, Lynn, McKnight, Thomas, Mensik, Hanna, Mitchell, Jan, Moeller, Jennifer, Montanez, Edward, Montoya, Paul, Nemecek, Tiffany, Neumeister, Amy, Newcomb, Jefferey, Pracht, Shelby, Radke, Kaitlin, Rahman, Jennifer, Renter, Samantha, Reynolds, Jill, Grace Rodriguez, Maria, Satorie, Jessica, Schiermann, Lynnda, Severson, Megan, Shivaswamy, Vijay, Snyder, Janice, Tillson, Renee, Vasey, Andrew, Wahl, Timothy, Weeks, William, Wolf, Thomas, Springer, Brian, Mitchell, Janice, Woodruff, Mark, Alvarez, Isis, Bowers, Rachel, Cala-Anaya, Franklin, Castellanos-Rodriguez, Rudiber, Christopher, Janice, Concepcion, Gelvis, Fernandez, Dareana, Ghanem, Paula, Harmon, Nicolette, Kaiser, Heather, Kaplan, Westbrook, Klugh, Serena, Le, Nicholas, Lehrner, Stephanie, Lopez, Robert, Martin, Olga, Martinez, Tina, Martini, Nicole, Molin, Clifford, Nakhle, Samer, Newsome, Yvonne, Neylon, Ellen, Olsen, Jarvis, Palal, Betsy, Philander, Peter, Rosario, Adriana Ruiz, Sanchez, Mary, Sierra-Garcia, Miguel, Smith, Myesha, Trenche, Samuel, Trippi, Danna, Vernetti, Nicholas, Villegas, Laura, White, Briana, Wilcox, Simmon, Carmolli-Cornette, Lisa, Chuang, Ellie, Hoffman, Sheila, Laliberte, Alison, Marshall, Lisa, Meroski, Pamela, O'Neil, Christine, Shippey, Jeanette, Spector, Linda, Cam, Jenny, Chen, Tina, Damle, Jagadish, Holman, Rebecca, Liu, Jenny, Milazzo, Carmelo, Quach, Brenda, Yang, Bin, Ahmad, Basharat, Aro, Dominic, Azeem, Fouzal, Bonaccorso, Antoinette, Brancato, Lenore, Brautigam, Donald, Charatz, Seth, Chiarot, June, Cunningham, Linda, DiCerbo, Nancy, DiGiovanna, Michael, Dluge-Aungst, Dawn, Dolbeer, Traci, Donovan, Daniel, Duma, Carol, Ellwood, Rebecca, Freedman, Zachary, Gorman, Timothy, Gunther, David, Hogan, Eileen, Hoffman, Lisa, Kapoor, Anoop, Kelly, Michelle, Kitchen, Timothy, Lam, David, Levister, Camilla, Levy, Carol, Lopez, Carlos, Lyons-Patterson, Jane, Makam, Sashi, Mauceri, Diana, McClary, Carole, Murak, Daniel, Nolan, Kelly, Nunez, Carlos, Elliott, Theresa Ohlson, Ostrowski, Phillip, Pallai, Ajish, Porges, Andrew, Rodes, Alfredo, Rosenberg, Richard, Rubel, Lance, Serrano, Lelanie, Shannon, Daniel, Sinha, Rabi, Snyder, Brian, Sy, Claude, Tang, Rocky, Varavenkataraman, Raghupathy, Winterberger, Amy, Allen, Stacy, Anderson, Marshall, Asbill, Mark, Beasley, Amanda, Bennett, Chrisitian, Bergamo, Katherine, Bilbro, Scott, Brannock, Sarah, Brown, Laura, Bryant, Danielle, Buck, Genena, Burdette, Tara, Buse, John, Butler, Laura, Caldwell, Ronald, Cannon, Daniel, Cannon, Kevin, Carter, Casey, Cherry, Amanda, Comer, Zoe, Crittenden, Susan, Cuffee, Juanita, Culmer, Dawn, Daly-Barnes, Kristie, Evensen, Erick, Saavedra, Rubin, Dean, John, Dezube, Milana, Diner, Jaime, Dodis, Regina, Dostou, Jean, Duclos, Michelle, Elmore, Miles, Ferree, Kristin, Foster, Leslie, Fuller, Gail, Garner, Susan, Godwin, Sarah, Goley, April, Gore, Whitney, Green, Brenda, Harris, Elizabeth, Harris, Joy, Harris, Rebecca, Hatharasinghe, Roger, Herring, Charles, Hill, Chernessa, Holmes, Robert, Hutchens, Erin, Jennings, Stuart, Kaake, Ashley, Kaygun, Handan, Kirkman, Marian Sue, Kretzschmar, Heather, Lang, Jaqueline, Largay, Joseph, Lewis, Melissa, Long, Maria Ann, Lucas, Kathryn, McCall, Roshanda, McDaniel, Catrina, McGinnis, Lee Ann, Mogabgab, Edward, Montero, Manuel, Montgomery, Richard, Moran, Joseph, Morgan, Katie, Motley, Taylor, Narendran, Mahendra, Narron, Brooke, Newman, Walter, Nicholson, John, Norris, Stephanie, Norton, Jennifer, Nowell, Erin, O'Brien, Heather, Otero, Heydin, Perkins, Victoria, Quesada, Reyna, Raad, George, Raley, Rosalie, Raman, Sujatha, Rappaport, Jonathan, Ray, Robert, Ray, Shannon, Rice, Lucian, Roberts, Christine, Ross, Kaylee, Scanlon, Erica, Schroder, Derek, Schulte, Michelle, Schultzaberger, Richard, Shoffner, Sylvia, Skrzynski, Michael, Smith, Brian, Smith, Holly, Smith, Jennifer, Smith, Justin, Smith, Kendall, Smith, Leigh, Sparks, Jeffrey, Speece, Jessica, Spivey, Jessica, Stebich, Andrew, Temple, Karen, Tessena, Boryana, Thompson, Casey, Traylor, Henry, Turner, Juliana, Turner, Sh-Rhonda, Van Cleeff, Martin, Vukojicic, Katarina, Wanchick, Leslie, Weinrib, Stephen, Werner, Devorah, Wishon, Candace, Wilson, Jonathan, Wilson, Stephanie, Wright, Heather, Young, Laura, Brown, Jamie, Lillestol, Michael, Allen, Mary Jo, Barker, Bruce, Bedel, Gary, Beuerlein, Shawn, Bhati, Amar, Breslaw, Nicole, Brown, April, Burtch, Brian, Check, Ellen, Chiodi, Shawnie, Colosimo, Linda, Cope, Kathie, Coressel, Denise, Cramer, Bethany, Crowel, Amy, Daboul, Nizar, DeLong, Rebecca, Dirkes, William, Farooki, Zia, Fixler, Don, Friedhof, Linda, Griffen, Julie, Hagan, Anjani, Haney, Kevin, Harris, Kira, Hoffmann, Amanda, Hsieh, Ronald, Ismail-Beigi, Faramarz, Kelso, Kim, Khamousia, Nidaa, Kremer, Gerald, Krol, Adrienne, Kulow, Tanya, Kuttler, Mary, Lee, Andy, Leksan, Jane, McElroy-Marcus, Susan, McNeil, Donald, Mulligan, Guy, Pantalone, Kevin, Perrino, Frank, Peysha, Lori, Pickett, Alicia, Pritchard, James, Provanzana, Kathleen, Rancitelli, Philip, Raupp, Randa, Schnall, Adrian, Siddiqui, Jaweriah, Smith, Cynthia, Sood, Ajay, Sortor, Jennifer, Spinelli, Kristin, Taylor, Diana, Thornton, Aaron, Tiktin, Margaret, Twine, Melissa, Urbank, Ann, Voegele, Francis, Wang, Lawrence, Weiss, Daniel, Werner, Amanda, Williams, Daniel, Wilson, Charles, Aberle, Teresa, Arcon-Rios, Sirlys, Arodak, Bassam, Aziz, Ammara, Bixler, Lacey, Brisko, Carolann, Cannon, Melanie, Choe, James, Connery, Lisa, Elkosseifi, Myriam, George, Aja, Hummer, Kimberly, LaBryer, Lauren, Lane, James, Lim, Jonea, Mirza, Lubna, Mittadodla, Saritha, Priest, Diane, Rao, Veitla, Ricci, Cassie, Salazar, Jennifer, Shaw, Jessica, St John, Jennifer, Talsania, Mitali, Joarder, Farahnaz, Riddle, Matthew, Yuen, Kevin, Ahmed, Intekhab, Austin, Barry, Bagnata, Linda, Bartkowiak, Anthony, Batrus, Jennifer, Baumgarten, Thomas, Belejchak, Paula, Belucher, Christine, Benton, Julia, Berger, Peter, Biscoveanu, Mihaela, Blasick, Abbie, Blyler, Kay, Casey, Linda, Chandler, Bronell, Chapman, Kim, Chou, Brian, Cisar, Jennifer, Clatterbuck, Tabetha, Cook, Richard, Cook II, Richard, Dardi, Inderpreet, DeSalle, Dina, Edevane, Shari, Elliott, Kelsey, Everhart, Brian, Furlong, Kevin J., Geishauser, Jennifer, Goisse, Marcy, Goodman, Yvonne, Gordon, Murray, Gutowski, Catherine, Harris, Ronald, Hu, Ying, Hull, Jenny, Iachini, Kathleen, Iannamorelli, Anthony, Jabbour, Serge, Jackson, Timothy, Jameson, Brian, Janosov, Paula, Jordan, Terry, Kennedy, John, Kurtzer, Gayle, Labuda, Joseph, LaRochelle, Anne, Levinson, Lawrence, Madder, Robert, Marconnet, Kari, Mareda, Patricia, Michael, Donna, Michaels, Debra, Miller, Cathy, Miller, Jeffrey, Minnock, Ann, Mitchell, Michele, Moturi, Hemlata, Moyer, Heather, Nagelberg, Steven, Oliver, Michael, Pepe, Constance, Porter, Patricia, Posey, Dora, Purighalla, Raman, Redmond, Jessica, Reiling, Joseph, Reiling, Susan, Rine, Kathy, Rust, William, Sandutch, Jill, Shaffer, Anette, Shalongo, Annette, Shawley, Sarah, Shonk, Pamela, Singh, Vinay, Slucki, Andrea, Spiller, Kellie, Springer, Nina, Sprouse, Heidi, Sun, Albert, Taylor, Judith, Watine, Robert, Watkinson, Jean, Weaver, Nancy, Wenocur, Howard, Yeoman, Gary, Ackermann, Jeremy, Averill, Nathan, Ballard, Thomas, Byars, William, Carter, Caroline, Castay, Cathleen, Cheek, Shonda, Collins, Jessica, Collins-Jamison, Traci, Cooksey, Erin, Crockford, Nicole, Cutshall, Christopher, Dar, Moahad, Drake, Almond, Dugat, Kameron, Durham, John, Durham, Nancy, Eagerton, Donald, Edmonds, Nataish, Farmer III, Joseph, Fogarty, Charles, Gatlin, June, Geisberg, Harry, Grossman, Margaret, Harrell, Wendy, Harrison, John, Harrison, Kristina, Heincelman, Sarah, Holladay, Lauren, Huberty, Chad, Isakov, Ingrid, Jordan, Norma, Kunkel, Michael, Laserna, Susan, Lawrence, Amanda, Lawrence, Andrew, Livingston, Yolanda, Lloyd, Eric, Lopez, Lina, Manuel, Joyce, Mayfield, Ronald, McDonald, Margaret, Morgan, Caroleann, Munn, Joanie, Murphy, Lauren, Nicol, Brent, Nicol, Philip, Norris, Rebecca, Phillips, Bunny, Reeves, Angela, Roach, Jacqueline, Ross, Irene, Santi, Jeffrey, Saunders, Jacqueline, Shugart, Henry, Singleton, Monnieque, Slee, Erin, Smalley, Kathleen, Smith, Kristy, Sofley, Carl, Solheim, Vesna, Spell, Samantha, Tanenberg, Robert, Whitley, Chester, Widel, Michele, Wilhoit, Gordon, Wood, Ruth, Wright, Jaime, Wulf, Alissa, Zapkowski, Julie, Adams, Kristi, Adams, Roberta, Ananthula, Parvati, Bass, Caitlin, Bates, Chad, Baum, Howard, Bays, Anna, Beck, Teresa, Bilbrey, Brett, Brown, Ashley, Carlton, Anna, Carter, Jenny, Cheri, Laura, Childress, Richard, Cloud, Mark, Cohen, A. Jay, Coulter, Alice, Dotson, Kimberly, Green, Christopher, Helton, Ashley, Houstrup, Jody, Huffman, David, Hurst, Fred, Hurst, James, Jantzi, Curtis, Jerkins, Randy, Jerkins, Terri, Jones, Mandy, Kelley, Shane, Kroulek, Judy, Lawhun, Dennis, Lee, Marcus, Louthan, James, Manning, Rickey, May, Michael, Means, Katherine, Monroe, Jeanabe, Morawski, Emily, Morin, David, Morris, Barbara, Murray, John, Nichols, Robert, Olivi, Stacie, Pennington, Kristina, Poe, Jenny, Pour, Omid Rad, Reeves, Michael, Reeves, Pamela, Root, Connie, Rose, Karen, Rutledge, Lily, Ryan, Eugene, Schwartz, Patricia, Shafer, Jennifer, Singh, Chitra, Smith, Ashley, Snow, Rodney, Stamps, Henry, Staton, Peggy, Stevens, Jeffrey, Stovall, Cathy, Sturgeon, Rodney, Tapp, John, Tapp, Stacy, Warner, Carla, Weiss, Melissa, White, Judith, Wierum, Craig, Williams, Konya, Wright, Tiffanie, Abreu, Marconi, Agarwal, Vandana, Ahmad, Aftab, Ahmad, Asma, Ahmed, Faiz, Ahn, Lily, Alaoui, Rachid, Alarcon, Stephanie, Allison, Dale, Annamalai, Rajasekaran, Arain, Khadija, Arellano, Angelica, Arispe, Barbara, Aronoff, Stephen, Arroyo, Jesus, Bachand, Trista, Bailey, Becky, Bajaj, Chris, Banarer, Salomon, Barnella, Christine, Bartz, Mary, Bates, Jason, Becerra, Karen, Benavides, Melissa, Bhuchar, Subodh, Blevins, Thomas, Bonazzi, Amanda, Brinson, Cynthia, Brown, Timiki, Buckley, Brandee, Bunker, Christy, Burbano, Jose, Busch, Vickey, Bustamante, Rosibel, Calais, Natalee, Camacho, Allison, Camp, Shana, Canada, Nancy, Canchola, Daniel, Cano, Monica, Cardenas, Veronica, Carl, Leighton, Casaubon, Luis, Castaneda, Jessica, Castro, Cindy, Ceniceros, Diego, Chaicha-Brom, Tira, Chaudhuri, Sudipta, Chavez-Velazquez, Alberto, Chen, Jocelyn, Cheyne, Theresa, Chilka, Sapna, Chionh, Kristen, Chunawala, Imran, Cope, Pamela, Cotton, Sonja, Daudjee, Munib, Davidson, Tichina, De Loa, Geraldine, Deniega, Ann, Dillow, Naco, Dominguez, Michael, Dorfman, Steven, Doshi, Ankur, Dunnam, Theresa, Dutta, Papiya, Eiler-Prater, Megann, Eizensmits, Christina, Espinosa, Valerie, Evans, Charles, Frisinger, Cathy, Ganta, Shylesh, Galtney, Kirsten, Gammon, John, Garcia, Analisa Marie, Garcia, Ronald, Glaspie, Tina, Golici, Laura, Gonzalez, Julian, Grant, David, Green, Carrie, Groce, Lindsay, Guevara, Stephanie, Gutierrez, Mary, Hance, Cortney, Harden, Tiffany, Harrison, Lindsay, Herrera, Carlos, Hettler, Evelyn, Holcomb, Michelle, Hoste, Laura, Hudson, Tina, Huerta, Leticia, Jain, Mahendra, Jayaram, Preeth, Johnson, Monique, Johnson, Olivia, Jones, Laurie, Joseph, John, Juarez, Misty, Karimjee, Najmuddin, Kephart, Ashley, Khan, Armgan, Khan, Jalil, Killian, Michael, Kniffen, Wendy, Koops, Maureen, Kwan, Louise, La, John, Laabs, Jessica, Ledesma, Gilbert, Lee, Monica, Leuck, Kathryn, Livingston, Carrie, Llanas, Teresa, Longoria, Andy, Lorta, Jesse, Lothringer, Larry, MacAdams, Maria, MacAdams, Michael, MacGillivray, Brian, Mageno, Melissa, Malek, Megan, Manley, Meghan, Marler, Karen, Martinez, Cristina, Massie, Jodi, Mateos, Glenda, Mathew, Reena, Maya, Claudia, Mazour, Meg, Mbogua, Caroline, McClendon, Robert, McMullen, Deirdre, Meisner, Carl, Menchaca, Ethelina, Meyers, Linda, Miklius, Audrey, Milam, Alissa, Milam, Ronnie, Miller, Tracey, Mize, Lisa, Moczygemba, Roger, Nafegar, Alexandria, Naidu, Jayaram, Nair, Archana, Nguyen, Alison, Nielsen, Douglas, Nisnisan, Josier, Nisnisan, Maria, Oden, Wendy, Orsak, Jessica, Ozer, Kerem, Papacostea, Olivia, Panchal, Ravi, Parikh, Manish, Parthiban, Beneta, Perrin, Brittney, Perkins, Harvonya, Poduri, Madhuri, Pop, Laurentiu, Portales, Nancy, Porter-Tucci, Linda, Postell, Sharon, Pucillo, Ronald, Reddy, Madhavi, Reddy, Rajneesh, Almodovar, Ramon Gilberto Reyes, Richard, Timiki, Richardson, Michele, Riesch, Louie, Rivera-Flores, Samuel, Rizvi, Abid, Rizvi, Samana, Rodas, Kristen, Rodgers, Mark, Roe, Erin, Rogers, Rebecca, Romero, Reina, Rooker-Morris, Leslie, Rosenstock, Julio, Sachson, Richard, Salcedo, Alfredo, Schill, Joseph, Schuh, Kristy, Schuster, Randall, Scribner, Anita, Shah, Arunkumar, Shaw, Stephanie, Shirley, Jefferey, Shook, Mindy, Siddiqui, Muhammad, Sims, Jamie, Singh, Kamalpreet, Skero, Jennifer, Smejdir, Debra, Stacey, Amy, Strzinek, Robert, Tan, Anjanette, Tayabali, Khadija, Tercero, Almundena, Terry, Jessica, Tinney, Irene, Toe, Florence, Toler, Sara, Tripathy, Devjit, Tumyan, Anna, Ulrich, Michelle, Underwood, Krissandra, Valdez, Christina, Valdivieso, April, Vanderheiden, Anna, Vandre, Morgan, Vardeman, Megan, Vargas, Richard, Vilchis, Monica, Warne, Desiree, Wallace, Jeannine, Weindorff, Kathleen, Welch, Heather, Wellmon, Brandy, Werntz, Gary, White, Leta, Williams, Tearani, Wilson, Maria, Wilson, Robyn, Wilson, Ronald, Wood, John, Wright, David, Yeatts, Rhonda, Zahir, Rezwana, Crockett, Becky, Fawson, Ashlee, Graham, Timothy, Mitchell, Zachary, Quinn, Sally, Reddy, Deepika, Rhudy, Jackson, Rosen, Priscilla, Shakespear, Kaylynn, Simmons, Debra, Turner, Ashley, Vanderhoof, Erin, Wahl, Matthew, Zubair, Imran, Algus, Michael, Gilbert, Matthew, Gorson, David, Marney, Annis, Rodriguez, Juan Pablo Perdomo, Roth, Marilynn, Scofield, Sheilah, Thottan, Anna, Bittorf, Margaret, Botros, Emad, Carpenter, Jeanette, Dashiell, Carie, Dimascio-Johnson, Nancy, Fredrickson, Sonja, Gruenther, M., Hall, Lisa, Hartman, Aaron, Hiner, Janette, Kelley, Donna, Kimmel, Melissa, Larrick, Laura, Lawson, Marie, Levy, James, Lewis, Teneshia, Lovell, Charles, Newby, James, Nichols, Michelle, O'Donnell, Philip, Orengo, Sheyla, Pecsok, Thomas, Reiss, Lind, Tarkington, Phillip, Yeatts, Donald, Zieve, Franklin, Ahmed, Imtiaz, Ali, Sajid, Anwar, Sami, Cathcart, Harold, Dawson, Lucia, Floresca, Rolando, Galvan, Ashley, Gardner, Timothy, Halsey, Kami, Hashmi, Farrukh, Hegel, Jackie, Landon, Megan, Moulton, Katlynn, Nand, Cheta, Sakic, Amra, Sevey, Brandie, Wilson, Bruce, Ahl, Scott, Blank, Robert, Coly, Gerard, Hoenig, Jennifer, Jain, Rajeev, Joseph, Elizabeth, Kasprzak, Debra, Kisiel, Lalaine, Maaske, Maurene, Manadhar, Smriti, Patel, Shailendra, Sickler, Whitney, Grp, D.E.V.O.T.E. Study, Acibadem University Dspace, Marso S.P., Mcguire D.K., Zinman B., Poulter N.R., Emerson S.S., Pieber T.R., Pratley R.E., Haahr P.-M., Lange M., Brown-Frandsen K., Moses A., Skibsted S., Kvist K., Buse J.B., and Buscemi S

Subjects
Insulin degludec, Blood Glucose, Male, medicine.medical_treatment, DEVOTE Study Group, Insulin Glargine, Type 2 diabetes, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, law.invention, diabetes, insulin, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, GLUCOSE CONTROL, 11 Medical and Health Sciences, RISK, COMPLICATIONS, OUTCOMES, Incidence, General Medicine, Middle Aged, Insulin, Long-Acting, VARIABILITY, Cardiovascular Diseases, diabetes mellitus, Female, Life Sciences & Biomedicine, Human, medicine.drug, medicine.medical_specialty, 030209 endocrinology & metabolism, Aged, Diabetes Mellitus, Type 2, Double-Blind Method, Humans, Hypoglycemia, Hypoglycemic Agents, Medicine (all), Bedtime, Article, EVENTS, 03 medical and health sciences, HYPOGLYCEMIA, Medicine, General & Internal, Internal medicine, Diabetes mellitus, General & Internal Medicine, medicine, Intensive care medicine, METAANALYSIS, Science & Technology, Hypoglycemic Agent, Insulin glargine, business.industry, Insulin, medicine.disease, business, BASAL INSULIN
Abstract

BACKGROUND Degludec is an ultralong-Acting, once-daily basal insulin that is approved for use in adults, adolescents, and children with diabetes. Previous open-label studies have shown lower day-To-day variability in the glucose-lowering effect and lower rates of hypoglycemia among patients who received degludec than among those who received basal insulin glargine. However, data are lacking on the cardiovascular safety of degludec. METHODS We randomly assigned 7637 patients with type 2 diabetes to receive either insulin degludec (3818 patients) or insulin glargine U100 (3819 patients) once daily between dinner and bedtime in a double-blind, treat-To-Target, event-driven cardiovascular outcomes trial. The primary composite outcome in the time-To-event analysis was the first occurrence of an adjudicated major cardiovascular event (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) with a prespecified noninferiority margin of 1.3. Adjudicated severe hypoglycemia, as defined by the American Diabetes Association, was the prespecified, multiplicity-Adjusted secondary outcome. RESULTS Of the patients who underwent randomization, 6509 (85.2%) had established cardiovascular disease, chronic kidney disease, or both. At baseline, the mean age was 65.0 years, the mean duration of diabetes was 16.4 years, and the mean (±SD) glycated hemoglobin level was 8.4±1.7%; 83.9% of the patients were receiving insulin. The primary outcome occurred in 325 patients (8.5%) in the degludec group and in 356 (9.3%) in the glargine group (hazard ratio, 0.91; 95% confidence interval, 0.78 to 1.06; P

Published
2017

25. Patterns of Chronic Conditions and Their Associations With Behaviors and Quality of Life, 2010

Author

Barile, John P., Mitchell, Sandra A., Thompson, William W., Zack, Matthew M., Reeve, Bryce B., Cella, David, and Smith, Ashley Wilder

Subjects
Adult, Male, Adolescent, Health Status, Health Behavior, Smoking, Middle Aged, United States, Self Care, Young Adult, Mental Health, Risk Factors, Chronic Disease, Quality of Life, Humans, Female, Obesity, Sedentary Behavior, Original Research, Aged
Abstract

Introduction Co-occurring chronic health conditions elevate the risk of poor health outcomes such as death and disability, are associated with poor quality of life, and magnify the complexities of self-management, care coordination, and treatment planning. This study assessed patterns of both singular and multiple chronic conditions, behavioral risk factors, and quality of life in a population-based sample. Methods In a national survey, adults (n = 4,184) answered questions about the presence of 27 chronic conditions. We used latent class analysis to identify patterns of chronic conditions and to explore associations of latent class membership with sociodemographic characteristics, behavioral risk factors, and health. Results Latent class analyses indicated 4 morbidity profiles: a healthy class (class 1), a class with predominantly physical health conditions (class 2), a class with predominantly mental health conditions (class 3), and a class with both physical and mental health conditions (class 4). Class 4 respondents reported significantly worse physical health and well-being and more days of activity limitation than those in the other latent classes. Class 4 respondents were also more likely to be obese and sedentary, and those with predominantly mental health conditions were most likely to be current smokers. Conclusions Subgroups with distinct patterns of chronic conditions can provide direction for screening and surveillance, guideline development, and the delivery of complex care services.

Published
2015

26. Who Treats Adolescents and Young Adults with Cancer? A Report from the AYA HOPE Study

Author

Parsons, Helen M, Harlan, Linda C, Schmidt, Susanne, Keegan, Theresa HM, Lynch, Charles F, Kent, Erin E, Wu, Xiao-Cheng, Schwartz, Stephen M, Chu, Roland L, Keel, Gretchen, Smith, Ashley Wilder, and AYA HOPE Collaborative Group

Subjects
Adult, Male, Pediatric Research Initiative, Lymphoma, Adolescent, Pediatric Cancer, physicians, National Cancer Institute, Oncology and Carcinogenesis, Nursing, Cohort Studies, AYA HOPE Collaborative Group, Young Adult, Rare Diseases, Clinical Research, Neoplasms, Humans, Survivors, Cancer, Pediatric, treatment, Hematology, United States, National Cancer Institute (U.S.), place of care, AYA HOPE Study, Public Health and Health Services, Female
Abstract

PurposePhysicians play a critical role in delivering effective treatment and enabling successful transition to survivorship among adolescent and young adult (AYA) cancer patients. However, with no AYA cancer medical specialty, information on where and by whom AYAs with cancer are treated is limited.MethodsUsing the National Cancer Institute's population-based AYA HOPE Study, 464 AYAs aged 15-39 at diagnosis treated by 903 physicians were identified. Differences in physician and hospital characteristics were examined by age at diagnosis and cancer type (germ cell cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, acute lymphocytic leukemia [ALL], and sarcoma) using chi-square tests.ResultsTreating physicians were predominately 51-64 years old, male, United States-trained in non-pediatric specialties, and in group practices within large metropolitan areas. Older patients were less often treated by pediatric physicians (p < 0.01) and more likely to be treated by United States-trained physicians without research/teaching responsibilities and in hospitals without residency programs (p < 0.05). The majority of the few pediatricians (n = 44) treated ALL patients. Physicians with research/teaching responsibilities and those based in medical schools were more likely to treat patients with ALL and sarcoma compared with other cancer types (p < 0.01). Of HL patients, 73% were treated at a cancer center compared with 56% of patients with germ cell cancer (p < 0.01), while ALL (85%) and sarcoma (87%) patients were more likely to be treated in hospitals with residency programs (p < 0.01).ConclusionsMost AYAs with cancer were treated by non-pediatric physicians in community settings, although physician characteristics varied significantly by patient cancer type and age at diagnosis.

Published
2015

27. Young and uninsured: Insurance patterns of recently diagnosed adolescent and young adult cancer survivors in the AYA HOPE study

Author

Parsons, Helen M, Schmidt, Susanne, Harlan, Linda C, Kent, Erin E, Lynch, Charles F, Smith, Ashley W, Keegan, Theresa HM, and AYA HOPE Collaborative

Subjects
Adult, Male, AYA HOPE Collaborative, Pediatric Cancer, Epidemiology, and End Results, Oncology and Carcinogenesis, Basic Behavioral and Social Science, Insurance Coverage, Young Adult, Clinical Research, Neoplasms, Behavioral and Social Science, Humans, Survivors, Oncology & Carcinogenesis, Cancer, Pediatric, Medically Uninsured, Surveillance, Patient Protection and Affordable Care Act, Age Factors, Health Services, humanities, United States, Good Health and Well Being, Public Health and Health Services, Female, adolescents and young adults, SEER Program, insurance
Abstract

BackgroundYoung adults have historically been the least likely to have health insurance in the United States. Previous studies of survivors of childhood cancer found lower rates of insurance and less access to medical care compared with siblings; however, to the authors' knowledge, no studies to date have examined continuity of insurance after a cancer diagnosis in adolescents and young adults (AYAs).MethodsUsing the AYA Health Outcomes and Patient Experience study, a cohort of 465 individuals aged 15 to 39 years from participating Surveillance, Epidemiology, and End Results registries, we evaluated changes in and sponsors of health insurance coverage after diagnosis, coverage of physician-recommended tests, and factors associated with lack of insurance after a cancer diagnosis using chi-square tests and multivariable logistic regression.ResultsGreater than 25% of AYA survivors of cancer (118 survivors) experienced some period without insurance up to 35 months after diagnosis. Insurance rates were high in the initial year after diagnosis (6 months-14 months; 93.3%) but decreased substantially at follow-up (15 months-35 months; 85.2%). The most common sponsor of health insurance was employer/school coverage (43.7%). Multivariable analysis indicated that older survivors (those aged 25-39 years vs 15-19 years; odds ratio, 3.35 [P 20% of survivors indicated there were physician-recommended tests/treatments that were not covered by insurance, but > 80% received them regardless of coverage.ConclusionsInsurance rates appear to decrease with time since diagnosis in AYA survivors of cancer. Future studies should examine how new policies under the Patient Protection and Affordable Care Act extend access and insurance coverage beyond initial treatment.

Published
2014

28. Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers?

Author

Keegan, Theresa HM, Tao, Li, DeRouen, Mindy C, Wu, Xiao-Cheng, Prasad, Pinki, Lynch, Charles F, Shnorhavorian, Margarett, Zebrack, Brad J, Chu, Roland, Harlan, Linda C, Smith, Ashley W, Parsons, Helen M, and AYA HOPE Study Collaborative Group

Subjects
Adult, Male, Adolescent, Pediatric Cancer, Health Status, Oncology and Carcinogenesis, Basic Behavioral and Social Science, Health Services Accessibility, Insurance, Young Adult, Rare Diseases, 7.1 Individual care needs, Clinical Research, Neoplasms, Behavioral and Social Science, Humans, Survivors, Oncology & Carcinogenesis, Cancer, Pediatric, Rehabilitation, Hematology, AYA HOPE Study Collaborative Group, humanities, Good Health and Well Being, Logistic Models, Health, Public Health and Health Services, Female, Management of diseases and conditions
Abstract

PurposeAdolescent and young adult (AYA) cancer survivors experience barriers to utilizing healthcare, but the determinants of cancer-related medical care of AYAs has not been fully explored.MethodsWe studied factors associated with medical care utilization among 465 AYA cancer survivors in the AYA Health Outcomes and Patient Experience Study, a cohort of 15 to 39 year olds recently diagnosed with germ cell cancer, lymphoma, sarcoma, or acute lymphocytic leukemia. Descriptive statistics and multivariate logistic regression methods were used.ResultsMost AYA cancer survivors (95%), who were 15-35 months post diagnosis, received medical care in the past 12 months and 17% were undergoing cancer treatment. In multivariate analyses, compared with AYAs with no cancer-related medical visits in the previous year, AYAs receiving cancer-related care were more likely to currently have health insurance (odds ratio (OR) = 4.9; 95% confidence interval (CI) = 1.7-13.8) or have had health insurance in the past year (OR = 4.0; 95% CI = 0.99-16.3). Cancer recurrence, lacking employment, and negative changes in self-reported general health were associated with ongoing cancer treatment versus other cancer-related medical care. Eleven percent of all AYAs and 25% of AYAs who did not receive medical care in the past 12 months lost health insurance between the initial and follow-up surveys.ConclusionAYA cancer survivors with health insurance were much more likely to receive cancer-related medical care than those without insurance.Implications for cancer survivorsDespite the need for post-treatment medical care, lacking health insurance is a barrier to receiving any medical care among AYAs.

Published
2014

29. Lateralized abnormalities in auditory M50 sensory gating and STG cortical thickness in PTSD: Preliminary results

Author

Hunter, Michael, Villarreal, Gerardo, McHaffie, Greg R., Jimenez, Billy, Smith, Ashley K., Calais, Lawrence A., Hanlon, Faith, Thoma, Robert J., and Cañive, José M.

Subjects
Male, Psychiatric Status Rating Scales, Brain Mapping, Magnetoencephalography, Electroencephalography, Middle Aged, Sensory Gating, Epilepsy, Post-Traumatic, Magnetic Resonance Imaging, Article, Functional Laterality, Temporal Lobe, Vietnam Conflict, Acoustic Stimulation, Evoked Potentials, Auditory, Image Processing, Computer-Assisted, Linear Models, Reaction Time, Humans, Veterans
Abstract

Auditory sensory gating deficits have been reported in subjects with post-traumatic stress disorder (PTSD), but the hemispheric and neuronal origins of this deficit are not well understood. The objectives of this study were to: (1) investigate auditory sensory gating of the 50-ms response (M50) in patients diagnosed with PTSD by utilizing magnetoencephalography (MEG); (2) explore the relationship between M50 sensory gating and cortical thickness of the superior temporal gyrus (STG) measured with structural magnetic resonance imaging (MRI); and (3) examine the association between PTSD symptomatology and bilateral sensory gating. Seven participants with combat-related PTSD and eleven controls underwent the paired-click sensory gating paradigm. MEG localized M50 neuronal generators to the STG in both groups. The PTSD group displayed impaired M50 gating in the right hemisphere. Thinner right STG cortical thickness was associated with worse right sensory gating in the PTSD group. The right S1 M50 source strength and gating ratio were correlated with PTSD symptomatology. These findings suggest that the structural integrity of right hemisphere STG cortices play an important role in auditory sensory gating deficits in PTSD.

Published
2011

30. Minimizing the source of nociception and its concurrent effect on sensory hypersensitivity: An exploratory study in chronic whiplash patients

Author

Schneider, Geoff M, Smith, Ashley D, Hooper, Allen, Stratford, Paul, Schneider, Kathryn J, Westaway, Michael D, Frizzell, Bevan, and Olson, Lee

Subjects
Adult, Male, Pain Threshold, lcsh:Diseases of the musculoskeletal system, Sensory Receptor Cells, Temperature, Nociceptors, Middle Aged, Hyperalgesia, Physical Stimulation, Research article, Chronic Disease, Cervical Vertebrae, Pressure, Humans, Female, Orthopedics and Sports Medicine, Joint Diseases, lcsh:RC925-935, Whiplash Injuries
Abstract

Background The cervical zygapophyseal joints may be a primary source of pain in up to 60% of individuals with chronic whiplash associated disorders (WAD) and may be a contributing factor for peripheral and centrally mediated pain (sensory hypersensitivity). Sensory hypersensitivity has been associated with a poor prognosis. The purpose of the study was to determine if there is a change in measures indicative of sensory hypersensitivity in patients with chronic WAD grade II following a medial branch block (MBB) procedure in the cervical spine. Methods Measures of sensory hypersensitivity were taken via quantitative sensory testing (QST) consisting of pressure pain thresholds (PPT's) and cold pain thresholds (CPT's). In patients with chronic WAD (n = 18), the measures were taken at three sites bilaterally, pre- and post- MBB. Reduced pain thresholds at remote sites have been considered an indicator of central hypersensitivity. A healthy age and gender matched comparison group (n = 18) was measured at baseline. An independent t-test was applied to determine if there were any significant differences between the WAD and normative comparison groups at baseline with respect to cold pain and pressure pain thresholds. A dependent t-test was used to determine whether there were any significant differences between the pre and post intervention cold pain and pressure pain thresholds in the patients with chronic WAD. Results At baseline, PPT's were decreased at all three sites in the WAD group (p < 0.001). Cold pain thresholds were increased in the cervical spine in the WAD group (p < 0.001). Post-MBB, the WAD group showed significant increases in PPT's at all sites (p < 0.05), and significant decreases in CPT's at the cervical spine (p < 0.001). Conclusions The patients with chronic WAD showed evidence of widespread sensory hypersensitivity to mechanical and thermal stimuli. The WAD group revealed decreased sensory hypersensitivity following a decrease in their primary source of pain stemming from the cervical zygapophyseal joints.

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31. Do pain-associated contexts increase pain sensitivity? An investigation using virtual reality

Author

Daniel S. Harvie, Michele Sterling, Ashley Smith, Harvie, Daniel S, Sterling, Michele, and Smith, Ashley D

Subjects
Adult, Male, Nociception, Pain Threshold, medicine.medical_specialty, Nocebo, Conditioning, Classical, classical conditioning, Stimulation, Context (language use), Audiology, Placebo, Young Adult, 03 medical and health sciences, conditioned hyperalgesia, 0302 clinical medicine, pain mechanisms, 030202 anesthesiology, Physical Stimulation, medicine, Noxious stimulus, Humans, pain, business.industry, Virtual Reality, Chronic pain, Classical conditioning, medicine.disease, nocebo, contextual conditioning, Anesthesiology and Pain Medicine, placebo, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background and aims Pain is not a linear result of nociception, but is dependent on multisensory inputs, psychological factors, and prior experience. Since nociceptive models appear insufficient to explain chronic pain, understanding non-nociceptive contributors is imperative. Several recent models propose that cues associatively linked to painful events might acquire the capacity to augment, or even cause, pain. This experiment aimed to determine whether contexts associated with pain, could modulate mechanical pain thresholds and pain intensity. Methods Forty-eight healthy participants underwent a contextual conditioning procedure, where three neutral virtual reality contexts were paired with either unpredictable noxious stimulation, unpredictable vibrotactile stimulation, or no stimulation. Following the conditioning procedure, mechanical pain thresholds and pain evoked by a test stimulus were examined in each context. In the test phase, the effect of expectancy was equalised across conditions by informing participants when thresholds and painful stimuli would be presented. Results Contrary to our hypothesis, scenes that were associated with noxious stimulation did not increase mechanical sensitivity (p=0.08), or increase pain intensity (p=0.46). However, an interaction with sex highlighted the possibility that pain-associated contexts may alter pain sensitivity in females but not males (p=0.03). Conclusions Overall, our data does not support the idea that pain-associated contexts can alter pain sensitivity in healthy asymptomatic individuals. That an effect was shown in females highlights the possibility that some subgroups may be susceptible to such an effect, although the magnitude of the effect may lack real-world significance. If pain-associated cues prove to have a relevant pain augmenting effect, in some subgroups, procedures aimed at extinguishing pain-related associations may have therapeutic potential.

Published
2018
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32. Tactile acuity is reduced in people with chronic neck pain

Author

Daniel S. Harvie, Ashley Smith, Grace Edmond-Hank, Harvie, Daniel S, Edmond-Hank, Grace, and Smith, Ashley D

Subjects
Adult, Male, Pain Threshold, medicine.medical_specialty, Graphesthesia, neck pain, Physical Therapy, Sports Therapy and Rehabilitation, two-point discrimination, Risk Assessment, 03 medical and health sciences, Chronic neck pain, Two-point discrimination, Young Adult, 0302 clinical medicine, Physical medicine and rehabilitation, Sex Factors, Reference Values, medicine, Whiplash, Humans, 030212 general & internal medicine, musculoskeletal pain, Whiplash Injuries, Neck pain, Neck Pain, business.industry, whiplash, Chronic pain, Age Factors, somatosensory precision, Middle Aged, medicine.disease, Prognosis, Tactile acuity, Cross-Sectional Studies, Touch Perception, Touch, tactile acuity, Somatosensory Disorders, Body region, Female, medicine.symptom, Chronic Pain, business, chronic pain, 030217 neurology & neurosurgery
Abstract

usc Background: Tactile acuity deficits have been demonstrated in a range of persistent pain conditions and may reflect underlying cortical re-organisation. Objective: This study aimed to determine whether tactile acuity is impaired in people with chronic neck pain relative to controls,and whether deficits relate to pain location,duration and intensity. Methods: In this cross-sectional study, 20 people with chronic neck pain (5 idiopathic neck pain;15 whiplash-associated disorder) and 20 pain-free controls underwent two-point discrimination (TPD) testing at the neck, back and arm, and point-to-point (PTP) and graphesthesia tests of tactile acuity at the neck and arm. Results: Linear mixed effects models demonstrated a significant group*body region interaction for TPD, Graphesthesia and PTP tests (Ps< 0.001), with post hoc tests showing impaired TPD in people with neck pain relative to controls at the neck, low back, and arm (P≤0.001). Graphesthesia and PTP was also impaired at the neck (P< 0.001)but not the arm (P≥0.48).TPD correlated with intensity and duration of pain (Pearson's r=0.48, P< 0.05; Pearson's r=0.77, P< 0.01). There was no sig difference between the two neck pain groups for any tactile acuity measure (TPD: P= 0.054; Graphesthesia; P= 0.67; Point to Point:P= 0.77), however, low power limited confidence in this comparison. Conclusion: People with chronic neck pain demonstrated tactile acuity deficits in painful and non-painful regions when measured using the TPD test, with the magnitude of deficits appearing greatest at the neck. The study also revealed a positive relationship between TPD and pain intensity/duration, further supporting the main study finding. Refereed/Peer-reviewed

Published
2017

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